Malignant Melanoma

Abstract

Almost 25 years ago, when I was in my late 30s, I was busily engaged by a growing private practice of internal medicine. I admitted my patients to a sleepy community hospital in southern New England whose medical staff was made up of about 25 to 30 private practitioners. Because there were relatively few of us, we worked closely together and usually knew about each other’s patients and quickly knew when anyone else’s patients had life-threatening or particularly trying illnesses. At the time, one of our general practitioners was caring for a prominent local citizen who was having a painful and lingering course of metastatic malignant melanoma. The disease had been diagnosed when a solitary axillary lymph node was excised for biopsy, and it was clear to everyone that the young man would soon be dead. Pain control for cancer was not well worked out then, and the patient was rarely if ever pain-free during his many admissions to our local hospital and to the teaching hospital of Yale Medical School. Because of this patient’s dreadful course our medical staff frequently discussed the distressful vagaries of melanoma and the stresses of caring for such patients.

Dr. Harvey Mandell spent 22 years in the private practice of internal medicine until 1976, when he became medical director of The William W. Backus Hospital in Norwich, Connecticut, a post he still holds. He has a clinical faculty appointment at Yale and enjoys writing about the American medical scene as he sees it.