CHAPTER 1

INTERNSHIP

Medical school graduation had been 3weeks ago. My wife Iris and I drove homefrom Kingston, Ontario in an old 1947 Pontiacwith a worn automatic transmission. Ourfew possessions (mainly books and old 78records) were tied on an open trailer webought for ten dollars from a local farmer. Ithad formerly been used to haul manure, andwe left dreadful odors and smells along theway as we traveled down the NY Thruwayto Queens on Long Island. We had very littlemoney and when we suffered a blown outtire and had to buy a new one, we almostexhausted our very small cache of cash.

So with the car leaking oil and transmissionfluid and bringing the smell of manure fromCanada we arrived in Queens, very tired,broke, and with no place to stay. After a smallloan from my parents who were visiting friendson Long Island after graduation, we found asmall apartment in Hollis and settled in.

I had obtained a rotating Internship atMeadowbrook Hospital in East MeadowNassau County. Established in 1935, itwas the largest hospital in Nassau, run andowned by the County. The hospital was agood teaching center with residencies in alldisciplines, and primarily served the poor ofthe county.

After a few free days setting up ourapartment, I reported for orientation alongwith a large group of newly graduated doctorsand after about 15 minutes of instructions wascalled out by the Superintendent to informthat he had received a phone call that myfather had suddenly died of a hemorrhagicstroke that morning. My parents were stayingwith friends on the eastern end of LongIsland and father passed away there. Thefuneral was held in Hollis as that was wherehe had previously lived and spent his yearsas a General Practitioner. I was proud of thelarge number of mourners who had beenhis patients who came to tell me about thewonderful things he had done for them. Hehad been a family physician during the GreatDepression and I often went with him while hemade house calls. Frequently if a poor familyhad several sick children he never asked forany kind of a fee. I remember a quiet momentafter the final day of the wake, by myself athis coffin, when I wept and promised myself Iwould always try to follow in his steps and bea good caring doctor as he had been.

The funeral and grieving took several daysand upon returning for duty at the "Brook" Iwas completely ignorant about the hospital,how it functioned etc. because of the missedorientation. I found myself assigned to"Ambulance rotation". At that time the onlyambulance service in Nassau County wasrun by the hospital. There were no privateones, EMS services or police or fire dept.ambulances. Two types of services wereavailable, one ambulance for trauma andmedical emergencies, and one for obstetricalpatients. These were our obstetric clinicpatients who went into labor or had pregnancyemergencies and could not get to the hospitalbecause public transportation was so poor,or had no way to get to the hospital on theirown. Each ambulance had a doctor and adriver, we both sat in the front seats. Theambulances were brand new Cadillacs, large,and had plenty of room in the back for patientcare.

I had only been on duty in my new"whites" for a few minutes when the driversaid "OK Doc, let's go." I grabbed our blackbag, jumped into the front seat and away weroared at top speed with the siren screaming"get out of the way," going down WantaghParkway toward Southern State. "What isthe emergency I asked?" "A driver hit thebridge abutment at a very high speed and weare going to help him" was the answer. Thethought of what we might encounter filled mewith fear, and I said to myself, "I hope he isdead because I don't know what to do."

We arrived at the scene with police cars allabout and a gathering of onlookers. The carwas crumpled against the abutment with thedriver, motor, and steering wheel in the backseat. He was still alive and terrible drunk. Wegot him into the ambulance and back to thehospital. He had almost no injuries and after afew hours, sobered up, and walked out.

A few minutes later the call came again. Igrabbed the big black bag, hopped into thefront seat and away went with siren againtelling everyone to get "out of the way, we areon our way to save lives."

"What do we have this time? I asked""A guy slumped against the firehouse inHempstead; they think he had a seizure," wasthe answer. We arrived and found anotherdrunk whom we returned to the Emergencyroom.

After a fourth "Let's go doc" I hopped intomy now familiar seat and suddenly realizedI had not explored my black bag for thephysician tools I would need to handle anyemergency. I mentioned this to the driver whosaid "Don't bother to look doc, you brought thewrong bag and it's full of sandwiches." And itwas. What a way to start a career as a caringphysician.

A daily routine at Meadowbrook hospital,which I have not observed at the otherhospitals I have served in through the years,was a daily trip through the whole hospitalIt's Full of Sandwiches | 11made by the Superintendent and the Headof Nursing. They walked proudly togetherthrough every ward, clinic and part of thehospital, paying attention, and not missing athing. They checked the cleanliness, generalfunctionality, and staff behavior. They listenedto patient's complimentary comments orcomplaints with sympathy and promptly actedon them when their stroll was over. I wish ourcurrent CEOs would do this. They sit, hiddenin their offices, pretending to know what isgoing on in their hospital. It is almost as if thewere afraid to come out and see what is reallygoing on.

