“If It Isn’t Fun.” – The Old Ancker Hospital, 1956
I love traditional structures like the old Ancker Hospital in St. Paul. Its high ceilings and large sunny wards and scrubbed wood floors and resounding tile treatment rooms and starched white uniforms were comfortable and pleasing to me. But that may have been because we were still able to practice modern medicine within these hallowed halls. The same traditional buildings in France, for example, were repulsive, because the level of care when I was there, in 1949-50, was primordial. I recall seeing open urine pans on the floor of the old Hotel Dieu across from Notre Dame cathedral in Paris. And you may have read elsewhere in this volume of my experience with the French consultant who didn’t “believe in” penicillin. But I was happy rounding in the ancient wards of The Ancker.
The mid-1950s witnessed, however, among its fads and advancements, a period of rampant, pseudo-heroic cardiorespiratory resuscitations in public hospitals. No moribund old codger, having made peace with his God and family, was safe from the zeal of the young house staff for reanimation. Sickly, sallow chest walls were opened willy-nilly using the nearest available cutting tool, with little regard to sterile technique or to the realities of survival, or to the dignity of sick old people trying to die. Wan, sere, tired old hearts were exposed directly and massaged by the insolent bare hands of house staff bent solely on “saving lives.” Neither good medical care nor quality of life nor humility were a part of this distorted “lifesaving” fad, mercifully shortened by the advent of electrical defibrillators and by rules of informed consent and living wills.
Among more useful innovations in the modern medicine that we practiced at The Ancker back then were I.V. steroids and pressor agents for bacteremic shock, which otherwise was universally fatal. There seemed to be an epidemic of gram-negative sepsis among indigent catheterized elder male patients in those days. [I wonder if it still goes on.] At any rate, as chief resident, I held the key to the shock box, and it was required that I be consulted about, and sign off on every case in which Levophed, for example, was used. This potent agent restored blood pressure for the duration of its administration and actually saved lives, I’m sure, sustaining circulation as it did until the antibiotics and steroids took hold. But at a cost that I suspect was never adequately evaluated of its brutal pressor effect, with its profound redistribution of blood flow.
Tamponade!
Of many memories from those homey halls of The Ancker, now razed and gone, one stands out from the end of my time there. Early one morning, I was assisting Bill Mazzitello, chief of service, in a routine right-heart catheterization on a young Mexican-American girl; this was before the day of left heart catheterizations and we were seeking indirect evidence of the severity of her rheumatic mitral valve disease with right-sided heart and pulmonary artery wedge pressures.
Suddenly, while Bill was advancing the catheter in the right atrium, her arterial pressure dropped out. In a moment, the lightly sedated patient began to thrash, shocky; we shouted simultaneously: “Tamponade!”
The nurse hurried to summon surgical assistance and the young woman was soon revived by pericardiocentesis with suction to remove the large clot that compressed her heart. The atrial puncture that we had inadvertently made quickly sealed itself. Our patient survived to get the definitive, open-heart valve repair that later became possible.
Bonding takes place among medical folks involved in such traumatic events. When I saw Mazzitello in recent times at an American Heart Association function, a few weeks before his sudden demise, it was the first time we had met in decades. The trauma of that morning of tamponade 40 years before was even fresher in his memory than in mine. In fact, he mentioned it first.
I flourished at The Old Ancker, felt confident and loved my job. I enjoyed a marvelous staff of junior residents and interns and nurses and trainees. And, I had something else most needed by the chief resident in medicine, that is, sophisticated and collegial resident counterparts in surgery: John Alden and Joe Sprafka.
The days and nights on end at The Old Ancker now merge into each other. I’ve lost contact with most of my residency colleagues. But my favorite attending physicians there, Milt Hurwitz and Ben Sommers, both offered part-time jobs in their St. Paul practices. I joined Sommers and Lindell, who provided a rich practice setting and support that came in handy to augment my university research associate stipend. I subsequently hired Peggy Wedell, among the more direct and competent of the nurses I worked with there, and we had a fruitful, career-long association in research and in insurance medicine. John Alden, surgical resident, took care of my pianist’s acute tendinitis on our jazz band’s opening night at Conroy’s Restaurant in 1962. Years later, I interviewed Mike, the son of Ancker’s chief resident in surgery, Joe Sprafka, and after an extended evaluation, as Mike was leaving my office, I astounded him by asking casually, knowing full well the truth, “Are you related any way to my good ole colleague at The Ancker, Joe Sprafka?”
Unfortunately, such is the temporary nature of relationships when one’s career is in academic research and outside the practicing community where one trains. I do miss those colleagues of the VA and Ancker Hospital days: particularly Cy Brown, Don Gleason, John Hagen, Frank MacDonald, Bob Mulholland, Ray Scallen, Ralph Smith, and Jack Vennes, among others. And from The Ancker, especially Jack Duval, Milt Hurwitz, Bill Mazzitello, and Ben Sommers.