Frankfurt

Waking Dead exhibited at

Frankfurt Book Fair October 2020

Ivan the Great

When I was a medical student on the University Hospital medical ward, an intern, Ivan, was my mentor. Following him around from patient to patient, I was impressed by his enthusiastic care of patients. His commitment to each patient was so palpable that the patients were believed they were receiving the best care possible. His bedside manner and intellect made him appear to be an exceptional doctor, and his patients called him Ivan the Great. Some doctors, including his fellow interns and residents, considered his performance one-upmanship, but the patients loved him.
 A particular patient encounter illustrated the conflict between an intern who matches his wits with a senior staff physician. An elderly female patient,  Grand Matron of High Society celebrated and featured frequently in the local newspaper for her galas that raised enormous amounts of money for charity was admitted to his service. The private physician caring for her was primarily known for a practice that catered to the social set and had a priggish and overbearing manner. Ivan, the admitting intern evaluated his patient that day. I've forgotten the name of the attending physician, but I'll call him the Prince for the sake of the story. In many ways, he was the complete opposite of Ivan, but both had comparable huge egos. The patient had difficulty walking, falling several times as though experiencing multiple small strokes due to the hardening of the brain's arteries. Ivan did his usual thorough evaluation and entered his findings in the hospital chart along with a concise differential diagnosis listing three possible disorders. He ordered the laboratory work and some X-ray examinations that evening.

 The Prince came in during the evening to check on his patient and review her hospital chart. He quickly excused himself from the patient's room and ran to the doctor's conference room, searching for Ivan. Ivan was not on call that night and wasn't in the hospital. The Prince became ballistic, ripping out Ivan's examination report from the chart, and immediately phoned the medical director who was in his office. With the written findings in his hand, he rushed into the director's office to show him what Ivan had written. The director carefully reviewed the two-page report and asked the Prince if there was a problem. The physician flustered stammered,  "Do you see what the first diagnosis is!" The director's answered yes, adding that Ivan's examination was consistent with the diagnosis. In an imperious tone, the physician exclaimed that it was impossible since the patient was a pillar of society and a spinster who had never married. The diagnosis, which hadn't been confirmed as yet by any tests, would ruin her if it became known, he shouted. The director telephoned Ivan and told him to come in and rewrite his examination and list his initial diagnosis as the last one in his list of probable diseases. He warned Ivan that with suspicion of a sensitive diagnosis, he had to notify the admitting physician of the findings before writing his report for hospital rounds in the morning.

 The following morning everyone was waiting for the fireworks to start when rounds began as Ivan and the Prince met to examine the patient. Ivan had stopped by the lab to obtain results of the blood work drawn the night before. The confrontation began with a brawl in the hallway before they examined the patient. Both were quickly escorted to the conference room to avoid the battle overflowing into the patient's rooms. The Prince told Ivan that his insensitive diagnosis of a dreaded social disease was inappropriate for this sweet old lady whose only problem consisted of trouble walking. He added that only an arrogant moron who enjoyed grandstanding would use an outlandish diagnosis before knowing the test results. At that point, Ivan quietly withdrew the lab reports from his pocket and showed him the positive screening test for syphilis. The Prince raised his eyebrows in shock, stating the test was wrong, a false-positive. It was unbelievable to him that his elderly patient had an advanced stage of syphilis; neurosyphilis. Follow-up tests confirmed the diagnosis, and a further history revealed that she had been sexually active in her youth. Neurosyphilis usually develops decades after the initial exposure. It can result from a failure to diagnose syphilis at an early stage or from receiving inadequate treatment for syphilis during its early stages.

I often wonder what kind of physician Ivan became. He had the temperament of a surgeon but would have been a brilliant internist. Had he maintained the skills he developed when dealing with patients and his incredible bedside manner?

  

November 2019 Guadalajara International Book Fair Waking Dead exhibit

WAKING DEAD by Jay Glendell 

US Review of Books 

The medical profession meets the FBI; keeps the pace swift, clues piling up and shocking surprises in this novel to be thoroughly enjoyed by fans of adventurous thrillers.

