Wives, Yes; Husbands, No (Essay 26)

Bernard Lown, MD

The above title, instead of enlightening, mystifies. Is this some sort of reverse sexism or political correctness gone awry? Actually, it reflects a deep clinical truth that took me years to fathom. Wives know more about their husbands’ health problems than husbands know about their wives’ or even their own.

Many years ago I began to encourage husbands to make sure that their wives accompanied them on medical appointments. At times I was very insistent that the wife come along, and rarely I even indicated that a return visit would be postponed if the wife could not be present. Yet I cannot recall ever telling a married woman to bring her husband. I must confess that at the time I began this practice, I did not fully understand the basis for my insistence that wives be present.

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Black Blood Must Not Contaminate White Folks (Essay 25)

Bernard Lown, MD

In the mid-20th century the Johns Hopkins Medical School was at the apogee for training doctors in the US. My matriculating there was a fluke. Every other medical school I had applied to rejected me. It was not because of low scholastic achievement. On the contrary, I graduated summa cum laude from the University of Maine, with a near 4.0 point average as well as with departmental honors in genetics and biology. The majority of my premed college colleagues, with lesser academic records, had been readily accepted. My Jewish heritage was the unbreachable impediment. The dean of the Harvard Medical School made no bones about the matter. In an interview he told me outright, “We have already filled the quota allotted to your people.”

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US Media: Unending Frustration (Part III) (Essay 24)

Bernard Lown, MD

If transformed into a Martian, I would be in utter awe of the power of the US media to shape global opinion. At no time was this more evident than during the Cold War, when the US, time and time again, bested the vast Soviet propaganda machine. The American media convinced the world that the Soviets were ahead in sophisticated nuclear weaponry, that they were outspending us, and that they were planning a first strike. In short, the Soviets were driving the nuclear arms race while Washington was doing all in its power to halt and reverse it.

As a close observer of the international political scene, with entry to a number of key Kremlin policymakers, I found the converse to be true. America’s overpowering drumbeat was the pacesetter in the cacophonous rhythm of the nuclear danse macabre. Had this been a pre-atomic-age arms race, no clever PR could have concealed the overwhelming asymmetry of the competition. With the colossal destructiveness of even a single hydrogen bomb, “superiority” and “inferiority” were irrelevant descriptors of military power. This reality was crisply captured by the prevailing acronym, MAD, for “mutually assured destruction,” to describe the strategic doomsday reality of those perilous days.

From the very outset of the atomic age, the US aimed to monopolize nuclear weapons in order to maintain its global dominance. To do so, the American public had to be sold a benign, even felicitous, view of the atom. First and foremost it required blocking the dissemination of the unspeakable genocidal horror inflicted on Hiroshima and Nagasaki. Indeed, for seven years after the atomic bombings American occupation authorities in Japan prohibited survivors from circulating their stories; they withheld medical reports, news articles, poems, and even private letters depicting the gruesome effects. (1, 2) Over the next 40 years the United States engaged in the complete suppression of all films shot in Hiroshima and Nagasaki. (3)

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Sudden Cardiac Death: Resuscitation or Resurrection? (Essay 23)

Bernard Lown, MD

In early January 2011 my son, Fred, drove me to the Brigham and Women’s Hospital emergency ward for a recurrent intestinal obstruction. The streets from our upscale suburban home are full of potholes. For the first time I experienced each one as a painful jab in my distended belly. Arriving at the hospital I was in no mood to socialize. Beside me at the check-in desk was a familiar face, a heavy-set, elderly, unkempt woman in a wheelchair. Scraping my distracted memory evoked no name, no identity, no hint of recognition.

The woman made an announcement for all in earshot: “This is Doctor Lown, the greatest doctor in the world.” My contorted bowel remained indifferent to this ego enhancing proclamation.  It did however awake a dormant memory.  I finally recognized her. She was Priscilla , the wife of the Reverend Keith Johnston, who had been a patient 36 years ago on my service in this very hospital. The reason for his hospitalization then  was due to a cardiac arrest, from which he had been  resuscitated with difficulty. Priscilla told me that her husband had been now admitted with a massive cerebral bleed and was not expected to survive. I later learn that he died that very week.

