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Part 1

MERELY THE PATIENT

By HENRY HOWARD HARPER

MINTON, BALCH & COMPANY NEW YORK 1930

Third Printing, February, 1932

_Printed in the United States of America by_ THE KNICKERBOCKER PRESS, NEW ROCHELLE, N. Y.

CONTENTS

PAGE PREFATORY NOTE 7 A PAIN DISCOVERS ME 19 RUNNING THE GANTLET 23 THE CYSTOSCOPIC TRAP 36 YOU NEVER DISCOVER IF YOU HAVE PASSED OR FLUNKED YOUR EXAMINATIONS 40 THE SHOCKING DISCOVERY 44 “ALL YE WHO ENTER HERE—” 50 MY ENCOUNTER WITH ADHESIVE TAPE 62 THE ATMOSPHERE OF DISSIMULATION 72 THE CALAMITOUS VERDICT 78 FLIRTING WITH THE SHADOWS 82 THE ROAD TO RECOVERY 87 SUBCONSCIOUS HALLUCINATIONS 91 CONCLUSION 94

TO THE EIGHT DOCTORS AND NINE NURSES WHO ASSISTED, NOT IN WRITING, BUT IN MAKING THIS BOOK POSSIBLE

PREFATORY NOTE

By SAMUEL W. LAMBERT, M.D.

It is an unusual privilege to look into the mind of a person afflicted with a serious illness and learn the point of view of a patient who, without losing confidence in his medical advisers, questions the when and the wherefore of his treatment.

In this book Mr. Henry H. Harper presents a graphic and realistic picture to the reader. It contains the confessions of a patient to whom the fact is very palpable that his progress from illness to health was not all that he had been persuaded to expect when he entered upon his medical and surgical adventure.

The majority of persons who have experienced only the minor discomforts of an appendectomy or a tonsillectomy may not fully appreciate the underlying importance of this masterpiece which Mr. Harper’s skillful pencil has drawn. Their idea of an operation will be confined to a preliminary period of worry and apprehension, an active horror of thirty-six or seventy-two hours of pain and distress, followed by a convalescence of two or three weeks of comfort, of visits by friends, of a world in which the recovered patient is the central object of attention. But Mr. Harper does not present such a commonplace picture; for his convalescence became a disease, and almost a fatal disease at that. One of the chief messages implied in his story is the tribute to his skillful surgeon, and a grateful remembrance of the care and untiring attention which pulled him through a serious blood poisoning, and of the radical method of treatment which became necessary to insure his recovery.

Moreover, the author has written a colorful and humorous description of his clinical and hospital experiences. There is a pertinent message for every past or prospective patient. After his return from the operating room he was subservient to the restraints of a convalescence from a major operation; he was observant of his symptoms and anxious to communicate his subjective feelings to his medical attendants. He did not exaggerate his discomforts. The post-operative message of this case portrays an interesting and exemplary lesson for every individual, and especially every surgical patient. It is not clear how much of this good behavior is due to overcoming the preliminary antagonism of a man trying to escape a surgical fate, and how much to the breaking down of a strong human will before the inexorable training of a professional habit of thought founded on an unbending scientific routine.

But the most important message in this story of a nephrectomy is perhaps unintentional: it is of importance to the physician himself, and here is a book which should be read by every member of the medical profession.

The lesson begins at the patient’s first encounter with a complete up-to-date routine health examination. His reactions during his journey through a modern clinic are far from placid, and not free from a resentment--expressed with playful seriousness--which any person, lay or professional, can easily understand. The author displays a keen appreciation of the humorous side of the modern system of diagnosticating disease in a scientific manner; although he does not admire the detail. Being a layman, he cannot be expected to follow the relation between the determination of the amount of free hydrochloric acid in a stomach that was digesting everything without known complaint, and a kidney which at times was the seat of a pain. Nor does he realize that he may make a better convalescence if a blood test is made which some scientist unknown to him, has determined can decide whether any ancestor has had hard luck with his diseases.

Mr. Harper describes his experiences from the unusual viewpoint of an invalid’s bed, giving the humorous impression that the joke is on him, without realizing that all these jokes, little and big, were training him to go to the operating room with a feeling of elation and courage for the outcome, and there to climb on the operating table unassisted.

But the physician can learn from this story what the author has taught, all unconsciously: he can learn to omit unnecessary examinations made purely for scientific curiosity or record alone, and not for diagnosis; also to listen considerately to the complaints of his patients; to appreciate that a patient’s feelings during convalescence may have more value in determining treatment than all the physical signs of disease or of well-being which he can discover by fingers, eyes and ears, or by instruments of greater or less precision; to beware the use of new and non-official remedies, even when endorsed by manufacturers of honest intent; to look twice at remedies which are patented for the personal profit of an exclusive chemist or sometimes, I regret to say, for pecuniary gain to some member of my profession.

