John Stone, M.D.
Professor of Internal Medicine
Former Dean of Admissions
School of Medicine
Emory University
"Patients as Teachers"

The first story I heard in medicine was from a dead man. It was in St. Louis at Washington University School of Medicine. I came into the medical school off of Euclid Avenue, and then up the stairs through a veritable tunnel of displayed cases and into the large anatomy lab. At that point in anatomy we had two students per cadaver, and we spent months studying that cadaver. During that time--and particularly when we opened the chest-- the cadaver, a husky man, taught me very much. Dr. Charles came around and said, "this is the nerve that gives rise to tictolaroo." And, I thought to myself, that is something that I will have to read about. If I have a daughter, I might just call her tictolaroo. It is such a pretty word instead of spatial nerve spasms.

When we entered the chest, the man taught us something about his life. That experience became one of the early poems of mine that was published. I want to read it to you now. It is called Cadaver, and there is a little epigram at the top, which I wrote:

The initial lesion of syphilis may result over the years in a gradual weakening and dilatation--aneurysm--of the aorta. This aneurysm may ultimately rupture and lead to death of the patient.

I never forgot that story, of course. It was such a dramatic one. Not only was it my first encounter with the aorta, but with an aorta that was diseased by syphilis. I was so taken with this encounter that years later, when I was riding in the country of hearts, I put it in prose--that experience.

The body on which we worked was that of a man, perhaps of fifty years old. He was muscular--a laborer I imagined. His body was like a textbook--perfect, flawless. As freshman medical students, we had no idea why such a perfect body might have died, until we opened the chest. His heart, like his other muscles, was heavy with the weight of life. But the most striking abnormality within the cave of his chest was the enlargement of his aorta.

His aorta was ballooned out, swollen to three times its normal size. Such a weak, bulging aorta--an aneurysm--could have come only from syphilis, which he had contracted years or more likely decades before. This revelation completely transformed our daily encounters with our cadaver. This was now no longer a mere anatomy textbook yielding up its slow secrets. No, this was a man, instantly humanized, who had walked and worked among us and died of love. In some metaphysical sense, the woman from whom he had contracted the disease was still there with him on the dissection table, after all those years.

As Racine wrote in Phèdre, "It is no longer a passion hidden in my heart; it is Venus herself fastened to her prey."

That indelible story led me down several paths in medicine. The most important one was that I should expect to hear such dramatic stories because medicine is full of epiphanies; medicine is full of stories. But, unless we listen for them, they will disappear like a dream.

Writing stops the clock. Keeping a journal helps stop the clock, helps fix in time those patients who will become, over time, as close as kin to you in training.

As far as I can tell, it may well have been a genetic reason that I began to write. My grandfather, another John Stone, worked between 1875 and 1950 in north Mississippi where he delivered in a small hamlet, formerly called Stone's Crossroads and later called Treemont, three thousand babies and where he told us stories--my brother and I as I sat on his lap--about a rabbit that slid down a hill on one ear. He took me once to his office. I remember that the smell was of ether and antiseptics.

Another thing I remember was that, as I sat where the patients sat and he sat where the doctors sat, I could see a whole row of display cases of small bottles with things in them such as gallstones, byproducts of the doctor's work--cases that were important to him in some way. One of the little bottles contained a fetus. I spent about twenty years trying to figure out why he had that fetus. I think I know now after I wrote the poem called the Bottle, which I am going to read. It was clearly the product of a miscarriage, but the question was why, in full view of the patient, would he keep it?

The poem that came out, as I said, took me about twenty years to write, although I was not thinking about it the whole time.

The Bottle

I think he kept it there for magic. Nowhere in 2003 is there less of a demand for magic on the part of the patients. He realized full well that, with his armamentarium of ten or fifteen drugs that really did something, he needed all the magic he could get. He needed magic to reassure himself, for one thing.

That is my grandfather. I just had a picture sent to me by the magic of email and it shows him suturing up someone's arm. What a remarkable man he was. I have great, fond memories of him. I am sad to say that his office is now torn down, but we did save the desk at which he worked.
Three years ago I had the opportunity to go to the Middle East. I went with a group of theology students--about twenty six in all. There were some people who were older than the theology students, such as I. Because I was the doctor and because virtually everybody got sick at one time or another, I began to feel like the plague doctor. Remember the plague doctor who covered himself with leather, gloves, this long flowing gown, and something that looked like a bird head up on top. In the end of that was antiseptic, and that was supposed to protect the doctor against plague. I began to feel like that, but I also had another experience that I want to tell you about after this poem about the plague doctor.

Back Through Time

When I was in the Middle East, we went from Syria to Jordan to Lebanon down through Mount Sanai and that area of the Middle East, and then to the holy land itself. I was thinking of my father, in part because we were so close to Egypt, and in part because he used to sing in the shower this song:

Go down, Moses

Way down in Egypt land.

