Osler’s visit  

When the doctor previewed his patient-schedule for the day, one name stood out. 

Osler, W. 9:00 am, sick visit. 

Ok, very funny. Clever prank. Must have been Schaefer up to his old tricks. He’d been quiet for the last year since pretending to call out sick with Ebola last April Fool’s Day.  

Looking through the pre-visit chart prep, there was no photo or phone number, and his address was listed as just, “Johns Hopkins Hospital.” 

As the doctor tried to process this enigma, the intercom started to chirp. “Doctor Wrightfinger, it’s Kim at the front desk. You’d better get out to the waiting room. There’s an older guy out here who is examining other patients—says he’s here to see you.” 

“My god,” he thought. “Could it really be?” 

He walked out into the waiting room and spotted him immediately, ear up against a young man’s back listening to deep breathing punctuated by cough spasms. He looked like he’d just emerged from an old photograph—a serious yet warm face with deep-set eyes, thinning white hair, an overgrown handlebar mustache, classic vintage gray suit, and slim bow tie. Doctor William Osler. No doubt about it.

He must have spotted the white coat in the corner of his eye as the doctor approached, sat upright and pulled his “patient’s” shirt down. Then he rose from his chair and extended his hand. 

“Osler. William Osler. I couldn’t get my stethoscope through your metal detector at the front gate, but a well-trained ear can improvise,” he said. 

“It is a great honor to meet you Dr. Osler. Jeffrey Wrightfinger here, general internist. Let me walk you down to my office.” 

“What is a general internist? Is that a new designation?” Osler asked. 

“I’ll explain. There’s a little over a century to catch up on. Any idea how you ended up here? Was there some kind of bizarre space-time wrinkle?” 

“My name came up at a ‘Who, alive or dead, would you most like to invite to lunch?’ contest. My abdomen began to ache shortly after I arrived though, so plans were delayed.” 

Osler was spry for a man of around 60, which was quite old in the early twentieth century. When they arrived at the office, Wrightfinger sat down next to Osler, as he couldn’t possibly talk to medicine’s great clinical icon from behind a desk. Osler eyed him up and down quietly and carefully before he spoke. 

“What became of the home office? And what about the house call? Now you have this large sterile building. And what about your loose-fitting green costume and white overcoat? It looks ridiculous.” 

“I’m not a medical history scholar, but offices became a better way to preserve sterile conditions and store more complex equipment. Also, most people don’t live in small insular communities anymore. Planes, trains, and automobiles—they’ve pushed us farther apart. And we call the costume scrubs—surgical attire, easy to launder. Many of us started wearing them in the office during the pandemic.” 

“Pandemic?” 

“Yes indeed. It was like the 1918 Spanish flu all over again. Millions died, but we developed a vaccine and medications which limited the devastation. Now let’s curtail the history lesson and hear about your abdominal pain.” 

Wrightfinger led Osler to the exam table, held out a gown for him to change into, and stepped out of the room momentarily. When he returned, Osler was gowned and laying supine on the table massaging his abdomen. 

“Tell me about your pain,” Wrightfinger began. 

“It began as twinges and is now a sustained discomfort in McBurney’s region,” he said, pointing to his right lower abdomen. “My appetite has decreased and there’s been little bowel activity. There’s some rebound tenderness, and there is no audible borborygmi. Perhaps a little salicylic acid or morphine would help, but I’m worried about my appendix.” By rebound, Osler was referring to heightened pain with pressure and sudden release—a sign of more serious inflammation in the lining of the abdominal cavity. 

“I think this goes a little beyond what you meant by ‘Listen to the patient, he is telling you the diagnosis.’” 

“Actually, I never said those exact words, but I do like them, and don’t mind that they’ve been attributed to me,” Osler replied. 

“But I do think it was you who said that ‘A physician who treats himself has a fool for a patient.’ Now let’s complete your history and examination,” Wrightfinger retorted. 

“You got me there,” Osler replied. “You know a lot of my best lines, but I’m a little miffed that you don’t have any of my titles on your bookshelf.” He had the last word after all. 

Osler was generally well with slightly elevated systolic blood pressure and moderate tenderness in the lower abdomen, more so on the right side. Wrightfinger couldn’t detect any rebound tenderness. He percussed over the liver and spleen, tapping on Osler’s abdomen listening for changes in pitch telling him their location, and found both normal in size. This was mostly to show Osler that he had not dispensed with classic examination techniques.  

“Dr. Osler,” Wrightfinger said, “This may very well be appendicitis, but I’m not entirely sure. You don’t appear ill enough to require immediate surgery. I’m going to recommend something that may sound like science fiction—a computerized cross-sectional picture or tomogram, commonly known as a CT scan. It may help us zero in on the diagnosis.” 

“I’m glad you are addressing me as an individual, rather than focusing solely on the disease characteristics. If this new imaging technology will assist you, then let’s get on with it.” 

Wrightfinger was surprised that Osler was so agreeable and trusting. Perhaps it was simply characteristic of his time when there was a certain reverence for the physician that has since waned.  

Fortunately, the office had onsite radiology, so Osler was escorted over for his scan right away. Wrightfinger registered Osler by his lesser known prankster pseudonym Egerton Yorrick Davis, to avoid any unnecessary distraction. It was good to know that their most experienced radiologist, Dr. Gretchen Chisolm, was in the reading room that afternoon. She was told of the ruse to protect Osler’s identity. Shortly after the study was completed, she came out to review her findings. 

“Gentlemen, I have some interesting news,” Chisolm began. “It is not your appendix Dr. Osler. I see some thickening of the cecum with fat stranding which suggests diverticulitis.” 

“Fascinating,” Osler said with a stunned look of amazement. “I’m surprised doctors still examine patients considering that you have this technology at your disposal.” 

“It’s quite extraordinary, but we still follow your guidance on the importance of listening to and examining the patient, Dr. Osler. ‘Begin with the patient, continue with the patient . . .’” Wrightfinger chimed in. 

“I never imagined that my teachings would still be quoted after so long. That’s extremely rewarding to know.” 

“Doctor,” Chisolm added, “What have you eaten recently?” 

“Well, when I arrived in this time period, I was starving. Time travel seems to deplete one’s energy stores. I went into a small market and the only snack I recognized was Cracker Jack, which was introduced in the late 1800s. I ate two full boxes. Was a little disappointed that they don’t have a prize inside anymore.” 

“Aha!” Wrightfinger exclaimed. “The caramel popcorn probably set off the diverticulitis!”  

They all nodded in agreement. 

“Fortunately, sir, we have some effective medicine for this problem—should have you feeling better in a few days.” 

“I suppose I’ll reschedule the contest winner’s lunch for next week,” Osler said. 

“You’ll certainly have a good story for them. Not sure how long you’ll be here, but it would be great if you could fit in a Grand Rounds for the department of medicine—maybe about intergenerational clinician collaboration? It has been a hot button issue these days and I can’t think of a better example than what we’ve just gone through!” 

“I would be honored,” Osler replied. “In fact, I have been considering a new essay entitled ‘Collaborare,’ a follow up to ‘Aequanimitas.’” 

“I get your schtick. Latin titles are more likely to become legendary,” Wrightfinger said. 

Osler just smiled and gave a wink. 

Dedicated to the CLOSLER editorial team.

This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.