If I can stop one heart from breaking, I shall not live in vain; If I can ease one life the aching, Or cool one pain, Or help one fainting robin Unto his nest again, I shall not live in vain. Sometimes, as physicians, as care givers, this is all we can do.
The Dermatologist, My Father and Me
To cure sometimes, to relieve often, to comfort always. Abstract: The patient, a teenage boy with early male-pattern alopecia, is brought to a respected academic dermatologist at a famous medical center for an opinion. Sixty years later, the experience still resonates. Keywords: doctor-patient communication, alopecia, baldness, consultation, cruelty, male pattern alopecia My father was especially sensitive about being bald, which, in the context of the 1950’s, was not unusual. So, when I was in my mid-teens, and the familiar signs of thinning and receding hair began to show, he took me to see a dermatologist. Determined to spare no expense to find a cure for my impending affliction he had … Continue reading
Same-old, Same-old Grand Rounds
“The student begins with the patient, continues with the patient, and ends his studies with the patient, using books and lectures as tools, as means to an end.” — Sir William Osler, Aequanimitas, 1905 Keywords: grand rounds, incontenentia pigmenti, VGRD, academic medicine, continuing medical education, CME I recently attended a regional Dermatology Grand Rounds held at an academic medical center. The first such meeting I attended was over 45 years ago. The recent program featured live patient viewing of around 20 people with a variety of unusual skin disorders. Around 150 – 200 dermatologists were present. It started with a 1.5-hour patient-viewing during which we all trooped around the clinic … Continue reading
Grand Rounds Circa 1990
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, … Continue reading
Human Microbiome (Introduction)
The human microbiome is the collection of microorganisms (such as bacteria viruses and fungi) which live on and inside humans (on the skin, in the saliva and mouth, in the eyes, and in the gut and the rest of the gastrointestinal tract). Foreign microbes outnumber human cells in the body a wide margin; humans have about 100 trillion cells, and carry ten times as many microorganisms in the intestines alone. We know that some of these organisms are useful for humans. However, most have no known effect; they are just symbionts and are referred to as the normal ‘flora.’ Studies in 2009 asked whether our health is damaged if we reduce this biota (collection of … Continue reading
Hunting for Bear: A Melanoma Postscript
Hunting for Bear: A Melanoma Postscript by Tim Guetti Abstract: A 62 year-old man relates his experiences after being diagnosed with an acrolentiginous melanoma on his foot. The surgery interferes with his plans to go on a father-son bear hunt. We hear and read many stories about the diagnosis and treatment of melanoma, but few relate what is important to the patient with the disease. Keywords: hunting, bear, melanoma, foot, acrolentiginous, melanoma, father, son My story begins a few years back when my son Scott, now 39, said to me “Dad, we need to go on a hunt.” It had been many years since we had been on a “hunt” … Continue reading
The Rudolph Sign
The Rudolph Sign: Red Nose as a Sign of Nasal Infection [Dahle and Sontheimer reported a case of what they dubbed “nasal vestibular folliculitis” (NVF) in the Dermatology Online Journal1 in March of 2012. We saw a similar patient in November 20122. Our patient has provided his history here, to add to the literature on NVF. With each new case, we will learn more about this emerging disorder.] “I’m an 81 years old man, and if I remember correctly, I initially noticed tiny growth(s) in my nostrils. They were annoying more than painful. After a few days, my nose and face became swollen and painful (7 on the pain scale3). That … Continue reading
Quilted
Clara Luu’s poem is the most eloquent description of severe atopic dermatitis ( often called S.A.D.) that I have come across in a long dermatological career. If you read it, you don’t need all the textbooks or review articles. It speaks to what we are trying to do with the OJCPCD. Persistent scratches ripping through the tranquility of the night, and bedsheets dusty with flaked skin, mingled with dried blood in the mornings. Her skin stained with the purple sting of potassium permanganate, burning from the relentless scorch of tea tree oil, smothered in topical corticosteroids. Bandaged to retain moisture. Unbandaged to promote air flow. A blur of diagnoses and … Continue reading
Hand of Angel
“I Want Too Hold Your Hand” by Corinne Viens. Abstract: Dermatologists perform many minor surgical procedures on patients who are often anxious and/or needle-phobic. The simple act of holding a patient’s hand during the injection of local anesthetic has a calming and therapeutic effect. This essay is the personal experiences of a professional hand holder and her reflections on this service to the patient. Keywords: minor surgery, surgery, anxiety, needle phobia, hand holding, comfort, dermatology In the dermatology office where I have worked for nearly twenty years, I often hold the hands of patients while the doctor administers the local anesthesia prior to their procedures or, if they are exceptionally … Continue reading
Chronic Telogen Effluvium?
Chronic Telogen Effluvium Hope never dies. Having lived with chronic telogen effluvium for 14 years, I still find myself hopeful that the current shedding that I am experiencing will be my last, that the new ¼ inch hairs that are now sprouting on my scalp will be the real thing – that they will live out the normal cycle of hair growth and shedding. Yet, I know realistically that this is not what will happen. I continually shed and grow hair, but the cycle is such that by the time new ¼-inch hairs reach a length of two inches, the old two inch hairs shed. Consequently, my hair is always … Continue reading
