Work Hard, Play Hard
Luke Abrams walked wearily to the bank of elevators, glanced quickly at his watch on
the inside of his wrist, and pushed the down button. As usual, there was no immediate response; soon, however, an arthritic hand pulled the door open and the County operator slid back on his stool. “Glad to see a man in whites; you’re working late,” said the appreciative, senior patronage worker.
“Thanks,
Tony. I’ll take number six.” Luke stepped out, shook his head, and almost
spoke aloud: “Been here two months, and after seeing some super competent
surgeons, I get stuck in the O.R. for twelve hours with one of the Associate
Attending who’s here, probably at the bequest of his Democratic Ward Committee
man, trying to have the Residents teach him surgical skills, with scant
success.” Walking swiftly to his room,
he anticipated an hour’s nap, then a hamburger at Gus’s, followed by his on
call duty in the E.R.which would probably mean being
up most of the twelve hours since this was Friday—blue collar payday, alcohol
loosened aggressiveness, and sex with possibly the wrong woman. This and other
misadventures would lead to beatings, knifings, and bullet wounds: all taxing
the facilities and personnel of the
The
solution to his problem lay in the
patients
a day, and the two Interns pulling night duty rarely used the on call beds
available to them; if they slept at all, it was usually on a gurney in the hall
of the labor line. Luke walked the
length of the sixth floor, then one flight down to
“Any chance that I could bed down for a couple of hours?”
Pulling down her surgical mask, the
middle aged nurse smiled broadly, and immediately said, “Sure,” signaling that
she had heard this request before. “Your
roommate kick you out? No matter, use
that first room down the hall on the right, and what’s your name in case you
get a call.” Luke mentioned his name
almost apologetically, and thanked her profusely. “And,” she continued, “
Dr. Bemson’s face flushed, his chin slowly dropped as he took a long slow breath : “Luke, are you sure?” Their eyes met as Luke replied: “Yes, I’m sure.”
“ We haven’t sent one of our graduates to County for years; you have no idea what you would be getting into—it’s old, dirty, terribly overcrowded, poorly equipped, absolutely rife with politics, and little or no Intern supervision. With the patient clientele they have, it could be quite a dehumanizing experience.”
Luke felt a soft hand gently
prodding his shoulder, then sweeping her fingers across his forehead. “Time to get up, you’ve had your nap. The world is waiting for you.” She was gone before he could utter a thank
you. A quick glance at his watch evoked
a gratifying smile--
Walking the full length of the
corridor from the entrance of the main building brought Luke to the emergency
room area. Two large waiting rooms, one
each for men and women faced the driveway crowded with incoming and departing
police cars along with a like number of private cars. Both waiting rooms were mobbed, with
overflows already in the corridor. Some
were standing, some lay on hospital carts, others sat quietly on the metal
chairs destined to wait and wait their turn, others shouted for immediate
attention, and the winos were there before their usual time, staring vacantly
as if no other humans were present. Luke
moved into the female wing, recognized
“Well, well Luke, my boy. This is apt to be, once again, one hell of a
night. A little suturing job awaits you.
Seems that some girl friend didn’t like one of her competitors, so she
slashed her. Missed her face and then
her breast, but zeroed in on her upper arm; it’s about five inches long, and
not too deep. You’ll have it done in
fifteen minutes, compared to some clowns who take twice that long.”
“Do you have the kitchen timer set,
“You know you’re not old enough to drink, Luke. And get your mind off older women. You’re not old enough for that either.”
After injecting the local
anesthetic, Luke finished in just fifteen minutes. During that time, the victim lay impassively,
but her eyes were fixed in a fierce, hateful glare. Good Lord, thought Luke. I
might get the reprisal as early as tonight.