The description of the night before the first operation is much to the point. The patient’s experience with the amateur hospital barber gives a vibrant touch of humor to the mystery of preparing for the operating room, which is so apt to develop into a hospital tradition even in the best of organizations; a mystery which is, as likely as not, to hinder the acquiring of a good morale by a patient. Mr. Harper discreetly leaves much to the imagination concerning the gruesome details of his stormy convalescence. But the oft-told tale of the normalcy and expected sequence of such events as a patient is supposed to experience and describe; the account of the bottles of castor oil he was obliged to consume; the tale of the nurse who “died” behind a screen in his room; the tale of the military rounds of hospital service which seem cold but which are necessary, and which really can have a soul hidden within them; the tale of the prognostic nurse who prophesied the death of the kidney patient in “Number 88;” the tale of the first removal of the surgical dressings after the operation; the tale of the visit of consolation (?) from the official head of a neighboring church, all lend vividness and color to the tragedy and the gaiety of what must have seemed to the author as “one thousand and one nights” of horror and mischance. But throughout the entire melange he seems never to have lost his sense of humor.

Mr. Harper has seen fit to quote my first impressions when I commented on this book shortly after reading the privately printed first edition. I am correctly quoted, for I believe that every young graduate must secure an appreciation of the discomforts of illness if he is to be successful in making his patients comfortable during their sojourn in bed, and their subsequent convalescence. The art of every physician should include much more than a mere cure for his patient. There is no school like experience, and a personal accident or a febrile disease requiring a stay in bed will do more to educate a physician than all the books that have been printed, or than any service he may carry on in a hospital.

The most engaging story of today is the hard luck medical story; and the human individual, especially among women, is so prone to recite his or her own, or the experience of others, that the ladies’ luncheon party in modern society has been well designated “an organ recital.”

Mr. Harper enters only one complaint against a member of my profession, and that a justifiable one: his account of the first post-operative dressing should be told to every young medical student as a warning and a threat for them to avoid such a brutal performance. He refrains from telling us about the disagreeable offices of the hospital orderly, and of the painfully embarrassing moments of daily routine which led one patient of my acquaintance to greet every knock on his door with the challenge, “Who goes there? Friend or enema?”

I feel a kindred claim to cherish this little book, for although I have never taken a general anaesthetic yet I have had typhoid fever once, and pneumonia twice. It was during one such convalescence that I composed during a wakeful night what I dared call a sonnet. I am no poet but my overwrought nerves, chagrin, temper or some unknown caprice, induced the Muse to urge me to give birth to this thought:

HELL IS NOT PAVED WITH GOOD INTENTIONS

Oh Bedpan! Implement of woe To one who is compelled to go In bed. Whence camest thou? Who first thought to make of thee a plan To minister to urgent need of man? No mind celestial ever gave thee birth.

No human science ever tried to break The law by Isaac Newton found, And make go up what should go down. Let thine own anatomy quite frankly speak! Whether of clay or agate it is clearly read That fires Satanic were thy natal bed.

Thou art a stolen quadrate, I know full well, From the tessellated pavement of deepest Hell.

I have since used these words to cheer up suffering humans who rebel at fate and the unnecessary crimes of brutal attendants, which are the results of doctors’ orders.

Mr. Harper has written of his remarkable experiences in a calm, humorous and analytical spirit. I recommend his story to professional and lay readers alike.

MERELY THE PATIENT

A PAIN DISCOVERS ME

THERE is said to be no subject on earth more entertaining (to the narrator) than a major operation; and two operations, especially if they fall close together, ought to be--for purposes of self-entertainment--twice as good as one. Thus reckoning, it will presently be seen that I have a decided advantage over those who have to content themselves with only one, or none at all.

And it occurs to me that to write a book is the most considerate as well as the most expeditious means of acquainting your friends with the details of an operation or other painful experience; for in this way you can expatiate at large on the most harrowing aspects of the case, and everybody is at liberty to read as much or as little as he can stand, and skip the rest; whereas if you get the listener’s ear he is almost obliged to suffer attentively through to the end of your story. Furthermore, in a book you can advertise your troubles far more widely and effectively, and with less effort. Another advantage in writing a book on some pet theme is that, like a filibusterer in the senate chamber, you have the floor all to yourself: the difference being that while his verbosity is wholly without interest or sense, either to himself or his sleeping audience, your story is at least self-absorbing.

