access to health care, 41, 175, 282, 285–87
adult-onset diabetes. See diabetes: type 2
aging
drug company marketing and, 96–98, 99
effects of the immune system, 271–72
effects on the brain, 222
nature of the knowledge acquired with, 203–4
research on cellular processes, 90, 275–76
AIDS (acquired immune deficiency syndrome)
transmission, 41, 46, See also HIV: transmission
treatment: antiretrovirals, 40–41, 255, 282–83; context of a cure, 173–74; impact of new, 40–41, 43; importance of adherence to the regimen, 180–81; low-tech aspects, 166; myths, 282; role of trust, 153, 180; of symptoms vs.
causes, 87
United Nations program, 286
Yale-New Haven Hospital research, 1, 40–41
Alzheimer’s disease, 62, 98–99, 272, 284–85
American Heart Association, 28–29 America’s Pharmaceutical Companies, 96–97
angina, 65, 132, 244, 245–46, 258
angiography
of the author: attempt to see Dr. Beck, 71; by Dr. Cabin, 3, 6, 80, 83
definition, 1
historical background, 93, 230
angioplasty
percent of patients who need second, 43
percent of unnecessary, 37
research by Helfant, 263
stent: failures, 99, 132; impact of this development, 15, 43, 95; probability of needing second, 44
effects on mortality rates, 109–10
historical background, 94, 109, 270–71
pathogen resistance to, 26, 102, 255, 288
production by microorganisms, 270
treatment for bypass patients, 259
antibodies, 255
antidepressant medications, 43, 97, 154
antipsychotic medications, 105, 150, 268
antiretrovirals, 40–41, 255, 282–83
arm pain, 5
Armstrong, Moe, 17
arterial plaque. See plaque
Atelenol, 70
Atherosclerosis
genetic aspects, 114
infectious disease linked with, 259, 260
as an inflammatory process, 255–60, 272
limitations of medical knowledge, 16, 43, 249, 252, 260
limited role of risk factors, 30, 256
back pain
author’s symptoms prior to surgery, 59, 60, 64, 65, 69, 245
placebo effect with, 154
Barker, David, 30
Barnard, Christiaan, 281
baseball, 11, 13, 190–91, 235–36
basketball, 13–14, 17, 80, 120
Baycol, 133
Bay State Hospital (Springfield, Mass.), 8
beating-heart surgery, 33
Big Man (Neugeboren), 77, 213–14
blood clots, 29, 43, 70, 94, 258, See also plaque
blood platelets, 70
blood pressure
levels of the author prior to surgery, 5, 56, 69
rise due to medical exam, 251
as risk factor, 5, 24, 249, 251
blood vessels
reaction to chronic high blood pressure, 251
body. See also mind-body connection
ability to heal itself, 34, 161, 264
feelings of dissociation, 121, 123
temperature during surgery, 4, 279, 280
brain
damage. See neurological conditions
effects of aging, 222
endorphins released by, 155
inability to heal itself, 87, 162, 216–17
wonders of the, 15
breast cancer, 28
breathing difficulty
with angina, 246
of the author: prior to surgery, 49, 51, 52, 55–57; two years after surgery, 122–23
with viral heart disease, 248
breath strength test, 56
Bronx State Hospital (Bronx, N.Y.), 19–20
Brooklyn Dodgers, 11, 13, 190–91, 235–36
Brumlik, Dr. Joseph V., 242–43
bypass. See coronary bypass
postsurgery checkups with, 22, 127, 130
views: on being “cured,” 233; on postsurgery Norvasc, 123
calcium channel blockers, 123, 263
cancer. See also Hodgkin’s disease
breast, 28
cervical, 32
chemotherapy and life expectancy, 99, 112
future scenario for treatment, 116
genetic aspects, 117
Li-Fraumeni cancer syndrome, 274
limitations in medical knowledge, 91
MRI for diagnosis, 231
P53 system and the aging process, 272–75
radiation therapy, 77
risk factors, 111, 113, 116, 117
screening and prevention activities, 112, 113, 116, 117
trends in types, 112
cardiac care unit, 14, 43, 94, 243
cardiac electrophysiology, 263
cardiology
limitations of medical knowledge. See medical knowledge: limitations in
multidisciplinary nature of, 277
quality of care. See managed care; physicians: relationship with the patient
cardioversion, 38
caregiving
author’s anxiety about, 42, 58, 65
for chronic conditions, 1990 data, 172
Care of the Psyche (Jackson), 158–59
CAT scan, 95, 118, 133, 222, 230–31
Centers for Disease Control and Prevention, 46
cervical cancer, 32
Charyn, Jerry, 80
chest pain or discomfort
author’s symptoms prior to surgery, 50, 51, 52, 55, 59, 64
