This Month

Of all patients who confront the medical man, one of the most exasperating must be the asthmatic. The various “neuros” who plague the practitioner can at least be perceived in the course of time to be a bit balmy and nothing worse; the doctor can turn them away or string them along as his other work permits. Even a rich doctor may take a big fee from a rich neuro just to make the neuro happy. Even a needy doctor may brighten his own day by shucking off a few neuros once and for all.

The asthmatic is something otherwise. His trouble may be identified with horse-feathers, ragweed, cotton blankets, or lobster salad. But again, tests for allergy may show nothing. Fatigue, teeth, or virus? Another blank. Yet there sits the asthmatic, breathing loudly, with a chest that sounds as if someone had sat down on the keyboard of a pipe organ, not getting enough air and likely to get less. Medication will help, but the doctor will have to do some very fancy digging to find out the why of the case. The upshot of it may prove to be anything from the imminent visit of a motherin-law to a defective checking account-perhaps some snub that the patient underwent at age nine from the girl who sat next to him in the fourth grade.

Most medical men have long since concluded that massive psychological causes underlie the woes of the asthmatic. It’s not always the wise thing to tell the patient that in so many words. Thus the doctor must perform a delicate wire-walking act in his interview, tilting between medicine and psychiatry, thinking fast, and saying the right thing.

My own medical man gave me a fine demonstration of it the other day. Around for a checkup, I told him of my vacation plan to get away from the ragweed and make a big new start against the asthma.

“I want to get into a dry climate,” I began.

The doctor started to say that I did not need a dry climate but he checked himself in a hurry. He knew as well as I that chasing a dry climate would be expensive and limiting as to choice, and he knew that I liked the sea anyhow. But he did not say so.

“Fine, fine,” he said, “that ought to be perfect.”He continued his thumping and listening, pokerfaced. Yet it was plain to me that his talents of a scientist, salesman, sorcerer, and detective were actively in play as he came to sum up the prospects. I guessed his inner reasoning to be going along somewhat as follows; —

Now here is this guy, not a neuro . . . but could be, could be ... a real wheeze in that chest . . . ragweed worth considering . . . but any vacation place without ragweed where he could have some fun and break up the patterns of his routine would be all right . . . but he’s got this nutty idea that he needs a “dry" climate . . . not at all the fact ... I have a real cardiac case waiting outside . . . yet if he goes to a damp climate he’ll spoil his whole vacation fretting because he thinks he needs a dry climate . . . ought to see that diabetic coma in the West Wing . . . if I’m not careful, this vacation will make his asthma worse than ever . . . what a mess. . . .

The doctor finished his examination. “Now about that vacation,” he said, “the main thing is to go where you will have a good time and nothing to worry about. ’That’s the first point. The other thing is to get away from the ragweed.”That was what it all added up to for him, but he was not quite satisfied with the result. He looked at me searchingly and said, “Perhaps some place in a dry climate.”

The advice was so casually offered as to seem more like amiable conversation than the shrewd medical pronouncement which it was. I could not help thinking how many times each day the doctor must put his whole conscientious best into the instant of utterance. A lifetime of high purpose lay behind that word “perhaps.”As for the vacation, I think I’ll try BERMUDA.-CHARLES W. MORTON