“If It Isn’t Fun.” – Extern, The U.S. Marine Hospital of New Orleans
It is difficult to believe that the commercial marine fleet of this country, now much diminished but still a lifeline of our economy, once had a government medical service of its own. The Marine Hospital Service, predecessor of the Public Health Service, was founded in 1798 and at one time involved a dozen hospitals in stately colonial-style buildings of a type still seen on old government compounds in many parts of the country. There, all medical needs of merchant mariners and Coast Guard sailors were taken care of. I had the good fortune to be an extern at the New Orleans Marine Hospital from early in my sophomore medical year through graduation.
First, a telephone operator:
I suppose I heard about jobs at the Marine Hospital from classmates, but I have no recollection of interviewing. I surely appeared in my midshipman’s uniform soon after I was discharged from the Navy in January, 1946. Once engaged, I went through the normal rotation of the externship, from the more menial nonmedical to the more responsible medical jobs during three years on the staff. It started out with the tedious function of switchboard operator, which I recall as a rather pleasant job. [In fact, I have little problem with routine parts of jobs, being able either to put my brain on hold or to occupy myself with reading and homework while carrying them out.]
The hospital had an old-fashioned PBX system with a buzzer and flashing lights. On signal, I took up the cord adjoining the light and plugged it in, taking the call on my headset with the mouthpiece on an adjustable boom. Open the switch, take the call, pull out the adjoining in-house wire, plug it into the requested station, pull the toggle switch in several short rings, wait to see the light indicator that the call is connected, then get back to reading, which is only interrupted when a buzzer and light indicate the parties have hung up.
Those days I was courting Jane B., the shy, sweet daughter of a Mississippi riverboat captain, and, depending on the homework she had as a student at Newcomb College, and mine, we would sometimes simply keep a spare line open for much of an evening, chatting between tasks.
Then, an ambulance rider:
Junior year of medical school, my second year as extern, I graduated to admitting patients in the emergency room and taking ambulance calls. In parallel, in my Tulane office in Hutchinson Memorial downtown, I rapidly garnered clinical experience and assumed what I took to be a professional demeanor.
Marine Hospital admissions were an adventure I loved. We, of course, had standard formularies to be filled in with the patient’s presenting complaint, past medical history, family history, and standard physical examination. But this early clinical experience was so much fun that I remained in school during the first postwar summer break to take a special course in physical diagnosis, so eager was I to become a “real doctor” and to do proper histories and physical exams.
Then seeing patients
Merchant mariners are an unusual segment of the world’s population. Socially they seem to be only a rung above drifters and prisoners; emotionally, they are dreamers; behaviorally, they swagger, all machismo, attempting, it would seem, to escape themselves. They apparently find mystery on the high seas, and, in port, fulfillment in the sleaziest bars.
The gamut of conditions we encountered among this strange population included exotic tropical diseases, bizarre venereal diseases, and many conditions related to the physical risks of the mariners’ jobs — along with their self-destructive lifestyles. I took ambulance calls that led us deep into the holds of the converted liberty ships of that day.
One night, I dealt with a particularly filthy drunk, a violent sailor who required six mates to hold him down while I administered calming barbiturates intramuscularly. Then we put him in restraints, carried him up myriad ladders, through myriad hatches, across the gangplank, into the ambulance, and off to the hospital detox unit. Later that same year, a young commissioned officer on duty in admissions had his chest stove in by the wooden leg of a raving drunk merchant mariner.
Finally, house staff member:
For my final year as extern, I graduated to a doctor’s gown and carried out workups on the wards. Serving essentially as interns, we did histories and physical exams that were more extensive than those taken in the admitting room. Then, at the end of my exam I would phone the attending physician for consultation on the differential diagnosis and get his authority to write admission orders. We became full-fledged house staff, feeling and behaving like young physicians, moving about the wards during twice-daily rounds, sitting in the clinical-pathological conferences and with the visiting consultants.
Consultations were memorable with William Sodeman, one of the more distinguished leaders of internal medicine nationally. Herman Hilleboe visited us regularly as a world authority on tuberculosis. He subsequently became commissioner of health in New York and one of the founders of the American Heart Association. There were also our grand consultants in tropical diseases, Dr. Faust of cysticercosis fame, and Isadore Snapper, author of Chinese Lessons to Western Medicine, who taught us how to differentiate among clinical and pathological lesions that looked similar: disseminated histoplasmosis and the Leischmania parasite of kala-azar. Exposure to these fine people, and serving under a superb chief of medicine, Alex Doerner, oriented me early toward internal medicine. Its calm, contemplative, and orderly strategies of observation and deduction were appealing from the very beginning.
The ambience of a government hospital
Fifty years later, I recall nostalgically the delightful atmosphere of that old government hospital campus with its soft, balmy mornings and romantic, misty nights. There was much collegiality among the student externs and the staff in those quiet days at the end of World War II. The U.S. Public Health Service interns and house officers treated us as colleagues, while providing models of professional and social demeanor. Of several close friends among the group, one friendship persists to this day in Russell Roberts, then a law student. Bill Clark, down the hall, almost continually played classical music on his record player, teaching me the joys of Mozart and Beethoven as well as the skills of sharpening cactus needles. John Fort introduced me to “southern” literature, mainly Faulkner. I was so young on entering medical school that I needed considerable maturation, intellectual, emotional, and social. Along with the rediscovery of good music, I became fascinated with books, and during this period became an amateur bibliophile, reading, handling, and collecting them.
As I lay abed reading late evenings, I could hear and marvel over the lions at their frequent lovemaking across the way in Audubon Park Zoo.
Along with all these new adventures came the relative freedom of the later years of medical school. I found rapture in long evenings reading Chaucer and Rabelais and Whitman, listening to the swells of powerful music, while sipping Taylor’s sherry or tawny port, my idea of elegance at that tender age. And then there was the delightful companionship among externs and nurses and nursing students, pleasant evenings of babysitting with Russ Roberts and Betty MacFarland, later to become Betty Roberts. I still have a blurry photograph of one those evenings when Russ snapped us with Betty and me posed back-to-back, a collection of books between us, as if we were bookends.
Life went on calmly yet richly at the New Orleans Marine Hospital. We did our jobs well, serious students that we were, earning our way through medical school. We received room and board and uniforms and laundry but no pay; work assignments were distributed among us equitably. We came to know each other well, and were generally well thought of by the senior staff. Throughout school I had sought quiet anonymity and thought it was better that way. I missed thereby many rich personal contacts with fine people and potential mentors, which was surely a mistake.