Saturday, July 12, 2008
You know when a bull like DeBakey dies it is the natural order of things. Not that I know either well, but I found him reminding me in his aggression of Dr. Donald Seldin of UT Southwestern Medical School. I thought of Dr. Seldin's reputation for a painful level of aggression. One hears such stories about people but unremarked, and really why the story is enjoyed, is because, in part, of the virtuosity of their professional conduct. I can still recall Dr. Seldin's lecture to our new sophomore medical school class, the pathos of the situation of the middle aged black man who had renal failure probably from having had strep impetigo and from one of the antigens of the staph leading to the development an attack on the man's kidney. Dr. Seldin was dry in the interview but then told us how the 'Present Illness' should be organized with historical factors and symptoms appropriate to our ultimate diagnosis and also pertinent negatives. He developed a differential diagnosis and invited our opinions. For some reason I spoke up in favor of a syphilitic kidney; it's useful as a teacher apparently to allow a little participatory idiocy. I have thought of it subsequently when I see a nurse practitioner try to develop a present illness or I have read other evaluations. It was virtuosic, like Stern playing the violin and then teaching us.