Contributor: Clarence Grim

I had spent all night working up a middle age man who had undergone a number of GI surgeries in an attempt to "cure" his many GI complaints by an outside doctor. I was very angry that many of these procedures may not have been needed and was cursing the referring doctor under my breath.

After presenting the patient to Dr. Stead he asked my what would I do with this difficult patient. My angry reply was I would send him back to the doctor who had done all of these procedures and let him take care of the mess he had created.

"Dr. Grim, WHAT THIS PATIENT NEEDS IS A DOCTOR."

He was, of course, correct. I was really embarrassed at my anger in this situation and I followed this patient in the outpatient clinic and we did indeed get many of his problems under control, without any more surgery. I believe I protected him and many future patients from unnecessary procedures by listening to him.

Title: These Interns Have a College Degree

In 1964 we found that the Hospital Administration interns on the Duke Hospital Administration Service were making at least twice as much as we did (we were making $220 a month). We had a meeting with someone about this from Hospital Administration and were told: "You must remember that our interns have a college degree. We can't pay them only $220 a month!"

Title: Fellowship is a Full Time Job

After beginning a fellowship year in Nephrology I was contacted about working at Lincoln Hospital to cover at night and on weekends. I did one night and had a good time and did not have to work too hard but thought I had better talk to Dr. Stead about it.

I told him how much help they needed, that the money would be helpful and that I would likely learn new things.

"Dr. Grim" he said "I think this is a great idea and know that Lincoln and the patients will benefit from having you there. Just as long as you don't want to do your fellowship here at Duke it is OK. We consider a fellowship a full time job."

He of course was correct as this would have taken away time that I devoted to one of the most exciting and productive years I have ever had.

Title: Being Too Fat Is All Relative (A Kempner Service Story)

I was an intern on Dr. K's service and had worked up a patients with severe obesity (5'3" and 400 lb.) who was very depressed and tearful about her inability to control her eating behavior. I tired to cheer her up by telling her about a recent success we had seen in a lady who weighed 500 pounds when she first came to Duke. She listened intently and then commented: "Five hundred pounds! How could anyone let themselves go like that!"

Title: Another Kempner Story

The service had a 70 year old woman with severe aortic insufficiency who developed (again) flagrant congestive heart failure after eating at a pizza place. The only thing she was being treated with was distilled water to drink and the Kempner colored pill, which were placebos. Amazingly (to me) her heart size quickly decreased to nearly normal and her signs and symptoms of CHF disappeared.

I told Dr. K that I thought she needed to have her aortic valve replaced.

"Dr. Grim," he said, "I have been taking care of this lady for a number of years. As long as she stays away from salt she does not have heart failure. Two of the last four patients I have sent for aortic valve replacement have died soon after surgery. I think she is safer avoiding salt."

I suspect this and other patients seen on Dr. K's service as well as Dr. Stead's statements a number of times during my 3 years, "Dr. Kempner is the smartest doctor at Duke Hospital!" forged my interest in the role of salt and blood pressure that has driven my career for almost 40 years. I still use slides from Dr. K's papers every time I talk about high blood pressure.