Lorraine was right as usual, it was one hell of a night- a steady stream
of patients ranging from those with critical trauma injuries, to the acute and
chronic really serious ill, to those with minor afflictions who used the County
ER as their primary medical provider, and finally the unfortunates who sought
out the ER as their refuge from the inhospitable night air. The predawn hours, however, brought with it
some respite, with the inevitable coffee break.
“I remember your first night here the ER,”
“ I wasn’t just scared to death,” Luke answered. “I was petrified. It all started that very day, at orientation in the amphitheater. Dr. Boynton, the administrative medical director, gave us a rather detailed history of the hospital with its origins tracing back to 1835. I looked around the room: the Intern class numbered 110, with a like number of Residents. I assumed that the majority of the Interns came from one of the local medical schools, which meant that they had clerked at County. I, in contrast, wasn’t even familiar with the geography of the buildings. Each of us was given his rotation schedule for the year, a key to our room, a reminder that we were expected to report to our ward that afternoon, and an invitation to take a brief tour of the hospital guided by one of the senior residents. Half of the group denied the invitation, and half of the remainder dropped out after the first fifteen minutes. My sense of insecurity remained intact. Most of the Interns were given a two-bed room somewhere within the hospital confines, but I was assigned to a four-bed room on the sixth floor in the main building. The beds there were exact replicas of those I had seen on the hospital tour. The sleeping quarters opened into a spacious living room, which was outfitted with a rather ancient sofa, and several comfortable chairs.
After spending a few hours with my roommates, I walked up to the Pediatric Surgical Ward, where I met the lone nurse on duty. All was quiet for the first hour—until the nurse hurriedly came into the room where I was sitting: “The firemen are bringing up a burn victim from a house fire. The Resident is on his way, be here in about five minutes.” Just then, two burly firemen, their faces almost obscured with soot, burst into the Ward. One was gingerly carrying a young girl about eleven or twelve, and the two gently placed her on the examining table. She showed no evidence of burns; her skin was pale, and there was a slight bluish mottling of her face.
“All smoke inhalation, Doc. We found her in a back third floor bedroom.”
I placed an oxygen mask on her face that the nurse held in place. I could feel no pulse, heard no heartbeat, and saw no respiration.
“Is she dead, Doc?” I was stunned by the question. I had never pronounced anyone dead. I thought she was, but how was I to be sure. I looked up hopelessly; all were staring at me. The nurse in charge nodded very faintly. “Yes, she is dead, I murmured.”
“I practiced sewing up the incisions I had made in oranges. Both thick and thin skinned ones.”
“Well, it worked, and now you act like you’ve been here for years, adjusting to it’s size, all of the inconveniences, the lousy food, the grueling work schedule, plus that autocrat, Dr. Mason, who’s had absolutely complete control of this place since 1917. But Ill bet there is one thing you haven’t fully appreciated: the level of teaching you’ll get from the Residents and especially from the Attendings. Sure, Mason has appointed the Attendings, but these, in contrast to all of the patronage that’s rampant, are prestigious, sought after positions. Pay attention, you’ll learn a lot. What’s the rest of your rotations?”
“Next, Medicine, female and male,
then Surgery,
“You’re going to see some real stars on those services. As for the Associate Attendings, some are top notch, others such as one of Mason’s relatives, pretty pathetic.
“ I’ve seen one of those recently,” Luke mused.
“No, just a few beers now and again,” he answered.
