University of Minnesota

“If It Isn’t Fun.” – The American Hospital of Paris Yesteryear

Culture Shock

In the quiet, western Paris suburb of Neuilly is a small private hospital nestled among bourgeois apartments and plane-tree-lined boulevards. The American Hospital was chartered by the U.S. Congress in 1914 to serve Americans attracted to Paris, that “femme fatale.” For generations this has been the place where an American in Paris could be comfortable seeking medical care.

When I interned there it was considered a Golden Age of the hospital and one of the Golden Ages of Paris. In that sweet period just after World War II, France was recovering from its war wounds and Paris was not yet choked by commerce and traffic, its graceful skyline not yet interrupted by skyscrapers.

For decades the American Hospital had recruited its interns from the United States. Francophile medical students of Tulane University, smitten with the exotic culture of New Orleans, were the more frequent applicants. I interviewed early for the Paris internship, in part because I hoped to complement my hurried college education, which was deprived in the arts and humanities by World War II.

Eventually, I left for France on the liner S.S.America, and arrived in Paris by the boat train from Le Havre. I was met at the Gare Saint Lazare by fellow Tulanian, Albert Sullivan (who later became Associate Dean at Minnesota and also my lifelong friend), who introduced me to Paris with uncommon artistry. First, we crossed the square to a sidewalk cafe for a glass of wine and a language orientation (he shushed me when I repeated too loudly his slang term for the female breast, “nichon.”). Then we descended into the Metro, emerging from the darkness at intervals to encounter stunning Paris vistas against a bright fall sky. Everything about Paris then was overwhelming. Every day brought new delights — as well as cultural faux pas and culture shock.

For example, I made an early language slip as I completed the entry workup on a very ill man who had complications from biliary surgery. The patient was tired and uncomfortable by the time I had finished my tedious examination, and he asked me, “Is that all doctor?” When I responded in my best French, “Oui, je suis fini,”  the miserable man doubled up in spasms of laughter, his first merriment in months, according to his wife. “Je suis fini,” were, by French scriptural accounts, the last words of Christ on the cross, and they mean, “I am finished.” Unlike us less precise Americans, the French are very specific about the difference between “I am finished,” and “I have finished,” or “J’ai fini,” as I should have said.

Soon afterward, I was examining a handsome French lady who was being admitted for cosmetic breast surgery. Another attractive woman entered the room and introduced herself as the colleague of the surgeon who would perform the operation next morning. When I expressed medical curiosity about the nature of the surgery, she asked directly, “Would you like to see my partner’s handiwork?” Before I could reply, she deftly unbuttoned her elegant tweed jacket to expose her own, braless, sculpted breasts — to my downcast eyes and blushing stammers of “professional” admiration.

I experienced another rude culture shock later when I was drafted in the night to be anesthetist for a delivery. The nurse handed me a large metal bulb on the side of which was etched in German script: “Schleicht. 1/3 ether, 1/3 chloroform, 1/3 ethyl chloride.” A holdover device from the German occupation, the gas was administered in a closed system, an effective but hardly optimal anesthetic for labor. In the midst of the delivery, with the babies head actually crowning, the elderly French obstetrician in attendance used his gloved hand to impede the delivery momentarily as he looked about and hissed accusingly, “There is a draft in here!” (“Ici il y a un courant d’air!”).

The assistants scurried frantically to close the windows of the ancient salle d’operation. The French are known for being fanatical about many things, including drafts. But a passion so great as to arrest the course of a delivery was unnerving. All turned out well. We delivered a healthy descendent of the Martell (Cognac) family, and I, the draftee anesthetist, received a gift bottle of vintage reserve from the vintner.

These medical adventures were punctuated by enthusiastic travels in France, with cycling tours of Seine et Oise, and of Paris boulevards and parks, which were then quite free of traffic. There were heady nights in Montmartre with colleagues where for the equivalent of a couple of dollars we dined sumptuously and afterwards attended charming evenings of folksongs Au Lapin Agile., or later, sophisticated plays of the Comédie Française and grand performances at L’Opéra or elegant musical concerts at Salle Pleyel.

