Page 14 - Volume 70 Number 1
P. 14

Share Your Story
Boston City Hospital, Winter 1967-68: Becoming a Doctor By Richard E. Burney, MD
Part II: Peabody 1
After 6 weeks on Peabody 2, I made the transition to Peabody 1. In my journal I recorded my expectations: Peabody 2 is “where the action is: twice as many admissions daily – more alcoholics, more chronic lungers and patients with tuberculosis, more MIs and malignancies – dirty old men in place of decrepit old ladies.”
After a week, I wrote:
In my first week on the men’s floor, Peabody 1, I picked up two very good cases. The first, Robert Weeks, is a 40 year-old Negro with Sickle Cell Disease and all the classic complications thereof – pulmonary and renal infarcts, CHF and Cor Pulmonale, hepatomegaly and autosplenectomy, jaundice, painful crises, and a diathesis for infection. He is in now with erythema multiforme exudativum major (Stevens- Johnson Syndrome) – a real rarity – caused presumably by a reaction to ampicillin. A true fascinoma, he had been taken care of by Dr. (Edward) Kass (popular Infectious Diseases specialist) in the early 50’s when they were treating him with ACTH, and later by Dr. (James) Jandl (an imperious Teutonic hematologist). Dr. Kass tells me that Mr. Weeks is alive because he has had very few transfusions – on purpose.
My second patient is a 70 year-old gentleman who had hypertension, atherosclerosis, 2 old CVA’s, and who came in passing blood and clots from his rectum. I was up all night with him the first night – getting 45 minutes sleep – and had to go in today (Sunday) to look after him – and talk his family into giving blood – and ended up being there for five hours. He has stopped bleeding now. This case has been rewarding because I think I have been able to inspire his faith \[“Dr. Burney, I have a lot of confidence in you”\] and his family’s trust. He’s not over the hump yet, though, because it looks as though he had an MI during the bleed, at least by EKG. Cases at the City are never simple.
Both of those patients were discharged home a week later.
I was assigned to the outpatient department following week: OPD at the (Massachusetts) General was better. It
(BCH OPD) wasn’t a waste of time but I need the ward experience more. ... I admitted yesterday, which was fun but not a great learning experience. My new patient is an older Negro gentleman with psychomotor epilepsy in the middle of a several day seizure, an interesting case.
The following Sunday, after a week back on the ward, I wrote that it had been “another almost unbelievable week:” Between Monday morning and this morning – 6 days
– I put in 103 1⁄2 hours at the hospital in an exhausting
week. The entertainment \[Monday\] was the admission of Mr. Frank Ferrandini, whose stated occupation was “safe robber.” He was admitted because of chest pain. He had had his first MI while awaiting trial, just outside the courthouse, and since then he has had angina when he pulls off jobs. A fantastic guy – 41 years old.
My elderly Negro epileptic, Mr. Moses, had a seizure on Monday just after rounds and was hypotensive for an hour or so. He had an EEG that afternoon – what a zoo it was trying to keep him quiet enough to get a decent recording – which showed a probable left anterior temporal lobe focus.
Mr. Moses had another seizure the next day, and
became profoundly hypotensive again requiring a cut-down for IV access and 9.5 liters of saline to bring his BP up over 100 systolic.
The rest of the week, beginning Wednesday afternoon, became, once again, a surreal experience.
When I got back to the hospital \[after an uninspiring talk by Dr. Robert Marston, the head of the Regional Medical Care program for Heart Disease, Ca and Stroke\] two DL’s (danger list patients) had just arrived: 1) an old \[55 y/o\] guy with pneumonia and an acute belly in a chronic alcoholic with an incredible history
– primary cancers of the tongue, mouth and larynx, gastritis with bleeding, chronic duodenal ulcer with bleeding on several occasions, Paget’s disease and an MI in 1964. I picked him up. In 45 minutes (John) McGowan (the intern) and I had drawn bloods for analysis, lytes, pro time and blood bank, blood cultures, and started an IV, examined the pt., called the surgeons, delivered a clot to the blood bank, blood to Biochem, gotten a Hct and WBC and called x-ray for some more films.
Meanwhile the other DL was developing signs of increasing intracranial pressure – one dilated pupil and decerebrate posturing – quite dramatic when you see it. He was scheduled for carotid arteriogram \[the only way at the time to detect an intracranial mass lesion\], which I saw, showing deviation of the anterior cerebral artery to the left and the right carotid downwards. By this time, despite mannitol and steroids, his pulse was slowly dropping and his BP was slowly rising – the classic occurrence.
I got back home around 4 AM but was at the hospital early because of the bloods I had to draw \[the night float didn’t draw bloods on the students’ patients\] and the precarious conditions of my patients.
Most of that day was spent in a conference on diuretics in patients with ascites, a lecture on the pharmacology of diabetes, and a very entertaining lecture given to the H.O.’s by Dr. Charles Friedberg, from New York, the author of the authoritative text on Diseases of the Heart. After that, at 8 PM, I returned to the ward to write progress notes and before I could get away, both of my patients had spiked fevers of over 101°.
After muttering under my breath for a few minutes –
Washtenaw County Medical Society BULLETIN JANUARY / FEBRUARY / MARCH 2018

   12   13   14   15   16