“Look, did you know that there are
about 1,000 nurses around here? Some in
training in our school, some in rotation from hospitals all over the
Ward 60, one of the female medical units was virtually identical to all other patient wards in the hospital. On either side of the long corridor, some 40 to 60 beds were situated side by side without any curtain between them. In an enclosed room at the back of the main ward, there were an additional four beds which were set aside for the most seriously ill patients in the ward and /or for those who were designated as being VIP. Any ranking County employee, either having been elected or simply appointed, might qualify. Relatives of the above were not excluded, nor were influential precinct captains or their workers. It was the responsibility of just one nurse, whose station was positioned just inside the main east west corridor of the hospital, to care for all of the patients. Luke, along with Dave, the other Intern, were the ever-present medical members of the ward, each being on call every day and every other night. The routine ward activity was established early on: Morning rounds with the Residents, head nurse with her students, and the medical student clerks; report from the Intern on night duty of new admissions, significant changes in a given patient’s status, including the deaths which occurred. Bed by bed appraisal
with decision for discharge, change in oral or
intravenous medication, further lab tests, x-ray examination. The latter, requiring transport to an
adjoining building was included in the duties of the Intern. Once or twice a
week, the Attending physician, Dr. Edmund Foran, a
Medical School Professor appeared promptly at
Midway through his rotation, Luke looked and felt more at ease and confident; early one evening, on call, as he sat at a desk on the ward reviewing the chart of a patient whom he was to present to Dr. Foran the next morning, a new patient was wheeled into the examining room. Minnie Slocum was a moderately obese, black woman who exhibited some labored breathing as she lay on the hospital cart. Luke quickly reviewed the ER notes: 60 years old, hypertensive, sick 3-4 days, first with cough, then fever, chest pain, difficulty breathing. He checked her vitals:temp 102, BP 160/100, pulse 96. Heart normal, crackling sounds in left lower portion of lung field. “Minnie, I’m Dr. Abrams. I’ll be taking care of you while you’re here, but first we have to take you downstairs for a chest x-ray. It won’t take too long, and we’ll have you back, where we can get you more comfortable.” Luke and an orderly wheeled her toward the bank of elevators. “Jim, there’s got to be a more efficient way of handling these elevators in an emergency.”
Jim laughed as the doors opened: “I’ll tell the old man the first chance I get.” The operator headed to the basement without being told, since the x-ray department was in another of the five buildings in the hospital complex. The journey took them through the underground tunnels, a maze sadly in need of repair, then up to the first floor where Radiology was situated. Without delay, the x-ray was taken. While waiting for the films to be developed, Luke had a chance to talk with his patient about her family. Married for 43 years, six children, all had finished high school, one in the Army. Nice story, probably not unusual, Luke thought. The Radiology resident popped the films onto the view box. The right lung field was clear, as was the upper portion on the left. A marked infiltration occluded the lower lobe. “Lobar pneumonia,” Luke said, slowly and deliberately. “Right you are,” the resident answered. With the diagnosis in hand, there was greater urgency in the return to the ward. There, Minnie was placed in the four bed unit, oxygen was initiated, and intravenous fluids were started. Immediate treatment with penicillin was indicated, but the drug was still in very short supply. At night, it was apportioned only with the permission of the physician on duty: he was called the night warden, always referred to by his retired Army rank, Colonel Blakeford. He was a small, unpleasant soul whose exhaustive query regarding the indication for penicillin therapy had temporarily shattered many an Intern. Luke had never encountered him, but he was always visible, sitting stiffly at his desk on the second floor. Approaching him gingerly, Luke introduced himself, and pleaded the case for antibiotic treatment for his patient. The experience was not only one of detailed questioning, but also one of a point by point discussion of the illness itself. True, it was grueling, but Luke had never experienced such a learning session in the middle of the night. Minnie was started on penicillin that night.
Over the next few days, Luke monitored her closely; she remained stable with only slight improvement until the fifth day, when there was an abrupt change. Breathing was eased; fever was down, concomitant with x-rays showing signs of resolution. That crisis was over, and Luke finished the remainder of his ward duties, well into evening. Looking forward to a night off call, he headed quickly toward his room. Opening the unlocked door leading into the “parlor,” he stood for a moment, his eyes adjusting to the darkened interior; a party of sorts was going on. Two of his roommates, Karl and Joe, along with three or four girls were standing around loudly conversing or rather story telling amidst intermittent laughter. It struck Luke akin to a John Cheever description of a suburban cocktail party excepting that the stories were not about last week’s party at someone’s pool, but rather just real to life County stories. Luke joined in, introducing himself to those he did not already know; somehow, cold beer suddenly materialized, and the stories became more animated. At one point when Luke sat down on the couch, Margie, a very recent acquaintance, who was a dietitian, not a nurse, shortly joined him. Their conversation was quiet and subdued, rather than being clamorous. Margie was very friendly, and remained so.