heart attack with lack of, 28
stopping movement until it recedes, 65
as symptom of heart disease, 5, 246
childhood diseases, 86–94, 109–10, See also specific diseases
Chlamydia pneumoniae, 259, 260
cholera, 102
cholesterol. See also cholesterol-lowering medications
author’s blood level: after surgery, 134; prior to surgery, 5, 59, 69
heart disease with normal levels, 29, 259
risk of death with low, 30
cholesterol-lowering medications, 29, 31–32, 99, 133, 260, 262–63
cholestyramine, 262
Christopher Reeve Paralysis Foundation, 269
Chronic Care in America: A 21st Century Challenge (Robert Wood Johnson Foundation), 171–72
cigarette smoking. See smoking
clinical science
rise in the influence of, 168–69
clozapine, 150
cognitive losses, risk with coronary bypass, 9, 44
collateral blood vessels, 6, 130, 131
Columbine High School, 234
The Coming Plague (Garrett), 255
communication in relationships, men vs. women, 125
computed tomography. See CAT scan; CT screen
conflicts of interest, 37, 261–62, 290
Cooley Dickinson Hospital (Northampton, Mass.), 68
coronary bypass
of the author: diagnosis, 4; exercise in the hospital after, 14; “last words” before, 13; procedure, 13, 83–85, 179; scars in penis due to catheterization, 140; symptoms prior to, 5, 8, 47, 49–62; timeframe of surgery, 13; use of his own arteries, 84, 123
beating-heart, 33
cost of surgery, 43
definition, 4
effects of cholesterol-lowering medications, 29
mental decline from, 44
number of patients annually, 118
number performed annually, 5
percent of patients who need second, 43
unnecessary overuse of, 37
use of heart-lung machine, 4, 13, 277–80
coronary disease. See heart disease
cortisone, 268
cultural aspects of
disease transmission, vs. biology of organism, 183–84, 194
not showing fear, 48
cystic fibrosis, 250
cytomegalovirus, 260
Dalai Lama, 263
Darwinian medicine, 252–57, 259, 271, 272
The Deadly Truth: A History of Disease in America (Grob), 86
death. See also life expectancy
author imagining his, 78
coming to terms with, 73
medical data. See mortality preparations for, 82–83
as a series of preventable diseases, 98
defibrillator, 38, 95, 243, 290
Demetri, Mrs., 89
depression
clinical judgment in diagnosis, 204
following a heart attack, 154
of Friedland’s father, 196
impact of new treatments, 43
placebo effect with, 154
postsurgical, 48
rank in global burden of disease, 204
diabetes
coexistence with heart disease, 28
complications, 107
incidence rate, 107
inflammation and, 272
diagnosis
as an art: importance of listening. See listening to the patient; role of instinct, 101, 105, 247; role of judgment. See physicians: judgment skills; role of technology, 32, 34, 43, 95, 147, 233; uncertainty and probability, 292, 296
of the author: Dr. Flynn’s analysis of the echocardiogram, 70; Dr. Flynn’s analysis of the EKG, 69–70; Helfant’s analysis of the echocardiogram, 82; for Hodgkin’s disease in college, 76; “missed,” 8, 24, 28, 31, 47, 74; possible viral infection, 8, 70, 71, 247; reaction to, 3–4
categories, changes over time, 92
danger of dependence on technology. See technology: vs. listening to the patient
heart disease
cardiac care unit, 14, 43, 94, 243
difficulties and limitations, 16, 28–29, 30-31: test results, 32–34, 248; evaluation of heart sounds, 35–36; “missed,” 29, 32, 248–49
percent of information in patient history, 38
physician conflicts of interest, 37, 261, 290
diet
of the author, 134
as risk factor for cancer, 116
as risk factor for heart disease, 24, 106, 260–63
as risk factor for type 2 diabetes, 107
digestive system, 91, 109, 156, See also peptic ulcer
digoxin, 86
direct-to-consumer marketing of drugs, 26, 96–97, 260, 261–62, 290
disease. See also infectious disease
after reproductive age, and natural selection, 254
chronic: increase in the U.S., 171–73, 272, 289; salaries for health-care workers, 290
“conquest” of, 26, 90–91, 96–98, 268–69
global, ethics and policy, 286–88
preventable, mortality rates, 286
prevention: effects of activities for, 112, 113, 116, 117, 119; need for medical school training, 163, 173
as punishment from God, 116–17
reemergence of, 26, 90, 102, 255
