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Pharos Article

Helen Glaser — The Lighthouse Keeper

Originally published in the Fall 1999 issue of The Pharos

Faith T. Fitzgerald, MD

The author (ΑΩΑ, University of California, San Francisco, 1969) is a member of the editorial board of The Pharos and a previous contributor to the journal. Helen Glaser, longtime managing editor of The Pharos, died in 1999.

In an age of rapidly evolving technology and forced efficiency, Helen Glaser’s Pharos continues to emphasize the artistic, the literary, and the place of music, language, and culture in medicine. This is obviously inspiring to potential authors and a source of great gratification for the readership. Although themes may shift — now touching upon the economics or the ethics of the times — humanism was Dr. Glaser’s enduring legacy to the content of our ΑΩΑ journal.

In my practice now, patients often are diagnosed and therapy begun in the emergency room after the briefest of histories, the scantiest of physicals and a scattergram of diagnostic studies which present the admitting physician with a diagnosis made, a therapy begun. And while the diagnoses may be incorrect, and the therapy modified, even this often is mandated by further laboratory diagnostic studies, roentgenograms, scans, and serologies, rather than by history and physical examination. Because of this, talking to patients has become more rare, more hurried, even in sorting out the patient’s principal problem. In addition, the rapid turnover and shorter length of stay of today’s hospitalized patient makes difficult any pursuit of the side of medicine that illuminates the human being (who has a disorder) rather than the diagnosis and expeditious management of the disorder itself.

Why, then, in spite of current conditions, has Pharos policy continued its devotion to all of these “nonessential” areas of patient care? It is hard to prove them cost-effective. Alternately, some would say that doctors, broadly educated, deeply committed and often very curious, should need no further inspiration.

But that is simply not true. The demand, particularly of young doctors, is for increasing mastery of a variety of practical points in medicine. The intercalation of the arts and humanities into patient care, as well as the background necessary to do this, may come only — if at all — with age and experience. But why bother?

Here’s why we must bother:

The old Englishman was in his seventies, admitted for weakness and failure to thrive in his nursing home. The medical student, presenting the case at bedside rounds, was — in her own way — complete. She shot out a rapid fire history and physical in well-organized bursts, finishing with recent laboratory tests that suggested liver disease, anemia, increased bilirubin, transaminase elevations, and — the mystery — an elevated creatine kinase. I examined him: The fact that the patient was on Coumadin and had ecchymoses in the swollen right quadriceps explained all of his laboratory findings. I returned to his social history.

“You said he was in the RAF?” I asked the student.

“Yes,” she answered. I turned to the patient.

“Were you in the Battle of Britain?” I asked.

“Indeed I was,” he said.

“A pilot?”

“Yes.”

And so we talked, and re-lived the days when “so much was owed by so many to so few.” It was riveting, living, glorious history. Outside the room, the student had one more question: “What’s ‘RAF’ stand for?”

* * *

Mrs. K, with pleurisy, was ninety-nine years old, articulate and with keen memory and orientation in spite of glaucomatous blindness and decreased hearing. In her youth, she told us, she’d been in the theatre (you could tell, by the way she spoke, that she would have spelled it theatre not ­theater). She was “legit.”

“With whom did you play?” I asked.

“Pat O’Brien. Oh, he was a lovely man.” The group around her bed looked blank. “And Spencer Tracy!” The faces of the housestaff registered recognition. “and Georgie Cohan.” The resident and student faces emptied again.

“’Yankee Doodle Dandy’,” I said to them. A few of the residents perked up.

“Did you know that Georgie Cohan said to Spencer Tracy that he was the greatest actor he had ever seen? And do you know why?” she asked.

“Why?”

“Because of the way he closed a door.”

In the conference room, after I had explained who Pat O’Brien was, and a bit more on George Cohan, I turned to the student. “Spend time with this woman. She has lived through almost the entire century, and her memories are clear. Have her tell you what it was like when, as a youngster, she heard about the onset of World War I, and how it was when she got the influenza during the great epidemic of 1918. Remember, she saw Douglas Fairbanks, Rudolph Valentino, and Charlie Chaplin films in their original release. She heard Woodrow Wilson speak, and survived the depression. She was already in early middle age when Pearl Harbor was bombed, and some might have called her old when Kennedy was assassinated. She began her life in an age of horse and buggy and will die in the age of space. Listen to her stories. You may not have this opportunity again.”

The student looked unhappy.

“What? Problem?”

“I don’t know enough American history to ask her any good questions,” she said.

* * *

The nurses were trying to reach the intern on call for surgery, but he had not answered yet, and they were distraught. I had been on the ward writing notes, so they asked me to see the patient, about whom they were deeply concerned.

She was a seventy-five-year-old woman who had, that very day, undergone elective ventral hernia repair. She had been transferred, still groggy, from post anesthesia recovery room to the wards. Within hours, according to her nurse, she began “babbling incoherently” when alone, though she appeared to be fully oriented when addressed directly. Her nurse was concerned that she might be “sundowning,” and wanted an order for Haldol.

I went to see her, and as I approached her room I could hear her rhythmic speech, unintelligible, but punctuated by modulations of intensity ranging from prayerful quietude to vigorous exhortations.

“There,” said the nurse. “See what I mean?”

I looked in the door of her room; she was alone, on her back in bed making her declamation to the ceiling. As I watched, I began to recognize some words: Hrothgar, Herot, Beo, Grendel. I laughed, and walked into her room.

“Hello,” she said brightly.

“Hello back,” I said. “You’re doing Beowulf?”

“Yes. I thought it would be a way I would know whether or not I had all my brain left after anesthesia.”

She had been an English professor at a small university. Her specialty was Old English literature, and she was well familiar with the epic tale of Beowulf and his companions in their battle with the monstrous Grendel and Grendel’s Dam. Before her operation, she had decided to recite it in total in the Old English upon recovery, just to check for cerebral damage.

* * *

The point is not, of course, that knowledge of literature, history, music, art, or other nonmedical scientific subjects makes one a better diagnostician (although this may be true) or a better therapist (although that is almost certainly true), but that the possession by the doctor of the background necessary to explore these areas with patients vastly enriches the relationship, and generates those moments in the doctor’s life that flavor memories ever after. For constantly reminding us of this in The Pharos, the lighthouse keeper (or more accurately the light itself), Helen Glaser, deserved our gratitude.

Updated on October 9, 2013.


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