Athenaeum 2009

Some memories are too valuable to lose in the meanderings of time. We should 
preserve these

As a recently retired internist I want to pass on to you a few of my medical 
experiences, some poignant but mostly humerous. Usually I conceal the 
identity of my subjects, but at times the name of the patient is so important 
to the tale that I simply avoid transmitting any medical confidences. And away 
we go....

As I was disecting my cadaver that firsts year of medical school, the father of 
one of our quartet (you see two medical students worked on each side of the 
table) dropped into the anatomy lab. He was a family physician in Lebanon and 
told us to come out into the hall so he could show us something. The something 
was a quart Windex bottle that he had just delivered from a man's rectum with 
obstetrical forceps. The man's wife had explained to the doctor that the 
patient was simply getting out of the bath tub when he slipped and fell 
astride the bottle that happened to be on the floor beside the tub. The 
absence of any anal tear or bruise belied that tale, as did the strange, 
plastic, cone-like contraption screwed onto the top to facilitate introduction 
of the bottle neck into an orfice just the size of an anus. From that time 
onward I decided no tale was too strange in medicine. 

An unbelievably similar event was the recovery of a Pepsi Cola bottle from a 
vagina. The story was that she was "playing with myself, and it just got away, 
whooosh!"

The third case of inappropriately placed objects was a teenage boy at 
Nashville General Hospital who presented with a severe cystitis. When it 
failed to respond to treatment, the urologist cystoscoped him and retrieved a 
tiny snake, by now thoroughly decomposed, that the boy had used in his urethra 
to provide what must have been a unique sensation.

In Obstetrics Clinic at Vanderbilt we were teaching indigent  females the 
forms of birth control. A few weeks later one of our more robust ladies 
grinningly told us she was pregnant. "Didn't you use the diaphragm we gave 
you?", we asked. "Sure. Here it is", she held up the device duly pierced to go 
on a chain around her neck. 

And not too many years ago a woman, who had recently been in jail, came to me 
because of a heavy vaginal discharge. Pelvic exam showed gross pus covering 
the cervix, but closer inspection revealled a gray mass underneath. So I 
swabbed out the pus and fished out with sponge forceps a crumpled lump that I 
proceeded to rinse off in the lavatory. Just as I got it clean enough to see 
that it was a wadded up twenty dollar bill, the patient threw off her sheet, 
ran toward me grabbing the money, and scurried out of the office never paying 
a cent and never to be seen again.

Leaving for a moment body orfices, I have over the years had opportunity to 
see several prominent people. As an intern I had World War I hero Alvin York 
at the Nashville V.A. Hospital. I asked him what he said when he got the drop 
on all those Germans. "Stick 'em up", he grinned. He was from Pall Mall 
Tennessee, and his little adoring wife loved the attention the media gave her. 
Television reporting was new, and the cameras and lights were her glory. Each 
day we would give her a confidential update on Sarge's condition, careful to 
exclude the press. But each evening the TV stations and newspapers had all the 
latest facts. It wasn't until we followed her after one briefing to a 
telephone booth that we realized how important celebrity status was to her. 
Each day she had rushed to call the newspapers the latest update on old Sarge.

I saw Tennessee Williams, the Alton Giant (purportedly the world's tallest 
man), and Walter Slezak, the actor, all in Barnes Hospital. Slezak had not 
been weighed, and the scales were down the hall some distance. So with a 
flourish he swept the bedspread across his nakedness and strode past the 
nurses' station like Cesar himself. Also at Barnes Hospital, in the posh 
addition known as Queeny Tower, I was assigned Edgar Queeny himself, CEO of 
Monsanto. He had his own suite of rooms and personal chef. Althiough he had to 
endure examination by his personal doctor plus my intern and me, and although 
he was ill, he was delightfully courteous and patient.

Then there were the miracles, the cases that should have turned out badly but 
beat all odds. A woman in her thirties had breast cancer all through her 
chest. That was before we had any oncologist in town, and I was about the only 
person here trained in giving chemotherapy. I told her that the cancer was 
incurable but that I might give her a little extra life. She would have to pay 
the price of hair loss, nausea, and misery. She said she had two small 
children and would do anything to have a little longer with them. For two 
years I filled her veins with my poisons. She vomited, cried, and came back 
for more. Until I retired, she kept coming back, continuing these thirty or so 
years to give me a grin and a hug.

Another happy case was one of lung cancer, an almost never curable problem. 
The lady was coughing up blood, and her sputum showed tb germs, but we 
bronchoscoped her nevertheless. And was that fortunate. We might have just 
treated her for the proven tuberculosis, but no. We found a tiny nubbin of 
cancer in one bronchus. So removing one lung gave her 25 years or more life. 
She finally died of another problem just last year.


But the most incredible case I ever heard of I'll call Virginia. If I could 
tell you her real name, you might see the humor. Anyhow, one night in October 
1970 Dr. Jack Amis asked me to see a sixty-seven year old lady because of 
hypertension and lung disease. Her blood pressure was an astronomical 230/160. 
I found she was diabetic as well. She finally went home, but we found blood in 
her stools. And colonoscopy was yet to reach Hopkinsville or even Vanderbilt.

