Those Internship YearsApril 1946-June 1947

Dressed in an all white uniform including white shoes, my firstrotating intern service was pediatrics. This was the pediatric worldwhere I thought I wanted to spend my life, even back, then.This thought never wavered until 1988 when my practice years endedand retirement beckoned. Now, it was that time of life to spend withmy Beloved Mary forever more. What a great blessing this retirementbecame for me.

There were eight of us who manned the ramparts of the UniversityHospital. Before this time, there were no residents in specialty trainingin those days at the University Hospital, except for an amputee inInternal Medicine. Everyone else was in the service or was overwhelmedin private practice trying to care for the civilian population with thedepleted numbers of doctors available.

This med school was geared to produce General Practitioners towork in outstate Nebraska; thus no residency programs until now. Theaftermath of the War changed that philosophy for ever more. Today,there are over one hundred residents in training in different medicalspecialties.

The University Hospital was a teaching hospital and, as such, was aprized internship. One was expected and required to accomplish manydifferent medical procedures and to care for numerous patients with aminimum of supervision.

When a new patient was admitted to one's particular service, it wasa mandatory requirement that a complete medical history and physicalexamination be on the patient's chart the next morning regardlessof what time of the day or night this admission occurred. These tasksincluded performing a complete blood count, urinalysis, taking anynecessary x-rays, and/or doing any needed diagnostic procedures suchas a spinal puncture. There were no x-ray or laboratory techniciansavailable during the bewitching hours of 6:00 pm until 7:00 am; so, oneaccomplished these multiple honors himself in a solo manner.

This entire body of the patient's admission work had to becompleted before the start of the next day regardless of when the patientwas admitted. At times, it was almost an unbearable chore when therewere two admissions to your service at the same time and at night. Thosedays and nights were hard, but so would be life later on in medicine, as Iwas soon to learn.

At that time, there were only two full time Clinical UniversityProfessors at the Medical School. Dr. Gedgoud, my idol and mentor inPediatrics for many years to come, and a Dr. Roy Brown in OB-GYN.Neither of these men was paid by the University, but was paid by StateMaternal and Child Health Funds.

The rest of the medical clinical faculty was composed entirely ofvolunteer physicians. They were available on rotation and on call for theintern to consult according to whatever service he was on. As interns, werotated through the many different medical services, i.e. men's medicine,surgery, pediatrics, etc. This rotation exposed us to the differentramifications of medicine. The rotation helped us to decide our desiredfield of medical endeavors to pursue. Unfortunately, this system nolonger exists. A student goes from the classroom straight into a medicalspecialty position and never appreciates the ramifications of the othermedical entities; a huge loss in my estimation.

Tom Viner was the intern in the Admitting-Emergency Room. Onebright day early in April 1946 I was on the Pediatric Service, he calledand asked me to look at this sick child. Well! You never saw a dirtier,filthier, more miserable little waif than this fifteen month old boy lyingin filth on the examining table under my eyes.

He had a strange grimace to his face {risus sardonicus} and hisabdomen was as rigid as a board. "Could this be a case of Lockjaw, Iasked myself'? My memory was harking back to my senior thesis. Dr.Gedgoud was called. He came and confirmed my suspicions. I suddenlybecame a highly respected intern amongst my colleagues for my astuteobservation and diagnostic acumen. Naturally, my fellow interns neverlet me forget my prowess. Ha!

Now, the party with this child began for me. Because of the rigidabdomen and if this rigidity was not relaxed, this child might go intosevere muscle spasms and death. He had to be fed through a tube placedinto stomach to supply his nutritional needs. He was incapable ofswallowing.

Every three hours day and night, I was called by the nursing staffto check his abdomen for the degree of rigidity present; then, thedecision must be made by me on how much "Avertin" was needed tobe given rectally to this boy. "Avertin" was a relaxing anesthetic typeof medication. Each dose had to be individually calculated. It wasimperative that the rigidity be kept relaxed so the body could heal itself.There were no helpful antibiotics for this disease in those days.

We did not have the luxury of telephones in our rooms in the internquarters. Instead, there was an instrument of the devil in the form of adoorbell type of device high on the wall in each room. This inhumanedevice provided a loud, piercing and annoying noise. This noise couldand would arouse the dead. One would sleepily stumble down thehall to a phone positioned at either end of the corridor. This frequentarousing every three hours created such a conditioned "startle reflex"within me that even today if I am asleep and the phone rings, I jumpwith an annoying startle.

Later on when in practice, this sudden reflex was very bothersometo my Beloved Mary. The phone would frequently ring at night. Thisstartle reflex would automatically occur depending upon the seasonof the year and what epidemics were making the rounds. The bedwould shake. She would be shaken awake causing a major irritatinginterruption of her rest and some rancor within the marriage state.Finally, in desperation and with great reluctance, we shifted to twin beds.We rested much better with this arrangement.

