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Elmira - Steele Memorial Library 1 610.695 REI Adult NonFiction Book
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Summary

Summary

An epic story told by a unique voice in Ameri-can medicine, One Doctor describes life-changing experiences in the career of a distinguished physi-cian. In riveting first-person prose, Dr. Brendan Reilly takes us to the front lines of medicine today. Whipsawed by daily crises and frustra-tions, Reilly must deal with several daunting challenges simultaneously: the extraordinary patients under his care on the teeming wards of a renowned teaching hospital; the life-threatening illnesses of both of his ninety-year-old parents; and the tragic memory of a cold case from long ago that haunts him still. As Reilly's patients and their families survive close calls, struggle with heartrending decisions, and confront the limits of medicine's power to cure, One Doctor lays bare a fragmented, depersonal-ized, business-driven health-care system where real caring is hard to find. Every day, Reilly sees patients who fall through the cracks and suffer harm because they lack one doctor who knows them well and relentlessly advocates for their best interests. Filled with fascinating characters in New York City and rural New England-people with dark secrets, mysterious illnesses, impos-sible dreams, and many kinds of courage-One Doctor tells their stories with sensitivity and empathy, reminding us of professional values once held dear by all physicians. But medicine has changed enormously during Reilly's career, for both better and worse, and One Doctor is a cautionary tale about those changes. It is also a hopeful, inspiring account of medicine's poten-tial to improve people's lives, Reilly's quest to understand the "truth" about doctoring, and a moving testament to the difference one doctor can make.


Reviews 2

Booklist Review

Reilly's medical narrative nicely intertwines true stories of challenging patients ­difficult diagnoses, tough medical and ethical decisions, and the management of critically ill people with valuable lessons on doctoring and patienthood. A fever of unknown origin, profound thyroid deficiency, severe hypoglycemia, chest pain, delirium, bleeding bladder cancer, and life-threatening infection of a heart valve are some of the medical problems encountered. Reilly, a hospital physician with 40 years of experience, also recounts caring for his elderly parents. He writes about the importance of grunt work in medicine, sustained doctor-patient relationships, and clinical instinct. The doctor confesses, Over the years I've learned to listen to my gut, but that doesn't mean I can trust it. Indeed, medical decision making can be hard and hazardous. Risk and probability always factor into it. A medical problem can be handled in multiple ways, but outcomes are never guaranteed. Benefit and harm are both possibilities. Reilly admits that physicians know lots about regret but rarely discuss it. Empathy and thoughtfulness One Doctor has oodles of it.--Miksanek, Tony Copyright 2010 Booklist


Publisher's Weekly Review

He was chair of medicine at Chicago's Cook County Hospital, on which the hit TV show ER was based, and Reilly-now at New York-Presbyterian/Weill Cornell Medical Center-matches the heart-pounding pace and drama of that fictional show in this remarkable memoir. Reilly painstakingly relates his most challenging cases, beginning in the present-when he sees 19 ER patients on an average day-before backtracking to his early career at Dartmouth in 1985. That year, Reilly struggled to identify the cause of an eccentric and lovable patient's delirium. By the time he figured it out, the patient-Fred-had died. "[H]ealth providers still feel guilty when things go wrong," Reilly notes of that troubling cold case, but he insists it made him a better doctor. After all, harm is inherent in the pathway to healing: "in a brave new post-Hippocratic world, medicine's venerable first principle had become an empty shibboleth.... First, do no harm?... If we didn't do harm, we couldn't do good." It's a sobering reminder that though medicine is a science, it is not an exact one. Fast-forwarding to today, Reilly describes another wrenching struggle: making end-of-life decisions with his own elderly mother. But his book is about more than the joy of saving lives and the sadness of losing them-it's an intimate exploration of modern medicine and the human condition. Agent: Janis A. Donnaud, Janis A. Donnaud and Associates. (Sept. 3) (c) Copyright PWxyz, LLC. All rights reserved.


