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Not Too Old (or dead) To Learn

March 2001

I recently completed a year as Chief Medical Resident at a large University Teaching Hospital in the midwestern USA.

My job included organizing our department's weekly morbidity and mortality conference, an academic exercise devoted to frank discussion of challenging medical cases, some of them with less-than-desireable outcomes. These conferences are feisty by nature, but one faithful attendee in particular could always be counted upon to shake things up.

He was known to most of the faculty, residents and students as 'the old Limey'. A few of the emeritus Professors remembered a time when this eccentric elderly gentleman actually practiced medicine, but I'm quite sure this man was retired around the time I was born. He was called the "old Limey" because his accent was undeniably British. He looked (literally) a century old, and always wore the same worn-out tweed sportcoat and bow tie. Every Thursday at 11:30AM he would arrive at the auditorium for our noontime conference, sit in the eighth seat of the eighth row, and promptly fall asleep until the conference started. Sometimes he would awaken with a startle and shout, always to the sniggers and jeers of those around him. I often approached him before the conference to hand him a copy of the case protocols and references.

The combination of Old Spice and old man was at times overwhelming. "Thank you, young sir" was his stereotyped reply.

What made this man a legend in our institution was his propensity to ask the most ridiculously arcane questions. I'll avoid specifics, but suffice it to say his questions left all in the room wondering when (or if) this man studied medicine. His queries demonstrated an utter lack of understanding of modern medical practice. He seemed particularly baffled by critically ill patients. Of those with low blood pressure he had asked (more than once) "If his pressure was low, where did the blood go?". What made the situation more comical was the context in which these questions were posed. Our institution prides itself on its academic prowess and most of the faculty who participate in these conferences are national or international experts in their respective fields. Nonetheless, these esteemed (and sometimes pompous) doctors were not immune to the often biting, always loud questions of 'the Old Limey'.

Many faculty, my Chairman included, contemplated barring him from these conferences. Others, myself included, protested this. Truth be known, his antics often livened up an otherwise droll presentation. I actually liked the guy.

A few weeks before the end of my chiefdom my program director informed me that the 'old Limey' had died in his home. From this conversation I learned his name, his age (98!) and that he was a retired urologist. He had no family or next-of- kin and had essentially died alone. In retrospect I could recall several weekends where I noticed him having lunch or even dinner in the hospital cafeteria. I realized that the medical center was probably the only place he had to go, and that made me feel incredibly sad.

I was preparing a case the following week that involved a very sick man with fevers and low blood pressure. I thought that the 'old Limey' would have liked this case, so prior to conference, in his honour, I placed a copy of the case protocol on the eighth seat of the eighth row. There were several odd occurrences during that hour that I can't write off as mere coincidence. The thermostat seemed to be working appropriately, yet it was quite cold in the room, even with the temperature turned up to 90 degrees. Our AV equipment, which had never failed us before, was completely inoperable for that hour. The lights even cut out briefly several times during the conference. Nobody really made much of these technical failures, but I couldn't help but wonder if... .

As I was gathering my things after the crowd had gone I walked over to seat eight of row eight. The protocol was gone, but the strong smell of Old Spice lingered in the air. It could have been my imagination, but as I turned off the lights I thought I heard a voice, undeniably British, say "Thank you, young sir".

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