Making a diagnosis is, after many years of experience, often more an intuitive process than it is a function of informed reasoning. The new edition of The Bedside Dysmorphologist, coming 8 years after the first edition, should therefore reflect the further gradual enlightenment of its ageing author. Similar sentiments were expressed recently by a retiring Psychiatrist colleague who bemoaned that it was stupid that he should have to retire at 65, just as he felt he had learned how to do his job and that a 30 years younger successor would now spend his life acquiring the same knowledge, at considerable cost to the patients.

A decade ago, I felt emboldened to offer the outline of a book for young Geneticists, Paediatricians and others charged with identifying malformations in children to Oxford University Press. Rather to my surprise, they took me up on the offer. I then learned the reality of writing -  expressing ideas and experience on the page can be challenging. The appropriate format of words is often elusive. The empty page does not easily fill and demands constant rewriting and revision. This hard learned lesson had many benefits. Not only did my appreciation of and regard for the written word increase exponentially, but the value I placed on those who had grappled with the problem of writing, of creating something from nothing, became a new pillar of my thinking. I now understood why it was that Kingsley Amis, who gave us one great book – the original campus novel “Lucky Jim” – never equalled his achievement again despite a long career. In his later years, he wrote for 3 hours every morning, producing progressively slighter books as a matter of rote and financial necessity. That elixir of effortless humour and fluid jocularity eluded him, despite earnest, but uninspired endeavour.

On the face of it, a second edition should be easier to write. After all, empty pages no longer stare disobligingly back at one, daring the aspiring author to try to create something where there is nothing. The template of the book must have been reasonably successful if the publishers are pressing for a further edition, with mounting anxiety that it has not materialised. The author has the benefit of the suggestions and corrections of his readers from the first edition to assist, assuming that he has had the wit to keep them in a file that is identifiable on the computer hard drive. All of these elements should buoy the enthusiasm of the no longer ephebic (or youthful) author. Nonetheless, despite these fair winds behind me, a second edition of “The Bedside Dysmorphologist” was not an easy task and took far longer than I would have wished. I daresay these sentiments are shared by my devoted, patient and inspiring Editor at Oxford University Press. Not only has medicine, and genetics in particular, moved on with the requirement for extensive textual editing, but the shortcomings of illustrations and clinical photographs from the first edition were all too evident to my critical eye and required replacement, supplementation or other elaboration. Finding the right illustration was often challenging and frustrating – it is especially irritating to remember the clinical sign, the perfect illustration which the text calls for, but to be unable to recall the name of the patient, under which that picture will be filed! A decade ago, when embarking on the first edition, that younger man would have told you about one of his favourite authors, the late Paddy Leigh Fermor, a man once described by the BBC as “a cross between Indiana Jones, James Bond and Graham Greene.” I would have told you about how infuriating he was, to have delivered 2 of the most beguiling travel books ever written “A Time of Gifts” (1977) and “Between the Woods and the Water” (1986) but who died (2011, aged 96) without delivering the manuscript for his long promised final part of the trilogy. His despairing publisher, “Jock” Murray had given up hope and died himself waiting for the final delivery! A decade on from my conception of “The Bedside Dysmorphologist”, and chastened by my own comparatively minor writing experience, I am grateful to Paddy for overcoming all his hurdles to give us the two great books he did and I am completely at ease with the incompleteness of the final part of the projected trilogy. Such is the insight of experience.

An unlikely association which has been distilled for me by writing this book is the parallels between patient management and writing a book. In the clinic one makes a diagnosis, explains it to the family, writes a report and discharges that case back to the referring physician. However, old cases have a recurring habit of returning to disturb one’s calm – the patient’s sister becomes pregnant and needs an urgent appointment, or his brother has lost your report and needs to get another copy or similar episodes reflecting the importunate nature of patient care and the turbulent unpredictability of daily life as it is lived and experienced. As an author, I grappled with the unmanageable wealth of knowledge which required to be compressed into a manageable size, sought to identify the illustrations which are the beating heart of this book and submit them to my Editor. The temptation, at that point of submission, to consider the book as finished is overwhelming. Like patient care, it is never finished – there are new emails from copy editors with deadlines for response, errors introduced by gremlins – never by the author - to be identified and rectified, further requests from copy editors for urgent review of chapters with deadlines which mean there will be no sleep this week-end. Unseen and unimagined among these calls for further devotion of time to a project which one had delusionally considered complete, emerges the new scourge – the request for a blog contribution! The late American history writer, Cornelius Ryan left us a wonderful book on the ill-fated attempt by the Allied forces to break through German lines and take a series of strategically important bridges in occupied Holland during 1944. He called this book “A Bridge too Far.” The temptation to view the gracious invitation to contribute to a blog on “The Bedside Dysmorphologist” as a bridge too far was quickly supplanted by my recognition of a glorious opportunity to thank my publishers and readers for their encouragement, as well as to re-iterate the purpose of the book. It is written with an eye to my young self, who 30 years ago was completely incapable of understanding the language of malformation and simply could never feel secure that I really had grasped what my seniors were trying to teach me about the fundamentals of clinical examination in malformations and related anomalies. These essential skills can be learned. I am living proof of this and in this book, much improved from the first edition, I share my ambition to make these skills accessible. They comprise a lifelong toolkit which I have found invaluable and for which I give daily thanks to the memory of my great mentors. With the enthusiastic assistance of patients, colleagues and friends at Oxford University Press, I am pleased to introduce the new Edition. I even confess that I have started to hoard instructive clinical photographs in a special file lest they ever be tempted to seek a third Edition from me in my senility! 

 

You can purchase a copy of the Second Edition of The Bedside Dysmorphologist at Oxford University Press

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