“If It Isn’t Fun.” – More Letters Home from Medical School Pt. 2
These next letters pretty much fill in the gap in my medical school journal, which I had largely abandoned during 1946-47.
A Scolding
September 1, 1946
Dear Mom: I see red when I hear of your heavy work and activities. You, Mother, must get your hemoglobin checked again. And I see no reason why Dad should wear himself down to a nub every year before annual conference. Just so much can be done, and it should all be dropped before you go to bed at night. We should get something to put him to sleep if he’s insomniac.
I hope I’ll be as productive at age 50 as he, but I hope I’ll have sense enough to know how much my body can stand. Love, Henry, Jr.
September 7
Folks: I am tired and shaken tonight after the trip back from the wonderful Labor Day visit with you at home. It was a bumpy flight, which is always a strain. Then a car in front of the airport limo I was taking to town struck a kid on a bike right in front of us, the car doing at least 50. Without saying anything about being a medical student, I tried to get things straight before we pulled away. I turned the kid’s head to relieve pressure on the part of the skull that was undoubtedly crushed on the pavement. I saw that he wasn’t going to bleed to death, got an ambulance summoned, and fought off the country bystanders who wanted to move him. When the ambulance arrived, I got away quickly.
I could eat little supper.
October 1
I haven’t stopped for two weeks. If I had known about this junior year I think I might have quit and gone into another business. It’s a rat-race.
I believe I’ve mentioned that I’m on “colored” pediatrics service, which has the heaviest load and most rapid turnover and is the most crowded service at Charity Hospital. Many mornings I have to skip lecture to keep up with my ward duties. After working up my patients, I try to attend one of several conferences, but, in fact, rarely get there.
Six of us are responsible for an entire infant ward and a juvenile ward at Charity, with patients assigned to us in rotation as they arrive. Tulane has three admitting days a week, alternating with LSU. My name comes up first so that I get the first in rotation of new patients and usually never get caught up thereafter. I have to do all the lab. work as well as the history and physical exams and progress notes, and have to spend many nights at Charity. I also have reading assignments, a lecture course in OB/GYN, a lab. course in tropical medicine, and an elective in surgical anatomy.
Soon I will transfer to “white” pediatrics, which may be slower though pneumonias are beginning to pile in. Then I go on contagion for two weeks, followed by OB for six weeks, during which I have to be on call every fifth night and participate in virtually all Charity Hospital deliveries, that is, 15 to 40 per night. That means one night of five with no sleep at all. On days, I get back home around 6:00 p.m. and sit down to read furiously.
Despite the pace, I’m liking pediatrics. My youngest patient is five months, the oldest three years. I am baffled by the complexity of diagnostic possibilities when the symptoms and signs are the same for a galaxy of kid conditions: spouting at one or both ends, soaring fever, meningismus (stiff neck), pink rashes, and so on, about which you as parents are probably more informed than I. It is all so interesting. I seem to have adapted unconsciously to the noisy wards and boisterous kiddies without too much stress.
On Looking Ridiculous
I was more than a little non-plussed yesterday when I realized how ridiculous I must have looked to an attractive LSU student in whom I’ve developed some interest recently. She was walking down the hall in Charity as I emerged from an elevator, a squalling, month-old black infant in my arms that I had just taken to fluoroscopy. I must have been holding the babe in an unorthodox fashion and looking generally bizarre. At any rate, she found the scene hysterically funny.
October 24
The Hospital Day
It’s a fast, hard life, this hospital life. I hope I can take it. There’s not much chance of breaking mentally because it’s all so interesting; my mental tolerance is directly related to the challenge. The more about a particular disease one knows the better is one’s physical diagnosis. Those of us who were here over the summer taking the physical diagnosis course are so much better prepared that the profs, who don’t know we’ve had this experience, are dumbfounded how we focus maturely on the case problems rather than on the rote procedures.
I’ve never worked as hard in my life as I have these days, making for both enlightenment and disillusionment. Here’s my current schedule in detail:
Up at the Marine Hospital at 6:15 to draw blood in the hospital till 7:00, then breakfast and the trolley ride to make the 8:30 lecture downtown. My partner and I do our history and physical exams on the colored male medicine ward till 11:00. We are then quizzed on 50 to 80 pages of text. (We were told today that no one was doing satisfactorily on these quizzes and only four have passing grades.) In the afternoon, I either go to tuberculosis or tumor clinic from 1:00 to 2:00 and then return to the ward; I get home to Marine Hospital by trolley, dog-tired, and then have to memorize two new chapters and write up some 30 pages of examinations on the medical service here. And I haven’t cracked a book for the upcoming State Boards.
The Mere Magnitude of Medicine
Despite the hard work and often unpleasant instructors, I begin to feel that I develop some diagnostic skills. It’s a great feeling to be a real part of the hospital. But doctor gowns with stethoscopes sticking out of the pockets seem an empty vanity when you realize how little you really know. And despite my increasing interest in what I’m doing, I sometimes get depressed over the mere magnitude of medicine and the immense problems that a career in medicine presents. If regimented medicine comes, my career will continue in easy steps, perhaps as now with brief periods of frantic and difficult work. If that kind of medicine does not arrive, I expect enormous other adaptive problems in the profession.