symptoms vs. causes, 87
use of technology prior to true understanding of, 44–45
vs. illness, 156
dizziness, 5
DNA. See genetic aspects
doctor-patient relationship. See physicians: relationship with the patient
drug industry
economic aspects of research, 286–87
marketing: the concept of choice, 287, 290; at conventions, 37; direct-to-consumer, 26, 96–97, 260, 261–62, 290; life extension claims, 96–98, 99
physician conflict of interest, 37, 261, 290
drug-resistant pathogens, 26, 102, 255, 288
Dupuytren’s contracture, 137
ebola, 255
echocardiogram
of Aaron Neugeboren, 36
of the author, 5, 8, 31, 68–69, 70, 82, 131, 247–48
false positives, 33
economic aspects
average health care spending annually, 286
care for chronic conditions, 172, 225, 289
cost of coronary bypass, 43
fee-for-service, 293
HIV/AIDS treatment and research, 282, 291
low- vs. high-technology treatment, 165–66
market values and choice, 287, 290
medical industry and physician conflict of interest, 37, 261, 290
medical school, 166
neonatal intensive care, 295
psychotherapy, 208
ejection fraction, 3, 70, 82, 130, 131
electrocardiogram
author’s, 8, 31, 59, 66–68, 69–70, 81, 247–48
false positives, 33
endocarditis, 36
endorphins, 155
Erasmus High School (Brokklyn, N.Y.), 11, 12, 72, 185, 229, 238, 300
ethical issues
access to AIDS treatment, 41, 282, 286
physician conflicts of interest, 37, 261–62, 290
treatment of global disease, 286–88
evolutionary medicine, 252–57, 259, 271, 272
exercise
by the author: first few weeks after surgery, 17, 18, 121, 122; in the hospital after surgery, 14; prior to surgery, 5, 6, 24, 47, 49, 53, 69; two years after surgery, 122–23
as risk factor for heart disease, 24, 106
as risk factor for type 2 diabetes, 106, 107
exercise capacity test. See stress test
faintness, 5
Fallot’s tetralogy, 280
false negatives, 133
family
history, of the author, 5, 9, 24, 45, 241
as predictor of recovery, 40, 41
as a support system, 42
family medical history. See patient medical history
Farber, Dr. Sidney, 76
fatalism, 25
father, author’s
background, 62
closeness to, after death, 61–63, 144–45
health conditions, 5, 57, 61, 247
as a parent, 62
recipe for longevity, 75
visit to, 136
of AIDS, 187
author’s, 48, 50, 53, 63, 66, 144
marketing based on, 96–98, 133-34. See also cholesterol-lowering medications
role in illness, 265
fetal environment, 30
Flynn, Dr.
diagnosis, 70
echocardiogram by, 5, 8, 68–69
letter to Dr. Katz, 69
stress test appointment, 56, 66–68
Friedland, Gail, 6, 127, 190, 282, 299
Friedland, Jerry
AIDS research and care: commitment to patients, 46, 188–89; future international work, 296; in Nigeria, 179–84; patients’ trust in, 151, 153; research on adherence to medications, 41; research on HIV transmission, 186–87; in South Africa, 166–67, 191–92, 281–84; at Yale-New Haven Hospital, 1, 41
Black Panthers and, 189–90, 192
childhood and adolescence, 11, 12, 185, 196–97
as consultant, 42, 79, 80, 84, 136
family, 188, 192–93, 196–97, 282
friendship with the author: after author’s surgery, 202, 281, 298–301; during childhood and adolescence, 12; like family, 124, 126; prior to author’s surgery, 2, 10, 12
in Israel, 192
motivation to be an infectious disease physician, 46, 179–85, 191, 196, 267
teaching positions, 192, 197–98
views: on AIDS research, 282–83; on health care policy, 289; on the human genome project, 114–15; on importance of trust, 151, 153; on insurance companies, 88; on medical school, 164–65, 170–71
work hours, 2
friends. See also Friedland, Jerry; Helfant, Rich; Rudy, Arthur; Yarnell, Phil
effects of author’s experience on, 25
importance of, 12, 14, 21, 40, 82, 124–27, 149–53, 201–2, 301
Gage, Phineas P., 218
gastrointestinal disease, 91, 109, 156
genetic aspects
alleles and genetic variability, 276
of cancer, 117
diseases with single causative abnormality, 250
ethical issues with testing positive, 295
of heart disease, 24, 114, 250, 251, 265
human genome, 113–15, 212, 276
of Huntington’s disease, 295
of natural selection, 254
of neurological conditions, 234
Granberg, Ronald, 89
HAART (highly active antiretroviral treatment), 40–41, 255, 282–83
