Dr. Galen's Little Black Bag: Stories. R.A. Comunale M.D. M.D.
jars. Needless to say, the urology and gynecology sections grabbed our attention.
“This is a perfect example of a teratoma,” Professor Madden intoned, pointing at a large jar containing the mortal remains of a woman upon whom nature had bestowed the ultimate indignity: Lining her vulva were two complete rows of teeth.
For you scientifically inclined readers, teratomas are tumors that usually begin when a baby forms inside its mother. Cells that ultimately become different types of organs and tissues locate in the wrong place and develop just as they would in their correct position—hair, eyeballs, limbs, you name it. They can be found anywhere from the base of the tongue to the genitals.
Our class clown, Andy—yes, medical school has them—leered at his girlfriend, Tanya.
“You aren’t going to surprise me, are you?”
The smile on her face could have air-conditioned the room.
“You’ll never know.”
Most of us had survived the first year’s comprehensive exams, that critical testing of mind and body, fighting fatigue and knowledge overload. Ten did not. Three would be repeating freshman year, one had shot himself, and six had decided their best interests lay elsewhere.
Year two meant pairing off, kindred men and women finding each other and beginning the dating/mating ritual full tilt. Dave had fallen head over country-boy heels in love with Connie, whom he called the Teacher. My other friend, Bill, aka Baby Face, had lost his gentleman’s reserve over Peggy, the Southern Belle.
Me? I wasn’t the passionate type.
Right.
Until I met June, aka The Model.
From that time on the six of us became life-long friends. We survived and thrived in school because of one another.
I miss you, my friends.
Sophomore year. We carried our black bags to clinical presentations, ready to jump up and approach a patient staring back at us from a chair, wheelchair, or stretcher when a professor called our name.
“Mr. Galen.”
“Yes, sir?”
“Take a look at our patient. What are your observations?”
Dr. Stemp was known for pulling surprises.
The young man, no more than seventeen, smiled at me when I approached him. He sat in gym shorts and tee-shirt, totally unfazed by the two-hundred-or-so eyes staring at him.
“Hi … uh … Mr.…”
“I’m Terry.”
“Okay, Terry … uh … would you please take your shirt off?”
“Sure.”
He reached over his shoulder and, in that special guy way pulled the back of the white tee up and over his head and then looked right at me.
I don’t know if my classmates in the amphitheater saw it, but I had one of those pit-of-the-stomach reactions when I spied the glistening, red-black, one-inch spot on Terry’s right shoulder. I moved closer to him, palpated it and then felt under his arms and around his neck. The enlarged lymph nodes were unmistakable.
“Terry, would you lie down?”
He stretched himself out on the cart, and I ran my fingers over the place in his abdomen where the liver would be. It wasn’t hard to find. It was twice normal size.
I helped him sit back up and turned to the professor.
“Terry has melanoma, and it’s spread to his lymph nodes and liver.”
The room went silent. Even as sophomores we knew what it meant. We had just completed a section on malignancies of the skin. This young man’s fate was sealed.
It is fairly easy to read a textbook and study photos and descriptions of different medical problems. It’s another story when the subject is alive, alert, and damned nice.
“Didn’t you forget something, Mr. Galen?”
Dr. Stemp raised his right eyebrow.
Terry whispered softly, so I think I was the only one to hear him.
“Listen to my chest, Doc.”
I quickly opened my bag, took out my stethoscope, and self-consciously strained my ears. The classical machine-shop rumble of a hole in the heart wall separating the two main chambers roared back at me.
“Terry has a VSD, Dr. Stemp, a ventricular septal defect.”
Stemp nodded, and I sat down.
In small groups, the rest of the class approached, examined the devil on Terry’s shoulder, and listened to the demon in his chest. After we finished we applauded the young man as an attendant wheeled him out of the room. When they reached the door, Terry sat up, forming the two fingers of his right hand in a V and yelling, “I’m going to lick this, guys!”
Stemp stared at the floor; the rest of us tried our best not to cry.
Other memories of those days march through my mind: more practical exams with microscope slides, unlabeled organs in jars, and fresh specimens delivered straight from the operating room or the morgue. Each bore the cryptic questions designed to tease and distract us. We didn’t just identify, we had to extrapolate: What would you expect this patient’s blood tests to show? What symptoms did he or she experience because this organ was not doing its job? And so on.
We learned something else: vigilance. At conferences we saw doctors called on the carpet and made to look like fools for missing what were obvious diagnoses to the pathologists once they had sliced open a deceased’s body. We witnessed even high and mighty specialists knocked down like bowling pins by the pathology reports. And indirectly we learned that cherished beliefs often have no basis in fact.
“Class, Mrs. Dayten was kind enough to share her problem with you today before her surgery.”
The general surgeon smiled benignly at the middle-aged woman sitting in the wheel chair. We had just studied breast tissue and the various tumors that could occur.
“Miss Sabo, would you do the honors?”
My classmate Judy hesitated then rose from her seat and approached the woman.
“Hello, Mrs. Dayten, I’m Judy. What seems to be your problem?”
She jumped back reflexively when the woman abruptly pulled open the top of her gown. Even from the back row we could see the corrugated surface on her left breast.
Paget’s disease of the breast. Insidious and misleading, it often appears as a skin rash like eczema and lulls the unaware into ignoring it until it becomes untreatable. Today’s health-savvy women are trained not to ignore even the slightest changes. Back then, neither the patient nor the medical professional were as enlightened.
Once more we stood in small groups around our patient and saw and felt the peau d’orange (orange-peel) roughness of the skin over the tumor.
Mrs. Dayten was to undergo a radical mastectomy in several hours. The women in the class held her hand.
We knew what would happen to her. Surgeons would remove not only the entire breast but also the lymph nodes under her arm and even some of the muscle tissue. That side of her chest would become a living skeleton.
Now, decades later, I shake my head in dismay. The procedure maimed those who underwent it and did little to prolong their survival.
What present-day treatments will become anathema under the scrutiny of future knowledge?
The year progressed and we marched through the various disciplines of the human body, studying each organ system with its unique chemistries, physiology, and anatomy, both visible and microscopic. And as we did so, we were introduced to the living personifications of what could go wrong.
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