Harvard Medicine

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Catching the Bouquet

A wine connoisseur follows his nose to diagnose disease

Photo by Tobi Newsome

This is how it would work. I would ask the residents to page me whenever they had a case of Pseudomonas pneumonia or Clostridium difficile enteritis. I might then reward them—or at least those who saw it as a reward—with some brief bedside teaching on the slightly-turned-red-grape odor of Pseudomonas or the more intricate coal-tar-in-the-horse-barn smell of Clostridium. By keeping the nurses in the operating rooms and endoscopy suites well-supplied with bagels and donuts, I could guarantee a page when gas gangrene or shigellosis appeared, and eventually, merely by sticking my head in the door, I could catch the whiff of rotten apples or rancid butter, nod my head, and wink.

For the more arcane stuff, greater rewards were necessary: a bottle of wine, dinner for two, that sort of thing. Those rewards I posted in the newborn nursery, for example, or on the pediatrics ward. And so I could collect the wet-mouse smell of phenylketonuria, the sweet aroma of maple-syrup-urine-disease, the subtle halibut-gone-bad hint in tyrosinemia. This was great fun at first, as are all hobbies, but in time became a curse, as do most compulsions. Let me start from the beginning.

As an intern, I had an interest in wine. My colleagues knew of my pastime and would often ask for recommendations. I’d steer them toward an affordable Vouvray rather than the pricier Pouilly-Fuissé. From this began a wine co-op. With thirty or so residents interested in an inexpensive mixed case of wine every month, I began a wonderful relationship with the owner of a major wine store in Rochester, New York. Buying thirty cases of wine every month made me one of his best customers, got me invited to after-hours back-room tastings with heavy hitters from the local high-tech industries, and exposed me to the smell and taste of an incredible array of wines.

It was during those tastings that I realized I had an unusually strong olfactory memory. It wasn’t just that I nailed the cedar-pencil whiffs and cigar-box hints amid the roasted cherries of a Pauillac. I remembered those smells, as you might remember a song at your high school prom. And just as you might recall from hearing the melody of that song whom you danced with and what you wore, the whiff of a ’61 Pichon-Lalande conjured up all the memories associated with my savoring of it because, as neuroscientists will tell you, our noses are wired to our limbic systems, which are somehow connected to prom nights and fine wines.

Many of those high-tech executives envied my talent. In wine tasting, such a flair is associated with connoisseurs and bon vivants. In medicine, though, anyone who strolls through an endoscopy suite leading with his nostrils is merely considered strange. In both cases, it is a gift—no more than that. Some are born with it.

I began collecting wines and eventually drifted toward cheeses and their smells and tastes, filling the house with the stenches my wife ascribed to Époisses and Livarot. And I planned vacations, holidays, and weekends around aromas I hoped to collect. I heavily lobbied, for example, for a trip to China, ostensibly to see the Great Wall, but with a secret side trip to Xing’an County, which had a problem with typhoid. I needed the disease’s freshly-baked-black-bread odor for my collection. Similarly, Brazil could be lovely at a certain time of year, and if my wife could be happy with Rio’s shops, I could explore the butcher-shop smells of Brasilia’s yellow fever epidemic. (Sadly, not the charcuterie aromas of those wonderful Parisian shops, but rather the off-putting ripeness of the back streets of Chinatown.) My wife put up with these odoriferous escapades. But I was creating a monster of greater proportion.

My monster had to do with my limbic-system connections. I found myself avoiding bakeries heavily into sourdough bread, and then, by association, all bakeries, because of the memories of those kids with pellagra in that orphanage in Casablanca. Eastern European restaurants also made the must-avoid index, as the cooked cabbage conjured up hypermethioninemia. And garlic-laden Italian restaurants were too reminiscent of that awful case of arsenic poisoning in northern Maine.

By then, too, my wife had become suspicious of any travel suggestion. She soon wearied of bland Irish meat-and-potatoes pubs. I longed for a wheel of Brie but couldn’t bear another conjured-up image of abscess.

It was with this heavy burden that I found myself on rounds one day. The interns and their attending had summoned me to weigh in on a case that had baffled them all. I was old, they hinted, and had seen everything. Could I render an opinion?

I introduced myself to the patient, a sweet, elderly woman redolent of Chanel No. 5. “I’m a cardiologist,” I told her, “but I understand there’s nothing wrong with your heart. It’s just that your doctors have asked me to see you. I’m old. I’ve seen everything.”

“I’ve consulted so many doctors, had so many tests,” she whined. “Maybe I should go to Boston. Should I go to Boston?” Then she stopped and asked, “What are you looking for?”

“The paperwhites. I smell paperwhites.”

“Oh, my daughter threw them out yesterday. What’s wrong with me?”

I hadn’t a clue. I had read her chart, run through her history. I took another history. Nothing new to add. I asked all the standard questions meant to uncover odd details—occupational exposures, travel, herbal medicines, hobbies. She hadn’t worked in any silos, hadn’t visited Paraguay, didn’t own a parrot. She began to regard me in the way those endoscopy-suite patients inevitably did.

I began the physical exam by taking her hands in mine. I scrutinized her fingernails, scanning them for diagnostic clues. No Muehrcke’s lines, no Terry’s nails. No hint of disease from her skin. I peered into the pale web of her hair, at her scalp. She pulled away.

“What are you doing?” she asked anxiously. “What are you looking for?”

I didn’t know, exactly. I was stalling. I began to examine her heart, listening at the base, then rolled her on her left side to listen at the apex, leaning over her, closer, closer still.

“You’re smiling,” she said. “Why are you smiling? Did you hear something?”

“What’s that smell?” I answered.

Michael A. LaCombe ’68 is a cardiologist at Maine General Medical Center. The University of Maine Press recently published his latest book, Bedside: The Art of Medicine, a collection of fictional medical stories. Unlike those stories, this original essay is excruciatingly factual, as his wife can attest.


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