The View from the Vue (30 page)

When the navy drafted me and sent me from Bellevue to Quonset Point, Rhode Island, I took a look around me at the peaceful countryside and decided I had been fortunate to escape in one piece from New York.

Then, not three months after I had gone to Rhode Island, I noticed an article in the Providence paper which mentioned that a resident at New York’s Bellevue Hospital had been shot. As I read on, I discovered that he had been a first-year resident in obstetrics, and that he had been plugged while on the maternity ward during visiting hours the night before. He was described as a hero: he had seen a man pull a gun on his wife and had stepped between the couple and tried to break it up. Whereupon the husband had opened fire on the would-be peacemaker, damaging his lung and pulmonary vein. At that point, the guards came on the scene, disarmed that attacker, and rushed the resident to the surgery suite. The article stated that the surgeons had sewed up his supernumerary orifices, and that now, forty-six blood transfusions later, they held out some hope that he might just possibly recover.

I put down the paper and looked at my wife, who had been reading the article with me. “What would you have done if that’d happened to you last year?” she asked.

I pride myself on being a basically honest man. Cowardly, but honest. “I would have run as fast as I could,” I said, “and hid behind the nearest piece of metal.”

We followed the recovery of the resident in the newspapers and by notes to and from my friends at The Vue. It drove me wild: I couldn’t figure out what had ever possessed the resident to try to disarm an angry Bellevue husband. No self-respecting New-Yorker I had known at Bellevue would have even thought of doing such a thing. I figured the guy must have been a Midwesterner, newly arrived at The Vue for his training and not yet accustomed to the prevailing New York mentality, which dictates that one watches placidly while women are shot, stabbed, raped, and/or dismembered. What can you expect from a greenhorn?

Six months passed. The resident finally recovered sufficiently to return to work, and my wife and I took a trip to New York. I went over to The Vue and visited with my old friends. While we were talking, a pale, fragile-looking fellow walked up and joined the group. One of my friends introduced me to him; I immediately recognized his name. “You’re the resident who got shot,” I said. Before he could squirm uncomfortably, I added, “Where are you from?”

“New York,” he answered quietly, his eyes looking mildly at me from behind his horn rims. “Why?”

“Because I can’t figure out what in God’s name ever possessed you to place your one and only body between that woman and her husband,” I said.

Now
he looked uncomfortable. “Oh God,” he said. “Did you read that in the papers?”

“Sure,” I said. “I just couldn’t believe that you tried to take the gun away from that guy.”

“Nuts,” said the resident. “I didn’t step between them. And I certainly didn’t try to take the gun away.”

Now I was puzzled. But he continued: “Actually, what happened was, I was running away; I was trying to get behind the metal wall in the Examining Room. The guy’s first shot went through a nurse’s cap and the next one got me.”

“But the newspapers said—”

“I don’t care what they said. I guess they wrote it up that way because it was a better story. I mean, how would it sound if they tried to sell newspapers that said, ‘Fleeing resident shot by husband with lousy aim’?” He laughed. “He shot me in the back, you know.”

Well, I only know what I read in the papers.

Everybody has his own idea as to what a medical student is like. Some say he’s a clean-shaven young man with determined bloodshot eyes who sits at the kitchen table studying until 2
A.M.
His wife, after an evening of being dutifully quiet, slumbers alone in the bedroom while a torn window shade does a poor job of keeping out the light from the street lamp strategically placed right outside the tenement window. Other people believe him to be an ever-jolly soul who divides his time between dropping stolen cadaver penises on crowded buses and deflowering panting, big-breasted student nurses. More recently he may be seen as a frustrated social worker who cuts out of his neurology lectures and refuses to learn gross anatomy, the better to spend his time tilting at the A.M.A., going to the storefront clinic in the ghetto where he dispenses what he figures is good medical advice, or doing other meaningful and relevant things.

Whatever medical students really are like, though, I think it can truthfully be said that they are also often quite funny. Not because of any intrinsic humorous propensity particular to the type, but because of the situation in which they are placed. They’re funny in the same way your teen-aged daughter is funny when she flounces around the dining room in her first bra. It’s interesting to watch someone’s reactions when he finally finds himself eating with the grownups.