Pacific Book Review

An esteemed medical man may or may not be a monstrous ex-Nazi; if you enjoy a good tale well told with intrigue and energy, you’ll enjoy the experience of Waking Dead.

The story involves a hospital-based physician facing a bitter divorce and the possibility of losing his job because he works in a hospital facing financial problems. He finds that he is unsuspectingly and unwillingly involved in solving recent murders and the death of employees at his hospital and another hospital in the northwest that had occurred in the past. He is recruited for this investigation by a gorgeous young female FBI agent, who had grown up in the northwest of United States. Her father, who had worked at a hospital in a university-community there, had died from a hunter’s stray bullet along with other colleagues who had died from similar suspicious events. His daughter, who always suspected that the death was not accidental, had found a definite way to identify the murderer that, until recently, was not available. To definitely prove it, however, she must trace the history of the suspect back to his origins in Europe and find a family that includes an elderly brother who is on his deathbed but is an essential piece of the puzzle. 

The plot includes romance, adventure, unusual locations, and surprise. 

    

                          Watch Video visit Barcelona with Dr. Peres and Agent Andersen                                                

PLEASE DON'T SHOOT THE INTERN

After graduating from medical school, I completed my medical training in a city hospital. I thought it would give me the best opportunity to see a wide variety of patients and the freedom to learn medicine without tagging along behind private practitioners. Many of them afraid to allow interns or residents to care for their patients. Obtaining training in a city hospital wasn't a free for all and provided more freedom to get hands-on experience. One of my most memorable experiences was my rotation in the emergency room. The emergency department was enormous and divided into several sections that included surgical cases, acute medical patients, female and male walk-in or stretcher cases, and an obstetrics section.

One evening I was assigned to the male medical section. As usual, it was full of the sick, the not so ill, and those with imagined illnesses. The patients were minimally screened for the severity of ailment by the admitting personnel consisting of a receptionist, and orderly, who was busy transporting patients. The service was overrun with patients 24/7. My dull gray room was packed that night with patients who sat on uncomfortable metal chairs lined up against the far wall awaiting an examination. The examining area on the opposite wall consisted of a stretcher, sink, and desk, separated by a drawn curtain separating me from the waiting patients. When a patient is called to be examined, everyone moves to the next vacated seat. It was musical chairs without the music.

After examining a patient, I'd pull the curtain open and look around the room before calling for the next victim. I quickly noticed an elderly gentleman who, by comparison, appeared relatively well dressed, with a shirt, tie, and clean, pressed pants. He was seated at least 10 chairs away from the launching chair and sat there quietly with his eyeglasses fogged up and forehead covered with beads of sweat. I walked over and, without saying a word, placed my hand on his forehead. He was burning with fever, and I helped him walk to the examining area. I shut the curtain and asked him to undress. While questioning him about his illness, the curtain was yanked open. A not-so-well-dressed man appeared demanding an examination.

I explained that the sick old guy sitting on the exam table had looked like he was ready to pass out and required my attention before of all the other patients. The not so well -dressed man said he was there before the older gentleman and I should have examined him first. I told him to wait until I finished with the elderly man, and I would then be happy to see him. At that point, he put his hand in his pocket and pulled out a small revolver, pointing it at me. He coldly stated that he would kill me if I didn't do what he said. In my panicked state, I thought about the time and energy it took to arrive at that point in my brief medical career that would be wasted if soon over. Collecting my senses and all the courage I could muster, I coolly told him if he killed me, I wouldn't be able to examine him and make him feel better. Looking at me with an anguished stare, soaked with perspiration, he said that there were people in the room threatening his life. His visions advised him that I had to examine him before they killed him. It was clear that I was dealing with a psychiatric patient and pleaded with him to put the weapon away. After a long pause, he reconsidered his options and slowly handed me the revolver.