Once again, I shift from my tale. This little boy recovered withoutincident or complications. He went home never to be seen again. Whatan introduction to my chosen field of pediatrics this case became!Obviously, it was never forgotten.

During these internship days, one learned the method of how totap the chest for fluid or pus; how to obtain blood from the internal orexternal carotid veins, the femoral veins, or an infant's anterior fontanel.The ability to perform a "Cut Down" on an ankle vein became animportant ability to acquire in order to administer IV fluids when nosuperficial veins were available. Control of the patient's circulation wasan imperative need in many circumstances.

This technique, used long ago, was a far cry from the presentsemi-permanent locked-in sterile IV Fluid chambered plastic devices.These devices can be put in place in a patient's arm or leg vein and beleft for days on end

These and many other techniques were quite essential feats tomaster. My fingers became very adept at obtaining blood specimensand performing spinal taps in cases of meningitis and other needs. Mycolleagues frequently called upon my skills when theirs had failed, muchto my satisfaction and their dismay. Later on when in practice, some ofmy senior colleagues utilized my skills in these areas.

There were no micro laboratory techniques at that time. It took largeamounts of blood or body fluids for any test to be performed. Thesetests, of necessity, required that all be performed manually in the hospitallaboratory. This contrasts with today's modern testing machines, wheremultiple tests can be performed on a single drop of blood, seemingly atthe drop of a hat, many times a day.

There was little Dicky B., who had Nephrosis. This entity was amajor kidney problem where fluid collects in the abdomen in largequantities. The kidney loses much blood protein through the urine sothe ability to hold fluids within the blood stream is greatly impaired,because of the "Oncotic Pressure of the Proteins".

Over time, fluid would build up in the body tissues, especially, inthe abdominal cavity. When the abdominal fluid reached a certainvolume, it could interfere with the movements of the diaphragm; thusmaking breathing difficult. When the accumulated fluid became sointense so that breathing was at risk, it had to be removed. This removalwas my job.

It took a very large bore trocar, similar to a needle only much,much bigger, to siphon off the offending liquid. This trocar had to beintroduced through the abdominal wall, below and to the left of thenavel, in an upward slanting manner. It was necessary to avoid theintestinal tract, in order to obtain the necessary drainage. The slant wasto act as a make-shift valve to preclude much leakage post the procedureand to aid in preventing an entrance for a possible infection occurringafter this procedure.

This action needed to be performed at periodic intervals dependingupon Dickey's kidney system and the volume of fluid. My, how I didsweat doing my first few "paracentesis", as this procedure was labeled.My hands were wet, sweat ran down my back, and my heart poundedlike a trip hammer. Surprise! I survived, and so did Dicky.

There was five year old Willie S., who wandered next door toGrandma's house one fine day. He found an inviting coke bottle partlyfilled, and proceeded to drink the contents. The only problem wasthat Willie drank a lye solution, which was contained within the cokebottle, instead of pop. This ingestion scarred his esophagus so badly thatnothing, not even water, would traverse this passage into the stomach.This problem required that a tube be placed through the abdominal walland into the stomach so that nutrition could be maintained.

Attempts to dilate his esophagus occurred every week. An ENTphysician, Dr. Lovgren, worked from above with an esophagoscopeand an Urologist, Dr. Lee, worked from below through the stomachhole with a Cystoscope. After almost a year of weekly attempts, finally,a string was able to be threaded down through the esophagus into thestomach.

Now esophageal dilatations could be done at regular intervals bypulling a boogie [a soft round dilating instrument] attached to this stringthrough the esophagus.

Willie would become so woozy and silly because of the rectal"Seconal", a mild sedation, which used for these many, repeatedprocedures. As a result, he was cuter than a "button" with his anticsduring the aftermath until the sedative wore off.

I never knew what happened to Willie after I went into the MilitaryService. I have been told by others that he came back to the hospital atfrequent intervals to have his esophagus dilated far into his adult life.This happening would be the expected course to occur ad infinatum.These two cases left quite an impression on me.

There was a pretty little blond girl with a clear, porcelain complexionand big "Blue Plate Special" eyes with a hint of blue tint to the sclera[white] of the eyeball. She had a genetic problem with her bonesformation.

This medical condition was known as "Osteogenesis Imperfecta" or"Fragilitas Ossium" [Fragile Bones]. The bone substance was not verysolid. It lacked the collagen glue to hold the bone cells together. Thebone was more of a crystalline type of substance. Some infants could beborn with fractures in utero. This child's bones could break just by herturning over in bed.

