S.Q. Lapius handed me the list. “Here, Harry. Mail off checks for the renewals to medical journals to which I subscribe.”
I perused the column of names and suddenly stopped. Wedged into the list, which included Lancet, the Archives of Internal Medicine, the New England Journal of Medicine, the American Journal of Medicine, I encountered one that surely was misplaced.
“Simon, what’s the Reader’s Digest doing here? A spoof, no doubt?”
“On the contrary, Harry, I use that to find out what my patients are reading. For months I have observed that patients would ask questions in clusters. One month it would be about liver disease, another about pulmonary function and so forth. Some of the questions were fairly sophisticated. It was all a puzzle till I had a sore tooth.”
“You have lost me,” I said.
“The tooth ached like the dickens. I was forced to visit my dentist. There was a long wait, which gave me a chance to catch up on six months worth of Reader’s Digest issues, and there I solved the mystery.”
“I’m breathless,” I told him.
“Well, you see they usually have an article on some medical thing or other. One fellow, what’s his name, Radcliffe or something keeps writing about the different organs of the body. Has a gimmick – writes about the different organs in the first person. I am Joe’s liver, I am Joe’s lung and so forth.”
“Has he done one on I am Joe’s ovary yet?”
“As a matter of fact, no. But I think he’s running out of organs. Anyway this month the Digest had a real winner. How to Survive a Heart Attack. I was wondering what was going on. All my patients kept asking me about EWS. I couldn’t imagine what they were talking about. But the article clarified the matter.”
“So clarify it for me. What is EWS?”
“EWS means Early Warning Signs, and refers to early warning signs of an impending heart attack or one that is actually in progress.”
“What happens. Does a light go on?”
“You are droll tonight, aren’t you Harry? No, but Dr. Glen O. Turner of Springfield, Ohio felt that if patients could recognize the early signs of heart attack they would get to the hospital in time to be protected against the arrhythmias that prove fatal so often during the first hours of the attack. After all if patients can be brought over the hump of the first few days, the outlook is quite good. The heart will heal. But the danger is that the electrical system of the heart is highly sensitized during the early hours of the attack, and fatal in-coordinate heart rhythms can occur.”
“Simon,” I interrupted, “You are lecturing me as if I was a high school student. I am a doctor, remember?”
“Oh – sorry, Harry I got carried away.”
“You should be carried away,” I said to myself.
“Actually I have been asked to address the high school students on this subject, and I guess I was practicing a little. I’m pleased to know that I reached you, Harry. But it wouldn’t hurt you to climb off your high horse once in a while and read the lay periodicals. For instance, do you have any idea how many Americans will die of heart attacks this year?”
“About 50,000 and one.” I said looking at him malevolently.
“Wrong.” Lapius paid no attention to my deadly stare. “About 650,000. And about 50,000 or almost ten percent of these deaths could be prevented by early hospital treatment and surveillance in a Coronary Care Unit.”
I had to admit that they were impressive statistics. I was a little abashed that my guess had been so far off. But I knew I wasn’t going to go around reading the Reader’s Digest. Lapius started foraging in the hall closet for his coat.
“Where to now?” I asked.
meeting of the
“Donating your heart to some hapless individual?”
“No, Harry. They haven’t asked me to do any such thing. But they did ask me to help plan for the Voluntary Screening Examination that they will conduct at the Community College, on 500 individuals chosen because their answers to a questionnaire about health and heart disease suggest that they might fall into a high risk group. The nurses at the hospital are putting a lot of time and effort into this. It is a worthwhile cause. Sort of an EEWS.”
“An Early-Early Warning System.”
“Nonsense. The whole effort is simply a drop in the bucket.”
“Perhaps,” said Lapius. “But it does get people thinking about community health and gets them used to working together voluntarily for community causes. They develop an awareness of the facilities available in the community, and hopefully its shortcomings too.”
“Well, Simon,” I told him, “You can spend your time being a do-gooder and social-service buff, but I’ve got some studying to do.”
Lapius left without another word. I gave him a ten minute head start and shot out the door. He didn’t know it but I was chairman of the meeting he was going to attend. They way he drives a car, I bet I get there before him.
This signaled the introduction of Preventive Medicine into a nascent Health Care System that asked doctors and patients alike to accept responsibility for personal health. Some believe that government motivation was to reduce the immediate costs of Health Care. At that time the subsequent prolonged costs of longevity had not yet been calculated. A Health Care System is much less expensive when the average life span is 65 rather than 85. As life span moves up the next generation will start to rethink its priorities. Is grandma worth keeping alive at my expense?