Haight, Dr. Malcolm, 137–38, 140, 143, 145–47, 148
Hashim, Dr. Sabet
background, 9
postsurgery checkups with, 123, 127
quintuple bypass surgery by, 13, 83–85
healing
body’s ability to heal itself, 34, 161, 264
faith, 157
as a natural process, 149
placebo effect, 153–57, 161, 264
health care
in the U.S. See drug industry; managed care; medical industry
heart
beats per minute after surgery, 127
ejection fraction, 3, 70, 82, 130, 131
pounding, prior to surgery, 60
slowing down for self-protection, 82, 246
sound of common abnormalities, 35–36
heart attack
asymptomatic (silent), 25, 28–29
depression following, 154
indication on an electrocardiogram, 67
with normal cholesterol levels, 29
risk with open-heart surgery, 44
role of arterial plaque and inflammation, 29, 105, 255–60
heart disease
coexistence with diabetes, 28
difficulty in diagnosis, 16, 28
effects of prevention activities, 119
genetic aspects, 24, 114, 250, 251, 265
judgment skills concerning, 31, 35–36, 265–66
progressive, 28
risk factors: of the author, 5; effects on mortality rates, 106; exercise test as predictor, 30; fetal environment and infant weight, 30; relative to total incidence rate, 30; statistical aspects, 252
treatment of symptoms vs. causes, 87
heart-lung machine, 4, 13, 277–80
heart surgery. See coronary bypass; heart transplant; open-heart surgery
heart transplant, 95, 277, 281
Helfant, Rich
childhood and adolescence, 7, 12, 72, 235, 237–40
as a consultant: after surgery, 123–24, 130–31, 132, 136; on diagnosis of viral infection, 28, 71, 247; on the EKG, 81, 248; on Peyronie’s disease, 136; prior to surgery, 7–8, 59, 65–66, 71–72, 79, 81, 244–49
education, 12, 72, 239, 240, 241–43
family, 72, 128, 237–38, 239, 240, 241
family history, 241
friendship with the author, 12, 72–73, 124–27, 201–2, 238–39
heart disease research, 8, 131, 257, 258, 263
motivation to be a cardiologist, 242, 267
views: on clinical trials, 176; on determination of “normal” cholesterol levels, 29; on the human genome project, 114; on the importance of listening, 93, 101, 244; on Jackie Robinson, 235–37; on Jerry Friedland, 46; on limitations of medical knowledge, 15–17, 249, 252, 260; on medical community conflicts of interest, 37, 261–62; on the mind-body connection, 264–65; on the physician-patient relationship, 163–64, 265–66
Herrick, James, 92
highly active antiretroviral treatment (HAART), 40–41, 255, 282–83
Hippocratic Rule, 162
historical background
ancient healing practices, 158–59
aspirin and blood clotting ability, 70
decrease in infant mortality, 94
germ theory of disease, 26, 249
increase in life expectancy, 94, 107–8
Koch’s theory of disease, 249–50
medicine prior to 1940, 86–94, 109–10
rise in hospital/laboratory medicine, 167
HIV (human immunodeficiency virus)
antiretroviral treatment, 40–41, 255, 282–83
infection of medical personnel, 283
number of children infected annually, 41
in South Africa, 282–83, 284, 285
transmission, 186–87, 191, 193, 194, 283
hives, 156
Hodgkin’s disease, 5, 76–77, 135
hormone replacement therapy, 295
hospitals
differences in quality of care, 10–11
infections acquired within, 26, 255
medical errors which occur in, 11
shift in focus from patient to disease, 167
human genome, 113–15, 212, 276
Huntington’s chorea, 250, 254, 297
Huntington’s disease, 295
illness, vs. disease, 156
Imagining Robert (Neugeboren), 19, 72, 244
immune system
antibodies, 255
evolutionary context, 253, 254, 271
vaccines and the, 156
infant mortality, 94, 102–3, 108, 109, 181–82, 286
infant weight, and risk of heart disease as adult, 30
infection
acquired in the hospital, 26, 255
from leaking aortic valve, 36
risk with coronary bypass, 9
risk with open-heart surgery, 44
infectious disease
change in treatment with understanding of, 45
drug-resistant, 26, 102, 255, 288
evolutionary context, 254
historical background: germ theory, 26, 249; treatment for childhood diseases, 88–90, 109; treatment prior to 1940, 86–94, 109–10
impact of new treatments, 42, 109
link with coronary artery disease, 259, 260
viral. See viral infection
inflammatory process
in atherosclerosis, 255–60, 272
role in the immune system, 271–72