The Emergency Room was where most ofmy action occurred. The ambulances broughtin the sick, the traumatized, and the mentallyill. Others arrived by car, friends or taxi. Noone was turned away. All were taken cared ofto the best of our ability. The ER trauma wesee in current, scripted TV shows happenedfor real there and I was part of it during myInternship.

The hospital Emergency area had a verylarge central room with swinging entrancedoors through which came every sort ofmedical and surgical problem imaginable.There were 4 large examining and treatmentrooms off this main central area, two on eachside. The stern ruler of this area was Mrs. K.She was 5 feet tall (and probable 5 feet wide)and ran the area like her own kingdom. Shewas a great nurse and taught me half of whatI know today. She seemed to always be onduty, keeping an eye on me as well on thepatients.

One night the doors swung open and apatient staggered in, quite drunk, holding abloody towel over her head. She had beenat a bar and gotten into an argument withsomeone who had smashed a bottle on thebar and ground it into the top of her head.We put her on the exam table, shaved off herhair, cleaned the area, and started to suturethe many lacerations. We needed very littlelocal anesthesia as she remained quiet andstill drunk. I sat behind the table with her headjust above my lap, putting in stitch after stitch,tying the knots and cutting off the ends whichdropped onto the floor. I had used a largenumber of sutures and the cut ends piled up.After a considerable interval I was finishedand put on a dressing. Our patient was nowmore sober, stood up and looked at the pile ofcut suture ends on the floor. "Um,um you suredid use a lot of thread on me" she said, "Yes,I used a large number of sutures," I replied."Well, you better have some more, 'cause I'mgoing to send you a customer," and out shestaggered through the swinging doors andinto the night. An hour or so later, the doorsagain swung open and another drunken ladystaggered in holding a bloody towel over herhead. Our first patient had gone straight backto the same bar, broken a bottle and ground itinto her attacker's head, and I had to start thewhole process all over again.

The Emergency Room usually had Mrs. Kand one other nurse and a male orderly onduty. When I came on duty in the morningperhaps only one patient was left over fromthe night's activities. The others had beensent home or admitted to the hospital. Onemorning I came in and there were seven oreight patients laying on stretchers, severalnew nurses and a couple of male orderlies.Obviously there had been a busy night but Iwas completely mystified when Ms. K grabbedme by the arm and said I had to be braveand act like everything was normal. I had noidea what she was talking about until sheexplained. Around the corner from the ERwas a small jail of four cells for sick inmatesfrom the county jail close by. If sick prisonersneeded hospitalization, they were transferredto us and taken care of in these cells, usuallyby the ER staff. It turns out that one of thecellmates, who had been sentenced to deathin the electric chair, was now cured of hisrecent illness and was to be transferred out toSing Sing and put on death row. Ms K. told methe county police had received a tip that therewas a plot afoot to spring him out and helphim escape. I looked around and now realizedthat each of our "sick" stretcher patients wasa police officer lying there with a machine gunat his side under the sheets. The nurses werealso officers carrying hand guns under theiruniforms. So I was to act like everything wasnormal? Fat chance! All day long I expectedour swinging doors to fly open and I wouldbe finished off in a hail of bullets. Luckilynothing happened, and our patient was safelytransferred upstate. For this I went to medicalschool?

After lunch one day I returned to duty onlyto be pushed by Ms. K into one of the examrooms where she placed herself acrossthe door and locked it from the inside. Thethought crossed my mind that I was about tobe sexually attacked by Ms, K. But I dismissedthat idea quickly when out of the corner ofmy eye I noticed a little old lady sitting onthe exam table and a large number of dollarbills floating to the ground. It was a rule ofthe ER that certain patients should have acomplete physical exam. As such they had tobe undressed and put into a hospital gown.This patient had been found ill on the streetsand brought to the hospital by ambulance.While being undressed, large amounts ofmoney were found on her person stuffed intoall her clothes. She was a homeless mentallyill person who had decided that the safestplace for her money was on her person. Ms.K locked the door, stood against it, armscrossed, looking very imposing. She orderedme to carefully collect all the money andgive it to her. She watched my every move tomake sure I keep none of the loot for myself.I was to carefully pick up all the bills, countthem, and sign a receipt before I was to bepermitted to leave the room. The money thenwas then put into the hands of the HospitalAdministration, duly accounted for. Shewas indeed in charge and the ER was herkingdom. "Every hospital regulation was to befollowed exactly" she said

It was always a good night to work in theER during a snow storm as long as it was ahuge storm with plenty of snow. Patientswere few in number. The deep snow keptthe cars off the roads, and all but the verysick and ambulance patients arrived. A littlebit of snow or ice however was horrid, forour patients arrived in droves. Minor fenderbenders, patients slipping on ice with fracturesand bruises, homeless looking for a warmenvironment, and sick patients who couldnot make it to their family doctor were our"customers" during those storms.

