Monday, July 29, 2013

The Doctor's Dilemma

I was speaking with a friend about Downton Abbey and Lady Mary Crawley's dilemma with the Turkish gentleman who, given his age, must have had a fatal arrhythmia during intercourse. It reminded me of a similar, little known , but celebrated circumstance in Lotus City in the mid 20th century when I began practice there. The city was very small at that time and medical practices were both tight and longitudinal so families were often attended by the same physicians from cradle to grave. As a result of this, patient and doctor loyalties were high. The doctor of whom I speak, attended, for years, two carriage trade families who lived in the same neighborhood as him. One night he received a midnight call from the wife of a prominent business man, in a panic, that a friend of hers had died in her bed. The man who died, a lawyer, was also the doctor's patient, a widower who had enjoyed a meal, and later, congress with the lady since her husband was away on business. Unfortunately good living had rendered the older lawyer somewhat unfit for such action. Faced with such a situation and the eruption of scandal involving two of his patient's families and also their issue, the doctor's dilemma arose. The man had clearly had a heart attack at the time. As a result the doctor and the lady, fueled no doubt by adenaline, carried the man to the doctor's car and transported him to his house and put him in his own bed with new pajamas and tucked him in. He then made a house call in the morning and called the coroner. The question of course is, what was the moral imperative that contended with the legal requirement of the doctor? A physician has a duty to the country, his colleagues and to his regulatory body to obey the law. He also owes a duty to the welfare of his patients at some cost, if necessary. He risked his medical practice by illegal transport of a human body from the place of sudden death in order to cover up the truth. However, dead is dead and a bed is a bed! What was the harm? It would have been easier for the doctor to avoid criticism by a self- righteous tack.  He took a chance! In a small city where everyone knew everyone's business, they thought,  the secret was kept for years. Succor for the innocent of the families I suppose, and avoiding the trials and near disasters that befell Lady Mary.

Monday, July 15, 2013


Avoiding pitfalls in university exams includes sidestepping opportunities to cheat. The temptation to do so in a competitive environment, when we were trying to get the marks necessary to get into and to stay in Medicine, presented themselves occasionally. I escaped the pitfall twice in my student years, largely through cowardice I must confess rather than any surge of ethics. In my premed year my marks were good since I needed them to transfer to the medicine faculty and a colleague, not a friend, but a playboy and bon vivant in my premed year and also an occasional drinking companion, knowing that I was heading to good marks in invertebrate zoology, asked me to write his exam for him. He offered me fifty dollars to do it: a big sum in 1953. I told him no, mostly because of cowardice, but also self-righteousness since he never bothered to spend any time at the subject. I don't really think at that time I had any strong ethical sense. I just was cautious about being found out and risking the destruction of my budding career. The second time was in second year medicine when my friend, in first year medicine, gave me a prepared copy of the final second year bacteriology exam two days before the examination. Once in my hand it was difficult not to look at it. There was no question on it that I couldn't have answered easily. However, paranoid though I may be, I think in retrospect I was being set up for disaster. I was a good student in bacteriology, but I wasn't a great student in bacteriology. A laboratory technician, whose wife had been trying to seduce me, had left a copy of the examination questions "inadvertently"  near my friend's library table in the evening. My friend couldn't help but notice it and was impelled to show me. What to do? I had no way out. I solved the problem by writing the exam badly enough that I could get by without detection while kicking myself at the same time. Cowardice however has a place in all of this. Had I taken great umbrage, and asked for a separate exam since I had seen a copy, the shit would have hit the fan for every one but me. Thanks to my cowardice no one lost their job, no one was exposed for cheating, no one was expelled for passing information about exams, and I was never seduced, probably again about cowardice and naivety rather than ethics. There is no doubt that growing up in the prairie boondocks you had to look where you were going to avoid stepping in fresh cow pies.