On Service

Written in appreciation of “100 Precepts for My House Staff” by Henry Schneiderman, MD, and dedicated to those fierce internist attendings who have bred fear, insight, and wisdom in so many of us (Part 1 in CONSULTANT, April 2009, page 270, and Part 2 on page 361 of the June issue).

The death of one of my former professors at the University of Chicago brought back an indelible lesson of clinical care. He had a stern reputation among students, but soon elicited affection for his quips, criticisms, enlightenments, trips to his office for the pertinent paper-provided we were prepared. He coordinated a cancer research center, but his chief interests were clinical, his vision that of an experienced internist. This showed in his manner of ward rounds: student to the right as featured presenter, team assembled around the patient, dialogue and discussion for the benefit of all.

I recall a patient with hemorrhage and hematochezia, a woman of about my age. She had terminal leukemia and was admitted that night for what would be the last time. I took the history, embarrassed by her discomfort, averting my gaze from her bruises and foul-smelling stools. Suddenly, my attending walked in. The very air in the room changed, lightened somehow by his enthusiasm and warmth, his voice strident with optimism and purpose. He came close to my patient and clasped her shoulders during much of his examination. The woman turned to him as if to a saving preacher. He was careful to give hope, to outline the plan but not to deceive; he acknowledged her plight and pledged that she would not suffer unduly. When he left, her eyes were brightened and our clumsy encounter given dignity by his empathy and encouragement. He taught me that healing is always possible, even for the acolyte.

I like to think back on that night when science failed, in these days of exaggerated documentation and undervalued clinical skills. I go through my charts, too regulated now for student notes, repeating the moronic litany of “I saw the patient, I did the examination, etc.” I remember my attending, kibitzing on difficult patients, roving the night wards, and cheering people with his wit or wisdom. I recall his attending note, written after he comforted my dying patient-a note of few words, saying little but underwriting everything. I see it still, the swirling strokes of his fountain pen, the simple credo of the physician: “On Service. John Ultmann, MD.”

-- Golder N. Wilson, MD, PhD
        Texas Tech University Health Science Centers
        Amarillo, Lubbock, and El Paso
        KinderGenome Pediatric Genetics
        Dallas

References:

FOR MORE INFORMATION:

A brief obituary for Dr Ultmann can be found in

JAMA.

2001;285:1518.