Richard Ratzan

Drowning is a cause of significant morbidity and mortality worldwide. In most circumstances, the proximate cause is attributable to human factors, such as inexperience, fatigue, intoxication, or hazardous water conditions. The phenomenon of drowning incidents precipitated by unusual circumstances (DIPUCs) – either fatal or nonfatal – involving othe...

In Reply Dr Scott raises an interesting and valid objection to my essay.¹ Why not appreciate the aspects of science that elucidate beauty and truth, ie, their humanistic aspects? I agree with that assertion but disagree with his thesis that implies that such wonder in science can equal or replace the humanistic benefits of a humanities education. T...

Forty-one years ago, physician-essayist Lewis Thomas proposed that applicants to medical school who were traditional premed science majors be considered last, if at all, for admission.¹ Instead, he wrote, preference should be given to students who concentrated on “some central, core discipline, universal within the curricula of all the colleges, wh...

Spontaneous spinal epidural hematoma (SSEH) is a rare diagnosis. One known risk factor is anti-coagulation medication. We present a case of SSEH in a 74-year-old male on rivaroxaban therapy who clinically presented with an intermittently resolving and then worsening neurological exam. Due to the extremely high morbidity and mortality associated wit...

Like most EM physicians presented with a wide assortment of patients I've never seen before, will probably never see again, and cannot schedule for a more convenient return visit when there are not three ambulances pulling up to the door, I sometimes get a bit cranky when I interview a patient who has registered for a less-than-valid "emergency." A...

For more than 50 years lidocaine has been used to treat ventricular arrhythmias. Neurologic dysfunction, manifested as a stroke, occurred acutely in an 87-year-old woman after she had been administered repeated doses of lidocaine, a lidocaine infusion, then an intravenous amiodarone infusion for ventricular tachycardia. This was ultimately diagnose...

mary shelley;frankenstein;monster;travel stories;disagreement

Emergency physicians frequently encounter patients whose medical conditions represent a risk of loss of control while driving, e.g., epilepsy and diabetes. In certain states, physicians are under a legal obligation to report such drivers to the motor vehicular authorities. To determine the uniformity of legislated reporting requirements for physici...

In lieu of an abstract, here is a brief excerpt of the content: Journal of the History of Medicine and Allied Sciences 57.3 (2002) 349-350 Book Review The Words of Medicine: Sources, Meanings, and Delights Robert Fortuine. The Words of Medicine: Sources, Meanings, and Delights. Springfield, Illinois, Charles C. Thomas, 2001. xvi, 424 pp. $84.95 (...

Radical changes are occurring in medicine which are impacting the practicing physician. This is especially true for specialists caring for very acutely ill patients such as those with congenital heart disease. This article explores developments such as the reversal of fiscal and medical paradigms, risk-averse behavior, price-based costing, and comp...

Richard M. Ratzan is an associate professor in the Department of Medicine at the University of Connecticut School of Medicine. His essay "Winged Words and Chief Complaints: Medical Case Histories and the Parry-Lord Oral-Formulaic Tradition" appeared in the Spring 1992 issue of Literature and Medicine.

Richard M. Ratzan is an associate professor in the Department of Medicine at The University of Connecticut School of Medicine. He was a Classics major at Trinity College, Hartford, Connecticut, where he studied with Albert E. Merriman and James A. Notopoulos. I would like to dedicate this paper to the memory of my teacher, James A. Notopoulos, a Ho...

In his writings, Edmund Pellegrino analyzes four deficiencies in the humanity of those who fall ill: the loss of (1) freedom of action, (2) freedom to make rational choices, (3) freedom from the power of others, and (4) a sense of the integrity of the self. Since Pellegrino's analysis and commitment to virtuebased ethics preceded much of the attent...

To the Editor.—We were surprised to receive a copy of the article by Drs Denenberg and Smith1—via a third party—criticizing our article on physician advertising,2 and further surprised to read the editorial footnote stating the need for a refutation in print of our article. Neither the authors nor the editor cited the correspondence between Drs Den...

In Reply.— We appreciate the interest shown by those who wrote concerning our work and we hereby reply. Dr Emanuel undercuts his protest that we did not employ his schema for evaluating risk: no needle-stick data support the suggestion that any physician anywhere is likely to stick oneself 5 to 10 times per year. This is not only an unverifiable a...

WE recently tried to verify the credentials of physicians who advertise in the Yellow Pages of the telephone directory, and were dismayed to discover that we could not get the information we needed about their training.1 We were consequently unable to answer certain questions — e.g., how many years of specialty training did each physician have — an...

This article has no abstract; the first 100 words appear below. This compendium of 74 interviews was obtained from people who work at Columbia–Presbyterian Medical Center. The interviewer, a medical sociologist, spent many days, nights, and parts of weekends at the hospital from 1985 to 1988 talking to security guards, gardeners, clerks, nurses, tr...

KIE The obligation of the medical profession to ensure that autopsy is available for AIDS patients is analyzed from the historical perspective of the risk and sacrifice inherent in medicine and the ethical obligations and responsibilities of physicians. Inappropriately avoiding autopsies in AIDS patients causes potential harm to the decedent, the l...

This article has no abstract; the first 100 words appear below. Some years ago I was discussing physician-writers with Anatole Broyard, a book reviewer for The New York Times. We eventually came around to Robert Coles. "Ah, Dr. Coles," Mr. Broyard fairly whistled into the telephone, "he can write about anything." As this sampler of 41 of his essays...

