“If It Isn’t Fun.” – More Letters Home From Medical School Pt. 3
My letters home tended to follow a pattern: reporting on my work load and performance, then a recounting of particular recent adventures, then a litany of my economic state, my health, the weather, and the girlfriend situation. Often a bit of unsolicited advice or scolding is tossed in about my perceptions of my parents’ excess pastoral activities and threats to their health. Most of my letters home were written on engraved Tulane University stationery, but many were on history sheets from Charity Hospital with headings of hospital number, name, service, ward, bed, age, sex, and color identification. Hospitals were segregated in my training days in New Orleans.
Surgery schedule
January 1, 1947
Dear Folks:
I have been busier than at any time in my life and have had no time to do anything except to survive. Incidentally, I received everything you sent in the holidays, including money for tuition, for which I am now receiving, I believe, an excellent medical education.
I started surgery service immediately after the new year, and, being first alphabetically, I got the first assignment of new patients and haven’t caught up since. We are assigned in groups of eight among five surgery wards. I cover one colored male and one white female service and three wards of surgical diseases of children (SDC). As each patient enters the Tulane service we are assigned in rotation. Each of these wards has overflow wards that are always full and are also our responsibility. You can imagine the number of patients.
For each patient we take and write up a complete history and physical exam, a summary, an impression and differential diagnosis, and then do all the blood and urine lab. work and any special procedure indicated. All this must be complete and on the chart within 24 hours of admission. We become responsible for knowledge of our patients’ diseases, in preparation for the presentation of cases on ward rounds, conferences, or bull pens, and we are required to witness any surgical procedure carried out on our patients. To complete the follow-up we write daily progress notes.
At the outset, I got assigned two old patients and four new ones. Because it takes on average 6-8 hours for each work-up, when you get more than one patient a day the 24-hour deadline is a joke. You then go about craftily constructing a plan, based on assumptions of when and where your resident will check the charts the next day, plus figuring in carefully when the visiting physician will make rounds and when the patient is likely to go to surgery, and so on, weaving all the threads together.
In addition, I have three quiz sessions weekly covering reading lists on assigned topics, each some dozens of articles long. Moreover, I am taking courses on surgical pathology, anatomy, an anatomy elective, radiology, and orthopedics, each requiring a certain amount of work. I can’t help feeling that I would learn more on a more leisurely schedule, but there’s just so much they have to give and that you have to get in the years allowed.
I got a bad sore throat over New Year’s that has rapidly subsided, leaving me with sinusitis for the last two weeks. The weather hasn’t helped; you may have read about it. There have been few hours of sunlight since my return from home on 28 December, with temperatures here fluctuating from 28 degrees to 85! Never have I seen anything so wretched as New Orleans weather.
All in all, I live precariously, sleep little, eat irregularly, and work to exhaustion. I can’t see how I’ll last three months of this, but, I suspect that “this too shall pass.”
My true love, Internal Medicine, follows and it shouldn’t be as strenuous a service. The thing that keeps us going is the constantly interesting and entirely new cases and concepts and situations, making it all far from monotonous.
Surgical Panic
Last week, I had a real scare and lost a whole night’s sleep with a new patient who came in at the end of a long day. Prof. Ocshner had done a pneumonectomy (pneumo = lung; ectomy = removal) on her a month ago and he was to conduct ward rounds and clinical surgery conference the next day. The resident was sure that my little patient, a 15-year-old girl, would be presented. So, I stayed at the hospital until 12:30 a.m. and had her all worked up. I memorized a concise and complete summary and got home for a few hours of sleep. After all that, she was not presented! But she probably will be discussed this week, so I will be at bat in the next bull pen, with Ocshner pitching.
Many a Tulane student has seriously considered dropping out of school on being assigned a bull pen case with the Chief presiding. He keeps asking, “What else?” “Why?” till you become frantic and draw a blank.
But I can’t quit now!
“The Chief”
I have often written you about Alton Ocshner, whom we call “Great White Father,” and “The Chief.” But in case you don’t recall, he is professor and chairman of surgery at Tulane, head of the Ocshner Clinic, which you might think of as the Mayo Clinic of the South, and he is the biggest “big shot” of them all. His son, Okky, is a classmate and friend of mine. Among the professor’s many idiosyncracies, he is the world’s leading opponent of smoking. Recently he has received millions worth of publicity for his clinic due to his South American surgical activities and his operation on Senator Bilbo of Mississippi.
Nowadays, I’m in satisfactory shape financially. But please expect a slow period of letters from my end.
Love to all, Henry, Jr.
Taking Stock
May 1, 1947
In less than six weeks I’ll be a fourth-year man and I’m quite happy about that. I passed all my surgery subjects, am doing rather well in medicine, and seem to be recognized a bit these days by fellow students and faculty. Generally, however, student-teacher relations are distant here due to large classes. This fits well my effort to be inconspicuous.
We invited all the faculty “big dogs” to the Owl Club banquet tomorrow. We will make suggestions and register gripes, tactfully, I trust, while sitting among the great ones, where we can make our remarks quite personal. I am responsible for student commentary on the bull pens (the daily 11 a.m. work conferences of the different departments), and will have to deal with several very testy faculty members.
Last week Prof. Mayerson was encouraging about how I might readily teach and do research for a period after my internship. In fact, he will give me a small research problem for my senior year. My presentation on edema for his class was well received. With neat graphs I laid it all out in seven minutes flat; brevity that everyone appreciated.
My health is good, but with still a tender hepar. I am stroking the ball pretty well in tennis. If I were a syntonic instead of a schizoid personality (look ’em up; good words) you might say that I’m now in a manic phase. For me, that’s good.
I was interested in Dad’s recent visitation from the American-Soviet Committee. I imagine that it’s infiltrated with Marxists but one can certainly admire its purported objectives. I particularly respect the scientists active in it and their whole-hearted support of cultural and scientific exchange with the Soviets, which may amount nowadays to more than we realize.
I’m happy you’re home together. I often worry about Dad being on the road so much, which worry he will undoubtedly resent. Love, Henry, Jr.