Contributor: Earl Metz
I was a junior resident on Osler when a young woman was admitted with profound ketoacidosis. I those days this was managed without blood gases, hourly electrolytes or central lines. We often used changes in the T waves on the electrocardiogram to help us monitor changes in the serum potassium.
A very good student worked with us that night and by early morning the patient was awake. It was the first chance for the student to take the patient'' history and he made the most of it. He learned that the woman had been taking care of an elderly man over an extended period and just a few days before her admission the man had died.
When Dr. Stead made rounds the next morning, the patient was sitting up drinking orange juice. Our student made a magnificent presentation, complete with flow charts, which didn't seem to interest Dr. Stead in the least. Finally he told us what he really wanted to know was what precipitated the young woman's ketoacidosis.
Our student was ready with the story of her relationship with the old man and then added, "Dr. Stead, I don't know how you feel about 'father figures,' but -"
Dr. Stead cut him off and said, "I have no quarrel with 'father figures.' I've been one myself for years."
During my year as chief resident a man with abdominal pain was admitted to Long ward. It became clear in short order that he had an acute surgical abdomen. He was seen by the surgeons, who were ready to operate, but the patient looked at me and shouted, "Young man, tell them nobody cuts on me unless Dr. Stead says so!" He had been a patient on Osler sometime in the past and remembered that Dr. Stead was a doctor there that made him feel as though he mattered.
I told him I would call Dr. Stead, which I did. I described the situation to him and he told me to tell the patient that it was OK to proceed with surgery. He then added, "And tell him 'Hey' for me."
Dr. Stead is more than deserving of Duke's Lifetime Achievement Award, he has had such a profound influence on the lifetimes of so many of us.
I had the good fortune to be assigned to Osler ward for my first clinical service as a junior medical student in the fall of 1959. And, sure enough, my first service as a junior assistant resident was on Osler. Add to that a year as chief resident and it amounted to a lot of time with Dr. Stead. The experience lead to a little book that Fred Schoonmaker and I put together called "Just Say For Me," a collection of aphorisms collected from morning reports and from Dr. Stead's writing. Anyone who spent time in the Department of Medicine at Duke during the Stead years will have his own stories. It seems to me that the more profound a person's influence, the more likely we are to remember those moments which confirm human qualities. It seems to me that such stories about Dr. Stead miss the point because in so many ways he has been larger than life. I still remember the anxiety he generated when he walked on to Osler my junior year in medical school. I also remember his great kindness to me when our third child was born and I needed a loan to make it through my JAR year. More than that, however, Dr. Stead taught us how to be doctors. He could make a poor tobacco farmer feel like the most important person in Duke Hospital and leaned hard on us to do the same.
Today physical diagnosis is taught, for the most part, by residents and fellows. During the Stead years, Dr. Stead taught physical diagnosis and set the standard. On Osler he did an exam as though everything depended on it and invariably found a bruit or a retinal hemorrhage that we had missed. I have a strong bias that, in these days of spectacular imaging studies, a good physical exam should provide the basis for interpreting these studies.
Being on Osler as a student was a special challenge for me, especially since Joe Warshaw and Vic Behar, two of the best students in our class, were also there. We all ended up doing all right, but my first presentation to Dr. Stead was a disaster.
I had worked until six AM trying to put the story together but when I finished my presentation Dr. Stead looked around the bedside and said, "Does anyone understand what's going on with this patient?"
I knew it was all over. I had put everything I had into it and it wasn't good enough. I doubted at that moment that I could ever be a doctor, but after such an experience there was no way to go but up.
During our time on Osler, Vic, Joe and I just about had our fill of an intern who found a way to pass on to one of us most of the work he didn't like. Somehow he got stuck with presenting a patient to Dr. Stead and as the presentation went on Dr. Stead asked him about a serum calcium value from a previous admission. The response came so fast that it had to have been made up on the spot.
Dr. Stead looked at him and said, "Young man, either you're a fool or you think I am and I guarantee that I'm not!" With that he walked off Osler and left three students doing their best to stifle a cheer.