One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine

One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine

4.6 11
by Brendan Reilly
     
 

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An epic story told by a unique voice in Ameri­can medicine, One Doctor describes life-changing experiences in the career of a distinguished physi­cian. In riveting first-person prose, Dr. Brendan Reilly takes us to the front lines of medicine today. Whipsawed by daily crises and frustra­tions, Reilly must deal with several daunting challengesSee more details below

Overview

An epic story told by a unique voice in Ameri­can medicine, One Doctor describes life-changing experiences in the career of a distinguished physi­cian. In riveting first-person prose, Dr. Brendan Reilly takes us to the front lines of medicine today. Whipsawed by daily crises and frustra­tions, Reilly must deal with several daunting challenges simultaneously: the extraordinary patients under his care on the teeming wards of a renowned teaching hospital; the life-threatening illnesses of both of his ninety-year-old parents; and the tragic memory of a cold case from long ago that haunts him still. As Reilly’s patients and their families survive close calls, struggle with heartrending decisions, and confront the limits of medicine’s power to cure, One Doctor lays bare a fragmented, depersonal­ized, business-driven health-care system where real caring is hard to find. Every day, Reilly sees patients who fall through the cracks and suffer harm because they lack one doctor who knows them well and relentlessly advocates for their best interests.

Filled with fascinating characters in New York City and rural New England—people with dark secrets, mysterious illnesses, impos­sible dreams, and many kinds of courage—One Doctor tells their stories with sensitivity and empathy, reminding us of professional values once held dear by all physicians. But medicine has changed enormously during Reilly’s career, for both better and worse, and One Doctor is a cautionary tale about those changes. It is also a hopeful, inspiring account of medicine’s poten­tial to improve people’s lives, Reilly’s quest to understand the “truth” about doctoring, and a moving testament to the difference one doctor can make.

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Editorial Reviews

Library Journal
Executive vice chair of medicine at New York-Presbyterian Hospital/Weill Cornell Medical Center, Reilly here portrays moments of medical drama while focusing on one symbolic case. Friend and patient Fred, an engineer whose invention included the navigational device removed from Amelia Earhart's plane before her last flight, died shortly after he claimed to see angels.
Publishers Weekly
He was chair of medicine at Chicago’s Cook County Hospital, on which the hit TV show ER was based, and Reilly—now at New York–Presbyterian/Weill Cornell Medical Center—matches the heart-pounding pace and drama of that fictional show in this remarkable memoir. Reilly painstakingly relates his most challenging cases, beginning in the present—when he sees 19 ER patients on an average day—before backtracking to his early career at Dartmouth in 1985. That year, Reilly struggled to identify the cause of an eccentric and lovable patient’s delirium. By the time he figured it out, the patient—Fred—had died. “ealth providers still feel guilty when things go wrong,” Reilly notes of that troubling cold case, but he insists it made him a better doctor. After all, harm is inherent in the pathway to healing: “in a brave new post-Hippocratic world, medicine’s venerable first principle had become an empty shibboleth.... First, do no harm?... If we didn’t do harm, we couldn’t do good.” It’s a sobering reminder that though medicine is a science, it is not an exact one. Fast-forwarding to today, Reilly describes another wrenching struggle: making end-of-life decisions with his own elderly mother. But his book is about more than the joy of saving lives and the sadness of losing them—it’s an intimate exploration of modern medicine and the human condition. Agent: Janis A. Donnaud, Janis A. Donnaud and Associates. (Sept. 3)
New York Daily News
"Reilly provides valuable insight into modern medicine as he relates his most challenging cases up to the present. Gripping and compassionate."
Booklist
“Empathy and thoughtfulness – ONE DOCTOR has oodles of it.”
Boston Globe
"Compassion, dedication, respect, professional competence, humility. All of these qualities shine through the many stories that make up the bulk of Brendan Reilly’s “One Doctor.’’ This book is much more than merely a gripping memoir written by an expert storyteller who also happens to be one of the nation’s most respected leaders of academic medicine. Spanning a 40-year career, the deftly woven tapestry of anecdotes and scholarly analysis...nimbly alternates between two time frames. Reilly’s moving and eloquently written book will be sure to interest not just those working in the medical professions. “One Doctor’’ is simply a terrific read."
WSJ
"Powerful...Many of the diagnoses Dr. Reilly discusses begin as little more than gut feelings. But watching him piece together a diagnosis, scrap by scrap, makes for riveting scenes—part mystery, part thriller. The action is all the more intense because some patients, despite his brilliance, really will die."
BookBrowse Editor's Choice
One Doctor is gutsy and heartfelt, a recommended read for anyone interested not only in modern medicine but also one man's professional and personal journey, as instructive as it is inspirational....Reilly's insightful ruminations make for a fascinating read, further strengthened by fast-paced, first-person accounts of challenging cases."
The New York Times
"Dr. Brendan Reilly has done history a true service... He is a good, fluent writer with a fine ear for dialogue, and his excursions from the particulars of his cases to broad medical, social and economic principles are always on point. Dr. Reilly deserves a resounding bravo for telling it like it is (sometimes), like it should be (always) and, increasingly, like it never will be again."
Abraham Verghese
“A gripping memoir by a doctor’s doctor. Reilly’s career has taken him from inner city hospitals to remote rural practices. He writes movingly about what it is like on the front lines: the mysteries, the frustration and the rewards of his chosen calling. A must read for the general public and any young person contemplating a career in medicine.”
Christiane Northrup
“One Doctor contains the essence of all of it: our humanity and nobility – and why we are all entranced by medical dramas of every kind. A stunning book."
Lisa Sanders
“Extraordinary up-close story-telling. Brendan Reilly takes us bedside to witness the dramas and dilemmas of everyday medicine. One Doctor is a love story about a man and his lifelong passion for the mysteries and miracles of medicine.”
Malcolm Gladwell
“Brendan Reilly has written a beautiful book about a forgotten subject – what it means for a physician to truly care for a patient. One Doctor shows why this matters today more than ever before.”
From the Publisher
"Empathy and thoughtfulness—One Doctor has oodles of it." —Booklist