About two months later I had to admit her to Jennie Stuart again, this time 
for vomiting. She had suffered abdominal cramps and burning in her epigastrium 
for many years, but her symptoms had worsened those two months; and she had 
lost enough blood to become quite anemic. Barium X-rays (no CAT scans yet!) 
suggested a stomach ulcer. She required several transfusions. Early the next 
month, January 1971, I was called in one night because of her excruciating 
abdominal pain. I examined her and thought she had probably perforated that 
ulcer. All this happened during the state Kentucky Medical Association annual 
meeting, and Dr. Amis (whose brother Bob had not arrived in Hopkinsville) was 
desperate for a surgical assistant. He looked at me. "Look, Jack, I haven't 
operated since dog surgery in med school!" He grinned. "Fuqua, You'll have to 
do". And we took her to the operating room. She did have a perforation, but 
not of an ulcer. She had tumors all through the belly, one blocking an artery 
to the bowel and thereby causing bowel infarction or death from lack of 
oxygen. The perforation was from rupture of six feet of dead ileum. The 
resulting shock compromised blood supply to her heart, and she infarcted a 
papillary muscle, one of the little fellows that normally keeps the heart 
valve leaflets in place. 

We cut out tumor fragments that filled a stainless steel mop bucket, finding 
the cancer had spread even above the diaphragm out of our reach. So Dr. Amis 
put the bowel back together, and I taught Virginia how to give herself 
morphine shots for the pain. Hospice was still in the offing too. And the 
pathologists, using the primitive methods then available, could not tell us 
what sort of cancer it was. 

I saw her at the office ten days after discharge, and found a new inch wide 
mass above one collar bone. I tried to alleviate her vomiting.

A month later she was back at my office, to my amazement still alive. She felt 
better and no longer required injections for nausea. She had been obese at the 
onset, but now she weighed 116 pounds.

A month later she weighed 121 and in 3 years 167. But her blood pressure was 
just not controllable. Considering her unexplained recovery from cancer I 
almost wondered who cared. But I referred her to the hypertension specialists 
at Vanderbilt in late Auigust 1974. A routine PAP smear there showed 
neoplasdtic lymphoid cells, and biopsy of the cervix was suspicious for 
granulomata with mycobacteria. After she left Nashville, one of Vandy's 
doctors called to suggest that I evaluate Virginia for disseminated 
tuberculosis. Her tb skin test was positive, but microscopic exam was negative 
on sputum, urine, and gastric aspirate. I could not get a bioppsy of her 
pleura or find the small amount of fluid seen in her thorax on chest X-ray. A 
local gynecologist took further biopsies of the cervix for culture. Since we 
couldn't prove tb, she was discharged without antituberculous therapy.

Now I concentrated again on her blood pressure and on good days got it down to 
160/90 and on bad 230/140. I used the most potent drugs we had.

Then late August 1975 I did a routine PAP smear and found five, white, low-
profile nodules on the left side of the vagina near the cervix. I tried to 
get Virginia to have a biopsy of these lumps, but she owed the gynecologist 
$50 still and declined. Finally we got a biopsy, and that showed only 
fibrosis, as we call scar tissue. But there were granulomas, the 
characteristic pattern for diseases like tb. That was far better than 
recurrence of her cancer that I had feared. 

But a year later, in August 1976, I did another exam and found only one tiny 
vaginal nodule, but now a new nodule had appeared in her abdominal incision 
scar, and I biopsied that. It showed also granulation tissue with no tb 
bacteria on special stains.

Except for horrendous blood pressures she did well. Then In July 1980 
Hopkinsville had unbearably hot weather. Virginia's house had been painted by 
her landlord, and the windows were all stuck. She had no air conditioning, Her 
daughter found her and gave her icewater baths, but the next day she was 
brought to the emergency room unresponsive with a rectal temperature of 108 
degrees.

She was kept in the intensive care unit, packed in ice, treated for seizures 
and shock. The morning after admission she  was alert and complained of being 
cold! At discharge one week after admission she still had slight brain damage, 
but MRI and CAT scan were not around to help us.


In May 1985 she fell and broke a femur. Her blood pressure reached 250/150. 
Finally we got it down enough for the othhopods to pin the hip.

But on 27 May 1985, while still in the hospital, she developed profound 
weakness of her right arm. I initially was sure she had stroked out from her 
pressures, but gradually I realized she had cervical cord compression. An 
attempted myelogram (spinal tap with dye) was unsuccessful, and still there 
were no CAT scans and MRIs. 

I transferred Virginia to a Louisville neurosurgeon and my favorite internist, 
a former student of mine, Tom Blanford. She improved without surgery, and the 
family kept her in Louisville, where she died 12 July 1985, fifteen years 
after we carved a bucket of cancer from her insides. I once asked her how she 
survived, and she replied that God had healed her. I can't give you an 
explanation better than that.

So medicine is full of laughs and tears. In today's climate I wouldn't go into 
the field again, but I don't regret the years of excitement, the wonders of 
these strange creatures called humankind.