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Ivan Pavlov is alive and well, though forgotten (Essay 22)

Bernard Lown, MD

Clinicians soon learn that many of the problems they confront derive from the rough and tumble of living. This was true for me as well, a cardiologist with a global referral practice. Psychological problems were commonly in the forefront of whatever medical reasons brought patients to Boston. I aimed to fathom the emotional stresses that amplified or even provoked the presenting symptoms.

The lay public grasps that life stresses shape and even cause illness. For example, when questioned why anyone suffers a heart attack, a majority point to stressful living. This understanding is embedded in our language, from “heartache” as a designation of emotional anguish to a “broken heart” as a cause of sudden death. Such an association long antedates modernity and was brilliantly captured in ancient Greek tragedies. It brims in Shakespeare’s plays. A brief two lines in “Macbeth” capture the essence: “Give sorrow words: the grief that does not speak/
 Whispers the o’er-fraught heart, and bids it break.”
(Act IV, Sc. III)

The relation between the “o’er-fraught heart” and symptoms is not always temporally sequential. One does not necessarily follow the other. The ache or dizziness or other troubles may be preceded by some innocuous or inconsequential event. To illustrate: Cardiologists often encounter patients presenting with angina pectoris. This consists of a tightening behind the breastbone provoked by exertion, usually while hurrying outdoors, especially after a meal. It reflects narrowed coronary arteries that limit the transport of oxygen to the heart when the demand for blood flow is increased by exercise. But at times angina is provoked by something seemingly unlikely to deprive the heart of oxygen.

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A Supreme Court Justice in the Examining Room

Bernard Lown, MD

My admiration for the Supreme Court dates to the Roosevelt era. The majesty of law then seemed dazzling. Dominated by four judicial giants — Hugo Black, William Douglas, Robert Jackson, and Frank Murphy — the court had never before been more progressive, nor has it since. These justices were committed to sustaining a vibrant democratic constitution, favoring the inalienable rights of the individual against the insistent demands of property. Then something unimaginable transpired. The same Supreme Court abandoned liberal constitutional principles to serve the momentary desires of the state.

In 1940 the Supreme Court, in an eight-to-one decision, approved the rights of a school board in Pennsylvania to expel two young children for refusing to salute the flag and recite the Pledge of Allegiance. The children, William and Lillian Gobitis, aged 10 and 12, who were Jehovah’s Witnesses, maintained that their undivided loyalty to God would be compromised by what they regarded as idolatrous practices.

Worse was soon to follow. In 1942 the U.S. government expelled 110,000 Japanese Americans who lived along the Pacific Coast and forced them into detention camps. Two years later the Supreme Court upheld the constitutionality of the internment. My judicial hero, William Douglas, supported the constitutional legitimacy of President Roosevelt’s executive order, maintaining that the internment was about loyalty, not race, and that disloyal Americans could be incarcerated in times of war.

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A Troubled Patient

Bernard Lown, MD

Doctors pride themselves on practicing evidence-based medicine. That is the simplest part of it. Far more difficult is practicing personalized medicine. Still more difficult is engaging in a practice that bonds two human beings. The proof of the miraculous comes when a patient permits a doctor to look deep into her eyes.

Patricia eventually did, but only  after a decade of jousting. She was not demanding, merely exerting the mysterious power of the persistent powerless, the constant drip of water that splits granite. She was frequently provoking, nearly reaching the limits of my patience. Several times Patricia dismissed me as her doctor, rarely followed my advice, and in many sessions remained mute, yet our relation flourished for nearly 30 years.

Once or twice a year she came trekking from Pennsylvania to Boston, a round trip of 16 hours. During the first decade, rather than face me, Patricia sat sideways looking at a diploma-covered wall and engaged in a soliloquy with a seemingly absent doctor. While being examined, her eyes were shut tight as though glimpsing at me would transform her, like Lot’s wife, into a pillar of salt.

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