Tell 'ole Pharaoh, "let my people go."

When I was a senior in high school, I came home one afternoon in Jackson, Mississippi, and my father was home from work--distinctly unusual. He was 45 years old and, at his job at Knocks Glass Bottle Company, he had experienced chest discomfort. He had come home, and in the leisurely way we used to treat patients with heart attacks, had been told by the family doctor that he had a heart attack. He was sent to Mississippi Baptist Hospital. This was 1954. The therapeutic technique of the time was to put the patient in a room by himself so he could rest. He was put in a big, huge plastic oxygen tank into which oxygen was piped. That was it. You can guess what happened. On the third hospital day, he had an arrhythmia and died. We were called to the hospital. It is, of course, a single, dramatic, terrible event in the life of an 18 year old.

When I was a cardiology fellow, I decided to go back and ask the doctor if I could see my father's EKG. It turned out to be an inferior myocardial infraction, which I suspect all of you know is the best kind to have, if you have to have one, because it involves a smaller part of the muscle of the heart than the anterior. It made me wonder what life would have been like had he been saved from that single dis-rhythmic moment. And so I wrote this little poem in the Middle East called "Spiritual."

That was an early story that had a profound effect on me. I remember going by the hospital on the night before the morning he died. He said to me, "You know, if you would like to go to medical school, you can. It's all fixed no matter what happens to me." So that indelible story is in my mind and was in my mind as I trekked through the Middle East, a place of such great astonishment and of such great need.

I want to read you a short prose piece that I only wrote last night, because it will lead us into the next section.

My mother, of course, has probably taught me more than anyone in the world, but I never expected her to teach me about biliary colic. Several years ago when she came to see me, it was clear that she needed some help in the activities of daily living and so we put her in an assisted care home. In the poem that begins this series, I want to call it "Serenity Gardens," which is not its real name. This is about a visit to her several years ago. It is called "Tuesday at the Assisted Care Home."

1. Waking Up

I go by Serenity Gardens for a visit. In her room, my mother is napping. I shake her shoulder. Smiling into her pillow then at me, she wakes up gently.

"How are you doing, Moms?"

"Fine, fine."

"Were you dreaming?"

"I've been planning like fury!" she says.

"Planning what?"

"Oh, a whole new life."

"And what will that include, this whole new life?" I ask.

"Oh, sitting out in the sun more, enjoying life more--that sort of thing."

"A new life, eh? Sounds like a good idea for a lot of folks. Maybe your cousin, Mary Blanche out in Fort Worth would like that prescription."

"Right. Yeah, you call up Mary Blanche and tell her that I said to follow suit."

2. Under the Sun

One December day I went by to see her and made a startling discovery. We, in medicine, are uncovering discoveries all the time. But, it is not that often that they come from our parents. I felt privileged to have made this discovery, but it was a time of great concern because of what was to come with her gall bladder disease.

Let me tell you about the gall bladder surgery. She had the gall bladder surgery. She has osteoporosis. I was very concerned about her. She was so thin. But, the laparoscopic removal of her gall bladder took about thirty minutes. She went through it easily and came back to her room. The surgeon followed and gave us the good news. Of course during the time when she had been in the hospital and she was already losing ground, she was losing weight and, of course, unbeknownst to us, had been losing weight before the surgery and before the diagnosis was made. She had had this for a long time, no doubt, before I listened to her diamond-shaped moans.

She had a long way to go. Fortunately they assigned to her case a physical therapist that made house calls. The physical therapist came to her bedside three times a week and an OT came the other two days of the work week. Of course there was pain in what they were doing. Her hamstrings were tight, as were all the muscles in her legs. The physical therapist told us that there was going to be some pain. And there was indeed. This little poem is about that early encounter. There is a sentence at the beginning that says from John Chardy the poet, "I think, perhaps, this woman is my child." This is called From the Flight Deck. My mother and I are sitting outside Serenity Gardens just reminiscing.

I am here to tell you it worked. A few weeks later her strength having returned, her nutrition having gone in a great tilt, she made an astonishing trip down the hall, which I record in a poem called, Processional: A Follow-Up. She had been in a wheelchair for months.

After daily sessions on the rack,

My mother rises from her bed to walk.

Down the hall we make a kind of train.

My Mother's first--the engine and the brain.

Next the therapist, in single file,

Urges my Mother's feet, all the while

I wheel an empty chair behind them both,

An earnest rear guard tucked up close,

Lest the lady general need to take,

In the sweep of battle, a sudden seat.

We make a left and lurch into the dining hall,

They begin to clap and the house joins in

To form a mighty circle of applause

For my mother who has broken all the laws.

You seemed, just now, to walk on water or wine

Or, for that matter, air.

And she sits down to dine.

How we take care of the elderly, how we take care of, in fact, our mothers and fathers, is a measure of how we are doing in medicine. She is doing well now. She sends her regards.