“If It Isn’t Fun.” – Scopolamania
“Intern X” was a tell-all account of hospital life published in the time of my own hospital training. It made me want to kick myself for not having kept a detailed journal during internship. I lacked the writing skills, sensibilities, and philosophy of the author of that book, now lost from my shelves, but I surely had experiences that rivaled his in drama and pathos.
Intern X’s exposés were no more turbulent or troublesome than my particular experience with the fad of using scopolamine as the main pre-anesthetic on the obstetric service at Wesley Hospital in the late 1940s.
Despite the leadership and technical superiority of American medicine, it is rife with fads. In future, we will marvel, I suspect, at the chest X-rays of people from this day, showing so many with the classic half-dozen wire sternal sutures and assorted radio-opaque circles from multiple coronary artery by-pass surgery. Similarly, when examining thousands of central European displaced persons following World War II, I wondered at the remarkable frequency of abdomens scarred by classic Bilroth operations. Bilroth was the famous Viennese surgeon cum pianist who started doing gastrectomies to cure peptic ulcers in the 1940s. These modern-day surgical fads are the equivalent, if presumably somewhat more effective, of earlier fads in medicine such as cupping, bleeding, purging, and electro-shock.
I suspect that fads are particularly likely to develop on the service of all- powerful chiefs who become corrupted by their exaggerated power and self-image, images often disparate from those held by their patients and house staff. Take the example of what I call here “scopolamania.”
The obstetric service at Wesley Hospital, a Northwestern University teaching hospital on the near north side of Chicago, had a well-to-do clientele. It was headed for many years by an academic leader whose textbook on obstetrics was then the standard reference in the field. Let’s call him “Dr. Rosemount.” For various reasons, surely salient and well-considered at the time, Dr. Rosemount had determined that scopolamine, commonly and effectively used as an adjuvant to anesthesia for normal deliveries and other surgery, should be the sole and primary pre-anesthetic given his up-scale Wesley patients before their deliveries. Scopolamine is a belladonna-like drug with profound pharmacologic effects which, nevertheless, and probably the reason for its choice by Dr. Rosemount, had little perceptible effect on the course of labor or on the function and activity of the fetus.
I rotated onto the obstetric service shortly after the scopolamine fad was instituted as standard procedure for Dr. Rosemount’s patients. I soon had enough experience with other doctors’ patients who were given other pre-anesthetic medications that it became clear to me, and to the obstetric nurses and other interns, that scopolamine alone was a disaster. Any effects that it may have had in reducing the discomfort of labor or preserving the health of the baby were not obvious to us. What was obvious was that the women on Dr. Rosemount’s service became near-crazed, while suffering normal, even exaggerated, pains of labor. Reduced to an animal-like state, screaming and thrashing about, standing up in their beds, soiling themselves, falling against the bed rails, they often required restraints on all extremities. Mind you, these were normal women in normal labor, who had come to the best hospital for the best care, yet who became writhing, tortured, out of control, psychotic, and having to be mechanically constrained to keep them from harming themselves and their babies!
By the time Dr. Rosemount finally saw his patient in the obstetric theater she was cleaned up, in stirrups, and further anesthetized. And after the delivery, the new mother was blithely happy with her infant, having total amnesia for her traumatic labor. Scopolamine therapy was not anodyne, not pain-relieving, but very amnesic.
Meanwhile, we house staff were dealing with the sufferings of these women, the indignities of their late-stage labor, and the danger they were to themselves and their babies. The orderly progression of women through labor and into the delivery room was disrupted; the rhythm, calmness, and professionalism of the obstetric service at that hospital were destroyed.
I am not sure when one learns, if one ever learns effectively, when and how to “blow the whistle.” I clearly did not know when or how. I was simply an irate, idealistic, and probably somewhat self-righteous young intern. I went finally to the chief of medical services of the hospital and told him what was happening on the obstetric service. I said that a couple of us interns and several of the nurses were prepared to go on strike against the unrestricted and, we felt, inappropriate use of scopolamine as the sole pre-anesthetic for labor. And I told him why, in detail.
I must have gotten his ear, though it wasn’t apparent at my first interview. At the time, he threatened me with disciplinary action for insubordination and with my removal from internship under a cloud. My parting words to him were, “Sir, I have not explained this well. Perhaps I’ve not gone about this appropriately. I simply beg you to ask the opinion of the chief nurse on the service. I am sure that you can respect her judgement.” Apparently, he did consult others and soon there was a major meeting of the professional staff. Scopolamania disappeared forthwith.
I heard no more about my threatened discharge from the service, and shortly thereafter I rotated off obstetrics, never again to be exposed to the fads of Professor Rosemount.