Late one night, just as I returned to my top floor hospital quarters overlooking the Seine, I was summoned to a major emergency — a patient with a bleeding peptic ulcer and much blood loss. A technician had done the typing and cross-matching, but when she reported the results she also gave us the incredible news that the hospital had no blood bank and that there were no blood services available in Paris this late at night.

As we prepared for surgery, the blood technician left and returned with a medieval-appearing apparatus. She also had in tow a character out of Pantagruel, an immense, wine-soaked maintenance man from the boiler room, whom she introduced as the hospital’s type O-negative “Universal Donor.” His plethoric purple hulk was gowned; he was masked and seated next to the patient. We learned, on the spot, to operate the primitive transfusion instrument, inserting one huge arterial needle in the donor’s arm, another in the recipient’s vein. The handle of the apparatus was turned halfway counter-clockwise to load the container, and halfway clockwise to deliver blood in measured 20 ml. amounts. Thus, we transfused nearly a liter, without adverse reaction from the recipient. The very next day, with a consultant hematologist, we American interns set up a minimal bank of citrated blood.

But we also learned in time that some of the French practices we found so quaint weren’t all that bad for the patient. There may be something to be said, for example, using rectal suppositories or proctoclysis for administering medications to debilitated patients. But I drew the line with one common treatment. Called one winter’s night to the Emergency Room, I found an obese elderly man in great respiratory distress with acute pneumonia. Removing his sweaty garments, I was amazed to observe large, perfectly circular hematomas widely distributed over his back and shoulders, with tick-tack-toe-like lacerations through each mysterious circle. Even in that relatively innocent age, I could only suspect some bizarre masochistic habit or ceremonial rite. The Chief Nurse was vastly amused at my first encounter with common cupping and scarification. In this home remedy in France, glass cups are heated over a candle to produce a partial vacuum and then attached to the skin over the affected site, their suction causing light bruises through which scratches are made with a fork or pen-knife when the cups drop off. This was widely and traditionally used as a form of “counter-irritant” therapy for respiratory illnesses.

The strange and wonderful French culture was full of pleasures and surprises for us young American interns. Elegant French logic and cool rationality clashed everywhere with equally French traits of charm and emotive vivacity, or dogmatic and conservative tradition. Among these cultural clashes was a strange and small one I encountered at the Christmas party held in the hospital foyer, complete with champagne. There, two of the elder “grands patrons” swirled tiny golden spoons attached to their watch chains through the bubbly in a studied but graceful maneuver. It was apparently an old and dear tradition for the old-timers, and the spoons something of a foppish fetish. Paradoxically, their sport effectively reduced the numbers of piquant bubbles that Messieurs Mumm and Piper-Heideck had spent so many years carefully nurturing in their champagnes.

December 10

Il y a deux mois depuis mon arrivé à Paris. And still my French leaves much to be desired.

Tonight was an easy one on duty. I stayed in my quarters in the company of a new French radio set, my journal, a book of short adventure stories by famous explorers, and with a feeling of vitality uncommon for my current self-effacing preoccupations. My room on fourth floor of the hospital is attractive, warm, and spacious, with a balcony and forged iron railing, a view of Paris rooftops, bare branches, and the distant, ever-present Tour Eiffel. Life here is filled with pleasant new sensations, of wine and seasoned foods and melodic passages of great music, the glory and mystery of Parisian boulevards, old and new friends, and good books.

My immediate passion is playing Mozart’s Clarinet Concerto, written two months before his death. It is the perfect medium for clarinet; light and fluid and not so far above my ability to be discouraging. Once again the pad on the dorsa-medial aspect of my thumb aches and toughens and the pulp of my lower lip is traversed by a strong narrow line. Jazzophiles would say, “I got Chops.”

December, 1949

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