A thorough physical exam was deferred as patient was noncooperative and threatened to spit and defecate on me.
On March 27, 1897, whilst eating some soup, [J.W.] aspirated a bone. This accident was followed by attacks of violent cough and dyspnoea, which, however, became gradually less… On direct laryngeal examination by mean of Kristein’s spatula, the patient being seated with his head strongly deflected to the left, I saw in the right principal bronchus a white mass. On the following day I introduced, under cocaine anaesthesia, a straight tube of 9 millimeters diameter and of 25 centimeters length through the larynx and the trachea until I came near the foreign body. The curvature of the trachea was thus removed, and the foreign body could be seen distinctly. I had great difficulty in catching hold of the foreign body, using a pair of slender forceps which had specially and quickly been made. The difficulties were great, as at that time…I was still without the necessary practice which enables one to look easily, and even more to operate, through long tubes. Eventually I succeeded in catching the bone and in extracting it. The patient was able to return home the following day.
Gustav Killian, 1902.
Direct endoscopy of the upper air-passages and oesopghagus; its diagnostic and therapeutic value in the search for and removal of foreign bodies. J Laryngol Rhinol Otol 17:461, 1902.
The clinic is a prison.
We treat patients, not diseases.
All healthcare flows through the relationships between the healthcare provider and patient.
The spoken language is the most important tool in medicine.
Life is not the form of the organism, but the organism is the visible form of life in its resistance to that which does not live and which opposes it.
A disease is a whole, because one can assign it its elements; it has an aim, because one can calculate its results; it is therefore a whole placed between the limits of invasion and termination.
Evidence-based medicine is the integration of the best research evidence with clinical expertise and patient values.
Please do everything. I do not want to die. I am not ready.
I learned that courage was not the absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers that fear.
It is the duty of a doctor to prolong life. It is not his duty to prolong the act of dying.