insulin, 86
“insult accumulation,” 92
insurance companies
approved physicians, 39
frustration with, 39, 100, 160, 233
malpractice lawsuits, 289
valuing technology over time, 88, 169–70, 175
Judaism
on miracles, 85
Katz, Dr. David
author’s call to office prior to surgery, 49
diagnosis of Aaron Neugeboren, 36
EKG by, 59
letter from Dr. Cabin to, 130
letter from Dr. Flynn to, 69
Kotker, Norman, 51
laboratory tests
danger of too much dependence on. See technology: vs. listening to the patient
duplicated, variation in results, 31
historical background, 167
interpretation of results, 31, 32, 34, 248
percent of total information needed for diagnosis, 38
replacement of stethoscope techniques, 35–36
language, challenges for medical care, 39
lawsuits, 289
legionnaires’ disease, 255
Lescol, 29
life
as a gift, 22–23, 24, 83, 120–21, 129, 178–79
quality of, 133
life expectancy
drug company marketing for increased, 96–98, 99
increase in the 1900s, 94, 107–9
vs. lifespan, 275
Life Without Disease: The Pursuit of Medical Utopia (Schwartz), 90–91
Li-Fraumeni cancer syndrome, 274
Lipitor, 29, 99, 114, 132, 134–35, 260
listening to the patient, 27
with compassion, 20, 212, 265–66
for full medical history, 38, 202–3, 229, 243–44
and mental illness, 20
vs. the “objectivity” of technology, 101
The Lost Art of Healing (Lown), 38
Lott, Bret, 56
Lown, Bernard, 38
lysozymes, 271
macrophages, 248
Madeleine, 17
magnetic resonance imaging (MRI), 33, 95, 231
malpractice lawsuits, 289
managed care. See also drug industry; insurance companies; medical industry
approved physicians, 39
damage to patient-physician relationship by, 34–35, 159–61, 232–33
dehumanization of physicians, 35, 87–88, 164–65
inadequacy for chronic disease, 171, 225, 289
need for training in new technologies, 37–38, 133
no value placed on physician’s time, 88, 169–70, 175
physician’s conflicts of interest with, 37, 261, 290, 293
policy overriding physician’s judgment, 35, 160, 169, 226–27
rise in hospital medicine, 167
role of specialists, 35, 232–33, 292
Massachusetts General Hospital (Boston, Mass.), 71
matrix metalloproteinases, 248
Medawar, P. W., 32
media
hype of medical “breakthroughs,” 27, 38, 45, 114–15, 133
questionable reality on medical television show, 27
Medical Committee for Human Rights, 189
medical history. See patient medical history
medical industry, 37, 261, 290, See also drug industry; managed care
medical knowledge. See also technology of the aging process, 90
art and science of. See under diagnosis: as an art
of atherosclerosis, 16, 43, 249, 252, 260
“conquest” of disease, 22, 25–26, 90–91, 96–98, 268–69
limitations in, 15–17, 21, 26, 87–92, 249, 271
media hype of “breakthroughs,” 27, 38, 45, 114–15, 133
paradigm shifts, 92
rise of clinical science, 168–69
role of serendipity, 114, 268, 270–71
medical school
additional training needs: disease prevention, 163, 173; end-of-life care, 163; evaluation of heart sounds, 35–36; history of medicine, 163; new technologies, 37–38, 133; public health, 163
courses on the physician-patient relationship, 164
efficacy, 170
mentoring, 170
overview of coursework, 170
percent of physicians who would repeat, 226
Medicare, 163
medications. See also drug industry; specific brand names
adherence to the regimen, 41, 153–54, 180–81
antiretrovirals, 40–41, 255, 282–83
calcium channel blockers, 123, 263
cholesterol-lowering, 29, 31–32, 99, 133, 260, 262–63
discovered through serendipity, 114, 268, 270–71
“lifestyle,” 97
to minimize possibility of heart attack, 4
“pharmacological forgiveness,” 180
for treatment of mental illness, 105–6, 150
vasodilators, 70
Melman, Dr. Arnold, 139–42, 143, 145, 146–47
men
communication style in relationships, vs. women, 125
mortality rate for heart disease, 28–29
mental decline
Alzheimer’s disease, 62, 98–99, 272, 284–85
mental illness
importance of humane treatment, 20, 103, 148, 150
leading conditions which cause disability, 205–6
learning to live with, 103
need for skill as well as compassion, 20
patient is not the disease, 147–48
role of medications, 105–6, 268, 269
symptoms vs. causes of, 87, 269
mentoring, 170
