![]() Biro is conscious of and grateful for the ease with which he obtains specialist consultations, but he glosses over the quick arrangements made for insurance coverage through inside contacts - an advantage that might be envied by less privileged readers in the US. By the end of the treatment, he appears less changed than his wife and parents by the intimations of mortality however, he has more self-knowledge and greater understanding of how the ravages of illness can extend beyond the patient's body. He portrays himself with candour: sheltered, naïve, privileged and perhaps even spoiled. Yet all - body, family, and marriage - emerge intact, though altered by the experience.īiro knows he is not the first doctor to learn that being a patient is full of unpleasant surprises. While Biro's body falls apart under the onslaught of cytotoxic drugs and narcotic analgesics, his family and marriage are subjected to equally destructive forces. His independent wife, Daniella, is put off by the intrusion as much as she is reliant on it to compensate for her necessary absences. ![]() Biro's parents, sisters and friends leap into action to provide round-the-clock support. Biro suffers all the complications: exquisitely tender radiation dermatitis that causes his scrotum to slough completely, severe mucositis of mouth and esophagus, hepatitis, unexplained fever, drug-induced delirium, weakness, weight loss and fears of impotence. The pain involved in radiation and chemotherapy and the six-week imprisonment in a small hospital room are described in graphic detail. The preparations are frantic and comic, especially the process of banking sperm. The rest of the book is devoted to the arduous consequences of Biro's choice. It is clear, however, that his decision is conditioned by personality and transference as much as by the diagnosis. Biro adores Luzzatto and wants to stick with him but Castro recommends a transplant, and Biro hears "cure." Impatient, and finding a suitable donor in his youngest sister, he opts for the transplant. Biro contrasts shy but determined Hugo Castro-Malaspina, a marrow transplant expert, with the warm but cautious Lucio Luzzatto, an expert on PNH recently arrived from Biro's beloved Italy. But their "personalities" spring entirely from the reactions they inspire in their patient, and those reactions vary from day to day. Once they have a diagnosis, knowing what - if anything - to do in terms of treatment is even more challenging.īiro's physicians at the Sloan Kettering Memorial Hospital are real hematologists, and he uses their real names. The young skin specialist and his family fret over the uncertainty of diagnosis in the unfamiliar territory of hematology. But what caused it? After repeated testing with conflicting results, he is found to have a true medical "zebra," the rare blood condition of paroxysmal nocturnal hemoglobinuria (PNH). A vague clouding of his vision was quickly diagnosed as retinal vein thrombosis. Married, athletic, Italophile and writerly (he had a novel in progress), he was happily set to share office and career with his dermatologist father. In 1996, at the age of 31, David Biro, a Jewish New Yorker, was only weeks away from his final examinations in dermatology. One Hundred Days is an entertaining addition to this tradition. Clinicians are fascinated by the genre - perhaps because they are intrigued, if not intimidated, by role reversal, a frustrating if enlightening movement from active to passive. Miller in 1952, Raymond Greene in 1971, and Harvey M. Several editors have published collections of medical autopathographies: Albert Grotjahn in 1929, Max Pinner and Benjamin F. Others have proudly proclaimed their experiences, advancing the cause of neglected diseases through professional identification. Some physicians have incorporated their own case histories into research publications anonymously. In the 1600s, for example, Thomas Sydenham wrote about his gout with such eloquence that his description is now a classic. Doctor-written autopathographies have enjoyed a special status for centuries. Perhaps the most famous specimen of the genre is Norman Cousin's Anatomy of an Illness, oft cited as the story of how a patient bucked authority to laugh himself back to health. ISBN 5-4 $35.00Īn autopathography is a memoir of illness, an account of how it feels to be on the receiving end of medical care. The doctor and the zebra One hundred days: my unexpected journey from doctor to patient David Biro Pantheon, New York 2000 289 pp.
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