This essay is about loss. Yesterday night, while on duty, I sat on a patient with pneumococcal meningitis for six hours before tapping him. He’s ok, but I (and he) had a near miss. As physicians we all have near misses from time to time. Some are our doing (“fault” is so harsh, so Old Testament). Some aren’t. Near misses serve a purpose, if you loo...

Without the constant support and sound advice of our fellow editors we would not have been able to complete this volume. We are especially grateful to Anne Hudson Jones for her editorial expertise and her sage counsel. We appreciate the help of Alice Schreyer, Head of Special Collections at the University of Delaware Library, in locating and securi...

This article has no abstract; the first 100 words appear below. This is a difficult book to review. For one thing, the author is obviously in love with his subject. As the physician who wrote the introduction has said, Dr. Kail has written for the "joy of it, reflecting the delight he has had as an enthusiastic Shakespearian." Not even the most cal...

A 73-year-old man presented to the emergency department twice with nonspecific abdominal pain. He was diagnosed as having mild diverticulitis and was discharged. Four days later he presented to the emergency department in severe abdominal pain with scrotal and penile ecchymoses. After an initial urologic consultation the correct diagnosis of ruptur...

We compared the specialty listings of physicians in the Yellow Pages of the 1983 Hartford, Connecticut, telephone book with the board certifications in specialties of the American Board of Medical Specialties as listed in the American Medical Association directory or the Marquis Directory of Medical Specialists. There were 1179 listings by 946 phys...

This article has no abstract; the first 100 words appear below. This book is a joy to read and to review. The content, with a few minor exceptions, is excellent. Its conception, format, and execution are at least as important as its treatment of a heretofore neglected subject in medical ethics. For those of us interested in this area, the periodica...

This section is reserved for commentaries and brief essays dealing with matters of interest to physicians. Material for consideration should not exceed five double-spaced typewritten pages. An honorarium of $75 is offered at the time of publication. Submissions should be addressed to: Editor, POSTGRADUATE MEDICINE, 4530 W 77th St, Minneapolis, MN 5...

Risk is inherent in every medical setting. Emergency medicine is an especially risky specialty for both patient and emergency physician, eg, the risk of death from trauma and the risk of adverse outcome from medical intervention that can't wait for more favorable circumstances. Risk assessment (the numerical quantification of certain risks) and ris...

All emergency departments face the possibility of having insufficient personnel to provide adequate care for patients. Such occasions may present an emergency department with several severely injured patients or merely an unusually large number of that emergency department's usual patient profile. When such staffing inadequacies occur, emergency de...

Mental incompetence in an elderly person who needs medical intervention represents a considerable problem for physicians, since mental incompetence can interfere substantially with medical care. To address such a problem successfully—that is, to perform the intervention with an ethically obtained informed consent—a physician may have to delay thera...

In 1983 a colleague invited me to join in teaching an elective course in literature and medicine offered to second-year medical students. One of my favorite sessions ever since has been a group of readings called "Self-Description of Disease." First-person nonfiction narratives can make invaluable contributions to a student's understanding of disea...

Obtaining a valid informed consent from an elderly person, especially with possible senile dementia of the Alzheimer's type (SDAT), first may involve solving the practical problems of effective communication. Perceptual constraints that frequently occur in the elderly and that may interfere with communication, i.e., the sharing of information, are...

This article has no abstract; the first 100 words appear below. If the most interesting event in the inanimate world was the appearance of life, and the next most interesting event the appearance, shortly thereafter, of death, then any observer still capable of surprise must have marveled at the next, intellectually stupendous and even more complex...

By virtue of their professional ethics as healers and because of their specialized technical knowledge and clinical experience in assessing and reacting to real and potential emergencies, physicians have an obligation to offer an unsolicited medical opinion when the following conditions are met: (1) physicians assess a high probability of potential...

Although several authors have recently championed the cause of informed consent in clinical geriatrics,1–4 few have dealt with specific, nuts-and-bolts issues involving technique. And yet, as any mouse who has tried to bell the cat can tell you, once the idea mice have had their say, technique is everything. In this paper I shall treat such technic...

This article has no abstract; the first 100 words appear below. I often muse about great teachers and history. I wonder, for example, about smallpox and Parkinson's disease, and about what would have happened if one of John Hunter's assistants, instead of the master himself, had performed the pedagogic chore (as it is looked on nowadays) of teachin...

The failure of a clinical research project to recruit elderly institutionalized subjects for participation in an experiment designed to evaluate sweat patches for the estimation of digoxin levels is recounted in detail. Of 312 institutionalized patients, all 11 who fulfilled criteria for participation refused for reasons of comfort and/or fear of v...

I WISH nurses, or whoever's been doing it, would stop tying our patients to bedrails and geri-chairs. Since no physician I've spoken to has ever seen the actual tying-on by hands, and no nurse that I've ever asked has confessed to tying them, the knots, like the shoemaker's new shoes, seem to be the work of elves. There's certainly ample evidence t...

Rabies continues to be a modern day disease and, until recently, one of the few infectious diseases with 100% fatality rate, despite treatment. This paper will provide a comprehensive review of the history, epidemiology, pathophysiology, and clinical features of rabies. Part of the mission is to understand the changing epidemiology of domestic rabi...