The Morning Sentinel

March 21

There's always a memory for a collector of smells

Keeping The

This is how it would work.

In the beginning, I'd ask the residents to page me if they had a case of pseudomonas pneumonia or C. difficile enteritis. I might then reward them (those who saw it as a reward) with some brief bedside teaching on the odor of slightly turned red grapes (pseudomonas) or the more intricate 'coal tar in the horse barn' smell of clostridia.

By keeping the nurses in the OR 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 aroma of rotten apples or rancid butter, nod my head, wink, and thank them.

For the more arcane stuff, greater rewards were necessary: a bottle of wine, dinner for two out on the town, that sort of thing. These rewards I posted in the newborn nursery for example, or on the pediatrics ward, and so collected the wet-mouse smell of PKU, the uncommon odor of maple-syrup-urine-disease, and the subtle hint of halibut gone-by in tyrosinemia.

This was great fun at first, as are all hobbies, but became a curse, as do most compulsions. Let me start from the beginning.

As an intern, I had a modest interest in wine, a pursuit my colleagues knew of. Frequently they would ask me for a recommendation for the holidays and 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 Sherwood at the big wine store between Kodak Park and Xerox in Rochester. Buying thirty cases of wine every month made me one of his best customers, got me invited into the after-hours back room tastings with the heavy hitters from the hi-tech industries, and exposed me to the smell and taste of an incredible array of wines.

This was how I found I had a tasting memory. It wasn't just that I nailed the whiff of cedar pencils and cigar box hints in the roasted cherries of a Pauillac. I remembered those smells, as you might remember at song at your high school prom. And just as you might recall from the notes of that song, whom you danced with and what you wore, the taste of a '61 Pichon-Lalande brought with it all the associated memories -- because, as the neuroscientists will tell you, one's nose is wired to the limbic system which is somehow connected to prom nights and fine wines.

Many of those executives from Kodak and Xerox resented this talent of mine, or more precisely, envied it. In wine tasting it is incorrectly attributed to the connoisseur or bon vivant, whereas in medicine, anyone who strolls through endoscopy leading with his nostrils is merely considered strange. In both cases, it is a gift, no more than that. Some are born with it. Others are not.

I began collecting wines. Logical enough, although quite a pain when moving from place to place as young doctors usually do. I drifted toward cheeses and their smells and tastes, often filling the house with the so-called stench my wife ascribed to Époisses and Livarot. And vacations, holidays, weekends, I planned with the collection of smells in mind. I heavily lobbied, for example, for a trip to China, ostensibly to see the Great Wall which they see in space but which we had never seen, but with a secret side-trip to Xing' an County, where there were problems with typhoid. I needed its 'freshly baked black bread' smell for my collection. Likewise, Brazil could be lovely at a certain time of year, and if my wife might be happy with the shops in Rio, I could explore the butcher-shop smells of the yellow fever epidemic in Brasilia. (Aside: not the charcuterie smell of those wonderful shops in Paris, but rather, your basic, off-putting odors of the back streets off Mott Street in Chinatown.) My wife put up with this. But I was creating a monster of greater proportion.

It had to do with that limbic system business I mentioned. I found myself avoiding bakeries heavily into sourdough bread, and then by association, all bakeries, because of the memories of that orphanage in Casablanca and those kids with pellagra. Eastern European restaurants also made the Index. The cooked cabbage conjured up hypermethioninemia. Italian restaurants heavy into garlic I avoided -- just too reminiscent of that awful case of arsenic poisoning in northern Maine.

I think you get the idea. My wife became suspicious of any travel suggestion. Both of us wearied of bland Irish meat-and-potatoes pubs. I longed for a wheel of Brie, but couldn't bear the image of yet another abscess.

It was with this heavy burden that I found myself on rounds one day. The interns and their teaching attending had asked 'someone of my experience' to weigh in on a case that had them all puzzled. I was old, they hinted, had seen everything. Could I render an opinion?

"Hello. I am Dr. L____ I'm a cardiologist, but I understand there is 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 seen so many doctors, had so many tests. Maybe I should go to Boston. Should I go to Boston?" asked this sweet, pleasant old lady, redolent of Chanel No. 5. "What are you looking for?" she added.

"The paperwhites. I smell paperwhites."

"Oh, my daughter threw them out yesterday. What's wrong with me?"

I hadn't a clue, but I said nothing. I had read her chart, run through her history there. I took it again. Nothing new to add. I asked all the wacko questions -- travel, herbal meds, occupational/industrial exposure. She hadn't worked in any silos, hadn't visited Paraguay, didn't own a parrot. She began to look at me like those patients in the endoscopy suite.

I began the physical exam, taking her hands in mine as I always do to begin. I scrutinized her fingernails -- I used to collect them too long ago -- mostly stalling. No Muehrcke's lines, no Terry's nails. No hint of disease on her skin. I looked in her hair, at her scalp. She jerked away.

"What are you doing? I don't have lice! What are you looking for?"

I didn't know what I was looking for. I was stalling again. I said nothing. 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 in my heart?"

"What's that smell?" I answered.

(Dr LaCombe's latest book is Bedside: The Art of Medicine, a collection of medical stories just published by University of Maine Press. It can be ordered through local bookstores.)

Michael A. LaCombe is a cardiologist at MaineGeneral Medical Center. E-mail questions to: housecalls@mainegeneral.org