This beautifully written article in the New York Times reports the death this Tuesday of Henry Molaison, a.k.a. H.M., the most famous and influential neurological research subject of recent decades of neuroscience – the Phineas Gage of the 20th century. I won’t repeat their synopsis of his contributions to the understanding of the science of memory, one of the most inherently fascinating domains of neuroscience.
I do want to point out that H.M.’s life was another example of the uncomfortable truth that sometimes what is worst for patients is what is best for the intellectual endeavors of scientists and physicians. I hope to write more about this in the future, because it is something that I have seen repeatedly this year, particularly in my very defined role as a student, constantly learning from every patient interaction and every view into the workings of the medical system. I recently met a young patient with HIV since birth, now uncontrolled (and definable as AIDS) since she refused to take her medicines, who came to us with a lump under her skin that had become painful. The biopsy results aren’t back yet, but it is almost certainly cancerous. It was an incredibly tragic situation. But the flurry of medical activity that sprung up around her was medicine, and education, at its best. She was supervised by the Adolescent Medicine service, but was well known to the Infectious Disease/Immunocompromised team. They consulted (personally making attending-to-attending phone calls) to Oncology, Radiology, and Surgery. In the midst of it all, Psychiatry was trying to make some headway with the girl’s refusal to take her medications and the fear around the biopsy. All of these teams–each with its attending, a fellow or two, and sometimes another resident or NP–were swirling in and out of our already cramped conference room, where I could listen first hand as they discussed what to do. I followed them into her room several times to hear how they said what they had to say. And I was trying my best to help facilitate the interactions of all of these different teams and participate in this exemplary interdisciplinary medical effort. It was a situation that was painful and terrifying for the patient, and educational and exhilarating for me as a medical student. The positive view is that she is definitely in good hands, but that doesn’t stop me from feeling uncomfortable that, again and again, whether it is the thrill of making a new diagnosis or the joy of seeing different providers come together to care for particularly complex cases, the events and experiences that are best for me and the medical system may be the worst for the patient.