Let me say that the only way I really care to practice medicine is in a progressive and intellectual and supportive atmosphere. I have considered assembling a group practice in Florida to include up to a dozen Florida boys around my age, pooling resources, setting up complementary specialties.
October 28
Ellis Arnall of Georgia.
I took a night off from studies this week and went to a Lyceum series lecture that presented recent governor of Georgia, Ellis Arnall. It was well worth it. He’s a bald, hypersthenic, extroverted, warm-voiced, likable Georgian and a true progressive. I expect his good works will be wiped out after a month of Talmadge’s new administration. He has an interesting seven-point program for the South, including education, health, industry, agriculture, freight-rate changes, etc. His lecture tour should do the South a great deal of good.
I liked this illustration particularly: “A father brought his young son a jig-saw puzzle of the world. When the boy finished it in no time his father, amazed, asked how he had done it so well and speedily. The boy said he didn’t know much about the world, but there was a picture of a man on the back of the puzzle, so he put it together by checking out that picture through a glass-topped table. When the man was put together all right, the world automatically came out all right.”
On peds today I got two new admissions, one an intelligent nine-year old boy sick only a week with acute poliomyelitis and paralyzed only two days. He wants to know all about everything, mainly how long he’ll be in the hospital. Of course, I am not able to tell him that it may be months and he may end up with a deformity and disability for life. The other was a nine-year old girl with acute diphtheria who was pretty sick but we think will be OK. The aseptic technique we have to observe with such cases slows our day considerably.
If I leave the lab. at Tulane just before noon I can make it back to Marine Hospital for lunch, thus getting three good meals a day. We have a pleasant dining room just off the nurses’ quarters and during meals there is much medical discussion. It’s led mainly by a couple of real smart (and show-off) residents who present their cases at table and try to work out each others’ clinical problems. You’d be surprised how much one can pick up at table. Today, for lunch, we had Vincent’s angina, abscessed teeth, TB, and some venereal diseases. Yesterday, we had pneumothorax, bronchiectasis, blood protein disorders, and schizophrenia. Rich fare.
Today our contagion group visited the federal leprosarium at Carville, Louisiana. The glum picture there was much brightened recently by the substantiated benefit of sulfa-type drugs in arresting the disease, after years of probably worthless dosing lepers with Chaulmoogra oil.
November 29
Situs Inversus
I had a bitter disappointment this week while working on a project for Dr. Cummins, head of the department of anatomy. At Charity Hospital there is a case of situs inversus, complete transposition of the viscera or internal organs, with heart on the right, liver on the left, etc. Remembering his interest in the phenomenon, I reported it to him and he loaded me down with questions and equipment to run palm and fingerprints. Turned out the fellow is a south Georgia, anti-everything psychopath. He “wouldn’t be no guinea pig for nobody,” and no approach of friendliness or sacrifice for science would appeal to his thick head. I had to return empty-handed. Dr. Cummins has collected 50 such cases in 30 years.
On OB I am mainly a flunky but last week delivered one “grand multip” in an emergency. I was so nervous I could hardly hold the baby and siphon out its mouth. Obstetrics is challenging and satisfying, but those poor guys never get a good night’s sleep. Apparently there is a significant concentration of deliveries between midnight and 7 a.m.
I’m starting to fit out my little black bag before I go on the wards full time (and before my birthday to help out with the cost). The leather bag itself is about $30, the blood pressure manometer $35, plus an ophthalmoscope, hemoglobinometer, hematocytometer, stethoscope, etc. I will go into my reserve for this.
Your last letter mentioned Christmas gifts but I want you to know that I’ve had mine: the dental work, the great Glasser text on medical physics I bought this week, and my anticipated holiday trip home. So please don’t think of giving me anything more!
Wishing The Pace Might Slow
Dear Folks: These days, I realize more and more that I won’t be able to do what I want in life with my present superficial state of knowledge and culture. Before I am resigned to a life of mediocrity, I want the chance to prepare myself for better. And that would require a scholarship to pursue studies at a more leisurely pace than my hurried education so far. I may as well tell you what this is all about — that I will be trying out for a Rhodes Scholarship in spring. (See the sad account above.)
Research and higher science are above me, but a reasonable fundamental scientific understanding is not. So this is my hope: to get my BS from Miami next summer, come back here to the Department of Physiology where Prof. Mayerson is very supportive, and then hie away to Oxford in the fall. Failing the latter, which is probable, I’ll try again next year and would then have a BS and MD before going to Oxford. Alternatively, I can go for a national cancer scholarship which allows pursuits in many areas related to the problem. If none of the above succeeds, I could take off a year or more after graduation and return to the university for study.
I feel that I am a victim and a part of the mass psychology of today, that: “College is for grades — which grades are for getting into med school — which grades are to get through med school — which is to go into practice, get married, have a family, and make a million.” So I made good grades and got to med school and somehow along the way failed to learn very much. Now, almost through med school, I have no desire to make a million, if it has to be in some slip-shod racket.
Tulane prepares some of the best clinicians (and money-makers) in the country but it puts out few who can appreciate or evaluate or keep up with or contribute to the advance of science, which, in fact, makes modern medical practice possible. I estimate that a third of my life is already gone and I’d rather start my real education late than not at all.
Some dreams, huh?
Love, Henry, Jr.
Well, the residency “scholarship” at The American Hospital of Paris sort of met my perceived need for an expanded liberal education.