University of Minnesota

“If It Isn’t Fun.” – “This Is What We’re Getting for Interns These Days”

It was my first day in the surgical theater as intern on the service of Wesley Hospital’s Chief Surgeon, let’s call him Dr. Domuch. I was at once surprised at the different feeling on his service from that on the service of Peter Rosi, my last assignment. Dr. Rosi’s surgical service was highly competent and effective, but it was also congenial for patients and house staff alike. There we knew we were in the presence of a master but could enjoy that presence unintimidated. Dr. Rosi exuded a spirit of warmth and caring, backed by his skill and scholarship. On Dr. Domuch’ service we also knew we were in the presence of a Very Important Person. But we were uncomfortable with it, intimidated by a man whose reputation may have befit his competence but surpassed his humanity.

By this time, I had been through six months of rotating internship and had made a modest name for myself as an intern, primarily for a couple of early diagnostic coups. But I had also landed among a small elite of the house staff called upon for the especially tough venipuncture problems that arise frequently in a hospital. The ability to capture veins in obese, clammy, scarred, or wizened extremities is both natural and learned, a combination of the “eye” for it, an ability to visualize the presence and course of an invisible vessel, a particular sensitivity of the first and second fingertips, and the capacity to hit and thread a vein accurately, then to quickly remove the tourniquet to avoid leaking into the tissues, then to fix the needle and avoid its dislocation — plus much experience. Having these skills made our specialist subgroup much sought after. We were the ones called to take blood samples or start intravenous therapy when the going really got tough.

My first day on Dr. Domuch’s service, the first patient of the day was rolled into surgery for a gastrectomy. I was responsible for starting the I.V., after which I would scrub again to hold retractors. In those days, there was an unhealthy fad in our hospital of administering I.V.s in the feet, supposedly to reduce the clutter around the arms and upper body during surgery. It was several years, unfortunately, before the excess was documented of superficial and deep vein thromboses of the lower extremities associated with this practice, after which it faded.

On this particular morning, the elderly patient’s foot was as cold and yellowed as a cadaver’s. No vein was to be seen; even after I applied a warm pack and tourniquet, I could palpate no vein. With a small-gauge needle, I probed unsuccessfully for invisible veins in the areas between the foot bones.

Professor Domuch entered the theater at this moment, gowned and masked and in the company of two visiting surgeons for whom he intended to demonstrate his latest gastrectomy technique. By this time, I was on the third attempt at the cold foot of our patient — to no avail. I called for another hot pack and tourniquet to apply to the other foot. As I made a fourth unsuccessful try there, Dr. D, holding his gloved hands before him in a prayerful posture, his eyes askance, remarked in a clearly audible aside to the visitors:

“This is what we’re getting for interns these days!”

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