as unique individuals, 21, 88, 149, 176, 229
Paxil, 97
Peace Corps, 180, 182
peak flow meter, 56
Penicillium notatum, 270–71
penile induration. See Peyronie’s disease
peptic ulcer, 260, 268
periodontal disease, 260
persistence, 39, 45
PET-scans, 231
Peyronie’s disease of the author, 135–42, 143
spontaneous remission, 146
variation in recommended treatments, 143
P53 system, 272–75
pharmaceuticals. See drug industry; medications
physical examination
of the author, prior to surgery, 55–56
percentage of total information needed for diagnosis, 38
physicians
dehumanization of, 35, 87–88, 164–65
economic conflicts of interest, 37, 261–62, 290
important qualities: active listening, 21, 88, 93; compassion, 20, 212, 265–66; saying “I don’t know,” 16, 244; sympathy, 212; training in new technologies, 37–38, 133
judgment skills, 88. See also listening to the patient; content and context for, 265–66; for diagnosis of depression, 204; as a gift, 34; impact of technology on, 35–36, 133–34; impaired by managed care, 34–35, 159–61, 232–33; importance in choice of treatment, 31, 34; role of instinct in diagnosis, 101, 105, 247
recent graduates, gaps in training, 35–36, 37–38, 163, 173
relationship with the patient, 17, 26: and clinical science, 168–69, 175–76; cultural aspects, 45; importance of, 38, 158–59, 265; lack in managed care system, 34–35, 159–61, 163, 175, 232–33, 293; lack of time, 88, 169–70, 175; listening. See listening to the patient; the power of authority, 124, 134–35, 145–46, 164; restoration, 294; as the “science” in medicine, 32; trust, 41, 146, 151–54, 175, 180–81, 202–3, 265
placebo effect, 153–57, 264
plaque
in the author’s arteries, 4
components, 29
limitations on knowledge about, 255
role in a heart attack, 29, 105, 257–58
Pneumocystis carinii pneumonia (PCP), 193
pneumoencephalography, 230
pneumonia, 91, 109, 110, 193, 271
policy-making, 287–91
poliomyelitis, 88–89, 109, 110
political aspects of AIDS treatment and research, 282
Porphyromonas gingivalis, 259, 260
positron emission tomography (PET), 231
post-traumatic stress disorder, 211, 219, 298
potassium para-aminobenzoate (PABA), 138, 140, 143, 145
poverty
access to AIDS treatment, 41, 282, 286
access to vaccinations, 285–86
in American culture, 184–85
childhood mortality from preventable diseases, 286
Pravachol, 29, 96, 260
prostate cancer, 33, 300
prostate-specific antigen test (PSA), 118, 138, 145
Prozac, 97, 99, 154
psychological aspects
appreciation of life. See life: as a gift
compassion, 20, 212, 265–66
concept of choice, 287–88, 290
distancing from reality, 68
effects of author’s experience on friends, 25
effects of positive attitude, 40, 47, 83, 131
empathy, 42
fatalism, 25
fear. See fear
feeling of no use, 297
importance of friends. See friends persistence, 39, 45
safety as an illusion, 210
self-revelation and self-reflection, 202
shock and denial, 3–4, 47
sympathy, 212
unreliability of memory, 50, 61, 69
of writing, 18–19
psychotherapist, of the author, 51, 63–64
public health
historical background, 91, 111
importance of clean water, 102–3, 108
medical school curriculum, 164, 165
in policy-making, 289
pulse, 5, 127
“pump-time,” 13
racial aspects
baseball, 236, 237
discrimination, 236–37, 281
quality of medical care and mortality statistics, 39–40
radiation therapy for Hodgkin’s disease, 76
recovery
of the author: after two years, 122–23; first few hours after surgery, 299–300; first few weeks, 17, 18, 120–21
effects of a caring relationship, 149–50
effects of positive attitude, 40, 131
family support as predictor for, 41
Reeve, Christopher, 268–69
retinal damage, 9
rheumatic fever, 111
rheumatic valve disease, 249
rheumatoid arthritis, 268, 272
The Rise and Fall of Modern Medicine (LeFanu), 262
risk factors
cancer, 111, 113, 116, 117
heart disease, 5, 30, 106, 252
type 2 diabetes, 106–7, 249
Robinson, Jackie, 235–37
Rofman, Sam and Elaine, 80
Rogaine, 97
Rudy, Arthur
background, 11, 12
education, 200, 201, 206, 209
friendship with the author, 11–12, 122, 124–28, 152, 199, 207
motivation to be a psychologist, 200, 205–8, 211–12, 267
personality, 199
responsibilities as a psychologist, 11, 200, 297–98
support for the author prior to surgery, 79, 81
in Vietnam, 209–11, 213–14, 219
views: on his future, 298; on the role of psychotherapy, 103–5
Rudy, Marcia, 213, 219
Rudy, Paulette, 200, 219, 297
Sachs, Fred, 300
Saving the Heart: The Battle to Conquer Coronary Disease (Klaidman), 33–34
scarlet fever, 94, 109
scars, 123, 140–41
Schaufenster schauen strategy, 65, 66
schistosomiasis, 182–84
self-revelation and self-reflection, 202
September 11 attacks, 151, 152, 285, 298
serendipity, role in medical discovery, 114, 268, 270–71
Seth
at the hospital during author’s surgery, 12, 14, 84
trip to London, 52, 53–54
visit with author after surgery, 17
wedding, to Miriam Neugeboren, 12, 57, 130
Sharon, 73–74, 75–76, 78–79
sickle cell anemia, 250, 253
Siegel, Asher, 192
smallpox, 90, 109, 110, 111
smoking
as risk factor for cancer, 111, 113, 116, 117
as risk factor for heart disease, 5, 24, 106
tobacco marketing, 291
social aspects
effects of a caring relationship on recovery, 149–51
importance of family and friends.
