Physician, diagnose thyself

Pioneering physicians have fallen prey to the very conditions they studied.

“I am lost….”

The pen stops. He searches to find the rest of the words to describe his thoughts, now that he knows he has cancer. His symptoms were sudden in their onset: a sharp, biting pain in his left arm that would not go away. It is Jan. 1, 1867, and this patient was diagnosed by the perfect physician for the job, Armand Trousseau.

Courtesy of Chris Bailey
Courtesy of Chris Bailey.

Dr. Trousseau was the first to recognize the association between cancers of the “visceral” organs of the chest and abdomen and painful, intravascular blood clots, often in the arms or legs. This association bears his name (Trousseau's syndrome), and Dr. Trousseau's collected lectures brought it to the world's attention in 1867. This patient was diagnosed quickly, on the same day as his symptoms arose, because the patient was Armand Trousseau himself.

Trousseau's despair is palpable in his letter to his assistant “…The phlebitis that has just appeared tonight leaves me no doubt about the nature of my illness.” His gastric cancer continued to progress, and on June 27, 1867, Dr. Armand Trousseau passed away.

More than 4,000 miles away and three quarters of a century later, another man also died of gastric carcinoma. The 78-year-old Minnesotan likely experienced abdominal fullness and pain in the period when his illness progressed, with a loss of appetite, weakness, nausea and vomiting. The year was 1939 and the place was Mayo Clinic in Rochester, Minn. By 1905, William Mayo was perhaps the foremost American stomach surgery authority, championing gastrectomy as a cure for stomach cancer.

Unfortunately, Dr. Mayo could not perform this ill patient's gastrectomy, for he was the patient. He was treated surgically in the spring and recovered quite well for a time, before passing away on July 28, 1939.

Dr. Mayo had often observed William S. Halsted, the father of modern surgery, while visiting Johns Hopkins. Both physicians spent a great deal of their careers working to improve the field of gallbladder surgery, but Dr. Halsted was the first person to surgically remove a gallstone from a patient in 1882. He never stopped trying to improve his technique.

Dr. Halsted's superb results brought patients from around the globe to seek his care. Like many others before and after, a 67-year-old male came to Johns Hopkins in early 1919, presenting with chest pain, abdominal pain, and jaundice. He had a 35-year history of narcotics abuse. Halsted's department quickly diagnosed the gallbladder disease and recommended surgery to remove the offending stones. The patient elected to postpone the surgery, perhaps hoping the pain and jaundice would resolve, or convinced he could mask the pain with morphine. But his symptoms progressed while at his home in North Carolina.

The patient returned to Baltimore in August of 1919 and requested the surgeons perform one of Halsted's procedures. It was, in fact, the very drainage procedure the patient had devised himself. The surgery was performed on Professor Halsted, and the offending stone and gallbladder were removed. He recovered slowly but was eventually discharged from the hospital in October.

A few years later, Dr. Halsted again experienced symptoms and traveled to Johns Hopkins from his retirement home in North Carolina. He was operated on once more. Dr. Halsted's condition deteriorated, and he died of complications from gallbladder disease on Sept. 7, 1922, just days prior to turning 70.

A kindred spirit to Dr. Halsted and his work ethic sits working in another office, 83 years later. He is 97 years old, still works full days, and is preparing a lecture he is set to give in a week's time. Suddenly, a sharp jolt of pain in his back strikes him.

Physicians agree on a diagnosis, a dissecting aortic aneurysm. It is almost always rapidly fatal, but the prognosis has drastically improved since Dr. Michael DeBakey devised a system for categorizing aortic dissections and the groundbreaking surgery to repair them. The patient knew exactly what had happened, and what could be done to repair it. After all, he was Dr. DeBakey.

Dr. DeBakey declined treatment, and the dissection continued to enlarge. Like Dr. Halsted before, his gamble that his body would repair itself had failed. Dr. DeBakey was taken into surgery.

Dr. DeBakey and his medical predecessors knew their attackers, as they had looked into the faces of these diseases in their battles to conquer them. At 97, Dr. DeBakey was saved by his own years of hard work. He died on July 11, 2008, just shy of his 100th birthday.