Excerpts

Excerpts

One Doctor INTRODUCTION Live a simple and temperate life, that you may give all your powers to your profession. Medicine is a jealous mistress; she will be satisfied with no less. --Sir William Osler (1904) Despite this famous advice from a legendary physician, most doctors don't live a simple life. All of us, seduced at an early age by Osler's mistress, conduct our own lifelong affair with medicine. This book is about mine. One Doctor is a true story about real people--most of which took place during two weeks in the winter of 2010. It recounts, in sometimes intimate detail, my doctoring of patients in the wards, emergency department, and intensive care unit of a renowned teaching hospital in New York City. These experiences exemplify many of the challenges doctors and patients face today in the dramatic, high-tech world of modern medicine. But doctoring has changed, not just since Osler's time but during my own time, too. For this reason, my story flashes back to long ago when I worked as a primary care physician in a small New England town. There, I did a different kind of doctoring, now largely forgotten or obsolete, when physician-patient relationships were deeper and more enduring than in today's "provider-consumer" medical culture. This difference--the contrast between doctoring then and doctoring now--lies at the heart of my story. It is a cautionary tale, but a hopeful one, too. My story is unusual in three ways. First and foremost, I am a dinosaur, an old-fashioned internist, a species of doctor on the verge of extinction. Although every doctor's perspective is unique, mine reflects the passing of a notable era in medicine. During my career, doctors like me served not only as their patients' primary care physician but also as an expert in the many subspecialties of internal medicine. As Osler did in his time, we cared for our patients whenever they needed us, day or night, and wherever they were--in the office or intensive care unit, in nursing homes and in their own homes. Such a task, daunting in the past, is impossible today. Medicine has changed irrevocably--on balance, I believe, for the better--and I harbor no hope of saving dinosaurs like me. But I am convinced that, as medicine continues to evolve, future doctors (and their patients) will do well to remember my medicine, my mistress. She is a goddess, her power and charms divine. But, like Osler's mistress, she is also a gadfly--a principled, perfectionist pain-in-the-ass--which my profession (and, I believe, modern society) can ill afford to lose. It is her spirit that I try to capture, and preserve, in this book. Second, I tell my story in an unconventional way, in the first person in real time. I describe my own actual in-the-moment, minute-to-minute experiences as seen through my own eyes. With this you-are-there approach, I try to bring the reader "inside" one doctor's world; I try to show you--not merely tell you--what I do, how I do it, what it feels like. In recent years, many people have told stories--some with happy endings, some not--about their experiences as a patient in the U.S. health care system. This book tells the doctor's side of those stories, up close and personal. Finally, an accident of timing motivated me to write this story. The events came together when disparate challenges in my own life--personal and professional, past and present--collided at one serendipitous point in time. This collision happened when challenges facing me mirrored similar ones facing my profession and my country. Most of the patients you will meet in these pages are older people with chronic diseases (including my own ninety-year-old parents) who don't have one doctor and who exemplify stormy issues roiling medicine today and for the foreseeable future. I focus on these patients (who, for various reasons, required urgent medical care) because most of us--you and I and our loved ones--will be one of them someday. Not only do these folks comprise the great majority of patients whom I (and most doctors) see today, they also "consume" the lion's share of all U.S. health care resources. One cannot begin to understand modern American medicine--or, increasingly, medicine around the globe--without understanding the challenges (and rewards) of doctoring such people. I interrupt my story occasionally to comment briefly about its historical background or future implications. These commentaries claim no special expertise about their subjects (each of which could justify a book of its own); rather, their purpose is to deepen the reader's understanding of my story. To paraphrase Hamlet, in this book the story's the thing: What actually happened to me and my patients during the time described was the wellspring for everything written here. For this reason, just as one physician's experience could never embrace the full sweep and complexity of modern doctoring, this book addresses only some of the many contentious issues facing medicine today. Whether my story will, as Hamlet hoped his own would, "catch the conscience of the King" is for you to decide. As I write this, politicians and policy makers in the United States are debating the form, function, and financing of smart new models of "accountable" health care. (Sadly, medicine has become increasingly unaccountable; today, it is often unclear who is responsible for the inexplicable way patients are treated.) Little good can come of these promising new ideas unless doctors step up, help to make them right, and take responsibility for implementing them well. But doctors can't do this alone. Ultimately, it is you--our patients, the body politic--who will be decisive in these matters. That's why I'd like you to meet my mistress and learn more about her kind of doctoring. All true tales contain errors. I have tried hard to minimize my own. All persons, events, and settings depicted here are factual. Most names and a few details have been changed to protect individuals' privacy or their confidential medical information. Reproduction of conversations is approximate, not verbatim, as best my memory allows. Any other misrepresentation of actual fact is unintentional. That said, let the story begin. Excerpted from One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine by Brendan Reilly All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.


Table of Contents

Introductionp. xi
Part I Now
Prologuep. 3
1 Lost and Foundp. 9
2 Caught in the Middlep. 37
3 A Safe Betp. 64
4 What's the Plan?p. 92
Part II Then
5 An Endp. 135
6 The Postman Rings Twicep. 174
7 Lost Marblesp. 215
Part III Now
8 Never Say Neverp. 257
9 To the Limitp. 298
10 Go Gentlep. 333
Epiloguep. 367
Notesp. 371
Acknowledgmentsp. 427
Indexp. 429

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