See family; friends
isolation, 82, 148, 150, 297
loneliness, 50, 55, 56, 58, 64, 129
societal aspects
access to health care, 41, 175, 282, 285–87
discrimination, 236–37, 281
medical training and service, 166
responsibility to other human beings, 166, 287–88
responsibility to provide doctors and universal health care, 166, 175, 289
Some Choice (Annas), 287–88
South Africa, 281–82, 284, 285
specialists
financial incentives, 295
“gatekeeping” in managed care, 35, 292
missed diagnosis from, 232–33
neonatal, 294, 295
vs. general practitioners, 246
spiritual aspects, balance with modern medicine, 184
staphylococcus, 26, 270–71
statins, 259. See also Baycol; Lescol; Lipitor; Mevacor; Pr
avachol; Zocor
stent. See angioplasty, stent
steroids, 268
stethoscope, use in heart disease diagnosis, 35–36
streptococcus, 249, 255
streptomycin, 268, 270
stress
of the author prior to surgery, 47, 50–52, 61
as risk factor, 24
stress test
of the author, 56, 64, 66–68
as predictor for heart disease, 30
procedure, 68
stroke
with coronary bypass, 9
MRI for diagnosis, 231
with open-heart surgery, 44
with type 2 diabetes, 107
surgery. See coronary bypass; heart transplant; open-heart surgery
survival, 126–27
symptoms
asymptomatic heart attack, 25, 28–29
of the author prior to surgery, 5, 8, 47, 49–62
of heart disease, 5, 16
vs. causes of disease, 87
teaching positions, of the author, 13, 57, 82
technology
economic and policy issues, 290
“halfway technologies,” 44–45, 87
impact on neurology, 230–31
limitations, 21, 101, 133, 244
limited impact on mortality rate, 109, 111–12, 119, 294
media hype, 27, 38, 45, 114–15, 133
as a modern miracle, 85, 88
need for proper training, 37–38, 133
needless and costly overuse, 37, 101, 146, 162–63, 294
short timeframe for obsolescence, 37–38
trends in, 25–26, 94–95
vs. listening to the patient, 38, 167–68, 202–3, 243–44, 248, 291
vs. “science,” 85, 88, 95
Thomas, Lewis, 256
Thorsen, Dr. Gerd-Ragna Bloch, 177, 178
Thursday Night Cardiac Clinic, 243
thyroid scan, 77
thyroxine, 86
Time Special Issue: The Frontiers of Medicine, 27
Time to Heal (Ludmerer), 168–69
tobacco. See smoking
Transforming Madness (Neugeboren), 53, 66, 82, 300
trauma, 153. See also post-traumatic stress disorder
traumatic injury to the brain, 105, 220–23
trust
adherence to medications and, 41, 153–54, 180
lack of continuity and time to develop. See managed care
mind-body relationship and, 154, 265
qualities that engender, 146–47, 153. See also listening to the patient
role in psychotherapy, 202
role in recovery, 153–54
tuberculosis
economic aspects of vaccinations, 285–86
integration with HIV prevention and treatment, 283
as major cause of death, 1800s-early 1900s, 91
mortality rate decline, late 1900s, 109
reemergence, 102
streptomycin treatment, 268, 270
treatment curriculum developed by Friedland, 192
United Nations program, 286
typhoid, 109
United Nations, 286
United States
average health spending annually, 286
dismal response to international epidemics, 286
health-care system. See managed care
Medicare, 163
mortality rates. See mortality
universal health care, 166, 175, 289
University of Massachusetts
basketball games, 13–14, 17, 80, 120
teaching position (as professor and writer in residence), 13, 57, 82
vaccinations
economic aspects, 285–86
effects on mortality rate, 109–10
immune system and, 256
for polio, 88–89
vasodilators, 70
Vasotec, 70
ventricular assist devices, 94–95
Viagra, 97, 99, 137, 150
viral infection. See also HIV
antiretroviral treatment, 40–41, 255, 282–83
diagnosis of possible, 8, 70, 71, 247
ebola, 255
heart disease symptoms, 248
natural selection and, 255
vitamin E, 138, 140, 143, 145
Waksman, Selman, 270
weight
as risk factor for cancer, 117
as risk factor for heart disease, 30, 249
as risk factor for type 2 diabetes, 106
white blood cells, 248
whooping cough, 94, 109–10
Whynott, Doug and Kathy, 66, 81
Why We Get Sick: The New Science of Darwinian Medicine (Nesse and Williams), 271
