Ask the Professor

After publishing the post about my first day of medical school, I felt a bit nostalgic. I googled some of the names I remembered from back then and sent a few emails with a link to my post.

C., who was a junior teacher and researcher in the department where I earned my one citation in Index Medicus, was the first to reply. Eight years my senior, he was listed in the University catalog as Professor Emeritus.

There is something profound about learning that someone you know reached such a pinnacle of academia, earning his place among Linnaeus, Celsius, Ångström, Berzelius and Bárány.

It is also remarkable that the man I remember as barely older than I is already an emeritus, and officially retired, although still busy in both academics and clinical medicine, as I learned.

In a return email, I shared with C. my memory of the practical portion of my internal medicine exam, where Professor Boström sat and broke tongue depressors in a corner of the room. Ever since, I have had a slight doubt in the back of my mind whether my performance on that day really was pathetic enough to drive the professor of medicine to distraction.

One sentence in C.’s reply wiped away thirty-eight years of gnawing self-doubt: “Harry was always fiddling with something or rubbing his palms together”.

That sentence was an unexpected bonus in my delight at reconnecting with C.

Sunday morning as I with my pitch fork and a tarp-covered garden cart took on the task of cleaning out the goat yard, I thought to myself: “Professor of medicine at Uppsala University, huh – I wonder if he has the answers to some of my questions that the specialists at Cityside Hospital haven’t answered to my satisfaction.”

As I toiled, I began making my list of things to ask C. The first thing I thought of was why a normal nuclear medicine study trumps an abnormal stress-EKG. That is the answer every cardiologist I have asked gives me.

The EKG can change with potassium levels, digitalis administration, pericarditis and all kinds of things. Why are cardiologists so nonchalant about ST depressions and T-wave inversions just because a grainy picture of the heart has a relatively uniform color? Is it, perhaps, because they still view coronary artery disease as a plumbing problem rather than an inflammatory condition?

Maybe a positive EKG stress test with a negative nuclear image should be viewed as evidence of heart disease with not-yet-critical blockages, but still cause for aggressive action, particularly to reduce inflammation and thrombosis risk?

That is probably enough to ask the professor; I wouldn’t want to bombard him with all the random everyday musings of a country doctor.

P.S. I first drafted this post in 2014 and never came back to it until now. Shortly after writing it, I realized that C.’s successor as Professor of Medicine at Uppsala University was S., a classmate of mine. He always had, like Columbo, one more question. I settled for “what do I do if I run into a [Blank]? That’s why S. became a professor and I a Country Doctor. But I wouldn’t trade my job(s) for any other career in the world.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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