Dr. Galen's Little Black Bag: Stories. R.A. Comunale M.D. M.D.
traveled by car to other institutions, including the local Veterans Administration hospital on the outskirts of Richmond. This time we saw first-hand the ravages of lifetime smoking, compliments of the countless free cartons of cigarettes given to soldiers during two world wars.
Two men, old before their time, sat in chairs, plastic tubes feeding oxygen from portable tanks into their mouths and noses. I stared at the two—so different and yet so alike. One looked like he had just been rescued from a concentration camp: thin and emaciated with flushed skin, his every attempt to breathe seemed a tiring effort. The other soldier, barrel-chested, wheezed and coughed and spat sputum (phlegm) into a cup by his side.
Seeing them took me back to my childhood, to my world in the tenements, when I was just a kid called Berto. To this day I retain vivid images of The Old Guys, three World War I vets who gathered at the shoe-repair shop of their legless war buddy, Harold Ruddy. That’s where I saw the devastation caused by the Germans’ use of mustard gas. Our neighbor, Tim Brown, lived a life of oxygen deprivation, drowning in a sea of air, because his lungs were almost non-existent.
But the men in that veteran’s hospital hadn’t been gassed—at least not by others.
They had unknowingly damaged themselves with decades of heavy smoking.
“Class, note the typical “blue-bloater” and “pink-puffer” habitus (body shape) of our patients.”
Dr. Marja Gortan was a lung specialist, a former refugee from Eastern Europe. Diminutive, almost doll-sized, she paced back and forth in front of us, her long white professor’s coat fluttering, as she pointed out the skin color and body shape of the thin emphysema patient and the large-chested variation, which we then called chronic bronchitis. Now they are considered varieties of chronic obstructive pulmonary disease.
We walked through the respiratory patient ward wide-eyed. Men—and women—so desperately ill from cancer that holes had to be cut in their necks, had tubes inserted to bypass the tumor-scarred upper parts of their windpipes. Such images burned themselves into my brain: terminal lung and voice-box cancer patients, some with no vocal cords, were forced to speak by burping out words. And what were they doing? Inhaling cigarette smoke through those tubes, their wasted fingers shaking while they held the lit cigarettes up to the openings in their necks called tracheostomies.
When we left the VA hospital to return to our campus, Dave looked toward a nearby doorway and gasped.
“Geez, looka’ that!”
The six of us stared: Gortan was standing in the doorway lighting a cigarette.
Year two saw perverse cosmic jokes played by the fates on the unsuspecting.
That year we lost our class clown.
“I have some tragic news,” the dean announced. “There was a terrible auto accident this morning and … uh … Mr. Andrew Kagill was fatally injured.”
He cringed, when a loud scream erupted from Tanya. Other students quickly surrounded her, and the sobs were not just from the girls.
This is life’s biggest lesson: No one is immune to the Dark Angel.
But the bitter irony lay in what transpired later
The year was coming to a close. We had covered the various internal pathologies of the human body, and now we would be exposed to the accidental.
“Old Gordie’s gonna do the horror show, isn’t he?”
Dave and I sat in the amphitheater next to Bill, June, Peggy and Connie. The pairing was so obvious that no one laughed or made snide comments anymore. Our class had found itself.
This was climactic, Grand Guignol horror show. Given by one of the foremost forensic pathologists in the nation, it was an anticipated event for every second-year class.
Gordon Makland had made a career of studying the effects of external trauma—accidental, malicious, or self-inflicted. Was it chance or murder? Show him a body, and within minutes he could tell you cause of death and whether or not it was by chance. He could wax poetic on the effects of gravity and its impact on falling bodies and why certain teenagers unintentionally killed themselves by hanging.
“Old Gordie’s slide show,” as everyone called it, was the culmination of our sophomore studies.
Makland was not one-dimensional. He was also an avid amateur geologist and rock hound. I was, in later years, privileged accompany him and play mountain goat and spelunker in search of mineral specimens.
That day in late April we sat and fidgeted and nervously joked while Sid Graham the projectionist set up the 35-millimeter slide trays. Yes, young doctors, we actually used primitive stuff like film back then.
Makland stood in typical slumped pose, his gaunt, six-foot-four frame leaning over the podium. He nervously drummed his fingers so close to the microphone that the room resounded with laughter to the elephant-herd sounds. When he caught on and stopped, the dark blue eyes in his rectangular jowly face penetrated the semi-darkness, and he cleared his throat. Then he smoothed graying cowlicks back into place and harrumphed.
“I want to warn you, ladies and gentlemen. What you are about to see is graphic, raw, and not to be taken lightly. These were once living beings like you. If I hear any snide comments or levity I will end the session. I will also have the offending individual expelled. Do you understand?”
We all nodded.
The first slide startled all of us. The vacant-eyed face of a dead, motor-vehicle-accident victim stared back at us in full frontal view. A good part of his brain had been forced down through his nose from the impact of his head against the windshield.
His demise had occurred long before mandatory seat belts and collapsible steering wheels.
“Visualize the force vectors involved as this man’s head hit and penetrated the windshield at sixty miles per hour.”
He didn’t have to remind us—we could feel it.
Slide two: two bushel baskets containing what appeared to be pounds of raw hamburger. What seemed out of place was the foot still encased in a worn work boot poking out the top of one basket.
Makland’s voice seemed overly dry, as he off-handedly remarked, “This farmer got pulled into his own thresher machine.”
One student in the back rose and quickly ran out of the room.
Slides three and four. Front view: a small hole with burn marks in the middle of a young woman’s forehead. Her eyes had popped out of their sockets. Back view: The entire back of her skull was missing.
“This was the result of domestic violence. Love and hate walk side-by-side, ladies and gentlemen. Please note how the shock wave of the bullet caused a massive exit wound.”
Several more students rose and left.
And so it went: bodies turned to mush by falls; burn victims, their muscles so contracted by the heat that they appeared to be in a boxer’s stance; drowning victims, their bodies bloated and their lips, earlobes, noses, and eyelids eaten away by fish and crabs.
“That should do it. You can shut down the projector, Mr. Graham.”
The fates laughed cruelly, as Graham’s finger hit the advance button by mistake.
Along with gasps, we stared at one final picture. Taken through the passenger door, the view showed the auto-accident victim impaled by the steering post, legs pulped by the engine, mouth wide open, tongue protruding, eyes staring at eternity.
You would have become a fine doctor, Andy.
May brought the usual, early, Richmond summer heat and humidity, but we sweated more heavily for another reason. Now we faced the first of a three-part hurdle to achieve the degree of Doctor of Medicine: the first part of the National Board of Medical Examiners’ certification exam. The faculty had lightened up on its academic onslaught by giving us review classes covering all of the information we had been