Dr. Galen's Little Black Bag: Stories. R.A. Comunale M.D. M.D.
Not impressive.
They showed us how to change into scrub pants and shirts and put coverings on our shoes and heads.
It was not an enlightened time for women, so Connie, Peggy, and June were required to change in the nurses’ locker room.
We learned that surgical rotations required an inhuman schedule. The surgeons started rounds at 5 a.m. before working long hours in the operating room and then doing post-surgery follow-ups on their patients in the clinics.
In recent times, various regulatory boards have declared that students and residents should only work an eighty-hour week. But back then you went on duty at dawn and went home the following day at 7 p.m.—if you were lucky—and then it started all over again.
“Thirty six on, twelve off” was the rule.
“Are you snoring, Mr. Galen?”
I felt the rap of a bloody forceps on my gloved hand, as I stood for hours holding a retractor while trying to control my bladder.
But we did learn. We helped yank out diseased gall bladders and perforated appendixes. We heard and felt the snap, as the orthopedic surgeon would rebreak an improperly healing bone and pin the ends back together. We observed the chest surgeon use giant snippers to cut through ribs to get at a lung or heart.
“Mr. Packard, a thirty-six-year-old carpenter, is here today for pericardiectomy. Mr. Galen, what were his presenting symptoms?”
We stood around the bed of the African-American male just before he was to be prepped for surgery that would remove the sack that covered his heart. He had suffered an unusual complication from an infection called rheumatic fever as a child. As a result the case around his heart had become stiff and hard, preventing it from fully contracting and expanding. He couldn’t walk or do the activities that most of us took for granted without rapidly tiring.
That’s what we all thought.
And then…
“Holy Jesus, look at that!”
The chief surgical resident had completed the initial cutting and removal of two portions of ribs to expose the heart. The heavy chest retractors had spread the ribs even farther, and we crowded and craned our necks to see what we could see from our back-row vantage point.
“Isolation precautions, stat!” the surgeon yelled, as we six, lowly, third-year students wondered what the hell was going on.
The operating room nurse quickly herded us aside.
“It’s tuberculosis. I’ve never seen anything like this!”
Today’s CT and ultrasound scans would have forewarned the surgeon. But we had only simple chest X-rays, and they could not detect the problem.
Ezekiel Packard had had rheumatic fever. What no one realized was that he also had tuberculosis and, unlike most TB that affected the lungs and kidneys, his infection had settled in the heart sack, the pericardium. The cheesy, thick-white, tuberculosis infection caused the scarring.
Tuberculosis is very contagious and, like syphilis, was a big concern among healthcare personnel who had to deal with a patient’s unknown condition.
They shooed us out of the operating room and told us to shower and change into fresh clothes—a fitting last day for surgical rotation.
We were happy to be back in whites again. Now we would be on call only every third night, with kids and little babies the beneficiaries of our developing skills.
“Children are not small adults. Remember that, ladies and gentlemen.”
That bit of wisdom emanated from the pediatric resident just before the professor of the day strode onto the ward. We had heard about Herr Professor Doctor Guetlich, aka the Nazi.
I have never been certain if the nickname fit. What I do remember are two things:
1. A previous, third-year class member had suddenly stood up one day, clicked his heels together, and shouted, “Sieg Heil!” As the story was told, Guetlich snapped to attention and returned the salute. Apocrypha?
2. The professor’s favorite expression was, “Die Kinder sind germ bags.”
Children are germ bags.
We had been warned: Expect to get sick at least once during pediatric rotation. I was lucky. Growing up in the tenements and hanging out at Dr. Agnelli’s clinic had exposed me to an array of bugs my friends had never dreamed of. I was the only one who didn’t develop some kind of viral infection.
These were the days before multiple vaccinations turned kids into pincushions by their second birthday. We were expected to have received all the UCHD (usual childhood diseases) before entering medical school. Oh, we still had to be vaccinated against smallpox, typhoid, tetanus, diphtheria, and polio. God bless him, Corrado Agnelli had administered those fun-filled shots to me using the thick stainless steel needles so common then.
The effect was profound. I wanted to crawl under my bed for a week, especially from the old-style typhoid shot. But a number of my classmates were not so lucky. Two of the guys came down with mumps and became sterile. In adult males the swelling is in the genitals, not the face, and the disease destroys the reproductive cells. One girl barely missed developing encephalitis (a brain infection) from chickenpox, even though her parents had told her she had had the disease in childhood.
My friends suffered several viral respiratory infections before their immune systems could get up to speed.
I also learned that, in pediatrics, book smarts do not always go hand-in-hand with common sense.
We were paired off in the infant unit the first week. This time my partner was Chuck, a classmate I knew only in passing. He was smart, had done well in the classroom and on written exams. But there was something not quite right about Chuck.
“My God, go stop him! Go stop your partner!”
The nurse came running down the hall and almost yanked me off my feet. She was gibbering.
“He won’t listen, he won’t listen.”
Chuck had been assigned the job of obtaining a blood sample from a month-old baby who had been admitted to the infant unit with an unspecified infection.
Simple task.
It is fairly easy to obtain blood from older children and adults. Put a tourniquet around the arm, watch carefully as a vein pops up in the elbow crease and, voila! You get your blood sample.
Babies are different. They are like very old people, whose veins in their arms and forearms are deeply buried and inaccessible. Instead, babies have nice, juicy scalp veins on either side of their heads.
Chuck was very good at taking tests and reasoning from point A to point B. If you needed blood from an arm, you put a tourniquet around the arm above the vein.
And if the patient is an infant? Chuck’s reasoning was very logical: for a scalp vein, well, you place a tourniquet around—you guessed it—the baby’s neck!
I stopped him just in time.
Chuck was advised to switch to a Ph.D. program, and he did well at it. Years later I heard that he taught comparative anatomy at a university and was made the faculty adviser for students who sought to enter the healthcare field.
Sometimes I saw miracles.
“Galen, she needs an exchange transfusion.”
The pediatric chief resident possessed the Wisdom of Solomon. Stuart Zelany was an older man, an engineer who had finally found meaning in life by returning to school, obtaining his M.D. then specializing in what he loved best: children. He, like Agnelli, was a doctor’s role model, a resident who made you want to stay late and observe even when you weren’t on call.
“Here’s the scoop, guys,” his deep voice rumbled.
He was, to