Dr. Oscar London, Kill as few patients as possible

Über das Blog des entzückenden Dr. Grumpy bin ich auf dieses Buch gekommen. Er bezeichnet es als seine Bibel und hält sich, weitestgehend, an die 56 Regeln darin.

56! Respekt, die meisten Mitteleuropäer sind mit 10 Geboten schon überfordert. An Halbgötter werden dahingehend wohl spezielle Anforderungen gestellt.

Nun zum Buch. Geschrieben wurde es 1987, ein bisschen überarbeitet 1997. So ganz taufrisch sind also weder Buch noch Autor, was den liebenswürdig verpackten Aussagen aber in der Regel keinen Abbruch tut.

Dr London stellt seine Regeln vor und untermauert sie jeweils mit einem kurzen Aufsatz darüber, warum es eine seiner Regeln ist und warum er sie für sinnvoll hält. Das macht er mit Ehrlichkeit, Humor und dem kleinen bisschen Hybris, ohne das man wohl nicht der weltbeste Doktor werden kann. ;-)

Regel 9, „Kill as few patients as possible", hört sich in meinen Laienohren schon mal sehr gut an, auch wenn ich mich vage frage, warum das nicht Regel #1 ist. Auch andere Regeln kann ich gut nachvollziehen, als da wären „Regel 3: If you can't save your patient's life, find someone who can", „Regel 13: If you make a mistake so horrible it is to die over, don't", „Regel 26: Don't try to feel a breast lump over the telephone" und „Regel 38: When she's absolutely, positively sure sie isn't pregnant, get a pregnancy test."

Einige der anderen („Be jewish", „Don't call me Doc" oder „Drive wooden stakes through the hearts of financial advisors") sind wohl eher persönlichen Erfahrungen und Ämpfindlichkeiten* geschuldet, tun dem Amüsement des Buches aber keinen Abbruch.

Als Zitat werde ich Regel 55 vorstellen, weil ich die Aussage darin sehr wichtig finde. Dass in Regel 55 auch eine Katze vorkommt, hat damit ü-ber-haupt nichts zu tun. Uh-uh.

Rule 55
Ask your patient what's shaking down at work and what's cooking at home.

London's law: If a patient is miserable at work AND at home, he will come down with a major physical ailment.
This double-whammied patient is easy to diagnose: stroke, heart attack, peptic ulcer, to name a few classics.
London's first correlate: If a patient is miserable in just one place – at home or at work – he will bring in a list of symptoms as long as the table of contents in Cecil's Medicine, an no diagnosis will be up to the task. Only patially burned out, this patient is en route to a major physical ailment.
London's second correlate: If a person is content at work and at home, he will never darken a doctor's doorway.

With every patient I see, I try to find out what's shaking down at work and what's cooking at home.
Some years back, I treated an elderly White Russian who had served as a general in the Czar's Army ans was now trying to make it as a real estate broker in Nixon's America. Whenever he failed to make a sale, which was often, he had to restrain himself from taking down his jeweled sword from the wall behind his desk and running the client through. Boy, did he have symptoms! (A recurrent, stabbing pain in the abdomen, of course, was one.) Fortunately, he also had an excellent marriage.

His wife had been handmaiden to the Czarina, spoke five languages poetically, and had grown more beautiful with each decade. She could cook a bowl of pelmeni whose aroma caused everyone downwind to hum something from Rachmaninoff. Beleaguered at work, the General had formidable reinforcements at home.

One afternoon, his wife dragged the General – pale and groaning – into my office and demanded that he be hospitalized.
"How's business?" I asked.
"Never better," she said. "Last month he sold an apartment building for three hundred thousand dollars. He was the happiest man in the world. Now look at him. Doctor, put Gregor in the hospital."
"How are things at home?" I asked.
"Fine, wonderful. Doctor, put Gregor in the hospital."

Who was I to stand up to the Czarina's handmaiden? How could I, a retired Captain in the U.S. Army Medical Corps, refuse to hospitalize a stricken general? My only problem was that I couldn't come up with an admitting diagnosis. According to London's Secons Correlate, a man who was happy at home and at work had no business being dragged half-dead to my office.

When I asked the General to point where he hurt, he feebly passed his right hand over his entire body. Wherever I touched him, he groaned. My examination was otherwise completely negative.
Bowing to imperial pressure, I admitted the General with a diagnosis of pandynia (pain all over).

A week passed. Prodigious amounts of blood, urine, and barium were shunted about in a vain effort to make a diagnosis. The General refused to eat. Intravenous fluids kept him just viable enough to moan. He was dying before my eyes, and I didn't have a diagnosis. The only thing keeping him alive, I concluded, was my failure to find out what was wrong with him.

On the General's eighth day of hospitalization, his son-in-law Sergei accosted me after work in my office garage and swore me to secrecy. Russian intrigue! In a hoarse whisper, Sergei said, "Get the cat."
"You want me to get a CAT scan?" I asked, knowing too well how helpful a patient's relatives could be in leading an inept doctor to the correct diagnosis.
"Not a CAT scan," he said. "Sasha. Sasha the cat. Get rid of her."

It turned out the patient's wife had adopted a stray cat the month before and had fallen madly in love with it. [...] The General, accousted to his wife's undiluted affection, reportedly went berserk with jealousy. It was beneath his regal dignity – and contrary to his military ehtic – to admit that a cat without a pedigree was defeating him.

Recently triumphant at work, but acutely miserable at home, the General nondiagnostically fell apart. Had the bottom fallen out of the real estate market at the same time that Sasha invaded his home, he would, by London's Law, have gone on to suffer a conventional stroke, heart attack, or peptic ulcer. But a man dying from feline envy was beyond my diagnostic ken – or kennel; I should have called in a vet to the General's bedside.

With the diagnosis in the bag, I gave the wife a choice: her husband or the cat. After a shocking amount of soul-searching, she gave up the cat.

Over the wireless went the message: SASHA EVICTED. When the General received this eleventh-hour-bulletin, he sprang from his deathbed and marched home in triumph.

A week later, his wife was in my office with a list of symptoms as long as the Trans-Siberian Railway.

Meine Meinung: ein schönes Buch, auch für Nichtmediziner.

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* sic, da ein weatherwaxischer Oggismus. Oder ein Carrotismus. Oder beides. Auf jeden Fall sic, so there.