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CHAPTER 8: Further Excursions in the Grey Zone

Dr. Herbert Ho Ping Kong ECW Press ePub



The physician should not treat the disease, but the patient who is suffering from it.

— Maimonides

IN THE LAST CHAPTER, I REVIEWED a series of cases dealing with the complex challenges that physicians face in dealing with syndromes that cannot be clearly identified, despite the obvious physical and mental suffering they inflict on patients. In this chapter, I will look at a few cases in which we can make a firm diagnosis of physical illness, but offer no effective or lasting solution. Here, the art of medicine is likely to be measured by other factors — by the level of care, attention, empathy and advocacy a doctor brings to the bedside. Sadly, in such situations, it is often necessary to deliver bad news to these patients. But that, too, is an art that needs to be developed.

A FEW YEARS AGO, A COLLEAGUE at a nearby hospital referred a very difficult case to me. Marnie was a 40-year-old woman that had been diagnosed with Erdheim-Chester disease. First identified by two pathologists in the 1930s — Austrian Jakob Erdheim and American William Chester — the syndrome is characterized by excessive production of histiocytes, a type of white blood cell that the body normally deploys to fight infection. When histiocytes over-produce, however, they invade the body’s connective tissue and begin to play havoc with key organs, including the heart, bone, kidneys and liver.

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CHAPTER 4: The Art of Seeing

Dr. Herbert Ho Ping Kong ECW Press ePub



Medicine is learned by the bedside and not in the classroom. Let not your conceptions of disease come from words heard in the lecture room or read from the book. See, and then reason and compare and control. But see first.

— Sir William Osler

WHEN WE FIRST ARRIVED IN MONTREAL, my wife and I initially planned to stay for three years, and then assess our professional situation. As it happened, our third anniversary in 1976 roughly coincided with the surprise election of the separatist Parti Québécois, led by the mercurial journalist-turned-politician René Lévesque.

The election results sent the anglophone community in Quebec into a state of shock. I vividly recall walking into Royal Victoria Hospital, at the north end of the McGill University campus, at 9 a.m. on the morning after the election and finding it virtually deserted. The corridors, coffee shops — completely empty. It was as if an official order had been issued to vacate the entire premises.

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CHAPTER 1: The Art of Medicine

Dr. Herbert Ho Ping Kong ECW Press ePub



It is more important to know what sort of person has a ­disease than to know what sort of disease a person has.

— Hippocrates

METAPHORICALLY, THE ART OF MEDICINE is a clinic that contains many rooms. In each, a different art is demonstrated.

In one room, there is the art of seeing, diagnosing illness by carefully observing what may be hiding in plain sight.

In a second, there is the art of listening, actively tuning in to the signature rhythms of the patient’s body, hearing both what the patient says and, equally important, what he or she may not be saying.

In a third, there is the art of human touch, which includes not only feeling the pulse, palpating the spleen, the kidneys and other organs to make the diagnosis, but may also include simply holding the patient’s hand to let them know that you care.

Two other rooms are dedicated to what is often called the Grey Zone. One is for patients who exhibit a range of clinical symptoms that defy simple diagnosis. They are clearly suffering, but there is no agreed-upon name for their ailment. How does the sensitive clinician deal with that increasingly common situation?

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CHAPTER 6: The Art of Palpation

Dr. Herbert Ho Ping Kong ECW Press ePub



Medicine is not only a science; it is also an art. It does not consist of compounding pills and plasters; it deals with the very processes of life, which must be understood before they may be guided.

— Paracelsus

ALTHOUGH IT MIGHT BE CONSIDERED a relatively minor aspect of the clinical examination, the art of palpation — using human touch to assess the patient — is, in fact, one of the most useful skills a physician can develop. It was certainly an important part of the old British system of training. We were well tutored in the art. This included learning how to feel for the shape, size, firmness and location of key organs and their spatial relationships to other organs.

And not only organs. There is great deal to be learned from any mass that might develop. Is it smooth or rough? Is it hard or soft? Does it move with breathing or is it fixed? Is there lymph node involvement? Does it pulsate? The answers to these questions can tell you a great deal about whether the mass is benign or malignant and, if the latter, how far it has progressed.

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CHAPTER 2: Starting Out

Dr. Herbert Ho Ping Kong ECW Press ePub



The whole art of medicine is in observation … but to educate the eye to see, the ear to hear and the finger to feel takes time, and to make a beginning, to start a man on the right path, is all that you can do.

— Sir William Osler

I ALWAYS KNEW THAT I WOULD become a doctor.

I knew it not, as one might expect, because my parents coaxed me toward the profession, but because of my childhood nanny. Let me explain.

I was the third child born — in 1939 — into a family of 10 in Summerfield, a country town in the district of Clarendon, some distance from the Jamaican capital of Kingston. My parents were both Hakka Chinese, a minority that, through the centuries, has exerted enormous influence in China’s political and social history.

My grandfather had arrived a generation earlier from China to work in the Caribbean cane sugar fields as an indentured labourer — one unglorified step up from slave. In time, some 10,000 Chinese would settle in Jamaica and, through thrift and hard work, become prosperous, particularly in the retail trade. So prosperous, in fact, that by the mid-1960s, racial tensions with the indigenous Jamaican community were bubbling up.

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