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Product Details

ISBN-13:
9781476726366
Publisher:
Atria Books
Publication date:
09/03/2013
Sold by:
SIMON & SCHUSTER
Format:
NOOK Book
Pages:
464
Sales rank:
149,274
File size:
3 MB

Read an Excerpt

One Doctor


  • Live a simple and temperate life, that you may give all your powers to your profession. Medicine is a jealous mistress; she will be satisfied with no less.

    —Sir William Osler (1904)

    Despite this famous advice from a legendary physician, most doctors don’t live a simple life. All of us, seduced at an early age by Osler’s mistress, conduct our own lifelong affair with medicine. This book is about mine.

    One Doctor is a true story about real people—most of which took place during two weeks in the winter of 2010. It recounts, in sometimes intimate detail, my doctoring of patients in the wards, emergency department, and intensive care unit of a renowned teaching hospital in New York City. These experiences exemplify many of the challenges doctors and patients face today in the dramatic, high-tech world of modern medicine. But doctoring has changed, not just since Osler’s time but during my own time, too. For this reason, my story flashes back to long ago when I worked as a primary care physician in a small New England town. There, I did a different kind of doctoring, now largely forgotten or obsolete, when physician-patient relationships were deeper and more enduring than in today’s “provider-consumer” medical culture. This difference—the contrast between doctoring then and doctoring now—lies at the heart of my story. It is a cautionary tale, but a hopeful one, too.

    My story is unusual in three ways. First and foremost, I am a dinosaur, an old-fashioned internist, a species of doctor on the verge of extinction. Although every doctor’s perspective is unique, mine reflects the passing of a notable era in medicine. During my career, doctors like me served not only as their patients’ primary care physician but also as an expert in the many subspecialties of internal medicine. As Osler did in his time, we cared for our patients whenever they needed us, day or night, and wherever they were—in the office or intensive care unit, in nursing homes and in their own homes. Such a task, daunting in the past, is impossible today. Medicine has changed irrevocably—on balance, I believe, for the better—and I harbor no hope of saving dinosaurs like me. But I am convinced that, as medicine continues to evolve, future doctors (and their patients) will do well to remember my medicine, my mistress. She is a goddess, her power and charms divine. But, like Osler’s mistress, she is also a gadfly—a principled, perfectionist pain-in-the-ass—which my profession (and, I believe, modern society) can ill afford to lose. It is her spirit that I try to capture, and preserve, in this book.

    Second, I tell my story in an unconventional way, in the first person in real time. I describe my own actual in-the-moment, minute-to-minute experiences as seen through my own eyes. With this you-are-there approach, I try to bring the reader “inside” one doctor’s world; I try to show you—not merely tell you—what I do, how I do it, what it feels like. In recent years, many people have told stories—some with happy endings, some not—about their experiences as a patient in the U.S. health care system. This book tells the doctor’s side of those stories, up close and personal.

    Finally, an accident of timing motivated me to write this story. The events came together when disparate challenges in my own life—personal and professional, past and present—collided at one serendipitous point in time. This collision happened when challenges facing me mirrored similar ones facing my profession and my country. Most of the patients you will meet in these pages are older people with chronic diseases (including my own ninety-year-old parents) who don’t have one doctor and who exemplify stormy issues roiling medicine today and for the foreseeable future. I focus on these patients (who, for various reasons, required urgent medical care) because most of us—you and I and our loved ones—will be one of them someday. Not only do these folks comprise the great majority of patients whom I (and most doctors) see today, they also “consume” the lion’s share of all U.S. health care resources. One cannot begin to understand modern American medicine—or, increasingly, medicine around the globe—without understanding the challenges (and rewards) of doctoring such people.

    I interrupt my story occasionally to comment briefly about its historical background or future implications. These commentaries claim no special expertise about their subjects (each of which could justify a book of its own); rather, their purpose is to deepen the reader’s understanding of my story. To paraphrase Hamlet, in this book the story’s the thing: What actually happened to me and my patients during the time described was the wellspring for everything written here. For this reason, just as one physician’s experience could never embrace the full sweep and complexity of modern doctoring, this book addresses only some of the many contentious issues facing medicine today.

    Whether my story will, as Hamlet hoped his own would, “catch the conscience of the King” is for you to decide. As I write this, politicians and policy makers in the United States are debating the form, function, and financing of smart new models of “accountable” health care. (Sadly, medicine has become increasingly unaccountable; today, it is often unclear who is responsible for the inexplicable way patients are treated.) Little good can come of these promising new ideas unless doctors step up, help to make them right, and take responsibility for implementing them well. But doctors can’t do this alone. Ultimately, it is you—our patients, the body politic—who will be decisive in these matters. That’s why I’d like you to meet my mistress and learn more about her kind of doctoring.

    All true tales contain errors. I have tried hard to minimize my own. All persons, events, and settings depicted here are factual. Most names and a few details have been changed to protect individuals’ privacy or their confidential medical information. Reproduction of conversations is approximate, not verbatim, as best my memory allows. Any other misrepresentation of actual fact is unintentional.

    That said, let the story begin.

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