The Midnight Meal and Other Essays About Doctors, Patients, and Medicine

Lowenstein, Jerome

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Annotated by:
Bruell, Lucy
  • Date of entry: Sep-04-2012

Summary

Jerome Lowenstein is a nephrologist, author, and founder of the Bellevue Literary Press and the Humanistic Aspects of Medicine Education seminar program at the NYU School of Medicine.  In this thoughtful and illuminating book of essays he explores the patient/physician relationship in a world where medicine has embraced technology and scientific advances in the laboratory at the risk of neglecting the humanistic underpinnings of the field.

Dr. Lowenstein graduated from medical school at NYU in the late 1950s and spent nearly his entire professional career at NYU Medical Center and Bellevue Hospital. When he was a resident, long before work hour limits were instituted, the house staff gathered in the cafeteria at midnight to dine on the days’ leftovers.  This communal meal “provided a fine opportunity to communicate with colleagues directly, rather than by beeper and phone, about many of the days ‘medical leftovers,’ ” (1) sharing information as well as the frustrations and rewards of caring for patients.  “The Midnight Meal” poses the challenge of retaining the core of relationships, both between patient and physician and among colleagues in the rapidly changing world of medicine today.

In the essay, “Can You Teach Compassion,” Dr. Lowenstein tells his readers about the student who responded to the question with “I don’t know if you can teach compassion, but you surely can teach the opposite.” (13) The student was referring to how students become “desensitized” during their clinical years to the suffering of their patients, sometimes to the point of using derogatory terms to describe them. Dr. Lowenstein argues that teaching attendings can and should encourage students to learn about their patients. He writes how he once interrupted an intern who began to present a case by stating: “This is the first hospital admission of this thirty-five year old IVDA.”  Dr. Lowenstein asks: “Would our thinking or care be different if you began your history by telling us that this is a thirty-five-year-old Marine veteran who has been addicted to drugs since he served with valor, in Vietnam?” (17) Learning about the lives of their patients, Lowenstein emphasizes, does not detract from the clinical picture, but rather enhances it.  

Commentary

Dr. Lowenstein is most passionate in writing about his work with medical students.  He draws upon his decades of experiences at Bellevue to emphasize that medicine is both a science and an art, and it is in practicing the art of relationships that physicians not only are able to better to care for their patients, but they can find personal satisfaction that enables them to sustain themselves throughout their demanding professional careers.  In his preface, Dr. Lowenstein counters critics who argue that modern medicine leaves little time to develop these relationships; however, he cautions the reader that his essays are not a rallying cry to return to an earlier period in medicine when, for example, heart disease was treated with bed rest. Instead, he makes a very strong and eloquent argument that knowing the person between the sheets remains at the heart of the profession.

Publisher

Yale University Press

Place Published

New Haven

Edition

1997

Page Count

128