Mevacor, 29
mind-body connection, 114, See also family; friends; social aspects
conditions that reflect, 156
reaction to physician’s presence, 161
miracles, 85
mitral regurgitation, 70
Montaigne, Michel de, 151, 152
mortality. See also death; life expectancy
associated with control of infectious disease, 109–10
changes in major causes of, 86–94
coronary bypass, 44
drug-resistant infections, 26, 255
effects of inferior medical care, 39–40
heart disease, 91, 119: heart attack, 25, 28–29, 154; and weight as an infant, 30
infant, 94, 102–3, 108, 109, 181–82, 286
open-heart surgery, 44
mother, author’s
Alzheimer’s disease, 62, 98–99
caretaking of, 42
childhood memories, 52, 76, 77, 197
long life of, 5
MRI (magnetic resonance imaging), 33, 95, 231
Muhlestein, Dr. Joseph B., 256
multiple sclerosis, 234, 268, 297
myocardial infarction. See heart attack
National Academy of Sciences, 11
National Health Service Corps, 166
natural selection, 253–55, 272
nausea, 5
neonatal intensive care, 294–95
Neugeboren, Aaron (son)
at the hospital after author’s surgery, 299
at the hospital during author’s surgery, il, 14, 84
move to author’s home after surgery, 17, 120–21
in Northampton, 7
reaction to author’s diagnosis, 79
Neugeboren, Eli (son)
in Brooklyn, 7
childhood, 120
at the hospital during author’s surgery, 11, 14, 84
reaction to author’s diagnosis, 79–80, 81
visit with author after surgery, 17
visit with Friedland, 281, 282, 284
Neugeboren, Jay
childhood and adolescence, 11, 12, 45, 72, 185
family history, 5, 9, 24, 45, 241
family medical history, 5, 57, 59, 60, 80
friends. See Friedland, Jerry; Helfant, Rich; Rudy, Arthur; Yarnell, Phil
Hodgkin’s disease, 5, 76–77, 135
initial doctor’s visit, 1–6, See also diagnosis: of the author
medical history of good health, 5, 52
move to New York City, 22, 121, 122, 298
nickname, 6
nodules on penis. See Peyronie’s disease
open-heart surgery. See coronary bypass: of the author
relationship with children, 9, 14, 120–21, 130, 300
as a single parent, 7, 12, 41–42
who will be caregiver for, 42, 58, 65
writings by. See writing career
Neugeboren, Miriam (daughter)
at the hospital during author’s surgery, 13, 14, 84
reaction to author’s diagnosis, 79, 81
visit with author after surgery, 17
in Washington, D.C., 7
Neugeboren, Robert (brother)
author as caretaker for, 13, 42
conversation during author’s recovery, 19
effects of caring relationships on, 150
effects of medications, 150–51
humane care at Bronx State, 19–20
life in New York City, 285
move to New York City, 58, 128–29
notification about the surgery, 13
neurological conditions
from coronary bypass, 44
impact of new treatments, 43
importance of family, 41
traumatic injury, 105, 220–23, 268–69
Northampton, move from, 22, 121, 122, 128
Norvasc, 123
O’Brien, Dr., 68
One Renegade Cell: How Cancer Begins (Weinberg), 115–16
open-heart surgery. See also coronary bypass
general procedure, 4
organ transplantation, 95
and antibiotic-resistant bacteria, 288
economic aspects, 290
first heart transplant, 281
immune response, 149
importance of heart-lung machine, 277
obsolescence with cure for atherosclerosis, 44
osteoporosis, 272
outcome studies, 33
oxygen
decreased body temperature and, 4, 246
supply to the heart, 245–46, 257–58
PABA (potassium para-aminobenzoate), 138, 140, 143, 145
pacemakers, 94
palpitations, 5
paradigm shifts, 92
patient medical history of the author, 5, 57, 59, 60, 80, 247
correct diagnosis from the, 38, 202–3, 229, 243–44
as risk factor for cancer, 17
taking time to get, 38, 169–70, 175
patients
with disease that is a unique entity, 33
experience of illness vs. disease, 156
ignored by physician, 68, 138–39, 147
importance of listening to. See listening to the patient
listening to their own body, 61
not a set of symptoms or disease, 20, 95–96, 147–48, 167
relationship with the physician. See physicians, relationship with the patient
as unique individuals, 21, 88, 149, 176, 229
Paxil, 97
peak flow meter, 56
penile induration. See Peyronie’s disease
periodontal disease, 260
PET-scans, 231
Peyronie’s disease of the author, 135–42, 143
spontaneous remission, 146
