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

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

by Brendan Reilly

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Overview

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

An epic story told by a unique voice in American medicine, One Doctor describes life-changing experiences in the career of a distinguished physician.


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.

Product Details

ISBN-13: 9781476726359
Publisher: Atria Books
Publication date: 11/25/2014
Pages: 464
Sales rank: 191,367
Product dimensions: 5.50(w) x 8.30(h) x 1.20(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

INTRODUCTION


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

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One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine 4.7 out of 5 based on 0 ratings. 12 reviews.
BenGoldwin More than 1 year ago
One Doctor is a book rich with information about the medical field. Every page is educational and informative. Here, Brendan Reilly tells of his career on the front lines of medicine. A splendid memoir to say the least.
Anonymous More than 1 year ago
Reading this book is like going on rounds with the author, Dr. Brendan Reilly, an outstanding physician and role model to thousands of doctors in the US and around the world.  How lucky we are!  We get to actually see how he approaches, interviews, examines, and treats his patients.  He includes asides that explain the science behind how he is thinking about the patients, how he is teaching his residents and medical students, and how his personal life tries to interfere with his doctoring.  As a physician, I was reminded about the things I need to be doing regularly in my job.  As a person, I was swept along by the story of a humble man, juggling his job and his family responsibilities, caught up in the high drama that sometimes comes into the lives of ordinary people.  Dr. Reilly is quite a storyteller!  I certainly look forward to reading more of them! 
ViajoMD More than 1 year ago
Fabulous! Dr. Reilly tells it like it is. I would make his book required reading for anyone that ever may need the U.S. medical system(everyone), and especially our politicians in the policy setting area, and all the budding doctors, residents, interns and students in the pipeline.
Anonymous More than 1 year ago
This is an incredible book. I am an RN & have been very involved in Advanced Directive promotion. Stories very much illustrate need to have an Advance Directive. Good educational read for anyone wondering or perhaps voting someday in regards to our” medical” care system. Would make a great book club read.
efm More than 1 year ago
Loved it, was a Nurse for 35 years, this is the way it is........
Anonymous More than 1 year ago
Insightful, well-written, engaging, compassionately critical - I can't think of enough superlatives. The fact that my wife (fiction) and I (non-fiction) not only each read One Doctor but found ourselves talking about it should be sufficient testimonial. To us, this work is far more than a memoir. Rather, it is a carefully crafted journey through and critique of our healthcare system, as told through one doctor and many patient experiences. Prior to reading One Doctor, I had just waged a "Free Dad" campaign for my wonderful 96 year old father to allow him to "die with dignity" - sure wish I had read the book first. I now insist my Mom's 96 year medical team(s) read One Doctor. I hope the author pens another book soon - the man can write!
Anonymous More than 1 year ago
Very easy read. His personal relationships with his patients was the interesting part. His review of how medicine has changed since he became a doctor was insightful. His assessment of ethics in medicine was brave. I enjoyed the book.
Anonymous More than 1 year ago
Having been in healthcare for over 40 years, I truly appreciated this book. It tells the need for your internist to have input into the care the "hospitalist" who cares for you during a hospital admission should have. Costs do increase with duplicate studies, and the hospitalists' decisions are not based on any personalized information. We must be assertive and speak for our personal decisions and rights. The cost of healthcare may benefit the hospital but what about the final condition to you/me for their decisions?
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Travel-and-Health More than 1 year ago
Excellent book, which most of my article "Pros and Cons of Cardiopulmonary Resuscitation (CPR)" is based on. It has debunked many myths in today's medical practices.
Anonymous More than 1 year ago
Kevin it wont let me post on my res one. How bout res three