I instructed him to wait on the other side of the room and quickly drew the curtain. With trembling hands, reaching for the phone on the desk, I quietly called security for help. During the episode, the patient sitting on the stretcher sat there peaceful and unruffled with a frozen facial expression. Surprised, I concluded he hadn't passed out because of an adrenaline surge he likely experienced from observing the whole event. I then described the intruder to security so they could identify him and take him to the psychiatric unit. I handed the gun over to them, finished administering to the patient with the fever, and called for the next patient.

Happily, I haven't had any more experiences like that.

BUG CURES STROKE

During medical school, I had a clinical rotation at the old Veterans Hospital in Washington, DC, in the 1960s. It was initially a private girl's school built-in 1930 that had been converted to a Veterans Hospital after World War Two. Its structural design didn't change very much when it became a hospital. The dormitory rooms became patient rooms with minimal changes. There was no air conditioning, and in the summer, it was hot and sticky. On Friday nights, many of the week's patients were discharged, and many vacated hospital beds were available. One evening on a sweltering summer night, I was assigned a newly admitted patient to evaluate. During summer, weekends usually presented with a surge of homeless veterans in the emergency room, recovering from a week of inadequate nutrition and the overconsumption of cheap alcohol.

My patient, a middle-aged male, admitted from the ER with a stroke diagnosis, was unresponsive to verbal and physical stimuli. He lay in bed with his eyes shut, unable to give a history of his illness. He was breathing comfortably, and vital signs were normal, but his extremities were flaccid. They fell to his side when lifted and released; however, all his reflexes were brisk and healthy when checked with a reflex hammer. Writing in his chart, next to the bed adjacent to an opened window, a sudden strange fluttering sound was occurring behind me. As I stepped away, a giant brown cockroach about the size of a baseball landed on his bare abdomen. His eyes immediately opened wide. His back arched upward off the bed, seeming to levitate as he rose upwards to jump out of bed, running out the room. I ran after him shouting for him to stop so I could finish my examination, but he escaped down a stairwell, and I lost sight of him. Embarrassed, I had to report that the exam was incomplete because a roach seemed to have cured a stroke, and I lost the patient. Later that evening, the intern informed me that security had found him and instructed me to finish my examination. He hadn't had a stroke, but he remained a guest of the hospital over the weekend. Admitting the homeless on weekends to feed, bathe, and dry them out (detox) was a service to the community and a way to keep medical students on their toes. I doubt that there are any therapeutic roaches curing strokes these days in our modern VA system.

Lucy in the Sky without Diamonds

At the time of my medical residency training in the 1960s, a tumultuous period in America, "Make Love, not War" was the mantra permeating the "Flower Children" culture. Like the beat generation before them, they desperately tried to break away from the conservative standards that this country sanctioned. I had minimal exposure to the Flower Children's period since I was studying medicine. The exceptional music of that era of Bob Dylan, The Beatles, Jim Hendrix and others captured that period's ethos for everyone's enjoyment, including mine.

I remember attending a medical meeting in San Francisco near a park occupied by the Flower Children. They dressed colorfully in various outfits in loud and dazzling colors. Disorganized and non-intrusive, making no loud noises or booming music and generally no hoopla, they appeared peaceful and non-threatening. Their generation preferred to demonstrate their independence with colorful clothing, hairstyles of different colors, music, and drugs. Devotees of powerful drugs producing psychedelic effects and hallucinations transported them away from the chaos created by their elders. 

This story is about their premier drug, LSD, lysergic acid diethylamide. Unlike heroin that dulled the prior generation's senses, it produced a heightened feeling of being alive with the ability to communicate with an imaginary world of visions, almost spiritual. The familiar anti-anxiety drugs used by the general population had evolved from Miltown in the 1950s, followed by Librium in the 1960s, then Valium, and the current flavor of the decade, Xanax. The Flower Children were not the only disciples of psychic altering drugs.