The bones were very slow to knit. She came into the hospital forthe umpteenth time while I was a resident with a broken leg sustainedmerely by stumbling, but no fall. There was no answer for her for thisproblem. What a dismal fate was her's to look forward to.

There was a sweet little girl who had multiple ear infections andmastoid bone infection [Mastoiditis] problems. Her ears would draina purulent material almost at the drop of a hat. When she was on acombination of ear drops, nosedrops, and the drug, sulfadiazine, her earswould not drain. Stop any one of these three medications, and drainagewould ensue again. She had had numerous mastoid bone operations toclear out the infection.

What a head ache for her to live with for her coming years. Dr.Henske had me do a financial audit of her care, and it was well over$20,000 back in 1947. This sum was a lot of money then, but would bepeanuts today in today's medical costs. These costs will get even worseunder Obama care.

There was a lovely blond, ten year old girl with osteomyelitis of herright leg which frequently drained pus. She would enter the UniversityHospital for surgery at frequent intervals. Osteomyelitis was causedby the staphylococcus bacteria for which there was no known effectiveantibiotic in those days. This particular staph bacteria was very resistantto medications even into this present enlightened antibiotic age.

Her bone marrow had to be scrapped to remove the offendinginfected material. She needed frequent blood transfusions to maintainher blood count. Her bone marrow was disturbed and could not keepup with her body needs. Red blood cells are manufactured in the bonemarrow cavity; thus, the need for the transfusions. Medicine was fairlycrude in those days of long ago.

Once again, Dr. Henske had me do an audit on the costs of her care.It exceeded more than $50,000 even then.

One night while fast asleep, there was a call for me from the nursingstaff in the newborn nursery. There was a newborn who had been cryingendlessly, and nothing would appease this little tike. Examination of thisinfant failed to reveal any apparent cause. I was at my wits end on whatto do.

I called Dr. Gedgoud at 2:00 am for advice. The situation wasexplained to him along with the lack of any physical findings. Therewas a long silent pause on his end of the conversation; then, he said,"Doctor, did you try feeding the infant". He immediately hung up hisphone! Needless to say, this sage bit of advice was all that was necessary."Where was the black hole which was going to swallow me up? If thereare any more goofs like this one, I won't last very long in pediatrics", Ithought to myself.

Being the pediatric intern, every Monday morning was urine dayfor me to test all of the patients' urine. The nurses collected a specimenfrom each patient. This urine had to be tested in many ways and hadto be recorded on the patient's chart by me before the 8:00 am wardrounds with Dr. Gedgoud. He was so prompt that one could set a clock,without referring to an actual time piece for these rounds.

If there were any diabetic children on the ward, quantitative sugartests needed to be performed on the urine before rounds began or else!

If l looked out of the corner of my eye when working in the wardtesting laboratory, I could see his long white coat go sailing bye on itsway to the nurse's station. Daily ward rounds were made on everypatient on the ward and every infant in the nursery seven days a week.Once again, this action became a lifelong medical habit for me.

When I was on the men's medical ward, I learned to write properorders onto a patient's chart. Mrs. Mason was the "chief major domo"on this ward. She ruled this ward with an iron hand. Her dedicated dutyseemed to be to raise interns to understand how to write orders on apatient's chart. She taught many interns the facts of medical life over theyears of her tenure. We, all, came to respect and admire her in our latermedical years.

One bright sunny morning, I made patient rounds and wrote anorder on a patient's chart: "Hot packs QID", meaning four times perday. This patient had a sinus infection. Mother Mason knew all of theinterns' habits from A to Z.

After lunch, the hospital was relatively quiet for a spell. Mostinterns endeavored to catch a few quick winks of sleep. Well! MotherMason was well aware of the interns' habits like she knew the back ofher hand. I had just fallen asleep, when that darn buzzer went off. It wasMother Mason on the line. She sweetly stated to me, "Dr. Oberst, youwrote an order for hot packs QID, but you did not specify where youwanted them placed. Did you want them placed upon the patent's feet,abdomen, or head? Would you please come to the ward and clarify yourorders so that my student nurses will know what to do".

Grumbling to myself all the way to the floor, it was a lesson whichwas never to be forgotten. Thereafter, my orders were always so clear,so precise, and so concise that there never was a question by anyone onwhat was desired by me. "Thank you, Mother Mason" as we, interns,called her behind her back.

Woe to those nurses who did not follow my orders exactly fromthence forth. From a physician's viewpoint, this attention to legible chartorders was critical for a patient's care, to avoid any errors, and to avoidmalpractice problems. Those legal problems were rather rare in pediatricsin those early days as contrasted to today's litigious society.