The Midnight Meal and Other Essays About Doctors, Patients, and Medicine (review)

In the preface to this tidy little collection of essays, Jerome Lowenstein, MD, states that his intent is to "speak to different listeners—to medical students, to their teachers, to physicians whose lives and energies are committed to the care of patients, and to patients themselves" (p. xv). Lowenstein, an internist specializing in nephrology, is well known for his pioneering work in academic medicine after spearheading a Program of Humanistic Medicine at New York University in 1979. Many of the essays he includes in this revised and expanded anthology appear to be based upon the subject matter the students and residents brought to those weekly small group meetings that took place on the busy hospital wards. Although Lowenstein's topics are wide and diverse (ranging from issues of homelessness and alternative medicine to the treatment of AIDS and the ever-expanding edge of medical technology), his twenty-some essays rarely deviate from a common theme: the primacy of nurturing and protecting the human relationship between doctor and patient.

The opening essay, "The Midnight Meal," from which the book takes its title, nicely illustrates this general theme. The author reminisces about the days when the "residents" (i.e., those physicians-in-training who spent most of their days and nights literally "residing" in the hospital, caring for their particular patients, while learning the art and science of medicine) would routinely gather at midnight for a meal provided by the hospital. Although the fare was usually nothing more than leftover cold cuts and cheese from the cafeteria, the midnight meal served a far more meaningful function than a simple free lunch. From Lowenstein's viewpoint, these nightly gatherings of young physicians and students allowed for the face-to-face exchange of clinical concerns about their ill patients as well as a desperately needed shot of moral support within the context of medical collegiality. Now that residents frequently operate in shifts due to the constraints placed upon the number of hours they can work in one week's time, there are few opportunities to cultivate the intimacy, clinical wisdom, and connectedness young trainees garnered from those late night retreats.

Lowenstein writes in a clear, spare style that is highly readable, wonderfully descriptive, and always aimed at highlighting the human considerations that enliven the real substance of medical care. His essays appear to follow a consistent stylistic format. Deftly describing for the reader a clinical vignette taken from his experience of working and teaching on the wards at Bellevue Hospital in New York City, Lowenstein provides a reflective exploration of the anecdote aimed at underscoring the inherent value of humaneness, compassion, and other-directed concern that are so intimately involved in the science and art of healing.

The Midnight Meal and Other Essays About Doctors, Patients and Medicine is certainly not intended to be read only by health care providers. However, it is a work that should be recommended to medical student, resident, and physician who is privileged to provide medical care to others. Through this little book of medical essays, Lowenstein has managed to capture the spirit and message of the father of humanistic medicine, William Osler, MD, who once wrote, "The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head."¹