Personal Reflections From a Front-Row Seat at the Greatest Show on Earth (Life)

Part I of this discussion of my 65 years since graduating from medical school covered my reasons for being in medicine at all, my explanation for the theatrical terms in the earlier para-scientific document, and finally the effect of World War II on my career.1Part II will attempt to touch on the privileged life I led in the field of stroke prevention research. In its entirety it is designed as a story or tale about my 50 years in medical practice and does not follow the standard format of a scientific paper.Previously I alluded to the ongoing prejudicial custom of critical attempts to resist new ideas in scientific endeavor. I gave as examples the discordant behavior in Toronto that greeted the discovery of insulin and of less far-reaching consequence my own attempts to convince Canadian and American colleagues that there were 5 distinct causal mechanisms leading to syringomyelia. Surgeons in Cleveland and Boston were adamant that there was but one. Postmortem studies and now routine MR studies prove them wrong.My next contribution of a controversial nature was a description of a group of young patients with stroke whose causes we defined in a study with age and gender-matched controls as being due to emboli associated with mitral valve prolapse and to suggest that this was a clinically overlooked cause of cerebral ischemic events.2 Denials of variable vehemence appeared but the accumulating pathological and surgical data were quite incontrovertible. Ultimately in an Olmstead County prevalence study its occurrence as a cause of stroke was validated.3 Its prevalence is probably less than we suggested in our first report. The difference is probably explained by improvement in the conduct, interpretation and the delineation of newer stroke causes revealed by echocardiography. At times more than one potential cause …