Luke shook himself awake the following morning, then shaved and showered somewhat more deliberately. On drying his face, he rubbed the towel over his eyes while facing the mirror, and stopped abruptly. He noticed something that prompted him to pull down his lower lid. There were tiny red spots on its inner surface; the same spots were present in both eyes. A lay person would probably have never noticed anything unusual, and if he did, he would have no doubt ignored it. Luke, however, went over to where Karl was sleeping, brusquely woke him up, saying: “Get up, I have a question to ask you.”
“Luke, are you out of your mind? I should get out of bed to answer a question, let me try while I’m lying down.”
“No,” Luke answered, as he grabbed Karl’s arm, hoisting him to his feet. “Now, take a look at my conjunctivas.”
“You are out of your mind, that’s not a question. O.K., let’s take a look.” Karl pulled down one lid, then the other, and without it being necessary, looked at both at the same time. “Jeez, Luke, you’ve got petechiae in both eyes. (Yes, minute hemorrhages, Luke thought). You ought to have one of the Medicine Residents see you. I’ll call down to your Ward.” Terry Brown was there in ten minutes, and confirmed the findings. “There’s no question that you have petechiae, and as you know this could possibly be the early signs of SBE; we’re going to put you in on Ward 24, get some lab work and blood cultures.” Having vetoed the use of a wheel chair, Luke and Karl walked to the ward in the male medicine building; other than men occupying the beds, it was basically identical to Ward 60. The nurse stood up, greeting them: “Well, good morning. Which one of you is Luke, she asked,” guessing that it was Karl, since he was the paler of the two. She continued after Luke identified himself: “You look pretty damn good to me; we’ll get to the bottom of this SBE thing. In the meantime, you’ll be our guest in the VIP quarters which as you know is our four bed suite. You’ll have two roommates, but they won’t bother you; in fact, they’re mostly comatose.” County nurses are a breed unto themselves, Luke thought as he smiled.
Now as a patient lying in bed, anxiety coursed through his senses; subacute bacterial endocarditis, the dreaded disease of infection in the inner lining of the heart muscle. He had seen several cases while in medical school, and the patients he remembered were all severely or critically ill; some recovered with or without sequelae, others, unfortunately, died. The Resident came in, took the medical history, and examined Luke. “Everything checks out except for the petechiae; we’ll get the blood culture going, and see what the blood counts tell us. Have you heard of Dr. Pete Greenman , our Attending here on 24?”
“I sure have,” answered Luke quickly.
“He’s super! Maybe even better than what you’ve heard about him. And he’s coming in later this morning; we’ll steer him in to see you before rounds.
Pete Greenman stood at Luke’s beside along with the Interns, Residents’ a half dozen medical students’ and the nurse on duty. His smile helped Luke to feel somewhat at ease. “I know the story, so let me take a look at you.” Only after examining Luke’s heart and lungs, did he carefully look at the petechiae. “Luke, tell me, what did you do yesterday?”
“I was on the ward all day, and left about eight. When I got back to my room, there was a little party going on, so I joined it. Had couple of beers, and whatever food was left.”
“What time did you get to bed?”
“Sometime after midnight, probably about 1 o’clock.”
Dr. Greenman was now smiling broadly: “Luke, you can forget about having SBE. What I think you do have, is an allergic reaction to face powder, or some other kind of make up. We’ll give you some pyrabenzamine, and your petechiae should be gone by morning.” Later, Luke lay in bed, feeling very groggy. He slowly got to his feet, wrapped the hospital gown tightly across his body, and walked the full length of the ward to the nurse who was seated at her station.