To go back to the origin of this story, it began with a pain--intermittent at first, but soon becoming violent and continuous. When it reached this stage I called in a physician, who pronounced it a bad attack of something with a strange name, which being reduced to simple English meant there was something wrong with my left kidney. He gave me a hypodermic of morphine and two days later I developed a bad case of septic pneumonia which, with resultant complications, laid me low for eight weeks. While convalescing from this I wrote a book on stock market speculation. I don’t know what prompted me to write such a book at such a time, unless it was that something in the nearness of my approach to the realms of the unknown reminded me of how near I came to leaving the world unprotected against the pitfalls of Wall Street.

In due time I recovered from both the pneumonia and the book, but the kidney was still belligerent, and about every six weeks, to quell its savage attacks I had to take morphine and spend a few days in bed with it. In the fall of that year while on a visit to my mother-in-law in Minneapolis I was persuaded to take this refractory organ to the Mayo Clinic at Rochester, Minnesota; and that sequestered little town, which in the domain of operations, sickness and suffering occupies about the same position as New York City does in the world of finance, provided the setting for the semi-tragic episode herein related, in which for many weeks I played the leading rôle before a mixed assemblage of doctors, nurses and anxious relatives.

Fielding tells us that to prolong scenes of distress to an unwonted degree is a task for which the reader feels but little indebted to the author. Therefore since we have here to deal chiefly with grim-faced facts such as are usually productive of more awe than amusement I shall treat the whole catastrophe as lightly as the circumstances will permit. But after all, a serious illness or an operation--like lion hunting, stock market ventures and suchlike hazards--has its varied and interesting phases; and many of its gloomy aspects are susceptible of humorous interpretation when viewed in retrospect by those who survive to tell the story.

In the present undertaking I was encouraged by the statement of both Doctor “Will” Mayo and Doctor W. F. Braasch, that one of the most difficult problems of the physician is to get the accurate viewpoint of the patient. Not that the patient’s viewpoint seems to make any difference, but they like to have it, possibly for the same reason that the little boy liked to hear the stuttering man talk--because it amused him. In order to get the reactions of a patient, Doctor Samuel W. Lambert goes so far as to say: “I have often told my students that every physician should have a severe illness, and every surgeon an abdominal operation.” Possibly those who read this account will feel themselves relieved from the need of trying out Doctor Lambert’s recommendation--which might also have included nurses, though he may have figured that they have other ways of kindling their sympathetic emotions.

RUNNING THE GANTLET

On arriving at the Mayo Clinic I found that, if unaccompanied by a physician, you are required to register and procure a numbered registration envelope, which serves as a sort of passport throughout the whole institution and entitles you to be examined, at their discretionary rates, for everything they can think of, including your income and your sanity. This formality disposed of, I was directed to a certain lettered and numbered desk (there are several floors of tremendous length and breadth, with a great number of such desks on each floor). This particular desk was presided over by a young lady who gave me a numbered slip and automatically directed me to “take a chair.” After waiting nearly three hours I was ushered into the presence of a diagnostician in the department of urology, to whom I briefly stated my case, and said I wanted to find out what sort of treatment they would recommend. Without appearing to have heard anything I said he took out a long questionnaire and began cross-examining me about my habits, my mode of living and other personal matters. He could think of more prying questions than a prosecuting attorney. He was particularly curious about my antecedents--how long they had lived, what they died of, and other long-forgotten data about the fallen branches of my family tree. Having no idea that kidney-stones were hereditary I wondered what all this long catechism had to do with my complaint, in which, by the way, he didn’t seem the least bit concerned.

Then having me strip to the waist he stretched me on a long table and thumped me over pretty much as one would test a watermelon to see if it were ripe. For some reason best known to himself he studiously avoided the kidney corner of my anatomy; which reminded me of a man I once played golf with, who when his ball landed in the bushes or tall grass always looked for it in some adjacent quarter for fear of finding it in an unplayable lie. Needless to say, we had mutually agreed that there should be no penalty for lost balls.

When the doctor had completed his record of all I knew, and also had pommeled me until his solemn visage betokened some momentous conclusion--which he guarded with profound secrecy--his air of mute sobriety was in nowise reassuring. He put the stethoscope to my heart, then shifted it to the left kidney and asked me to breathe deeply--perhaps to see if the two organs were beating in unison. But he shook his head negatively, which I took to mean that something was wrong with one or the other.

