There's a bug in my ear — and other unforgettable house calls

April 8, 2005

When he visited patients at home, the author found much that was surprising and enlightening.

I received my MD from Tufts Medical School in 1938, and after a prolonged residency in pulmonary diseases, I opened a solo internal medicine practice in Quincy, MA, on Dec. 1, 1945. For the next four decades, until my retirement in1984, I made regular house calls. Going to patients' homes always enabled me to learn something more about the patient, and sometimes it helped me to reach a diagnosis that had eluded me in the office. Here are four examples.

Something's bugging this patient Vickie Campbell, age 46, had a very pleasant, outgoing personality. She was a talented musician, whose band played at many social affairs in our small city.

Often, however, to put the brakes to her heart and quiet her nerves, Vickie came home, poured herself a glass of vodka, added a jigger or two of orange juice, and drained the glass. She kept drinking until the bottle was empty or she was sound asleep.

She's hallucinating, I thought. The evils of drink! What she needs is a sedative to calm her down. It was a long drive, but I found the farmhouse. Vickie, obviously intoxicated, was sitting in a chair next to her bed. Some vodka was still in the bottle.

I took my otoscope out of my bag, looked into her ear, and-surprise!-I saw a green-colored bug wiggling around in plain view. How to get the bug out? With no tools at hand, I had Vickie lie down on her side and I poured the remaining booze into her ear. The bug floated up to an area where I could reach it and pull it out.

I mounted the bug (it had such delicate wings!) on a cork as a small souvenir and kept it on my office desk until I retired. As for Vickie, I'm sorry to say, I never saw her again.

The hunt for toxic material Mary Johnson was in her 40s, the mother of two teenage daughters. She worked as a paralegal. When she came to my office because of a backache and mild cough, a chest X-ray revealed small, scattered densities suggestive of asbestosis.

I queried Mary. There were no asbestos panels in the walls, ceiling tiles, floors, or furniture where she worked, she assured me. Yes, she had checked with her employers. Her home was a simple summer cottage. Her husband, a high school math teacher, moonlighted as a cab driver to earn some extra cash. He had never insulated pipes with asbestos, never worked with brake linings. A puzzlement!

"My cough is worse," Mary phoned one day. "Can you make a call?" Yes, I told Mary, I would see her that evening.

From the outside, the house looked like a typical seaside summer cottage, shingles on the walls and a tar-and-paper roof. Then I went inside. In the bedroom, Mary's husband was busily at work-placing asbestos sheathing between the open studs! "He's winterizing the cottage, like he does every year," Mary said.

Now that the asbestos panels were right there before my eyes, I knew that I had read Mary's chest X-rays correctly: She did indeed have asbestosis. "That's asbestos!" I fairly screamed. "You've got to get out of here!" Mary took my advice. She moved to Tucson, and I never heard from her again.

The old man and the fan When Alfredo Alfredi came to this country from Palermo at age 17, he left his 14-year-old sweetheart, Angela, behind. Alfredo worked long and hard as a laborer in construction and a stonecutter in slate and granite mines. True to his promise to Angela, he returned to Italy, married her, and brought her to their new home in the states.