Page 16 - Volume 70 Number 1
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interspersed with the excitement and challenge.
Mr. Och’s case was presented the following week at “death rounds” with discussion by Dr. Kass, in whose opinion the transtracheal stick was unrelated to the patient’s death from Ludwig’s Angina, which had probably already begun prior to the procedure.
For the record, some clinical signs and laws attributed to Peabody interns and residents I worked with:
1. Hatem’s Sign \[attributed to AR Charlie Hatem\]: When the deviation of the nasal septum is to the same side as the Dupuytren’s contracture.
2. Hatem’s Law: In pancreatitis, do not give Demerol to the patient until he allows you to put down an NG tube.
3. Conger’s Sign: \[attributed to Chip Conger\] When the pill from the previous medication round is still stuck to the tongue.
The next day, Monday, four days after her admission and exchange transfusion, GG, who probably did have Reye’s Syndrome, “except for a somewhat disturbing fever, is almost as good as new – a heartwarming, exciting, and gratifying sight – a great cure \[so far\] but we’ll probably never know whether the exchange, the steroid, or fortune did the job. Someone’s going to write this one up.
A week after that, GG went home. I happened to be passing the elevator when she and her parents were departing. They stopped and offered handshakes. This was: “a miracle in the lay view – \[but\] for us, the 1one or tweo cases of 20 like her who live. It was a gladdening experience nonetheless.”
Tuesday, Mr. Moses “my epileptic who had a white count of 35,000 and a temp of 1030, started going downhill, tachypneic and tachycardic. He must have had sepsis somewhere or maybe a pulmonary embolus. He finally arrested and died without anyone ever figuring out what was going on. He had had two strikes against him: 1) he was confused and unable to speak or think rationally, and 2) he had no veins. It took the surgeons 2 hours to get in a cut-down. It was just a horror show. And we couldn’t get the post permission – on the type of pt. we most need to know about.
My last two weeks on the service I picked up a few more of the usual BCH patients: an 81 year-old with GI bleeding, hematuria, anemia, congestive heart failure and of course chronic lung disease; a “relatively uncomplicated” man with ulcers, diabetes, glaucoma, hypertension, pancreatitis; a 26 year-old alcoholic, who while sitting on the bed pan was attacked by another alcoholic in the next bed, who then had a full-blown tonic-clonic alcohol withdrawal seizure. The luster of stamping out disease at BCH was wearing off.
I had a week of vacation coming before starting Pedia- trics at Children’s Hospital. On that last day, I was in the hospital until 5:30 AM:
I stayed around for no good reason really – just the feeling that the rotation is almost over and I haven’t learned all there is to learn, an uneasy slightly anxious feeling, which I’ve known before – after almost every course in Med School.
Looking back though, it is hard to recall how much
I didn’t know at the beginning. That which has been learned has been totally incorporated into the working experience. I still would like about three more months of it in a way, and in another way, it’s time to stop and take account of what has been happening. One tends to get a feeling of premature competence, having the responsibility one does at the City. It’s a feeling I don’t mind having, but I wonder if it is a good thing at this stage. I’ve always favored taking on responsibility more slowly.
I don’t really have much else to say about the medicine rotation – it has left me with mixed feelings. I worked up a total of 20 patients on the ward – four in OPD – not really very many. I was never able to make much of a personal commitment to what was going on down there. The student’s role is really poorly defined and it took a long time to get a foothold, and now that I have some foothold, it’s not really the kind of foothold that I like. The inefficiency of the institution is very disturbing; there is too much low-caliber politics involved in getting things done; it’s bad for the patients, who have to wait around too long for things to get done.
As this first PCY rotation, which had begun the
process of transforming a student into a doctor neared a close, one additional bit of insight was becoming more and more clear: You know, life gets much easier when one just sacrifices everything in the outside world and spends all the time at the hospital. But you get tired. I’m going to need that vacation.
A week later, after I had been home on vacation for a few days, I tried to look back and reflect on my BCH experience. “Interestingly,” I wrote:
I haven’t really come up with any ideas of opinions about the good ol’ BCH except that it has its pros & cons. Before I left last Saturday, I took an extra hour to write a philosophical off-service note about Mr. Santiago, who, after getting his two units of packed cells on Friday – a somewhat controversial move \[he was dying of cancer of the palate\] – was markedly improved, smiling, and happy. He may be dying, but I’m glad we didn’t write him off too soon, and I thought it should be so stated in his chart, even if I’m only a student. One of the nice things about the City was that you didn’t always feel like a student, because your opinion was sought and given due consideration.
On Saturday, when I finally did leave, I said goodbye to Herm, Al Cline, Dave Gilmour, and Dick Garibaldi and they all said I had done a pretty good job, so it made the whole rotation seem worthwhile. I felt good about the rotation for the first time. It was an uphill climb all the way and I felt pleased that I was able to feel at the end that I wanted to write some discharge summaries and off service notes because I was important enough to the patient’s well-being that I should do these things.
It felt like I was becoming a doctor.
Note: Journal entries are unedited to preserve the historical significance and maintain the medical integrity of the period.
Washtenaw County Medical Society BULLETIN JANUARY / FEBRUARY / MARCH 2018

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