Correspondence

Trouble from a Literary Reference

N Engl J Med 1999; 341:1006September 23, 1999

Article

To the Editor:

A 51-year-old high-school teacher had a myocardial infarction and was taken to a community hospital in cardiogenic shock. His condition was stabilized, and he was transferred to a university hospital, where he spent seven days in the coronary care unit. While in this unit, he reported that the restrictions on his movement due to the numerous intravenous lines, the infusion pumps, and the nasal cannula made him feel as if he were “in Peter Coffin's inn.” Peter Coffin owns the Spouter-Inn, a lodging house, in Herman Melville's 1851 novel Moby-Dick. There, Ishmael, the narrator, must share a bed with the bulky Queequeg because of lack of space at the inn.

The patient's nurse heard the word “coffin” and wondered whether the patient was suicidal. Psychiatric consultants were called. They spent several hours talking with him and concluded that he was not suicidal. No one seemed to recognize the reference to Moby-Dick. No one had read the novel.

Two lessons may be drawn from this incident. First, medical personnel need to listen more closely to patients' remarks and ask about unfamiliar phrases. Second (and less readily changed), physicians and nurses need a broader education in the humanities.

Howard Fischer, M.D.
Children's Hospital of Michigan, Detroit, MI 48201

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