PHILADELPHIA REFLECTIONS
Musings of a Philadelphia Physician who has served the community for six decades

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Philadelphia Medicine
The first hospital, the first medical school, the first medical society, and abundant Civil War casualties, all combined to establish the most important medical center in the country. It's still the second largest industry in the city.

Medical Economics
Some Philadelphia physicians are contributors to current national debates on the financing of medical care.

Computers, Digital Cameras, and Cellphones
Much of the early development of the electronic computer took place in Philadelphia. We lost the lead, but it might return.

Intelligensia, Philly Style

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Mac Bus

On a hot summer evening, attendance at computer user-group meetings is light, so after a recent one got through discussing spammers and new software, we adjourned to the sidewalk tables of a nearby pizza joint, just off Broad Street. United only by a common interest in computer hardware, software and techniques, this one comes from many corners of the Philadelphia social scene, and goes back to those corners after the meeting. Whatever their background, computer geeks are uniformly good at math. But on this particular evening, the conversation turned to medical experiences.

A middle aged man with a pony tail related he had recently experienced Bell's Palsy, a paralysis of the muscles of one side of the face. The group was fascinated to hear how saliva dripped from a corner of his mouth, and his unclosable eye dried out and got sore. His doctor told him there was not much to do except wait, an opinion confirmed by a specialist. Immediately, this man who makes his living programming computers set out to find the best acupuncture person he could find. It was a familiar story, and I remained as quiet as I could while he essentially related that when the regular medical profession confesses failure, the patient feels released to take matters into his own hands. His instincts were to do something, anything, even if that something was plainly futile. He could not bear the idea of doing nothing, and sure enough, in time he got better.

{Bell's Palsy}
Bell's Palsy

I said nothing, because it was a familiar reaction to conditions that either would or would not get better by themselves. The more serious studious members of our little club were quiet, too, because their instincts were to do what they were told, and in his place wouldn't have acted the same way, didn't completely approve. In a moment, a large muscular man took up the medical subject by telling that he had spent two years in a hospital after falling down an 18-story elevator shaft. Man, oh man, it seemed like it took two weeks as I was going down, and when I hit I wasn't knocked out. He had landed on one buttock and his leg was nearly wrenched off, but he remained awake, not bleeding much. Within minutes, he was headed for an operating room, and reached out to grab the clipboard from the nurse. On it was written "amputation", which he circled, wrote "No amputation!!", dated and signed it. No way were they going to cut off his leg. His leg was in fact saved; he now scarcely walks with a limp. Then another computer nerd chimed in.

{Motorcycle Jump}
Motorcycle Jump

This man's story was that he spent fifteen months in a hospital after a motorcycle accident. He somersaulted seven times through the air before he landed on his chest, and twenty years later he could still remember every single twist of all seven turns. He, too, related many hospital disputes about morphine injections and contemplated surgeries. Both men related dubious experiences with young interns and medical students, and numerous proposed remedies that had been rejected. All three of these medical veterans expressed violent hatred of HMOs, for reasons unspecified. I was quiet; no argument from me. This motorcylist eventually had his vehicle repaired and proceeded to ride it for six more months until he sold the machine. So there.

We all had different thoughts about this, I suppose. I was lost in thought about why they had survived, and imagined that not being knocked unconscious meant that they had not hit their heads. Heavily muscled men like this were probably cushioned by their muscles; a skinny little bony nerd would have been much more smashed up. The negative side of that protection came out in hearing them both describe their heart problems, with by-pass surgery and whatnot later on in life. That's probably the negative side of their muscularity. Neither man smoked, but I bet they both did at one time.

As we strolled home from the pizza joint, it occurred to someone that the national political conventions were on television that evening. The women were fighting with the blacks. The studious nerds were silent; the wild men merely grunted. That didn't seem like something to fight about, or even to comment on.

As I walked into the darkness, I wondered if such a conversation would seem normal in any other city in the world.

(1513)

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