Dr. Galen's Little Black Bag: Stories. R.A. Comunale M.D. M.D.
We learned quickly who the real bosses were: the floor nurses and nurse supervisors—and justifiably so. They were the patient’s first line of defense against the incipient young Dr. Frankensteins, who wanted to diagnose and cure everything while creating unimaginable mayhem.
We started in learning about early morning rounds, the ritual procession of students, interns, residents, and professor doctors going from patient to patient, reviewing each one’s status, test results, and anything else the attending could throw at us to catch us off guard.
“Dr. Tremayne, what’s Mr. Jacobs’ renal status?”
Our intern flinched. He began to reach for the patient’s chart, but his hand was slapped away by Dr. Godfrey.
“Tremayne, I asked you a question. I don’t want you to read. Do you or do you not know your patient’s lab numbers?”
It wasn’t a fair question. Tremayne had just arrived that day. The resident tried to explain that but was stared down. Godfrey’s smile was not friendly. He had snared a victim. He would have fun playing with this mouse.
Then the floor nurse saved the day.
“Dr. Godfrey, Mr. Jacobs’ test results aren’t back yet.”
She stared at the pompous ass. She had been the floor nurse when his own ears were still wet.
“Uh … thank you, nurse,” Godfrey mumbled then turned toward another bed. This time he directed his questions at the resident who had actually dealt with the patient.
After rounds, our crew, minus Dr. Godfrey, sat in the doctor’s lounge in back of the nursing station. The first-year resident glanced at Tremayne then directed his words toward us and the senior medical students.
“Learn to expect the unexpected. Know who and what you’re dealing with, and then be prepared. Need I say more?”
We shook our heads.
The rest of the morning we introduced ourselves to our assigned patients and then familiarized ourselves with their charts. But that time was not uninterrupted. Patients could be sent to our floor at any time, usually admitted from the emergency room after they had been evaluated for their complaints. Those determined to have major problems were admitted to a general medical floor.
Dave got the first one.
“Mr. Nash, you’ve got Mrs. Cassidy. She’s a lol (little old lady) with dyspnea (shortness of breath) and leg pain. Work her up for CHF (congestive heart failure).”
Tremayne was a nice guy and, as it turned out, a good intern and resident who later specialized in gastroenterology. We kept in touch for decades until his sudden and unexpected death at age fifty-five.
He had always believed in being physically fit. Ironic, but he died in his home exercise room.
Dave was perspiring, as he grabbed his bag from the shelf and headed down the hall to room 315. I could see the orderly pushing a now-empty gurney from the room. His patient had arrived and was in bed. The nurse assigned to her would be checking her information and taking her vital signs. It was his first patient.
I have always maintained the greatest respect for nurses and, after witnessing how one had gone out of her way to save Tremayne’s ass, I vowed never to interrupt them when they were doing their job. It earned me valuable brownie points.
Bag in hand I likewise headed down the hall. I wanted to get to know my patients, get a feel for their physical and mental condition. There’s a difference between assessing medical information and developing empathy and understanding. Good doctors are well-versed in their technical skills; great doctors understand people.
Thank you, Corrado, for showing me what makes a great physician.
I walked into room 312. My first patient, Leroy Simpson, had been admitted three days ago. From the scuttlebutt, he was something of a scalawag with the ladies and was now suffering the consequences of severe prostate infection. His condition warranted IV antibiotics.
Yes, young doctors, today you whip out your electronic pads and send an e-prescription order for a quinolone (very potent) antibiotic after determining the particular type of germ causing the problem. And, yes, if your patient doesn’t have prescription insurance, he or she will bellyache until the cows came home about the cost—often up to $10 per pill.
Your patient would be better in a day or two but still hate your guts.
Back in my day those drugs didn’t exist. We were stuck with pills that could not handle those infections, so we were forced to pump very toxic medications into patients’ veins—or their butts if it could be given intramuscularly.
Sometimes it took two weeks in the hospital, assuming the patient didn’t suffer complications such as inflamed veins, massive skin rashes, blood clots, kidney or liver failure, or even sudden death.
And if they got better, they hated your guts.
Plus ça change, plus c’est le même chose.
The more things change, the more they stay the same.
I stuck my head in the door and saw a nurse taking Simpson’s blood pressure and temperature. She saw me, smiled, and then resumed what she was doing.
Never interrupt a nurse.
She finished and, barely avoiding Leroy’s attempt to pat her rump, passed me in the doorway.
“Thanks for waiting, Galen.”
She was younger than I was, just out of nursing school and, I have to admit, if I hadn’t been totally smitten with June, I would have been tempted. I watched her an extra second or two, as she left the room.
Simpson leered at me then growled, “You can’t have her, Doc, she’s all mine.”
I forgot to mention: Leroy Simpson was eighty-six.
And so it went, awkwardly at first, then with a bit of chutzpah and luck, I got to know my six patients. Leroy was the oldest; Barry Jackson, nineteen, was the youngest—and sickest. The boy had swallowed ethylene glycol (antifreeze) on a dare, and now his kidneys were shot. Our job was to attempt to stabilize him before transferring him to the renal unit, where he would undergo dialysis.
This was in the early days of treating kidney failure, several years before two brilliant surgeons—David Hume and Richard Lower—pioneered a kidney-transplant program at my school.
Barry didn’t make it.
Medical conferences at lunch were next. That was good. You could eat all the sandwiches you could steal from the faculty table. The afternoon brought scut work, such as taking blood, checking test reports, and wrapping up with the intern and resident. My friends had all gotten new patients and had done their first workup. They congratulated me for not having to work too hard that day.
Tremayne heard it and snickered.
“Don’t feel bad, Galen. In case you haven’t heard you’re on duty tonight.”
Yes, I had drawn the short straw. I would work the night shift and not return home until the following evening. I turned to Dave, who understood.
“Yeah, I’ll drop by with some fresh clothes and your shaving kit.”
It was after midnight when I got my first patient workup: Johnny Mangan. Johnny was the friendly young boy with only half a skull because of tumor surgery. I got to know Johnny’s hopes and dreams in that brief time between my examining him and his death several hours later.
The nurses brought me his untouched breakfast tray.
My friends and I made our bones on that first rotation in general medicine. We saw life snuffed out despite our efforts. And we carried those memories forward into our personal lives and careers.
Next stop: surgery.
Bill, Dave, and I felt like we had joined the big boys’ club when we entered