The internist I’ve been seeing my entire adult life recently retired. This essay, which originally appeared here in 2014, was not about her. But it did concern the sometimes—maybe always—precarious relationship between medical professional and medical naïf, one that I will now need to renegotiate with a new internist while bearing, believe me, this experience in mind.
The doctor was sitting in a chair next to the window, gazing out. His features gave nothing away, save serious thought. I watched him from my hospital bed, trying to discern meaning in his own effort to discern meaning in my symptoms. Silence. Finally, he turned back to me and spoke: “Medicine is an art, not a science.”
Screw you, bub. I’m the writer here. You’re the empiricist. So let’s go: What’s the diagnosis?
By then I had been running a fever for over a week. Every day it spiked, and every night it broke, and every morning it returned, rising throughout the day until, around midnight, it reached 103 or higher. Once I realized I couldn’t shake the fever, I had called my doctor, who turned out to be on vacation. So I went to see her partner. This was on a Tuesday.
Dr. Bub prescribed antibiotics and cold-water-only baths. The antibiotics didn’t work. Neither did the cold baths, though I did learn that I’d make a lousy POW; after 30 seconds of immersion I was ready to provide detailed troop movements.
Another visit to Dr. B, another round of antibiotics: This was Thursday. That evening the fever spiked. That night the fever broke. Friday morning, the fever returned.
Friday. The beginning of a weekend—worse, a three-day holiday weekend. Dr. B told me over the phone that if we couldn’t figure out what was wrong today, he was going to hospitalize me, so that he could monitor my symptoms on an ongoing basis rather than wait for his office to reopen on Tuesday. Then he sent me to the hospital for an esophageal probe, a procedure that involves a tube snaking its way from your mouth down your esophagus through your stomach and into the small intestine. The procedure provided more insights into my limitations as a potential POW and, I learned via a phone call from Dr. B after I returned home, none into the nature of my ailment. He told me to pack my bags and take a cab to the hospital.
He met me in the lobby. He’d been up until 2:30, he said, looking through the literature. And he’d finally found a diagnosis that might match my symptoms: endocarditis, an infection of the inner lining of the heart. If he was right, it should respond to the kind of massive dose of antibiotics that a hospital could provide. And if he was wrong, at least I’d be in a hospital.
Saturday: During my usual morning wait to see if the fever would return, Dr. B came to my room, looked out the window, made his pronouncement about art and science. That same day, I got a phone call from a doctor friend. I told her about the diagnosis of endocarditis, but, I said, it was only provisional. Maybe the word provisional is what prompted her response.
Medicine as we know it, she said, is only about a hundred years old. It’s in its infancy. We’d all like to think it’s a science of certainty, she said, but it’s not: A lot of diagnostics is guesswork.
Guesswork? Was this, then, my fate: a guess made by a desperate doctor in the middle of the night?
The fever didn’t return that day. Nor on Sunday. By Sunday evening I felt well enough to get out of bed and stretch my legs. Patrolling the hallway, wheeling my drip beside me, I thought about what the two doctors had said.
Medicine is guesswork, yes, but only in the same way that writing is guesswork. You follow an intuitive path. You make a guess. Only it’s not just a guess. It’s—whether as the result of choosing among endless aesthetic options or as the result of chasing down the most relevant medical literature—an educated guess. Which was what Dr. B had made—and he’d had enough of the artist in him to be a scientist who got a tough call right, and who saved my life.
Sunday night. Midnight. I’m startled awake by a nurse, swaying in the doorway, shouting at me.
“Happy New Year!”
No, wait. Performance art, I decided, and, curling up in the hammock of a correct diagnosis, I went back to sleep.