variation in recommended treatments, 143
pharmaceuticals. See drug industry; medications
of the author, prior to surgery, 55–56
percentage of total information needed for diagnosis, 38
physicians
dehumanization of, 35, 87–88, 164–65
economic conflicts of interest, 37, 261–62, 290
important qualities: active listening, 21, 88, 93; compassion, 20, 212, 265–66; saying “I don’t know,” 16, 244; sympathy, 212; training in new technologies, 37–38, 133
judgment skills, 88. See also listening to the patient; content and context for, 265–66; for diagnosis of depression, 204; as a gift, 34; impact of technology on, 35–36, 133–34; impaired by managed care, 34–35, 159–61, 232–33; importance in choice of treatment, 31, 34; role of instinct in diagnosis, 101, 105, 247
recent graduates, gaps in training, 35–36, 37–38, 163, 173
relationship with the patient, 17, 26: and clinical science, 168–69, 175–76; cultural aspects, 45; importance of, 38, 158–59, 265; lack in managed care system, 34–35, 159–61, 163, 175, 232–33, 293; lack of time, 88, 169–70, 175; listening. See listening to the patient; the power of authority, 124, 134–35, 145–46, 164; restoration, 294; as the “science” in medicine, 32; trust, 41, 146, 151–54, 175, 180–81, 202–3, 265
plaque
in the author’s arteries, 4
components, 29
limitations on knowledge about, 255
role in a heart attack, 29, 105, 257–58
Pneumocystis carinii pneumonia (PCP), 193
pneumoencephalography, 230
pneumonia, 91, 109, 110, 193, 271
poliomyelitis, 88–89, 109, 110
political aspects of AIDS treatment and research, 282
Porphyromonas gingivalis, 259, 260
positron emission tomography (PET), 231
post-traumatic stress disorder, 211, 219, 298
potassium para-aminobenzoate (PABA), 138, 140, 143, 145
poverty
access to AIDS treatment, 41, 282, 286
access to vaccinations, 285–86
childhood mortality from preventable diseases, 286
prostate-specific antigen test (PSA), 118, 138, 145
psychological aspects
appreciation of life. See life: as a gift
concept of choice, 287–88, 290
distancing from reality, 68
effects of author’s experience on friends, 25
effects of positive attitude, 40, 47, 83, 131
empathy, 42
fatalism, 25
fear. See fear
feeling of no use, 297
importance of friends. See friends persistence, 39, 45
safety as an illusion, 210
self-revelation and self-reflection, 202
sympathy, 212
unreliability of memory, 50, 61, 69
psychotherapist, of the author, 51, 63–64
public health
historical background, 91, 111
importance of clean water, 102–3, 108
medical school curriculum, 164, 165
in policy-making, 289
“pump-time,” 13
racial aspects
quality of medical care and mortality statistics, 39–40
radiation therapy for Hodgkin’s disease, 76
recovery
of the author: after two years, 122–23; first few hours after surgery, 299–300; first few weeks, 17, 18, 120–21
effects of a caring relationship, 149–50
effects of positive attitude, 40, 131
family support as predictor for, 41
retinal damage, 9
rheumatic fever, 111
rheumatic valve disease, 249
rheumatoid arthritis, 268, 272
The Rise and Fall of Modern Medicine (LeFanu), 262
risk factors
heart disease, 5, 30, 106, 252
Rofman, Sam and Elaine, 80
Rogaine, 97
Rudy, Arthur
friendship with the author, 11–12, 122, 124–28, 152, 199, 207
motivation to be a psychologist, 200, 205–8, 211–12, 267
personality, 199
responsibilities as a psychologist, 11, 200, 297–98
support for the author prior to surgery, 79, 81
in Vietnam, 209–11, 213–14, 219
views: on his future, 298; on the role of psychotherapy, 103–5
Sachs, Fred, 300
Saving the Heart: The Battle to Conquer Coronary Disease (Klaidman), 33–34
Schaufenster schauen strategy, 65, 66
self-revelation and self-reflection, 202
September 11 attacks, 151, 152, 285, 298
serendipity, role in medical discovery, 114, 268, 270–71
Seth
at the hospital during author’s surgery, 12, 14, 84
visit with author after surgery, 17
wedding, to Miriam Neugeboren, 12, 57, 130
Siegel, Asher, 192
smoking
as risk factor for cancer, 111, 113, 116, 117
as risk factor for heart disease, 5, 24, 106
tobacco marketing, 291
social aspects
effects of a caring relationship on recovery, 149–51
importance of family and friends.
