Morbus Propedeuticus

It was spring. My medical school class, two years along in our five-and-a-half year endeavor, had earned the “medicinae kandidat” degree. We were now worthy of leaving the basic sciences and research center on the outskirts of town and starting our preparatory clinical, “propedeutic” semester at the University Hospital. In Sweden, at that time, we used a lot of Latin words and phrases. Crohn’s disease was  Morbus Crohn, chart notes listed physical exam findings by Latin names for the bodily organs: Cor for the heart, Pulm(ones) for the lungs, Hepar for the liver, etc.

Uppsala Academic Hospital was an imposing campus, with several tall, white towers, housing the most modern wards, laboratories and operating theaters. We were relegated to a pink stucco building that housed the old tuberculosis clinic.

The physical exam course was taught by a couple of older pulmonologists. At first they struck many of us as relics from a bygone era, but as the course went on, our respect grew. These unassuming physicians could percuss a patient’s chest wall and describe in detail what the x-ray would look like, they made us feel the tip of the spleen by turning the patient on his right side, they measured jugular venous pulsations and pedal pulses.

Sometimes we had real patients with remarkably abnormal findings to examine, but we often were charged with examining each other for assessment of normal physical exam findings.

My partner for the Lymphatic System module was Sven Björk, a slow-talking kid from the very north of Sweden. He had jet black, completely straight hair and a broad face with eyes set wide apart. He was part Same, the native, reindeer-herding nomadic population from north of the Arctic Circle.

Sven was a bright young man. He had memorized the anatomy quicker than I had, well ahead of the exercise. Yet he seemed nervous. I soon found out why: he had noticed several enlarged submandibular and anterior cervical glands on himself. We compared each other’s necks and jaw lines, but found to our surprise that our lymph nodes were about the same size.

My glands had been big as long as I could remember; I had gone through repeated strep infections. In second grade I missed 42 days in just one semester. Sven had never had strep throat, and he didn’t remember feeling any enlarged lymph nodes before, but he had never checked himself quite like this before.

Our instructor came over to see how we were doing. Sven cleared his throat and started telling Doctor Bruun what both Sven and I had noticed on his neck.

The fifty-something doctor put his hands on Sven’s neck. Methodically, he worked his way up, down and around the neck and down into the armpits. He had Sven lie down on the exam table, supine for the liver, on his right side for the spleen, then reached for the lymph nodes in Sven’s groin. His face was serious as he whisked Sven off to his office, leaving me standing, feeling my own cervical lymph nodes, bigger than Sven’s.

Sven was diagnosed with Hodgkin’s Disease, a type of lymphoma that wasn’t quite as easily cured then as it is now, but Sven responded well to the treatment and didn’t miss much school.

The rest of our class, me included, went through a prolonged case of what our instructors called Morbus Propedeuticus, Medical Student’s Disease. It is natural to worry that you might have some of the bad diseases you learn about in medical school. Seeing one of your classmates develop cancer sets the stage for more than the normal amount of hypochondriasis.

I realized that even though Sven’s and my lymph nodes were similar, his had developed quickly without reasonable explanation and mine had been there for years and had their origin in my recurrent episodes of tonsillitis. I did ask my instructor to check me over, which he gracefully did. He was not worried, and I accepted his assessment. I never again worried about having a dreadful disease, but I often thought of Sven and me during that physical exam class; there but for the grace of God go I.

Around the time of my birthday a couple of weeks ago, I suddenly thought of Sven again: I know he was declared cured from his Hodgkin’s, but what about freak recurrences, late cancer treatment effects or other tricks of the Grim Reaper?

Google gave me the answer: Sven is head internal medicine physician at a medium sized hospital. He has published several scientific articles, and was interviewed recently about differences in heart attack survival between northern and southern Sweden. I even found a couple of pictures. Wouldn’t you know it, he doesn’t have a gray hair on his head or wrinkle in his face; he looks younger than I do.

Bless you, Sven. I wonder if you know how often my thoughts have gone back to those weeks we spent together way back then.

Country Doctor is a Swedish-born family physician in a small town in rural Maine. This post originally appeared on Country Doctor’s blog, A Country Doctor Writes.

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