Sample Chapter Lipoma

An example of my extreme fatigue occurred when I was a junior interne at the Toronto General Hospital in 1961. Every Thursday morning at 11 o'clock "hospital rounds" took place in the solarium at the end of the men's ward on Ward G. This area was crammed full of chairs and all the resident staff, the appropriate nursing and intern staff, a hand full of students and the staff physicians assigned to the ward would be in attendance. Two hospital patients would be presented, a short case and a longer case.

Usually the junior intern would present the history; the senior intern would discuss the lab work, show the x-rays and then outline the present management. The professor of medicine at the University of Toronto was Dr. K.J.R. Wightman and he was usually present, sitting in the front row holding the patient’s chart. We referred to him as "KayJeR" behind his back. He was definitely "old school", very formal with us and seldom smiled in our presence. I think, although he was probably a pretty nice guy underneath his somewhat harsh exterior, most of us, especially the junior interns, were afraid of him.

After much learned discussion, the patient was then brought in. The professor would introduce himself to the patient and ask a few questions and then often examine the patient in front of the rest of us. I don't think the patients minded this system because they felt they were getting the best possible management and they were after all being studied by The Professor!

On this particular day, the patient, a poorly controlled diabetic, who was also extremely obese was waiting on the ward ready to be brought into the solarium at the appropriate moment. This man wasn't my patient but I had walked past his bed many times and the nursing staff had told me he was a difficult patient and was always complaining about the poor quality of the hospital food.

KayJeR who was sitting idly reading the chart while the discussion was going on suddenly stood up, very red faced, and strode towards the podium interrupting the proceedings and said in a loud and stammering voice, "Who wrote this?"
He was holding the chart open pointing to some hand written history note. We, in the audience, couldn't read this writing from such a distance and finally KayJeR still in his loud voice repeated, "Who wrote this, It describes the patient as 'a 350 pound lipoma' in the physical examination. "

Now a lipoma is a common and usually benign fatty tumour that ordinarily lies just under the skin and can easily be palpated between the thumb and forefinger. For some reason, I thought that this description of this huge patient as a lipoma and the expression on the very serious face of KayJeR was very funny. I was just too tired and got the giggles. I was sitting in the front row and started to laugh in fact I couldn't stop myself even though I knew that it was totally the wrong thing for me to do, especially in front of KayJeR. In fact, I think I almost slid off my chair. One of the probably equally tired interns beside me and then some of the other people in the room started to laugh and suddenly the whole room erupted into laughter and my bacon and the bacon of the interne who had written this history was saved. I don't think that KayJeR was impressed but years later when I got to know him a little better he was always friendly to me.