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

by Brendan Reilly M.D.

Overview

Reminiscent of the eloquent writings of physicians Abraham Verghese, Atul Gawande, and Siddhartha Mukherjee, this compelling story is told by a unique voice in American medicine, Brendan Reilly, a distinguished internist whose work was profiled at length by Malcolm Gladwell in his bestselling book Blink.

Only One Doctor is a riveting first-person narrative—a true story that reads like a novel and recreates Dr. Reilly’s present-day, moment-to-moment “E.R.”-like dramas with patients, families, and medical staff at the Medical Center. At the heart of Only One Doctor is an unsolved medical mystery that haunts Reilly: the loss of a legendary engineer friend and patient, Fred, who died suddenly after he began to see angels and hear voices. Fred was renowned for many inventions, including a navigational device that was removed from Amelia Earhart’s plane before she took off on her last flight. As Fred sought to learn Earhart’s fate, Reilly searches for the reason behind Fred’s death, piecing together his last days to arrive at a chilling revelation. Lessons learned from Fred’s case resonate throughout Reilly’s experiences with other patients in the book, ultimately leading to the saving of thousands of lives.

From the cases in Only One Doctor, patients and caretakers learn what works and what doesn’t in today’s health care and how to avoid falling through the cracks. As compelling as an episode of House, written with the skill of How We Die and My Own Country, Only One Doctor is a wrenching, brilliant, inspiring read.

Product Details

ISBN-13:	9781476726298
Publisher:	Atria Books
Publication date:	09/03/2013
Pages:	464
Product dimensions:	6.42(w) x 9.12(h) x 1.34(d)

About the Author

Dr. Brendan Reilly is executive vice chair of medicine at New York-Presbyterian Hospital/Weill Cornell Medical Center. A widely published clinical researcher and educator, he has served as the chair of medicine and physician-in-chief at Chicago’s Cook County Hospital, which, during Reilly’s thirteen-year tenure there, was the inspiration (and setting) for the hit NBC television series ER.

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.

Table of Contents

Introduction xi

Part I Now

Prologue 3

1 Lost and Found 9

2 Caught in the Middle 37

3 A Safe Bet 64

4 What's the Plan? 92

Part II Then

5 An End 135

6 The Postman Rings Twice 174

7 Lost Marbles 215

Part III Now

8 Never Say Never 257

9 To the Limit 298

10 Go Gentle 333

Epilogue 367

Notes 371

Acknowledgments 427

Index 429

Editorial Reviews

Empathy and thoughtfulness – ONE DOCTOR has oodles of it.

Booklist

"Reilly provides valuable insight into modern medicine as he relates his most challenging cases up to the present. Gripping and compassionate."

New York Daily News

"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."

The New York Times

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."

BookBrowse Editor's Choice

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.

Malcolm Gladwell

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.

Abraham Verghese

"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."

Boston Globe

"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."

WSJ

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."

Christiane Northrup

Reilly’s medical narrative nicely intertwines true stories of challenging patients with valuable lessons on doctoring and “patienthood.” Empathy and thoughtfulness—One Doctor has oodles of it.

Booklist

Heart-pounding pace and drama … remarkable … 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.

Publishers Weekly

"Reilly provides valuable insight into modern medicine as he relates his most challenging cases up to the present. Gripping and compassionate."

New York Daily News

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.

Lisa Sanders

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.

Malcolm Gladwell

"Empathy and thoughtfulness---One Doctor has oodles of it." ---Booklist

From the Publisher