Luke pursed his lips, and said anxiously; “Something is terribly wrong. I can’t keep my eyes open.”
“Go to bed, Doctor” she answered. You’ve just taken an antihistamine.”
Luke Abrams, a.k.a. Dr. Powder Puff was back on his ward the following morning, being bombarded by remarks of all stripes; for the most part friendly and humorous, with varying tints of the off color. A story such as this would reach all corners of the County with a speed like the whoosh through a wind tunnel. Surely, it would have reached Margie in the dietitian offices that day; by evening she would busy herself changing all of her makeup. The powder puff escapade would become old news within a week, to be buried in the archives of old
County happenings, with resurrection scheduled for future reunions.
Ward 24, where he had experienced a momentous day as an inpatient, was Luke’s next rotation. The male patients, many of whom were ravaged from years of destructive health habits, differed from the women he had cared for: frequent, severe hypertension, diabetes, more difficult to control, emphysema, chronic liver disease, alcoholic neurological disorders, heart attacks, as well as undiagnosed tuberculosis and lung cancer. My instincts were correct, thought Luke on many occasions; County was the right choice for me. Dr. Greenman, with his unflappable, self-effacing presence repeatedly demonstrated his medical and teaching skills; toward the end of the rotation, he took Luke aside, commended him on his fine performance, and then laughingly said: “Do you realize, that since you’ve been on my ward, we haven’t seen another case of conjunctival petechiae. Not much of an epidemic.”
General Surgery was the next of Luke’s rotations, the first of the final three. His work schedule as usual was often grueling; in the OR 3-4 times a week with individual, complicated cases lasting 6-8 hours, or more, and total OR time often continuing through the evening into the night. All this compounded by the frequent emergencies headed for the operating rooms, and the on ward duties of caring for the pre and postoperative patients. Once again, there was a star in the picture; Dr. Roselli, a short, unimposing physical specimen, commandeered the operating room with an endless energy in a totally relaxed manner, exhibiting superb surgical skills while quietly teaching throughout the procedure. The Resident had finished the closure on the last patient of the day, when Luke again glanced up at the scrub nurse who had worked so smoothly with Dr. Roselli . Her eyes, a pleasant gray-green color, had a piercing quality that somehow exuded confidence, and the skin at the corner of her eyes was just wrinkled enough to suggest a smile as their eyes met. They dropped their surgical masks almost simultaneously, and both were now smiling broadly. “Hi, I’m Luke Abrams.”
“I know who you are. We’ve been in the OR together. You’ve just haven’t noticed. I’m Jeannie Parsons.”
“Now that we’ve formally met, why don’t we tie up this long day with a coke at Gus’s. . We'll just go over in our scrubs.” “Fine,” she answered .”Let’s go.”
Seated at a small table in the back room of the eatery, Luke recounted the essentials in his background, then said: “Where are you from, Arlington Heights?”
“Not quite correct; Grand Forks, North Dakota; trained at our hospital there, and always wanted to be an OR nurse. Girls born and raised in Grand Forks yearn to go somewhere else unless they get married at seventeen and immediately start to have babies. I didn’t choose that route and thought that Chicago would be preferable to Fargo, or Duluth, or even Minneapolis. The only hospital anyone at home heard of was County, so here I am for the past four months. Simple as that.” Luke smiled, as they easily continued the flow of conversation. . I must get Lorraine to take my name off the list of applicants for the Seminary, he thought as they walked, hand in hand, back to the hospital . And he did just that.
