“If It Isn’t Fun.” – The American Hospital of Paris Yesteryear Pt. 2
On the house staff at the American Hospital of Paris, we American interns observed with wonderment as the great, the near-great, and the notorious recovered and departed with their huge entourages, or as they suffered and expired among their large, demonstrative families.
My sleep was interrupted one Sunday morning by a sharp call from the chief nurse to hurry (“Venez vite, Docteur!”) to the Emergency Room to attend the Aga Khan. On arriving, I found the world’s richest man accompanied by his wife, the famous American actress Rita Hayworth, who was vocalizing a long series of annoyances. The Aga Khan himself was courageously fighting pain, having suffered a compound fracture of the tibia on an icy ski slope and been transported, with a crude temporary splint, halfway across France from the resort. The rest of that long Sunday for me was a battle against bone and cloth fragments and unending muscle spasm, all under the insistent, intimidating presence in the surgical theater of Rita, the “Lady in Red.”
We six American interns, by the end of our first winter, were a bit jaded by the excesses of Paris. But we were more particularly worn down by the necessity for carrying out medical orders with which we often did not agree, in an atmosphere where discussion of cases with the awesome “Grand Patrons” of France was usually out of the question. While on the one hand we were charmed and awed by their stature and oft-times clinical brilliance, on the other, we were frequently horrified by their inability to consider alternative diagnoses or therapies, to acknowledge error, or to correct obvious, even serious mistakes.
In one case, for example, a lovely young American woman had cycled through France, fighting a nagging cystitis for days, and finally arriving at the American Hospital with a soaring fever. We soon were able to identify a penicillin-sensitive streptococcus infection, but found that we were not allowed to prescribe penicillin because the grand old gynecological consultant, in that modern day of 1950, did not believe in penicillin! We interns alternated the risky job of administering her penicillin in the dead of night.
Another young American cyclist had experienced a nasty fracture of the humerus in a down-hill spill as he was practicing for the Tour de France, the maniacal international bicycle race. The fracture required open surgical reduction after which the patient was placed in an arm and upper-body cast. Jagged afternoon fever spikes turned by the third day into soaring peaks and by the fourth into profound sepsis with delirium. Again, the elegant consultant, the most noted of French “orthopods,” insisted on serial tests for fevers of unknown origin, including, as I recall, the relatively new Widal Test for typhoid fever. Every attempt had to be made to establish a source of infection other than the obvious one, a simple wound infection.
Finally, after the third day of the surgeon’s refusals for us to inspect the site, we interns took fate in hand. In the middle of the night, with knife and saw, we opened the cast at the shoulder and drained the anticipated deep wound abscess. To our amazement we were neither fired nor reprimanded. But that particular Grand Patron never returned to visit his patient, sending thereafter his junior partner.
Over time, however, there was probably a balance in favor of French medicine of those days in the late ’40s and early ’50s as practiced at the American Hospital of Paris. There were brilliant individual diagnoses and treatments, and some unbelievably skilled surgery. Particularly, there was the grand old man of French vascular surgery, René Leriche, who had the novel idea that atherosclerosis, which most consider a generalized fatty artery disease was, in fact, a localized arteritis or inflammation with obstruction of an artery. He proceeded to attack it directly and effectively with resections of the diseased segments, attaching allografts of healthy veins or arteries from the same patient. In addition to the skills and thrills we experienced scrubbing with him for some weeks, we American interns assisted with his first series of aortic angiograms, contrast X-rays, made in 100 patients with swellings or obstructions in their aorta, renal, or peripheral arteries.
Then there was the miraculous “cure” of a young boy with nephrosis and kidney failure with dropsy. The famous consultant and later pioneer in kidney transplantation, Jean Hamburger, brought in one day in his vest pocket a tiny vial of a German measles virus culture. We supervised its subcutaneous injection in a nine year-old child who was drowning in his own accumulated fluids. Not long after, when the measles rash developed, we interns watched the lad brighten, along with a dramatic diuresis. This happened, in the days before cortisone was available, because of the Professor’s astute observation of spontaneous resolution of a similar nephrotic syndrome in a sick child having a fortuitous case of measles.
We also became “sold” on that marvelous custom in French hospitals, as elsewhere around the world, of allowing live-in families. The presence of family members greatly enhances the level of personal care, and when the inevitable arrives, suffering patients are able to experience the close comfort and sustenance of their loved ones.
As time went on, we American interns finally decided that the honorable thing for us to do was to practice medicine as our consciences and our American training dictated, but to inform our French superiors about each independent order or act as soon as it was done. Thus, our intern class survived and actually retained the respect and affection of our distinguished senior colleagues. Unfortunately, the next class of American interns at the hospital could no longer make this accommodation and went on strike, protesting a medical system they could not accept. They were summarily fired. Since that time, I understand that there have been no more American interns at the hospital. Instead, the American Hospital has been splendidly served over the years by English and Irish house staff, and is now, by all appearances, on a long and remarkable upswing in the quality of medical care and facilities it provides.
Perhaps my most satisfying experience as an intern in Paris was the counseling of a young couple from New York City. P. and N. were living together in a Paris garret and studying art, having the time of their lives, and were manifestly very much in love. When they came to our out-patient clinic, she was eight to 10-weeks pregnant. My advice, on purely medical grounds, was that no one should subject themselves to an interruption of pregnancy in any French hospital of that time, based on my experience of the level of care available for bleeding and infection. I had no information to give them on the Swiss or British clinics about which they inquired. Together, holding hands, they made their decision then and there.
For many years thereafter, I received Christmas cards from the happy threesome, which eventually became a rollicking fivesome living in Greenwich Village. The mother, N., became a successful artist and the father, P., a renowned professor of art history. His Paris thesis, as I recall, was on the gargoyles of French cathedrals.
We recently have found each other on e-mail.
We American interns felt fortunate to live during this beautiful period of history in Paris, with its golden light, its graceful lines flowing over its seven hills interrupted only by the Tour Eiffel and the bright dome of Sacré Coeur. We also felt fortunate to study at the feet of many superb French consultants. But at the same time, we gave them a glimpse of our American-style liberté, egalité, and fraternité. And we were able, on the side, to do a few good turns for fellow Americans in trouble.