But tonight was a real "Nor'easter" withroads almost impassible and I knew it wouldbe quiet. However I was soon proved wrong.A phone call from Fort Dix in New Jersey wasasking if we could accept an injured officer.Of course we could, no one ever got turnedaway who needed help. But with all the snowhow would he get here? A close by airfield,Mitchell Field, had not yet been replaced bya huge shopping mall, (Roosevelt Field,) andthe plan was to have an Air force plane fly himthere and we would meet him with one of ourambulances. The incident involved a Navysailor who was visiting his Army buddy at FortDix when a gun accidentally went off and hewas shot in the head. So a supposed quietnight turned out to be a problem involving allthree armed services of our mighty country.

After quite a bit of time during which wehad little to do for lack of patients, we heardthe ambulance arrive and our patient wasbrought in. It was immediately apparent thathe was in extremis and not much could bedone for him. We obtained skull films and sawthe severe damage to the skull and brain,by the bullet. There was no neurosurgeryResidency at that time at Meadowbrook soin cases like this we had to call the attendingneurosurgeon on duty. I was very reluctant tocall Dr. S who was on duty on a terrible nightlike this, but had no other choice. So the callwas made, and he said he would be in. Dr.S was a person of very few words whethertalking to patients or house staff but a goodand respected neurosurgeon. Perhaps anhour later while we did our best for our patient,the swinging doors flew open and Dr. S camein followed by a cloud of snowflakes. He saidnothing. I pointed to the exam room where thepatient lay. He went in, coat and hat on, spenta few minutes examining the victim, came out,went to the ER chart, wrote his consult, exitedthrough the doors, snowflakes flying, anddeparted without saying a single word. I wentto the chart to see the written consultation bythis well known Specialist. His erudite andprofessional consult consisted of three wordsfollowed by his signature. It read "Patient willdie", signed, "Dr. S" and a few minutes laterhe did, and we pronounced him. So that is thestory of the US Armed Services and Dr. S on asnowy night at Meadowbrook Hospital.

On another cold and windy day the doorsflew open and the ambulance crew wheeled ina stretcher with a man wrapped in a blanketand with an IV in place. While attending tohim, our exam noted that under the blanket hewas stark naked. He had both femurs brokenby clinical examination and then confirmedafter x-rays. We stabilized him, gave him painmedication, and attempted to find out whathad happened to find him naked and withtwo broken femurs. He was very reluctant tosay anything but finally told us his story in anembarrassing way. He had been depressedand despondent, had no relatives or familyand decided to commit suicide. His methodhe picked however was rather unique. He haddecided to take off all his clothes (presumablyso no one could identify him), go out on anoverpass on Northern State Parkway, waitfor a large car (preferably a Cadillac), andjump off intending to land just in front of thecar so it would kill him on impact. He hadwaited expectantly on a bridge and as a carapproached, he jumped. The driver seeinghim jump, managed to slam on the brakesand stop the car just before hitting him. Helanded on the Parkway, breaking both legs,but missing his plan for instant death. So therehe lay, naked, in pain, cold, embarrassed, andhis suicide plan thwarted. I must admit I feltsorry for him. We admitted him to the PsychUnit and I then lost him to follow up. Howeverto this day I can imagine his state of mindwhen he found himself instead of being dead,humiliated and frustrated. How did he explainhis injuries in later life? I missed the papersnext day but I am sure readers got a chuckleout of the sad story if it had appeared in print.

My one year of rotating internshipconsisted of several weeks or a month onthe various branches of Medicine, Surgery,OB, GU, General Medicine, Psychiatry andOrthopedics. We were on duty from 8 amuntil 4 pm the next day. 16 hours off, thenback to work. The night we had to stay at thehospital, we had nice rooms with furnishingsfor two doctors. Interns were on the 3rd floorwith Residents on the 4th. Residents (doctorsin their second year of training) had a roomto themselves. My roomy was a pleasantdoctor who eventually went onto becomingone of the leading Radiation Oncologists inthe country. One night, we had just fallenasleep, when the phone rang. He was on callfor the Medicine service. It was a nurse whowas quite upset and told him she was takingblood pressures on a sick patient and "it was100 systolic the first time, then 70 a half hourlater and just now was only 56. What shouldI do?" His answer after a slight pause was to"stop taking blood pressures." For a moment Ithought he was going to roll over and go backto sleep, but he promptly left to take care ofthe problem.