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ALL HEART MARK M. RAVITCH, M.D* When it all began I did not know of her existence. I would prefer to blame fate or chance for our meeting, and the miserable train of circumstances which followed, but I am inclined to agree with those who say we determine our own fates, and only ascribe to fortune those consequences ofour acts so unsatisfactory that we wish to escape responsibility for them, or so wildly gratifying that like the superstitious Chinese peasant we wish to distract the attention of the gods, if not from our undeniable good fortune, then from our own secret consciousness of our responsibility for it. I lay in the Intensive Care Unit of The Hospital. With the sublime snobbery of affected anonymity, those who really belong to it and are of it, speak merely of "The Hospital," recognizing at once as parvenus, pretenders, or even merely unacclimated and mildly gauche—or worst of all, from "across town"—those who call the great seaboard institution by its founder's name. I had not reached forty. As a physician I knew my fate, and had known it for some years. They had let me into medical school on the basis of my then capacity for work. Admissions committees must make a judgment as to the likely returns from the investment the medical school makes in a student. On the other hand, how many years of return are required for the investment to be considered worthwhile; how many years are required for a man to be likely to make a significant contribution ? Osier, in a much misquoted statement, suggested that the world of medicine might not be much poorer if deprived of discoveries made by men over forty. In any case, it may be that medical school admissions committees, composed of physicians, find a special ethical and moral problem in refusing admission to an otherwise qualified student because he has a medical condition which medicine cannot correct, interrupt, cure, or compensate for. Be that as it may, I was admitted to the medical school in spite of the fact that, traipsing around through the hinterlands ofBrazil with my naturalist father, staying, as a child, in the relative safety (he should have known better) of small villages while hejourneyed even *Professor of Surgery, University of Pittsburgh School of Medicine, Montefiore Hospital , 3459 Fifth Avenue, Pittsburgh, Pennsylvania 15213. 94 I Mark M. Ravitch · All Heart farther into the backland, I was noted one morning to have an innocent little sore at the corner of my mouth. The natives knew it at once, of course, as the bite of the kissing bug, the barber bug, barbeiro (triatoma megista), which lives in the crevices of adobe huts and at night nourishes itself by biting victims near eye or mouth at the tender junction of skin and mucous membrane. They are fairly large, flat, slow-moving, harmless-looking creatures which a sleeping adult will generally brush off before the feeding ground has been reached. A sleep-drugged child does not rouse in time, and the bite itself is painless—and innocent. It is the insect's postprandial bowel evacuation, like the gastrocolic reflex which leads infants to have a blissful stool after feeding, that deposits the agent of disease, trypanosome cruzei, the agent of Brazilian trypanosomiasis—Chagas disease. But the bug is as innocent as the supplier of arms to an ambitious little state. He has merely provided the wherewithal, and what happens thereafter is none of his concern. It is allowed to the child to rub the deposit into the sore when he feels it itch, and thus to infect his bloodstream with the violently twisting, microscopic protozoan. I was subsequently quite ill, in a ward with twenty or thirty other children, all with huge affected hearts. Gradually I recovered , as most of them did not. I escaped, or have so far, the paralysis of esophagus or of terminal bowel often seen in these patients as the trypanosome destroys the nerve ganglion cells in heart, or esophagus, or colo-rectum. Now I have assumed that the distinguished physicians on the admissions committee saw the entry on my application blank, after "Childhood diseases . . . other" . . . quite...


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