A Harvard Death and Other Stories
Randy A. Birken
As we know, becoming a doctor is often a seven-to-ten year period of hard work, long hours, and the need for the emotional fortitude to survive a punishing system. Along the way, doctors-in-training face many unforeseen, challenging and provocative situations. Perhaps Oscar Wilde said it best: "Experience is one thing you can't get for nothing."
These stories reflect the author's many medical experiences which are woven into these writings, giving a richness and diversity to the plots, and each ending with a little twist.
The title story, "A Harvard Death," is recognized in the medical community as a person who dies in an academic institution, and yet is a moving testament to the healing power of personal connection between physician and patient.
Each story invites the reader to another medical setting as another mini-drama unfolds, or another ethical issue unwinds, or someone faces an ultimate decision, until the final suspenseful "whodunit" story of mystery and intrigue, "Not Always Benign."
Blending pathos and humor with a medical background - much like television episodes of medical drama - Dr. Birken offers these intriguing vignettes with a comment from Bernard Malamud, "life is tragedy full of joy." Such are these stories.
"A Harvard Death is compelling in its portrayal of how medical school changes the lives of men and women who choose this honorable profession despite the vagaries of managed care today. His stories, albeit composites of fictional characters, ring true today given medical ethics, dying with dignity, and medical advances that continue to chip away at the doctor-patient relationship. I was especially taken with his first chapter and portrayal of Mr. D'Amato, who chose to die on his own terms. This resonated inside my gut as I watched my mother make the same decision last year in a Houston hospital, and the compassion of her doctors and nurses after five years of end-stage emphysema. Kudos to Dr. Birken for his compassion and psychological insights which are rare among physicians and surgeons today." Dr. Keith Barton, psychologist and author
"In his diverse collection of stories about the experiences of medical students, Dr. Randy Birken writes with skill and compassion. The more the young doctors discover the humanity of their patients, the more readers appreciate the humanity of those who choose to practice the art of healing." Rosemary Poole-Carter, playwright & novelist (www.poole-carter.info)
"Steeped in the rich tradition of literature and medicine, Dr. Birken writes stories that unflinchingly explore the feelings that accompany the process of becoming a physician: fear and self-doubt, disillusionment and anger, and finally, compassion and confidence. For anyone who wants to understand how doctors really experience their training as it unfolds in the classroom and then in clinical settings, A Harvard Death is a must-read." Cheryl A. Koski, Ph.D., Professor of Writing about Health and Medicine, University of South Florida St. Petersburg
Table of Contents
A Harvard Death
History and Physical
The Conference Room
Birth and Rebirth
Father and Son
Third Year Journal
Not Always Benign
For almost an hour, the new Medical Three team presented cases. Kyle would follow up with a clinical pearl as well as a journal reference. Justin found his medical knowledge extraordinary.
The last patient was Mr. Tony D'Amato, a seventy-one-year-old transferred from a nursing home three weeks before with severe dehydration. After he refused to eat or drink for days, the nursing home doctor sent him to the city hospital. Mr. D'Amato had several medical problems, including emphysema from years of smoking, severe rheumatoid arthritis, and left sided weakness from an old stroke. While he ate and drank adequately at times, he would suddenly become uncooperative. The house staff faced the same problems as the nursing home. Social service was consulted, along with psychiatry, but no one suggested anything constructive.
The old man's wife died seven years ago and his estranged sister lived in another state. He had two children-a son killed in Vietnam and a daughter who died in an auto accident when she was thirty-two. There was no other family or friends. Yet, Mr. D'Amato could not be transferred back to the nursing home until he was stable or discharged via a hearse if he died. The house staff found him disagreeable and unmanageable. He would say little or nothing if questioned. The intern on call the night before told Alan how he spent over an hour putting a small butterfly IV into the old man's right foot and taped it with enough gauze that even Houdini could not undo; but Mr. D'Amato managed to pull the layers off and yank out the tenuous IV.
"He's a real turkey," the intern said. "He won't speak to you. He'll eat for a few days, then not touch a thing. So you put an IV in and then he ruins your work. The guy's bats. I wish he was well enough so we could send him to the psych floor. I guess he's going to die a Harvard death."
While "Harvard death" was meant to be sardonic, it was a phrase the house staff used when they saw no possibility for a patient leaving the hospital alive. In the academic world, it meant the patient would die in a teaching hospital while the house staff tried to keep the lab values normal. It was not a phrase to be used among the faculty.
"Can't social service get him to some kind of long term care facility?" Alan asked the intern.
"Why? He'll just end up back at the hospital and probably on another medical service so somebody else will get stuck with him."
Alan didn't give the specifics of the conversation to the new Medical Three team. Instead, he told them that the previous team found Mr. D'Amato to be "a most difficult patient." Kyle listened to the presentation and comments without his typical smile. He took the chart from Alan.
"In the original nurse's admission notes, it's says that Mr. D'Amato ran a newspaper and magazine stand for forty years at the Blogett Street train station."
Justin was confused. What did this have to do with the patient's medical condition?
Kyle rubbed his temple. "Let's go meet this man. I may have an idea."
He knocked on the unlocked door and entered. The team surrounded the bed. There was a small window above the radiator, and light from the morning sun shown on the old man's sleeping face like a spotlight on a stage with the medical team as the audience.
"Mr. D'Amato. Good morning. My name is Kyle North and I'm the chief resident of the medical services here at the city hospital."
The patient's mouth was opened slightly on a gaunt and pale face. Wispy white hairs lay on the pillow like sunspots shooting out into space. He opened his right eye but said nothing.
"Mr. D'Amato," Kyle said softly. "We want to help you get better and go someplace more comfortable than this old hospital."
The patient turned his head, surveyed the group surrounding his bed, and placed a pillow over his face. Kyle reached into his pocket and pulled out half a roll of peppermint Lifesavers.
"I know you used to run a newsstand for many years, so I'm just going to leave these Lifesavers here. Bet you used to sell a lot of them."
"See you this afternoon, Mr. D'Amato. I'll try bringing you something else to eat later." Kyle nodded to the team members as a silent command. They followed him out into the hallway.
"Alan. Call dietary and tell them to send him pudding, milk, and cookies for lunch and nothing else."
Justin was surprised by the attempt to bribe the old man. With the end of rounds, Kyle announced where the noon conference would be and left to check on the other medical services....
Blue Dolphin Publishing, 2006
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