See family; friends
loneliness, 50, 55, 56, 58, 64, 129
societal aspects
access to health care, 41, 175, 282, 285–87
medical training and service, 166
responsibility to other human beings, 166, 287–88
responsibility to provide doctors and universal health care, 166, 175, 289
South Africa, 281–82, 284, 285
specialists
financial incentives, 295
“gatekeeping” in managed care, 35, 292
vs. general practitioners, 246
spiritual aspects, balance with modern medicine, 184
statins, 259. See also Baycol; Lescol; Lipitor; Mevacor; Pravachol; Zocor
stent. See angioplasty, stent
steroids, 268
stethoscope, use in heart disease diagnosis, 35–36
stress
of the author prior to surgery, 47, 50–52, 61
as risk factor, 24
stress test
as predictor for heart disease, 30
procedure, 68
stroke
with coronary bypass, 9
MRI for diagnosis, 231
with open-heart surgery, 44
with type 2 diabetes, 107
surgery. See coronary bypass; heart transplant; open-heart surgery
symptoms
asymptomatic heart attack, 25, 28–29
of the author prior to surgery, 5, 8, 47, 49–62
vs. causes of disease, 87
teaching positions, of the author, 13, 57, 82
technology
economic and policy issues, 290
“halfway technologies,” 44–45, 87
limitations, 21, 101, 133, 244
limited impact on mortality rate, 109, 111–12, 119, 294
media hype, 27, 38, 45, 114–15, 133
need for proper training, 37–38, 133
needless and costly overuse, 37, 101, 146, 162–63, 294
short timeframe for obsolescence, 37–38
vs. listening to the patient, 38, 167–68, 202–3, 243–44, 248, 291
Thomas, Lewis, 256
Thorsen, Dr. Gerd-Ragna Bloch, 177, 178
Thursday Night Cardiac Clinic, 243
thyroid scan, 77
thyroxine, 86
Time Special Issue: The Frontiers of Medicine, 27
Time to Heal (Ludmerer), 168–69
tobacco. See smoking
Transforming Madness (Neugeboren), 53, 66, 82, 300
trauma, 153. See also post-traumatic stress disorder
traumatic injury to the brain, 105, 220–23
trust
adherence to medications and, 41, 153–54, 180
lack of continuity and time to develop. See managed care
mind-body relationship and, 154, 265
qualities that engender, 146–47, 153. See also listening to the patient
role in psychotherapy, 202
tuberculosis
economic aspects of vaccinations, 285–86
integration with HIV prevention and treatment, 283
as major cause of death, 1800s-early 1900s, 91
mortality rate decline, late 1900s, 109
reemergence, 102
streptomycin treatment, 268, 270
treatment curriculum developed by Friedland, 192
United Nations program, 286
typhoid, 109
United Nations, 286
United States
average health spending annually, 286
dismal response to international epidemics, 286
health-care system. See managed care
Medicare, 163
mortality rates. See mortality
universal health care, 166, 175, 289
University of Massachusetts
basketball games, 13–14, 17, 80, 120
teaching position (as professor and writer in residence), 13, 57, 82
vaccinations
effects on mortality rate, 109–10
immune system and, 256
vasodilators, 70
Vasotec, 70
ventricular assist devices, 94–95
viral infection. See also HIV
antiretroviral treatment, 40–41, 255, 282–83
diagnosis of possible, 8, 70, 71, 247
ebola, 255
heart disease symptoms, 248
natural selection and, 255
Waksman, Selman, 270
weight
as risk factor for cancer, 117
as risk factor for heart disease, 30, 249
as risk factor for type 2 diabetes, 106
white blood cells, 248
Whynott, Doug and Kathy, 66, 81
Why We Get Sick: The New Science of Darwinian Medicine (Nesse and Williams), 271
Wise, Dr. Carl, 77
women
communication style in relationships, vs. men, 125
hormone replacement therapy, 295
menopause and heart disease, 129–30
mortality rate for breast cancer, 28
mortality rate for heart disease, 28–29
World Health Organization (WHO), 286
World Trade Center, 151, 152, 285, 298
writing career of the author
book on Moe Armstrong, 17
book tour, 124
first weeks after surgery, 17, 121
inspiration for this book, 18–19
prior to surgery, 47
Transforming Madness, 53, 66, 82, 300
visualization of, 12
x-rays, 230
Yale-New Haven Hospital (New Haven, Conn.)
author’s decision to go to, 73, 79
Yarnell, Barbara, 217
Yarnell, Phil
author going on rounds with, 2, 215–16, 220–21
childhood and adolescence, 10, 12–13, 228–29
as a consultant, 10, 136–37, 245
friendship with the author: during adolescence, 12–13; after author’s surgery, 128, 202; importance of, 2, 13, 46–47, 124–27, 220; prior to author’s surgery, 1, 10, 12, 47, 79, 81
medical responsibilities, 2, 10, 161–62, 215–16, 225–26, 297
motivation to be a neurologist, 99–100, 226, 232, 233–34, 267
nickname, 227
office decor, 217–18, 223, 296
ranch in Kiowa, Colorado, 10
sculptures by, 218
views: on Arthur Rudy, 219–20; on death of a young woman, 221–25; on drug/technology marketing, 97, 133; on history of neurology, 229–31; on Jerry Friedland, 46, 281; on managed health care, 232–33