During my second year at medical school I got to put on a white coat for the first time. I stood in front of the mirror in my room for a full twenty minutes. I looked at myself with the buttons both open and closed. I looked at profiles and frontal views. I tried on three different ties. Finally ready, I went across the street to the hospital for the ophthalmology lesson. With my shiny new ophthalmoscope, I spent fifteen minutes trying to examine the eyes of an unwashed old bum who kept burping into my face and whose breath smelled as though he had been drinking Lucky Tiger Hair Tonic. Worst of all, I couldn’t see a damn thing, which made it difficult for me to do as I had planned, which was to astound the professor by calmly mentioning in an offhand sort of way the previously unnoticed minor finding which would have explained all the poor fellow’s medical problems. When the ordeal was over, I crept back to my room and slung the white coat into a corner of the closet. I’d have been much better off wearing a T-shirt and having some knowledge of medical facts and some experience.

At The Vue in the 1960’s, the students came, like asparagus, in bunches. Every six weeks a new group arrived on obstetrics and gynecology. They came with eagerness and they came with slothfulness, with innocence and with sophistication, with avarice and with altruism, with amiability and with hostility. Hopefully, they all left knowing at least a little more about the finer and the grosser points of womb-snatching, snatch-patching, and baby-catching. Best of all, several women went home never having even suspected that the young doctors who had carried them through their labors with such solicitous care and then had done such a good job of delivering their babies were medical students. Many a youngster who first saw the light of day at The Vue carries the name of the “doctor” who helped bring him forth. The teachers in the New York schools will never quite figure out Chayim Gonzales or Samuel Rabinowitz Sanchez. But we know, don’t we?

As I get older, the different batches of Bellevue students are beginning to blend into each other in my mind’s eye. Of course I can still remember that one particular psychotic from 1964 and the impossibly hostile son-of-a-bitch in 1965, and the character who was so incredibly proficient that we suspected him of running an abortion clinic to put himself through school. But I can’t distinguish one group from another anymore. Except one. That one I’ll remember as long as I live.

Whether fate had simply grouped these guys or whether they had purposely flocked together, I’ll never know. But whatever the mechanism, they arrived for their training on the Bellevue obstetrics service during my tenure as a first-year resident.

The obstetrics clinical clerkship for the students at The Vue was the backbreaker of the year. For three weeks, these guys rotated admissions. There were six or seven students in a group, and a student picked up every patient on admission and then followed her to delivery. If she happened to remain in labor for thirty-six hours, no matter. You stayed with your lady until she foaled. Period. This may have accounted for some of the behavior I was privy to during those three weeks, but that’s not the whole story. The fact that it only happened in this one group of students makes me a bit suspicious.

Sam Legg was the first one of the group that I met. He was a tall, thin fellow with a perpetually bemused smile and a nervous tic around the mouth. Sam reported for duty, black bag in hand, and I showed him to his patient. I warned him that she was a woman who had already delivered a large number of babies, that she seemed to be in active labor, and that he had therefore better keep a good eye on her. He smiled and said, “Yes, sir!” I told him that he needn’t call me sir, that Larry would do fine. He beamed appreciatively, and I ran out to see to the needs of the next customer.

About half an hour later, I heard the kind of screech from the Examining Room that could have meant only one thing. I charged over, pushed through the swinging door, and found myself in total darkness. I groped for the light and, as I switched it on, the woman bellowed again. Sam Legg stood there, ophthalmoscope in hand. “Hi, Larry,” he smiled. “I had the light off so I could examine her eyes better.”

I pushed the patient onto her back so the baby she had been sitting on could get the rest of the way out. Fortunately, no harm had been done. After we completed the delivery, I asked Sam what his findings had been on the pelvic examination. “Gee, Larry,” he said. “I never got to the pelvic exam. I was only up to the eyes.” For explanation he held up a mimeographed sheet, which I snatched away. It outlined a sample history and physical examination. Sure enough, the pelvic exam was described last.

“Sam,” I said. “This is a fine outline. Really it is. But it’s not for a medical patient. Since this is obstetrics, you should examine the abdomen and pelvis first.”