One memorable day during medical rounds, I learned a medical student was a patient on our medical service admitted the previous evening. Rumor had it that he had achieved the highest or one of the best scores on the MCAT (medical college admission test). He had graduated from Harvard and was a follower of Timothy Leary, the infamous proponent of the wonderous drug LSD that claimed to produce many beneficial psychological effects. That evening, the emergency unit admitted him with labyrinthitis, a diagnosis of an imbalance of the middle ear causing dizziness or vertigo. Neither Jim nor I had seen him when admitted to the unit since we were not on duty that night. The new patient was in the first bed of a large open ward of male patients on the hospital's seventh floor. The bed was close to the nurse's station so they could carefully observe him. Jim had examined him earlier that morning before rounds and was puzzled by the admission diagnosis. Admitting a patient with that disorder to a hospital dealing with life-threatening illnesses is unusual. The emergency room discharges a patient home with this diagnosis and usually treats them with a handful of seasickness tablets.

Another thing that confounded Jim was that his physical examination was negative. There were no physical signs to suggest the diagnosis of a middle ear imbalance. Jim also remarked that his patient, who I will call Jack for this story, presented with a strange affect. He did not speak or answer questions and required restrains to keep him in bed. Restraints should not have been necessary for someone with the diagnosis unless the patient was confused, which does not usually occur with middle ear imbalances in young patients. The constraints allowed some movement while keeping him in bed and were needed to prevent a confused, dizzy medical student from falling out of bed. 

After completing rounds, I usually examined new patients to allow more time to take a history and perform a physical examination.

Jim and I were examining the fourth or fifth patient in the ward when we heard a loud commotion from the first bed. Jack had taken off the restraints, jumped over the bed rails, and headed to the nearest stairwell. I told Jim to take the fastest route to the ground floor and block Jack's exit from the hospital. Jim was a muscular fellow with a physique resembling that of a football tackle. Our patient was a tall, gaunt guy who did not appear menacing. I followed my patient, who had had a head start to the stairway, where I could see him on the fourth-floor landing looking down at Jim, who amazingly had reached the ground floor. I yelled at Jack to return to bed and reassured him that we would not harm him. There was no answer as he moved out of sight. All I heard were clanking noises sounding like metal pots banging together, produced by empty green oxygen tanks stored on the stairwell landing. It soon became apparent that Jack was dragging an empty tank along the railing. The metal tanks were about 4 to 5 feet in height and heavy even when empty. Jack was attempting to lift a green tank over the stairwell railing and hurl it down at Jim. I yelled to Jim to get away from the stairway and call security.

 Security did rescue Jack and placed him in a locked psychiatric ward on the hospital grounds. The following day, a mental hospital in the city, not affiliated with our hospital or medical school, accepted him as a patient. A few days later, I heard that they had discharged him after three days of observation. I wasn't expecting to hear more about Jack. A few days following his release from the psychiatric hospital, I found the staff huddled together, looking down at something on an empty bed. As I approached, I asked what was happening, and they held up a newspaper with the first-page headline reading in large bold print, LSD killer. Following his discharge from the other hospital, Jack returned home and killed his mother in law. From what I recall, it was a gruesome murder in which he stabbed her more than one hundred times. 

 Following the murder, the news buzz was that he was a chronic LSD user and continued using it up to the day of his hospitalization. Was it all a bad trip (a term used to describe the opposite of a high) that made him kill his mother-in-law? This "Flower Child" drug could make you do terrible things and not just make love. For several months, there were various theories bandied about by a generally uninformed public. The final verdict was a brilliant young man with a paranoid psychosis could get high grades on tests while high from drugs. However, a twisted psyche prevented him from becoming a doctor.

 Unfortunately, there were no tests at the time screening for severe psychiatric disorders in medical school applicants. Passing the MCAT test provides essential information about one's intellect but nothing about their personality or psyche. The problem is that there is no simple window into a person's mind or soul to determine the required mental stability to become a doctor. That said, how can we predict a physician's bedside manner?