“Nothing serious, I hope,” said I, studying his inscrutable face for some hopeful token. For a few moments he seemed lost in meditation, which set me to wondering if he had found something he didn’t dare tell me about. Then without answering, he wrote out and handed me the following prescription: “Four ounces of castor oil and loganberry juice, no supper, to bed at seven o’clock, up at seven A. M., no breakfast, report at desk XY-4 at 7:30 tomorrow.” I suggested that four ounces was rather a generous dose, but he said the conditions warranted it, so I didn’t argue the matter with him. He also gave me several envelopes of assorted colors, directing me to various appointment desks, and informed me with great impressiveness that they contained orders for examinations. Incidentally he told me that when I had finished with these I might go to breakfast, then report back to him.

My first appointment next morning was for an X-ray of the offending kidney, and having finished with this I set out to dispose of the other four envelopes, curiously anxious to learn what the examinations would disclose--heart disease, kidney-stones, gall-stones, cancer or what. It must be something terrible, I thought; otherwise the doctor would not have shown such deep and mystified concern. It is remarkable how one’s imagination can run wild when the physical machinery is upset by some puzzling ailment. One fear begets another and, like bacteria, they multiply, until it becomes possible to alarm one’s self into almost any sort of malady. For example, while at the outset I was satisfied that my only trouble was seated in the left kidney, during the course of the next few days, owing to the variety and severity of the examinations, and the utter lack of information concerning the results of any of them, I fancied myself the victim of no less than half a dozen diseases, most of them fatal.

At the next desk, there being at least fifty people ahead of me, I told the young lady I’d call later. At this point I began to feel a little encouraged, because whatever I had, it seemed to be very prevalent, and the afflicted ones didn’t appear to be much disturbed, except one poor old fellow, who was badly doubled up with what I suspected to be a case of “gravel” pains such as I had often experienced. I asked him if he had kidney trouble.

“No,” he said; “it’s just a nasty hang-over from a castor oil jag last night.”

After waiting an hour at the third desk they sent me into a nearby room to have all my teeth X-rayed. This completed, I plucked up more courage, and taking my fourth envelope I wandered about among the crowd, looking for the specified desk, which I finally located two floors below. The attendant there, like all the others, asked me to “take a chair”--a phrase that one hears repeated everywhere, until eventually it gets on your nerves. After a couple of hours or so I got up and asked the desk girl how much longer she thought I’d have to wait.

“The doctor will see you in your turn. Take a chair, please.”

After a few days you get so that, like a trained monkey, you instinctively look for a chair the moment you approach a desk. You sit and sit--anywhere from an hour to all day. Your chief amusement consists of looking about, wondering what’s the matter with this or that one. The majority of the patients wore a look of calm but determined resignation, and naturally I supposed that most of them had kidney-stones.

Unless someone stumbles over your feet, you are rarely disturbed, whether awake or asleep, therefore it is necessary to exercise due caution that you are at the right desk; otherwise you may sit all day till closing time before discovering your error. When your turn comes, if you happen to be asleep from exhaustion you automatically revert to the foot of the line, which is apt to mean the loss of a whole day. But time means absolutely nothing here--to anyone but the patients. If you ask the diagnostician when you’ll be through he answers evasively, “As soon as we have completed your examinations.” There is something contagious about clinical examinations: the first one calls for at least two more, the next two show that you need five or six others, and so on _ad infinitum_, until you feel like a fellow in the dark, hunting for the last link in an endless chain.

Another stereotyped phrase that one hears on entering most of the examination rooms is, “Strip to the waist.” You are sent to a little _un_dressing booth and furnished with a sort of loose flowing Chinese robe to take the place of your upper garments. On being directed to one of these booths, and finding it already occupied, I sauntered along the hallway and presently found another similar looking room, with the door slightly ajar. Without observing the “For Women” sign overhead, I opened the door and switched on the light, supposing the room to be unoccupied. But a loud shriek from a back corner disclosed my error; and frightened almost out of my senses, I turned about to find myself face to face with a squatty, florid-featured Amazon, whose _dishabille_ indicated that she had rather exceeded the examiner’s customary directions to strip only to the waist. With an impromptu word of apology, I was making a hasty exit, when she snarled, “Can you _beat_ it!”

At the fourth desk I was called at the end of two hours, and they undertook a thorough examination of my eyes, ears, nose, and possibly my throat--I don’t remember. I do remember wondering again what all this wearisome routine had to do with my kidney; also that I was absolutely empty and exhausted. I recollect, too, that it was 2:30 P. M. and I hadn’t had a bite to eat since the morning before; so I pocketed the other envelopes till the following day and went to my hotel next door, where I found the dining room “closed from 2:30 until six o’clock.”