"His heart rate is elevated, but his pressure is still low and his urine output has dropped off, doctor. His CBC and chemistries are okay and his temp is only 99. He looks very pale and sick and he's going crazy, agitated. He knows where he is but he won't stay still. I can't get him to stop picking at his dressing."
The nurse calling me about this patient was a good one, but she was nervous. The patient was a well-groomed, 62-year-old tennis player who had given huge sums to the hospital's building campaign. Roger was young and active for a hip fracture; male patients don't usually get them just by falling. He saw his doctor regularly and was healthy. He was, in fact, a friend of my family. His hip surgery had gone very well, but here he was on the second post-op day, going as we say in hospitals down the tubes. We know this scenario: maybe unrecognized heart disease or maybe a blood clot to the lungs, but something was starting to kill my patient.
Wide awake now, I thought about Roger. I saw a handsome, husky guy smiling with his confident, slightly superior mien, strolling around the small, rich town of my boyhood. I heard his low hearty laugh, remembered his cutting, just off-color humor. Then that limbic system-memory link kicked in the thing that brings you right back to your kindergarten classroom when you get a whiff of a crayon. I smelled Roger: Chivas Regal. I called my nurse back. This was always an order that always made them nervous. "Two ounces spiritus vini vitis," I said, referring to the pharmacy's rot-gut $5 Scotch. "Now and with meals. Don't worry, he'll wake up for it. Call me back in an hour if he's not better."
The next morning I saw Roger on rounds. "How did things go last night?" I asked. He really didn't remember anything wrong. Good ol' Roger. Okay, for now.
Ah, the town of my childhood. The sound of ice cubes slipping around a low-ball glass half-full of whiskey was in the background whenever I called my friends' parents. It sounded glamorous and slightly sinful to my 10-year-old ears. When I walked over to my friends' houses in the evenings, they all had the same smell. It wasn't until college no joke that I figured out it was the smell of distant Scotch. Back then I thought it was some kind of cleaning agent that professional house-cleaners must use because we didn't have a maid and they all did. And their houses all smelled the same.
My sister and I knew only a little about liquor; Samantha greeted Darrin with it every night on Bewitched, but nobody in my house drank any, nor did the people with whom we spent Thanksgiving, Christmas or Easter. We had bottles and bottles of it in two or three locations around the house, with fancy decanters and cut-crystal glasses in trays, on shelves, in showy cabinets at the ready for someone who could actually swallow it. Everybody gave my father, the village orthopedic surgeon, a bottle of it when their bone was mended so the stuff came in as regularly as the mail. Every year or so my father would get a bottle of something and show it all around with a final pronunciation. "Now this is the good stuff," he would declare, deducing by this or that mark on the label, its color, or somebody important he'd seen drinking it, "just taste this. I can really see why people like it." So he'd collect himself against the burn and take a sip. I'd take a sip, my mother would take a sip and the glass would sit on the table. My parents knew it was expensive and highly regarded, but they couldn't seem to actually use it up. Although they offered it heartily when local people came over, it didn't seem to move. Something about the house just wasn't conducive to drinking. "There's something wrong with my family" was all I could conclude in fourth grade.
A hundred years ago or so this saying was true: "Who knows lues (or syphilis) knows medicine." That venereal disease, which most docs today have never once treated, was known as the great imitator it could present itself as a fracture, a brain tumor, consumption (like TB), back pain or renal failure. By the 50s, 60s and 70s, American medicine had to deal with strong doses of ethyl alcohol, and the spectrum of alcohol-related diseases was nearly as broad as syphillis'. The stumble-bum from New York's Bowery was easy to see. The huge vascular operations we did for hardened livers that backed up the flow of blood, the hip pinnings done for alcohol-related osteoporotic fractures (like Roger's), the psychiatric care for alcohol-induced psychosis, even the male mastectomies for alcohol-induced growth of the male breast these were all much less obvious. A good doctor, in those days, knew the subtleties of treating drinkers. And he or she knew one particular alcohol-related disease that had to be treated with great respect.
DTs (delirium tremens the acute alcohol-withdrawl state) scared us. Full-blown DTs has an unbelievably high mortality rate 50%, according to some reports. There was one thing I was taught well by the old docs of my early career. DTs are a withdrawal state; you don't get them if you don't take away the alcohol. You kept the ladies and gentlemen of our town smooth, happy and alive if you kept up their intake in the hospital. Roger broke his hip in the late 80s, when cigarettes and whiskey had given way to yoga and granola bars in American Afflaburbia. I had almost forgotten.
So medical fashions, like those of the Paris runways, do change, albeit with a far greater press of reality. But certain classics, like DTs and blue blazers remain. Of course, that just adds another worry for our docs-in-training; they all want to be specialists retinal doctors, infertility specialists, wrist surgeons but will they be able to recognize the classics? And will they realize that their medical education started with something they smelled in fourth grade?