Wise, Dr. Carl, 77
women
communication style in relationships, vs. men, 125
hormone replacement therapy, 295
mammograms, 118, 295
menopause and heart disease, 129–30
mortality rate for breast cancer, 28
mortality rate for heart disease, 28–29
World Health Organization (WHO), 286
World Trade Center, 151, 152, 285, 298
writing career of the author
Big Man, 77, 213–14
book on Moe Armstrong, 17
book tour, 124
daily routines, 18, 22
first weeks after surgery, 17, 121
Imagining Robert, 19, 72, 244
inspiration for this book, 18–19
Nightline interview, 17, 51
prior to surgery, 47
psychological aspects, 18–19
Transforming Madness, 53, 66, 82, 300
visualization of, 12
x-rays, 230
Yale-New Haven Hospital (New Haven, Conn.)
AIDS research, 1, 41
author’s decision to go to, 73, 79
trust in, 10–11, 42, 80
Yarnell, Barbara, 217
Yarnell, Phil
on Arthur Rudy, 219–20
author going on rounds with, 2, 215–16, 220–21
childhood and adolescence, 10, 12–13, 228–29
as a consultant, 10, 136–37, 245
education, 12, 215, 227–28
family, 227, 228, 234
friendship with the author: during adolescence, 12–13; after author’s surgery, 128, 202; importance of, 2, 13, 46–47, 124–27, 220; prior to author’s surgery, 1, 10, 12, 47, 79, 81
marriages, 214, 220
medical responsibilities, 2, 10, 161–62, 215–16, 225–26, 297
motivation to be a neurologist, 99–100, 226, 232, 233–34, 267
nickname, 227
office decor, 217–18, 223, 296
personality, 46, 215
ranch in Kiowa, Colorado, 10
sculptures by, 218
views: on Arthur Rudy, 219–20; on death of a young woman, 221–25; on drug/technology marketing, 97, 133; on history of neurology, 229–31; on Jerry Friedland, 46, 281; on managed health care, 232–33
Zocor, 29, 96, 260
All rights reserved, including without limitation the right to reproduce this ebook or any portion thereof in any form or by any means, whether electronic or mechanical, now known or hereinafter invented, without the express written permission of the publisher.
Some of the stories in this volume originally appeared in the NEW AMERICAN REVIEW, the QUARTERLY REVIEW OF LITERATURE, EVERGREEN REVIEW, PLAYBOY, ESQUIRE, CAVALIER, and OLYMPIA.
Copyright © 2003 by Jay Neugeboren
ISBN: 978-1-4976-6944-4
Dzanc Books
1334 Woodbourne Street
Westland, MI 48186
www.dzancbooks.org
Distributed by Open Road Integrated Media, Inc.
345 Hudson Street
New York, NY 10014
www.openroadmedia.com
Dzanc Books was created in 2006 to advance great writing and to impact communities nationally by building and supporting literary reader
ships, creative writing workshops, and events offered across the country. As a nonprofit 501(c)3 organization, Dzanc publishes innovative fiction and supports several editorially independent imprints and literary journals. It provides low-costing writing instruction to beginning and emerging writers by connecting them with accomplished authors through the Dzanc Creative Writing Sessions, and runs a writers-in-residence program that puts published authors in public schools. Dzanc also awards an annual prize to support a writer whose work shows literary excellence and who is engaged in community service. Through its International Literary Program, Dzanc organizes an annual writing conference held in Portugal.
FIND OUT MORE AT
WWW.DZANCBOOKS.ORG
FOLLOW US:
@DzancBooks and Facebook.com/DzancBooks
Dzanc Books is one of a select group of
publishing partners of Open Road Integrated Media, Inc.
Open Road Integrated Media is a digital publisher and multimedia content company. Open Road creates connections between authors and their audiences by marketing its ebooks through a new proprietary online platform, which uses premium video content and social media.
Videos, Archival Documents, and New Releases
Sign up for the Open Road Media newsletter and get news delivered straight to your inbox.
Sign up now at
www.openroadmedia.com/newsletters
FIND OUT MORE AT
WWW.OPENROADMEDIA.COM
FOLLOW US:
@openroadmedia and
Facebook.com/OpenRoadMedia
Open Heart Page 44
