Tales from the Emergency Room (4 page)

DVM

It was pharmacology class. We had already voted to learn how to write prescriptions in English instead of Latin. At each session we were given blank prescription pads to use in our exercises. The professor would hand our practice prescriptions back at our next session so that we could learn from our mistakes. At the bottom of each prescription was a line which ended in “MD”. We all got a kick out of signing on this line. One day we were given an exercise in which the dose involved a large amount of powder. We had a chart of capsule sizes to work with. I finally managed to get all the powder into four very large capsules. Most of my classmates did the same. When we got the prescriptions back, the professor had crossed out the “MD” and written, in red, “DVM”. This of course means Doctor of Veterinary Medicine and these then were prescriptions for “horse pills”. None of us has ever forgotten, I’m sure, that sometimes one must use many small pills or capsules to get the whole the dose into the patient.

BCG

Since I grew up in suburban Westchester County, New York, I did not have the same exposure to diseases that someone in the middle of a big city might. So, when I got to medical school, my TB skin test was negative. It wasn’t long, however, before my class was recruited into a study of the reversibility of the test. We all went to have our BCG vaccinations (protection against tuberculosis) done. Then, after some time, we were retested and lo! my TB skin test was now positive. No problem so far. When I went into the service, my test had converted back to negative. However, in the service I was exposed to a ward where active tubercular patients were treated. Not only did my TB test become positive again, but I also developed a Ghon complex (evidence of prior tuberculosis infection) in my chest which showed up sometime later in a routine chest X-ray. That was that until I began working in a clinic in the south Bronx. I was to be tested for TB about once every two years. Treatment would be instituted if I had a positive test. I was not happy about that, but my test was no longer clearly positive and so I avoided the treatment. What my TB test is now I have no idea and no one can quite follow the changes in it anyway.

Remus Roll

Anatomy lab came as a shock to most of us. The odors, the bodies and our ignorance all seemed too much to cope with. We began with the dissections as the very first class in medical school. The course was Gross Anatomy and the humor was gross, too. This story is not now acceptable—it wasn’t then either but we were young and naïve. There were four people per body, but we all had to learn male and female anatomy as well. Our body was a light-skinned black man. We all named our specimens. Ours we called Remus. He was very well endowed as we say. (The genital area of the bodies were kept covered except when we were studying those organs.) A classmate and I went to a small store near our apartment where they were selling breads and pastries. On a top shelf there were long rolls. My classmate, a wag to begin with, announced to the clerk that he would like a Remus roll. That about finished me for the day. Even now, though we no longer think that this was funny, the two of us chuckle when reminded of the story.

Alopecia Totalis

One of my closest friends in college, the aforementioned tutor, Dick, and I would often go to his family’s house in Batavia, NY for the weekend. His mom and dad were wonderful people and very good to me. His mother had the most beautiful auburn hair imaginable which people often commented on. After college, he went his way and I went to medical school nearby. One day while roaming around the medical wards I came upon his mother standing just outside her room. She was wearing a kerchief-cum-turban around her head. We had a pleasant conversation—I did not know why she was in the hospital—and I continued on my way wondering what had become of her lovely hair. Later, Dick told me that she did not have any hair at all (alopecia totalis) but that she owned two very expensive wigs. While one was out being cleaned and cared for, she would wear the other. Very few people look as well in their own hair as this lady did in her wig!

A Christian Scientist

One of my best friends in medical school was a chemical engineer by training since his father refused to pay for any other education for him. Hence, he was forced to pay for medical school himself. Tom was a musician, a largely self taught virtuoso at the organ and a terrific piano player as well. He auditioned for the job of organist at the First Church of Christ Scientist in Rochester among sharp competition given that the Eastman School of Music, like the medical school, was a part of the University. He was hired immediately and began playing for services at the church. There was much sought after vocal talent in town for the churches, and one “diva” sang at the Christian Scientist Church. Tom however, made a serious error by leaving several of his medical school books under the organ where they were eventually discovered. His contact telephone number was, of all places, the Anatomy Department. The call telling him he had been fired came to him there. The following Sunday, a new person sat at the organ in church. The vocalist got up to sing, noted that Tom was not at the organ and said, “I do not sing without Mr. Harter!” Then she sat down. The following Sunday, he was back playing the organ having promised to never ever do anything that would connect him with the medical school. And he was able to continue to finance his education.

The Bakery Truck

It was the middle of winter in Rochester, NY. My roommate and I lived in an apartment in the low-rent district. We were first year medical students. It had snowed all night and was terribly cold, below zero, and very windy. My car, parked behind the apartment, would not start and was buried in snow as well.

So we set out, bundled up, to the main road early in the morning. Of course, everything had been plowed already, Rochester being set up to deal with snow. We were looking for a ride and, sure enough, along came a bakery truck. The driver stopped for us and said that he was going up toward the University but would have to drop us off on the far side of the bridge over the Genesee River so as to keep to his schedule.

Off we went, warm in the truck for a 3-4 mile ride to a place in sight of the medical school on the other side of the Genesee River. Well, I have been cold before and since but never as badly as while we were crossing that bridge in howling wind and a deep freeze. That evening, having been delivered home by a classmate, we dug my car out, got it running and were good to go for the next day. Winter in Rochester is only a minor inconvenience but my roommate and I will ever be thankful for the bakery truck driver’s help.

