Symptoms of Unknown Origin: A Medical Odyssey

Chapter 1. An Unlikely Lesson from a Medical Desert

5 1 An Unlikely Lesson from a Medical Desert When I drove over the small ridge that had hidden Fort Hood, Texas, from view, my heart sank. As far as I could see, the land stretched into the distance to a faint line of horizon that barely separated sky from ground. I had no idea that such a desolate place would be the setting for one of the most important learning experiences of my medical career. There were few trees. The entire landscape was pale brown, as though the color green had vanished. Geologically, it was an ancient seabed. Sixty-five million years ago, water had covered the entire area from Fort Hood to the Gulf of Mexico. Giant dinosaur footprints were still visible on the stone riverbeds to the north. I thought at the time that there are some lands too new for human habitation. The year was 1957. It was the peak of the cold war. The world was poised for a nuclear exchange between the USSR and the United States that thankfully never came. I had just been drafted into the U.S. Army Medical Corps for two years’ duty as a general medical officer. The doctor draft had continued after the Korean War, which had ended only a few years before. The long stretch of bare ground in all directions could not have looked more different from New York City, where I had spent the previous two years in residency training in medicine at Columbia Presbyterian Hospital. The contrast in geography was not the only Meador฀pagesFeb15.indd฀฀฀5 2/17/05฀฀฀5:34:52฀PM 6 Symptoms of Unknown Origin difference. Instead of treating the sickest patients in New York City, I was to be one of the army physicians who would care for the ten thousand healthy draftees who formed the Fourth Armored Division . Fort Hood lay about two miles west of Killeen, Texas. The small town’s only economic reason for existence was the presence of the army post. Everything about Killeen was tied to the army. There were pawnshops, pool halls, tattoo parlors, hunting and fishing stores, several beer joints, and a few scattered gas stations. Used and repossessed car lots with hundreds of colored triangular flags sat at each end of the town. The highway that ran though the center of Killeen was its business district. It was the highway from Fort Hood to Temple, Texas, twenty-five miles to the east. The treeless residential sections, all new, sprawled across the land in curves of duplexes. The post hospital sat on the extreme western edge of Fort Hood. Looking out my office window in the dispensary, all I saw was a stretch of land that seemed to reach forever. In the early mornings I often watched the rising columns of dust thrown up by tanks and trucks as they moved slowly out to the impact zone for daily gunnery practice. The armored vehicles eventually disappeared over the horizon, and then all I saw was land and sky. Not only was I geographically isolated, but even worse, I was in medical limbo, banished from medical complexity and challenge. In my medical training at Columbia Presbyterian Hospital, I saw only the sickest patients or those with complex or rare diseases . The admitting system permitted us to send the less sick patients and those with more common diagnoses to Bellevue or other city hospitals. This process screened out the ordinary illnesses and created a distorted view of medical practice. Medical care is a pyramid with its base in the general population and its tip in referrals and complex diseases. I had been trained to work at the tip of the medical pyramid but had now been assigned to the very bottom . Mostly I would see well soldiers who were suffering from the Meador฀pagesFeb15.indd฀฀฀6 2/17/05฀฀฀5:34:52฀PM An Unlikely Lesson 7 varied stresses of army duty—too little water (constipation), too much sweating (rashes, jock itch, athlete’s feet), too much sun (sunburns ), too much marching (blistered and infected feet), and too much weekend liberty (syphilis and gonorrhea). I was lucky to be assigned to the post hospital. Most of the other drafted doctors were assigned to the various battalions of the Fourth Armored Division spread out across several miles of the post. Each battalion had its own aid station, the...