On Watch – Do No Harm

Alexandria, VA – I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery. – Hippocratic Oath

Over the past four years, an entire medical team has been scratching their collective, pointed little heads, trying to determine what’s been ailing my bride of 10 years, Pamela. It’s Sjögren’s Syndrome. It has taken six – six – physicians of various denominations, no less than nine clinics, lab visits, blood samples, CAT scans, and ultrasounds to unravel this mysterious medical Gordian Knot. (1) In the end, it was our dentist who diagnosed it.

Now we know that it is an autoimmune disease. In the medical lull between diagnosis and treatment, Pamela has committed medical blasphemy by doing her own research. She has learned that many are treated with hydroxychloroquine – you know, the Official COVID-19 Cure of the White House.

She also learned that the list of side effects went on for two pages and decided that a medication that could make her blind, have all her hair fall out, or invite the Big Sleep weren’t a whole lot of fun. So she decided to start a completely new diet to build up her immune system. Fish, no red meats, a wide variety of vegetables, and exercise seem to be the best alternative to anything being hyped by Big Pharma these days.

The whole immunotherapy and holistic medicine construct seems to run contrary to what our medical industry believes. Now, I know I’m generalizing a bit here, but it looks like the Greatest Medical System in the World has hit the wall. The more technologically advanced and sophisticated we have made it, the more difficult it has become to navigate.

Not rehashing old debates about having your own doctor, pre-existing conditions, or socialized medicine, I have observed that the American medical system has homogenized. Nearly every medical plan is identical and whether you have an appointment with a medical provider or you are an emergency case, it’s all the same protocol. In short, progress has created chaos.

American history has some eye-opening medical moments that are quite illustrative. Right here in Alexandria, George Washington had a similar medical experience as many of us during his last two days on the planet. After riding his fields on 12 December 1799 in the rain and snow, he came down with a sore throat, so Martha bundled him into his bed at Mount Vernon.

Dr. James Craik, one of Washington’s old Army buddies and his personal physician, lived at 210 Duke Street in Alexandria. On 13 December, Craik dashed down to Mount Vernon, asking Dr. Gustavus Brown, an expert in diagnosis and moderate medicating, and Dr. Elisha Dick to come along as attending physicians.

Washington initially asked his overseer Albin Rawlins to bleed him and Rawlins drained about 14 ounces out of Washington. When Dr Craik arrived around 9:00 p.m., he ordered another bloodletting. Dr. Dick objected, but since Craik was Washington’s close pal, Craik bled him again.

The crack medical team determined Washington had “Quinsy” and had him gargle with vinegar and sage tea. Over the next eight hours, the physicians bled the former president four more times. By the time he checked out, Washington was down a half gallon. The moral of this story? Even your personal doctor can get it wrong sometimes.

Another presidential medical malfunction was the case of President William Henry Harrison. Harrison was sworn in as president on 4 March 1841, a particularly gray, wet, cold Washington day. He rode to the ceremony on horseback and, since he was tough Old Tippecanoe, he didn’t wear an overcoat. He then proceeded to accomplish two presidential firsts. He delivered the longest Inaugural address in history, 8,445 words that took over two hours (2). And then he became the first president to die in office.

A few weeks later Harrison came down with chills and cold symptoms, which his doctors determined to be pneumonia caused by exposure at the Inauguration. His medical team applied heated suction cups to his torso, bled him, then treated him with castor oil, calomel, ipecac, and a mixture of boiled petroleum and Virginia snakeroot. These physicians were still shaking their heads when Harrison went to dance with the angels.

In 2014 a distinguished research study determined that Harrison died of septic shock due to typhoid fever brought on by sewage leaking into the White House water supply.(3)

Yet another slice of presidential medical history is the demise of President James Garfield. Garfield was besieged by office-seekers wanting a paid gig in the administration and Charles Guiteau was just such an ambitious man. He insinuated himself within the Republican Party to seek the position of Consul to Paris. Although possessing a French sounding name, Guiteau didn’t speak French or any foreign language that might come in handy in diplomatic circles, but he figured Garfield owed him.

He took offense when he was politically sidelined and decided to shoot Garfield. On 2 July 1881, Guiteau hid inside the ladies room of the Baltimore and Potomac Railroad’s Sixth Street station and waited for the president.(4) Garfield was heading for the New Jersey shore to enjoy the Atlantic with his family and as he and his entourage got to the station to board the train, Guiteau approached the president and shot him twice, once a grazing shot to the arm and once in the back.

Garfield, who had dodged dozens of bullets in the Civil War and was made a general for his leadership and strategic brilliance at Missionary Ridge, thought he’d seen it all. He turned to a staffer and said, “My God, what is this?” The bullet in his back had broken a rib and embedded itself somewhere in his abdomen. (5)

Over the next 80 days, doctors under the supervision of Garfield’s personal physician, Dr. Willard Bliss, probed the wound repeatedly trying to follow the bullet’s path. When Bliss told Garfield that the president had one chance in 100, Garfield stoically replied, “Well Doctor, we’ll take that chance.”(6)

Bliss even brought in Alexander Graham Bell with a crude sounding device designed to locate metal objects. After many “alarms” and two months of continued finger-probing, they were unsuccessful in locating the bullet. Garfield’s temperature raged at one point to 104 degrees, so an experimental air conditioning system of fans and ice was employed to cool the president down. He rallied once but then took a turn for the worse. As these were the days when sepsis was a new concept and a doctor’s hands and fingers were considered miraculous, probing Garfield was standard operating procedure. Unfortunately, Garfield slipped into eternity on 19 September 1881, still full of holes.

There’s a great line spoken by Chief Dan George to Dustin Hoffman in the film Little Big Man that is particularly apropos here, on the subject of medical wizardry over the centuries.

“Sometimes the magic works. Sometimes it doesn’t.”

Endnotes:

1 I have always thought that if you can pronounce it and spell it, you should probably be able to diagnose it.

2 Rivaled Bill Clinton’s convention nomination speech that finished at 3:00 a.m.

3 I prefer the story that his wife chewed him out for not wearing his overcoat on a bad day. The study is boring and redundant.

4 Washington D.C. in those days was really, really hot and humid in summer and many politicos left the city to hang out in the mountains, at the shoreline, or just stand in a puddle – anywhere but in Washington.

5 Robert Todd Lincoln, the oldest son of the 16th President, happened to be at the station at the same time and saw what happened. Most likely, a sharp advance man saw Lincoln and scurried him out of Baltimore before the National Enquirer got wind of the story.

6 By this time, bleeding the patient had become passé. At least Garfield had that going for him.

ICYMI: On Watch – Let’s Make A Deal