Mens sana in corpore sano —Juvenal
My Road to Ground Rounds—and the Results!
By H. J. W.
Abstract: These are the recollections of an 84 year-old man who was presented at Grand Rounds 22 years ago. He had dermatomyositis at time. His observations are important as they reflect on the academic activity and also the evolution of one man’s experience with dermatomyositis.
Keywords: dermatomyositis, grand rounds, illness narrative, academic medicine, pruritus, Massachusetts General Hospital
Twenty years ago when my glass shower door came off its track, I had a hard time lifting it back into place. “Am I getting weaker?” I thought. My upper body itched. I had no pep, and couldn’t sleep. I felt lousy! My family doctor was puzzled and suggested I see a dermatologist. He, in turn, recommended a rheumatologist. After looking at me and reading the reports, I was sent to an academic specialist at the Massachusetts General Hospital for a complete work-up.
After three days at MGH, a definitive diagnosis was arrived at: Dermatomyositis. Previous to this, I had been a generally healthy 63-year-old man with a wonderful life: a happy marriage, two great kids, a job I loved. I canoed, skied, swam regularly, and attained a karate second degree Black Belt. Over a short period of time, outside concerns, while they had previously impacted minimally on my life, were spinning beyond my control. Nightmares from the Korean War recurred frequently; multiple serious migraines now affected my personal and professional life.
Dermatomyositis is not a common disease. The Big Kahuna in Boston told me that he would make me an incredible offer: He would have me looked at by a great number of dermatologists—multiple simultaneous consultations probably worth thousands of dollars, or words to that effect. I was led to believe that someone might come up with a solution; so I agreed.
By this time, parts of my body were itching severely; some areas of my skin had become the color of ripe tomatoes; my eyelids looked like heliotrope leaves; my scalp burned and itched. I was very weak. My wife had to change my bed linen twice a day, because my skin bled profusely at the slightest scratch. I could be tracked by following the large flakes of skin that peeled off my scalp.
At Grand Rounds I was given clear instructions. The Big Kahuna would bring in groups of physicians and their apprentices. I was told not to say a word—just sit there, half-naked, exposing my wares to be ogled, touched, and probed; in short, to be on display like a piece of meat. After the viewing, the procession of savants filed into an amphitheater for discussion. I informed the Big Kahuna that I wanted to attend the post- mortem. He told me that I could with the stipulation that I only listen. Period. I neither agreed nor disagreed with his terms.
I remember the Big Kahuna addressing the scholarly convocation and stating that, in his opinion, lupus was preferable to dermatomyositis. In the end I violated the sacred covenant. Standing up, I introduced myself to the assembly and begged for an opinion on how to control my infernal scalp itch. An Angel spoke up and said he had seen this condition before and had treated it successfully. Later I found out the Angel’s name, contacted him and subsequently became his patient at another well-known clinic. Not only did he treat me effectively, this Angel also stayed in contact with my local doctors.
Thanks in addition to a now retired internist, rheumatologist and a terrific nurse/assistant, I am in remission 20 years later to suggest that if anyone reading this is asked to be a piece of meat at what I now call Ground Rounds, please subject yourself to this reasonable sacrifice of time where many doctors and trainees will get to see you. Someone there may just know how to help an “uncommonly afflicted” fellow human being. But… be sure to attend the ensuing discussion to assure that your “case” gets the attention it deserves.
As far as I understand, Grand Rounds are convened when there is something to be learned. To whomever it was that subjected themselves to some previous Ground Rounds where my Angel dermatologist discovered that atabrine/quinine could help my intolerable scalp affliction, I offer my heart-felt “THANK YOU!”
Disclosure: These are my recollections from over 20 years ago. I am now almost 84 years old and sometimes question the accuracy of my memory. Sorry ’bout that. The message is clear: Grand Rounds can be a useful teaching vehicle. We all stand to profit from those pieces of meat that preceded us.
HGW’s case was reported in Fitzpatrick’s Journal of Clinical Dermatology, March/April 1994, pages 24 – 28
PDF Version: Grand Rounds MGH
Jonah Zuflacht wrote us:
“I find it interesting that the Big Kahuna asked the patient to be on display at Grand Rounds but explicitly told the patient not to speak. One of the benefits of having the patient in the room while discussing the case is that he is able to communicate how he is affected by DM. To shut him up is to devalue the important role he plays in the learning endeavor.”