Apparently there was some mule in Dr. Legg. “This is the sheet they gave us in physical diagnosis,” he said. “They told us to stick close to it, and form good habits by practicing that way.”

“Sam, let me ask you a question.”

“Sure, Larry.”

“Suppose you were in the Emergency Room and a guy came in with his jugular vein slashed. Would you check the condition of his eyeballs before you tried to stop the bleeding?”

“No…well…well, that would be an emergency.”

“Couldn’t you call this an emergency? A lady delivering a baby sitting on a stretcher while someone is looking at her eyes? And in the dark, yet.”

Sam thought for a minute and then allowed that logically it did seem a bit out of order to him. He looked worried. “But how am I going to examine the patients if they deliver first?”

“The fact that they’ve emptied their uteri doesn’t change anything. If they had TB before they delivered, they’ll have it afterward too.”

A light came on. Sam beamed at me. “Oh—I see. I could do my complete history and physical
after
they deliver.” Then he looked worried again. “But wouldn’t that be cheating?”

I held onto my composure and assured Sam that it not only would not be cheating, it would be efficient and optimal medical care. So, thereafter, Sam performed his histories and physicals using something resembling the proper priorities. But he often allowed as how it didn’t seem quite right to him.

I repeated the story to the chief resident, and expressed some concern for Sam’s future functioning as a physician. The chief gently asked me whether I knew that Sam was at that point the top-ranking student in his class. I laughed.

“I’m not kidding,” said the chief. “That kid is Numero Uno. So maybe if he tells you something, you ought to listen to him.”

I predicted a bright future for Sam Legg as an internist-diagnostician, where he would patiently—and ever so methodically—unravel diagnoses that had stymied lesser minds. I was therefore surprised, to say the least, when a few years ago my wife called my attention to an article written in a popular women’s magazine. It was about a set of quintuplets that were born to a woman who had received fertility shots. In describing the woman’s delivery, it said, in part, “…the first baby was born with the help of the Chief Obstetrical Resident, Dr. Sam Legg.…” Before me flashed a mental image of a woman sitting in the dark on the edge of a stretcher, surrounded by five writhing babies, while a young doctor peered intently into her eyes.

When I got home after that night’s work, I told my wife about my new students. “Thank God it was a slow night,” I said. “Only one admission. I wonder what the rest of this group is like.”

My wife assured me that I couldn’t judge a whole group of students by one member, and that the others probably would be fine. She advised me to cheer up. So I cheered up. I stayed cheerful until I went back to work and met Jack Fields.

Imagine Charlie Brown all grown up and enrolled in medical school. This was Jack Fields. He was short and round-faced, with a light-colored crew cut and a perpetual intimidated little smile. Jack personified the concept of full-fledged wishy-washiness as a religion. For three solid weeks he tortured me. Intravenous solutions didn’t get started because Jack stood and wondered whether the vein on the left arm was bigger than the one on the right. Urinalyses were unrecorded because Jack couldn’t decide whether the color indicating the quantity of albumen was 1+ or 2+, so he wrote nothing. Women delivered in bed as Jack stood by in paroxysms of inaction. Patients dropped babies off the edges of delivery tables as Jack, standing back where the blood wouldn’t drip on him, made feeble passes with his outstretched hands at the emerging infants.

I tried everything I could think of. Pleading, cajoling, cursing, explaining. All gave me the same response: a little-boy smile, and “I’ll try harder next time.” He did, too. One thing, Jack was not lazy. Incapable, si. Lazy, no.

When Jack’s last patient came in, I pulled out my secret weapon: bullying. “Jack,” I said, “you work this woman up and take care of her. I will help you not at all. You’d better get the whole works done, and done right.” I really hoped that if he were forced to do it—just once—it might be enough.

Fifteen minutes later Jack was back. He held a bloody intravenous catheter in his hand. “I…can’t start it,” he murmured. “Please help me.” I waved him back to work. He returned in another ten minutes, holding another bloody catheter. Before he could ask for help, I waved again. Jack stamped his foot and cried out, “I just can’t start it. I’ve used every vein I can see.” Then his eyes filled with tears. At that point, I knew we’d both failed.