Contributor: Hugh Malone
When I was a medical student, Dr. Stead had a giant-sized reputation and a presence that filled up the room. He was a tremendously strong leader with phenomenal, penetrating insights, especially when it came to clinical diagnosis. I'm sure I was in a state of awe, just like everyone else was, when I was in his presence and that my remembrances are skewed because of that. The stories about him, his legendary performances at the CPC's, and the general aura that surrounded him as he traveled around the hospital no doubt influenced how I perceived him then and remember him now.
As far as specific instances on rounds on Osler ward are concerned, there are only a few that stand out in my mind. On one occasion a visiting professor, probably Tinsley Harrison, was accompanying us. The intern presenting the case was either Pat Henry or a fellow named Lewis, "Kikkie" Lewis as I remember.
In any event, when the presentation was concluded, Dr. Stead asked him what the Watson-Schwartz test showed. He blanched and told Dr.Stead that he hadn't done the test. There was silence. Dr. Stead told him we would wait while he went and did the test. With that the intern excused himself and everyone else just stood there in a state of disbelief, looking at the ceiling, shifting from one foot to the other. Dr. Stead may have made a few comments to the visiting professor, but for the most part, it was all silence. After approximately half an hour, the intern returned and reported a negative test.
Rounds were resumed, as if nothing out of the ordinary had occurred.
Question for Dr. Stead: What IS the Watson-Schwartz test?
Once after a pulmonary case had been presented Dr.Stead took us back to the conference room and got into a discussion of pulmonary function tests.
He went into infinite detail. He covered the gamut. It was as if he had crawled down into the bronchial tree and was discussing the abnormalities at the cellular level.
It truly reminded me of what used to be called "eidetic imagery," a process in which certain people, especially certain children, are able to focus on and appreciate certain objects or operations in the most exquisite detail with perfect clarity. It made everyone aware that here was an unusual human being who was able to see things differently from most, to see things from all angles and to appreciate all aspects more fully.
I had my negative moments. I can remember on one occasion when I presented a patient with aortic insufficiency to Dr. Stead on walking rounds with a whole entourage of nursing students, some of whom I knew. He spared me no mercy and cut me to ribbons.
I felt like I was made to look like a fool, especially to all those nurses. I can't to this day remember what I didn't know or what I did wrong or what I didn't do. In any event I was terribly humiliated and felt like I had been excommunicated to the backside of the moon.
Dr. Stead had a way of doing this without saying a whole lot. A certain distant, expressionless manner coupled with an icy look and a few well placed words was enough.
Needless to say, I was petrified when I learned I was going to have Dr. Stead for my oral exam in medicine. Of all things, he asked me about congestive heart failure and I thought -- damn, here I am being examined about heart failure by one of the leading authorities on the subject in the entire world!
Although I didn't know all the answers and was terrified, it ended up being a relatively benign experience -- and I passed!
I had presented a case, the nature of which I have completely forgotten, but it involved a relatively young woman who had already had eight children.
Dr. Stead became completely focused on this and the social aspects of the case. He wanted to know if I had discussed birth control measures with the patient. I hemmed and hawed and said, "Well, we touched on it."
Dr. Stead immediately told me that I should have a conversation with the patient's husband and explain to him that the penis is a relatively insensitive organ when compared to the tongue, which can detect the smallest detail, and she won't know the difference when he uses this birth control measure.
We were at that moment all taken aback, although in discussion afterwards we agreed that this suggestion made perfect sense. Of course it was before the time of "the pill."
Both Dr. Davison and Dr. Stead had a great influence on me while I was a medical student at Duke. I still conscientiously look in eyegrounds and feel for pedal pulses -- well, I did right up to the day I retired.
In those Duke days Dr. Davison was beating the band to get impressionable young medical students to go into family practice. Most of my classmates didn't bite, but a few of us did. I harbored to some extent an idealistic inclination to go into family practice in the small town in Georgia where I was originally from or a place like it.
I, therefore, decided to take a rotating internship at a university hospital and chose University Hospital and Hillman Clinic in Birmingham. I thought it was the best of the ones I visited. After a year I decided that a doctor would have to keep up with more different kinds of knowledge in family practice than I would want to do so I decided to switch to internal medicine, which I was most interested in. I was thereby thrown with Dr. Tinsley Harrison by being the resident on his service for two rotations. It was a wonderful experience. There were many medical students rotating through his service, and it was intriguing to observe and participate in the interplay between the novice medical students and the master clinician. When a medical student would present a patient to Dr. Harrison, he would patiently go through each detail, gently asking questions in order to get them to use their powers of reason. At the end he would go though an exhaustive differential diagnosis. His knowledge of medicine was encyclopedic, and he would work through each possibility.
At the end he would force himself and each student through differential diagnosis to a methodical and logical conclusion, so that a diagnosis was made. Then the studies to rule in or rule out the diagnosis and other ranked possibilities were logically gone through. With all of this he was very humane and kind. The students loved him.
I thought the way Dr. Harrison taught was in stark contrast to Dr. Stead's approach. Dr. Harrison was doggedly logical, methodical and analytical. Dr.Stead on the other hand was uncannily intuitive. He could come on the ward, get the essence of the history, do a focused exam and make a diagnosis in minutes that the students and house staff might have been up all night trying to make.
Dr. Stead seemed to have some eerie, immediate kind of comprehension of what was going on with the patient. His thought processes seemed to be short-tracked through his brain. But his diagnostic abilities were not all that made him such a good teacher. It was his absolute realism, his ability to thrust the student, as it were, into the cold-blooded scenario of the real world.
You didn't slack, you did what was necessary to get the diagnosis and the patient treated, even if you didn't get any sleep that night or screwed up on rounds the next morning.
Dr. Stead set iron criteria, which in reality are the criteria of the real world, that world that he knew you would ultimately be thrust into. He was preparing his charges. It was immaterial whether you loved Dr. Stead or not. He was indifferent to this. I think in some ways he was like a tough sergeant in the army during wartime. You might have hated his guts at times, but in the long run you were glad he was training you, because you knew you would have a better chance of making it over the next hill without getting blown to bits.