On the first day on the OB unit one of the Residents instructed Luke and the other Interns the technique of an spontaneous delivery, and after that the Interns were on their own in the labor and delivery rooms, with the knowledge that the Residents, ever present, were there when needed. On call duty at night generally meant little or no sleep, since frequently there were 8-10 deliveries in that twelve hour period. He learned that obstetrical occurrences often required immediate response and action since in those instances, doing otherwise could jeopardize either mother or baby, or both. This aspect of the almost always-potential emergency situations arising appealed to Luke. Challenges akin to the General Surgery rotation occurred during the Gynecology service. Without question, the most distressing portion of his Internship was his last, a short stint on Septic OB; a unit where patients were hospitalized after acquiring an infection subsequent to vaginal or cesarean section delivery, or more commonly following an attempted abortion. The “procedure” was performed by a “doctor,” real or bogus, a so-called midwife, a family friend, or frequently by the patient herself. Instruments used bordered on the bizarre, with a wire coat hanger being the most commonly used, and treatment of the consequences was complicated, whether surgical or medical; those who survived endured protracted hospitalization, and often life long infertility.
A few short weeks before leaving County, Luke had his last Friday night call in the ER. Lorraine was at his side when the police, brought in a young, unconscious black woman who appeared to be in her late teens. Her mother sobbed that she had “just’ fainted. Luke appraised her quickly: blood pressure 60, pulse 130 and weak, very pale gums, abdomen protuberant. Lorraine handed him a syringe, and he was able to obtain a small sample of blood for blood typing. “Get the Gyne Resident down here, call the OR, tell them we’re bringing her up as soon as we get some fluids going.” Luke was finishing a cut down so that the vein could be visualized, when Bob Goldman, the Gyne Resident came in, and did the same the same in the opposite arm. One of the nurses called out: “O Positive.” “Good,” answered Bob. “Get two units down here, or bring it up the OR. Cross match for two more. We’re going up now. Lorraine, call the Attending and tell him what’s going on; but we’re not going to wait for him.”
The OR was ready for them. “Quick scrub, Luke, and we go.” Entering the OR proper, Luke was surprised and pleased to see Jeannie standing confidently at her instrument table. Within seconds, she gowned and gloved the two; as they prepped and draped the patient, Bill Markey, the anesthesiologist uttered in a staccato fashion: “ This girl had a BP of 60 when she hit the O.R. I can’t get any reading now. You go ahead- I’ll carry her on something if you need it. With a swift decisive motion, Bob opened the abdomen down to the thin bluish bulging layer overlaying the abdominal contents; after a small then larger incision, aspiration of the bloody fluid was accomplished to the extent that Bob was able to reach in and deftly bring into vie w the enlarged, engorged left Fallopian tube, the site of a tubal pregnancy which had ruptured in its mid port, causing the enormous blood loss. “It’s on your side, Luke. Let’s clamp it, and stop the bleeding. I’ll keep an eye on you.
Luke held out his right hand, and was about to ask for a six inch curved clamp when WHACK—the instrument was placed securely in his hand. Without hesitation, he clamped the tube at the correct spot, and placed another beneath it so that the procedure for removal of he damaged tube could be made. Bill Markey announced as Bob was then in the process of excising the tube: “B.P back to 60, gentlemen.”
Luke walked back to the ER exhilarated at being a part of saving a life, and gratified that he performed as well as he did under pressure. Lorraine was sitting impassively at her desk; she held out her hand: “You did well for a powder puff,” she said as she grasped his hand firmly. “Do you have a car, Luke?’
“You’ve got to be kidding, on fourteen dollars a month?”
“O.K., my car’s in lot C. It’s a green two door Chevy. I’ll get the keys from my purse. Why don’t you go upstairs see if Jeannie can get off a little early; I’ll arrange cover for you here for the next few hours."”
She returned in a few minutes with the keys dangling from her fingers. Luke made no movement. Lorraine reached toward him and pressed the keys into his palm. “I want you to drive over to the lake shore—you two deserve to see the sunrise today.”
“Jeannie and I would love that,” he answered.
Grab your coat and get your hat
Leave your worries on the doorstep
Life can be so sweet
On the sunny side of the street*
*Lyrics by Dorothy Fields
.