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The Principal Clinical Year 1968
By Richard E. Burney, MD
PCY Part IV: Gynecology at the Brigham
Five teaching hospitals are located within walking distance of Harvard Medical School, whose  ve grandiose stone-clad buildings form three sides of a grass-covered quadrangle the open end of which faces the intersection where Avenue Louis Pasteur meets Longwood Avenue. At that intersection, Ave. Louis Pasteur splits to form a shield- shaped plaza, the Oscar C. Tugo Circle.1 On either side of the traf c circle are the curved facades of mirror-image sandstone clad buildings. On one side is Vanderbilt Hall, the dormitory for medical students; on the other side is the Boston Lying-In Hospital. On the far side of the quadrangle, broad stone steps lead up to the imposing columns of Building A, the main administration building. On the other side of Building A, lie Shattuck Street and the Peter Bent Brigham hospital. A short walk down Shattuck or Longwood to the west is the Boston Children’s Hospital. A few blocks further on, Longwood Ave. intersects with Brookline Ave., on which, a few blocks to the left, was the New England Deaconess Hospital and a few blocks to the right, the Beth Israel, to which, as a second year student, I had trudged with small black bag in hand to learn physical diagnosis.2
My next rotation in the PCY was 3 weeks of Gynecology at the Peter Bent Brigham Hospital, to be followed by 3 weeks of Obstetrics at the Beth Israel Hospital. Both were nearby, but not at all like one another.
The Gynecology rotation started strong, but rapidly  zzled. Gynecology was simply not a strong service at the Brigham. From what I could tell, there were only two gynecologists on teaching faculty there.
Tuesday, April 16, 1968
A momentous occasion. I did a D&C and then an appendectomy, which was thrown in as a bargain on a lady who had a  broid uterus removed. I am now on Gynecology at the Brigham and I hadn’t really expected to be able to do any surgery but when the opportunity arose, I was ready – and threw every stitch correctly. Great stuff.
This will probably be the high point, however. It is a slow service made slower because Dr. Sturgis broke his arm last week and Dr. Taymor is out of town. As of today, there were no admissions scheduled for the rest of the week, and Friday is a holiday.
In 1968, “Surgery” at the Brigham took a dim view of specialization, and the patients that we would now cluster separately by specialty mixed all together on the wards. I was disgruntled by my early experience there:
The problems with Gyn are basically 2 –  rst, there are not enough patients at the PBBH, and second there is no real gynecology service, so you have no center of operations at the hospital, and on the surgery ward you’re pretty much a second class citizen. You can’t really be there all the time – and you can’t keep going back and forth – and you’re never told about what’s going on.
In the newly abundant spare time I had that  rst week, I played bridge, had lunch with friends at Durgin-Park3, watched the Celtics defeat Philadelphia in the NBA Eastern
Division playoffs, and read 320 pages of a Gyn text. Finally, I got a patient to work up, and exhibited some surprising hubris in my comments.
I admitted my second Gyn patient yesterday – a 53 y/o lady with uterine prolapse, in for a vag hyst. I feel pretty good about the work-up because I picked up a murmur of aortic stenosis and carotid and subclavian bruits, which were missed by everyone else, including her private doc. These surgeons just don’t know what to do with
medical problems.
I wanted to learn. I prowled the hallways, trying to see as much of what was going on as I could and looked in on cases on other services, recording my observation.
Last night they did an emergency transverse colostomy on Dr. T, the orthopod4, for diverticulitis with perforation. Dr. Moore supervised and Dr. Vandam was anesthetist. Dr. T looked just like any other patient in the recovery room. The hospital is certainly the shredder of dignity.
Otherwise things at the hospital are so slow that last week I almost had to work up a man with gynecomastia to keep busy. One gets easily bored now because one has learned to live without extracurriculars.
Things eventually picked up. One day,
I was in the OR from 10 until 3:30 with 3 different cases, a culdoscopy, an exploratory lap, and a D&C, which I did all by myself on a lady with an incomplete spontaneous abortion. Then I worked up another (patient with) spontaneous abortion before going home. I felt really chipper, because I’d put in a good day’s work.
A few days later, a somewhat different experience in the operating room:
Yesterday, I excised a vagina  stula with Dr. K over at the BLI (Boston Lying-In) and it was not a good procedure. In the  rst place, Dr. K was late and was rushing. In the second place, I had no idea what I was doing with that Bard-Parker blade in this young gal’s vagina. Well, I carved out a chunk and sewed it back up but I wasn’t at all happy about what I was doing. Happily, I didn’t get nervous and was able to maintain at leas some presence of mind despite the rush being put on. I will be content from now on to learn my surgery from surgeons and not gynecologists.
I almost neglected to describe the scene in the O.R. last Friday when I did the D&C for Dr. G. Dr. G is kind of a hang-loose character with big, leering grin who has a habit of stretching his neck conspicuously and cleaning his mouth with his tongue in a fashion reminiscent of Al Quint (our class president) imitating a  brillating heart. Anyway he was in a hurry and started gaily prepping the pt. before she was fully anesthetized. I cringed as he took a cold pHisoHex soaked sponge on the end of a long sponge forceps and plunged it into the posterior fornix and swabbed vigorously. The patient jumped about 6 inches. His eyes were grinning as, plunging another home he turned to me and said, “Gotta keep these anesthetists honest” or words to that effect, as the patient nearly fell off the table. He then bounced up onto the balls of his feet and dove in for the pre-op pelvic exam. After a few seconds of vigorous thrusting and probing he whirled away and let me have a turn as he described everything I was to feel. “This is your chance to learn to do a good pelvic.”
20 Washtenaw County Medical Society BULLETIN JULY / AUGUST / SEPTEMBER 2018

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