Right Hand Turns

In my second year of college I acquired a car, the mouse-brown limousine previously mentioned. In my first year of medical school, my car had a run-in with some metal warning signs placed in the middle of Main Street. I knew that the left front fender was bent, but I didn’t realize the consequences of that until the next morning. After the accident, I turned right a couple of times onto my street and into my driveway. The next morning we realized that turning left was impossible with the damage done. This posed a problem as we set out for school. It took a long time to get there devising a route as we went along which enabled us to end up in the school parking lot having executed right turns only. Somehow we made it, probably by making a very wide left turn somewhere along the way. Bending the fender back toward normal with a crowbar permanently solved the problem so that I could round corners again in any direction.

Bacteriology

At one point in my high school study of physics I was doing poorly. My father and my physics teacher were very close friends and colleagues. From my desk in the front row I could hardly fail to see my father come into the room and immediately disappear into Mr. Wilson’s lab. I knew there was trouble afoot. At dinner that night, my father said, “You are not distinguishing yourself in physics.” No reply was forthcoming from me and my father never said another word about it. Since the time to take the New York State Regents exams was nearing, I studied a bit harder and thankfully passed the physics exam with a fairly presentable B grade. That was good enough to get into college.

Many years later I was having trouble with a subject in the medical school curriculum. This time it was bacteriology/parasitology. The department chairman called me into his office essentially to put me on notice. During the interview he went to his files and brought out my folder. He said, after looking it over, “You are not distinguishing yourself in bacteriology.” Déjà vu. This time I was able to croak out a question, “Am I still in medical school?” It seemed that I was but that depended on how well I did on the upcoming parasitology exam. Once again, I studied a bit more, eventually scoring in the high eighties on the National Board Examination in Bacteriology, taken at the end of the second year of medical school. Saved by the book!

I took parasitology the semester I got married and I didn’t much like the course. It seemed that I was always too busy to study the course material. Eventually, as it was important for me to do so, I passed the course. During the following summer while I was working in the bacteriology lab on a fellowship grant examining the role of phage viruses, professors, instructors and students all ate lunch together. The professors were not much older than the rest of us. We would have lively discussions of politics, religion, etc. Never one to keep my mouth judiciously closed, I once stated an opinion of mine in direct opposition to that of the parasitology professor. He looked at me and said, “Remember, Hermance, your grade is still in pencil.” That was enough to settle the argument in his favor.

Pass the Pipette

The summer before my junior year in med school, I worked for my bacteriology professor on a March of Dimes grant. He was doing research on phage viruses. My job in the lab was to do the busy work. I would use a glass pipette, suck the serum containing the virus (phage) to a measured point in the pipette and then deposit that onto an agar covered glass Petri dish. I was surrounded by glass tubes and Petri dishes. This was such a repetitive job (during which I only occasionally pipetted some material into my mouth) that I dreamed about it. One night I actually asked my wife while I was asleep to “pass the pipette”! She thought that was hysterically funny. I thought it less so but the story brings back memories of a very satisfactory time in my life.

Indian Curry

The same professor and his wife threw a dinner party for the department one evening. His wife was from India and she had just received a shipment of Indian foods and spices. The table was laden with delicious looking foods, some of which looked as if they might be very hot and spicy. My exposure to this cuisine was minimal up to then. Before long I was in need of something to counteract the hot spices in the food I was eating and I spied a small dish of what looked like pineapple preserve. Just the ticket I thought and I put some on my plate and ate a small forkful. Well, I thought I would burst into flames! I had never before experienced anything so hot. I couldn’t just spit it out so I swallowed it and then had to dab my eyes which were tearing heavily by then. All this transpired without anyone noticing except my wife who kept still until she found what the outcome of my discomfort would be. Eventually, with enough water—I knew it was water—and some other non-spicy items, I recovered. Ever since however, I have been very careful when sampling unknown foods especially garnishes and side dishes as when my present employer, also from India, takes me out to the Indian restaurant for lunch. He is always very good about pointing out the “safe” foods.

Statistics

Sometime during my junior year in medical school, the class was informed that a statistics class was going to become part of the curriculum and would be mandatory. Calculus had not been a requirement for medical school in those days as it is now. I doubt that some of us, including me, would have become doctors. No prior discussion except to express our horror took place among my classmates to my knowledge. However, no one showed up for the class when it was first scheduled and not for the second scheduled time either. The idea of a statistics class died a quiet death. Naturally, I had classmates who were already good at statistics and we all had to learn some of the subject as we continued our studies, so important are statistics in the medical literature.

Psychiatric Interviewing

In Wing R, as the psychiatric building was called, was a classroom with a one-way glass wall. Here, the part of the class rotating through Psychiatry would sit while a classmate interviewed a real patient. Afterward, the class and the professor would critique the session. Of course, criticism by one’s peers is often more anxiety provoking than that of the professor, but not being able to see the class was of some help. While I don’t remember the content of my interview, I do remember the class discussion afterward. I did fairly well as did most of us, having been trained extensively in history taking (the most important part of any medical exam). One fault about my technique did come up which I never forgot and about which I would often think in my medical career. It seemed that I tended to put a little more physical space between me and the patient than was necessary, perhaps leading to a feeling of aloofness or, worse, disinterest on my part. Not what I intended nor the way I felt, but still in need of correction.

One of the teaching exercises we were assigned in psychiatry was to follow certain patients and to interview their families. There didn’t seem to be too much trouble getting the family of my patient together so we all met one evening in a small conference room. (If one did not have prior experience conducting a meeting this was a fast way to learn for sure.) I was amazed at the insights the family members had into their relative’s troubles. Nowadays of course, medications would probably have kept him out of the hospital, but that course was not open to us then. So, we spent an hour discussing what the patient’s problem was, how he got that way, what family members could do about it and what his care would consist of once he was discharged. It’s hard to imagine that they were impressed with me, but I surely was impressed by them and I think they went away feeling that the good of their relative was uppermost in the minds of his hospital caregivers.