Nuland himself tells of the doctor-patient relationship from the perspective of him being the father of the patient. With that exception, these stories are told from the standpoint of the doctor. Often, they are as much about the doctor as their teacher or patient. And some are not afraid to relate tales where the conduct was not exemplary. Thus, an anesthesiologist recalls a respected and talented surgeon with bipolar disorder who went off his meds while on vacation. Upon entering the operating room for a routine gall bladder operation, the surgeon groped a nurse and sped into the operation, including removing and discarding part of a healthy stomach and slashing the patient's aorta before being restrained by three orderlies. Then there's the chest surgeon who admits still having "a perverse pride" in getting a night nursing supervisor fired before she could report his sexual tryst with a student nurse
Yet one public breach of decorum is also one in which the actions are most understandable. A neurosurgeon recalled a two-and-a-half-year-old boy who suffered a fatal brain injury when his mother's boyfriend threw him against a wall. During their efforts to save the boy, the medical team discovered a body covered in days' old bruises and with an extensive tear in the rectum. As the neurosurgeon went to tell the mother the child had died, he spotted the boyfriend, already in police custody.
I could not help turning to the behemoth and positioning myself on a chair so that my face was within inches of his bloodshot and now terrified eyes. I wanted to be sure that he could see the bits of brain clinging to my gown, the front of which was soaked in the fresh still-scarlet blood of the child he had killed. "This is what you did," was all I was able to say, because I was afraid I would vomit if I tried to speak another word.
To make sure there was no doubt left for law enforcement, the doctor concluded the operative chart with the handwritten entry, "The mother and her boyfriend are the stuff of worst nightmares."
Fortunately, most of the memorable patients in this collection are not involved in nightmare tales. And while their stories may not always end happily, they do help illuminate the range of experiences in the day-to-day practice of medicine.
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