Memoir

Wednesday’s Child Part Two: Manhood

A: Training days

 

Bar Mitzvah: 1973

Saint Luke’s Hospital in New York City is a private voluntary not for profit institution located on the upper west side of Manhattan. It is also one of several satellite teaching hospitals belonging to the Columbia University Medical School, whose mother ship; The Presbyterian Hospital of Physicians and Surgeons (P & S) is located further uptown near the George Washington Bridge. Being nearly adjacent to the undergraduate campus of Columbia University to the northwest and separated from Harlem to the east by Morningside Park, the immediate surrounding neighborhoods consisted of a mixture of university students and faculty, hospital workers, the earliest vanguard of upwardly mobile yuppies as well as the dregs of slum dwelling humanity. The more impoverished elements consisted of Hispanics, mostly emigrated from Puerto Rico, and Blacks that had emigrated from the Southern plantations at the end of the Civil War. At this point in time neither Harlem nor Spanish Harlem were holding out any bright rays of hope or promise for these denizens of New York City’s populous infrastructure. The result was that the local indigent population marginally used the medical clinics for long term health care issues or more likely than not, only used the hospital when they were forced to because of emergencies, crises, critical illnesses or when they were in extremis. These crash-landing presentations usually fall into the vernacular medical designation known as “The Train Wreck,” often requiring an enormous dedication of resources and clinical acumen to reverse them and then get their victims properly back on track.

The hospital owned two rental apartment buildings that availed subsidized affordable housing to the Medical and Nursing staffs. Because both buildings were located directly across the street from the main building this made commuting to work or taking night call relatively easy. The commute was also safe, because before Rudi Giuliani took the handcuffs off the police and let them actually do their work; the city, under Mayors Beame, Dinkins and Koch was a denizen of thieves, muggers, pushers, pimps, prostitutes, junkies, drug dealers, professional street beggars and homeless people who squatted in and took over public areas such as sections of Pennsylvania Station, bus terminals or parks. Certain highly profitable street corners were actually for sale on the beggar’s underground commodities market, sometimes fetching prices as high as five thousand dollars. Conversely, any beggar who attempted to encroach on someone else’s established territory might risk a knife or a gunshot wound. Even an ordinary public citizen taking a casual or accidental stroll either through the Pennsylvania Station Homeless Homestead or the notorious Needle Park could risk buying a one-way ticket to the morgue or an admission to the St. Luke’s Hospital Intensive Care Unit.

This was when my brother’s advice rang true about how to survive on the streets of N.Y City―wear old clothes so you look poor, put on sneakers in case you have to run, keep your cash in the toe of your shoes and above all else do not ever make eye contact with anyone. I did learn to navigate the streets as well as how to anticipate and to avoid potential trouble. But after five years of street survival it took another five years of living in peaceful suburbs to stop continuously looking over my shoulder or jumping out of my skin if I heard someone running, jogging or walking briskly on the street behind me.

The teaching hierarchy of the hospital consisted of University appointed Attending Physicians who directly supervised everyone else who was in training as distributed in the following pecking order: Fellows, Chief Residents, Senior Residents, Junior Residents, Interns, and finally P & S Medical Students. The hospital’s forte was Internal Medicine and Surgery, in particular, vascular and cardiac surgery; with the open-heart program being headed up by one of the finest surgeons of the day, John Hutchinson, a light skinned black man who could easily have passed for white. In fact, everyone did think he was white; including the red neck Afro-American hating bigot from Easthampton who subsequently shit his pants when he found out that it was a black man who had literally held his heart in his hands when reattaching all the vascular plumbing necessary to keep his own dark soul alive.

For the most part the medical staff was required to take care of general ward patients, meaning those indigents admitted without private insurance that comprised the bulk of the hospital census. Required rotations consisted of general medicine, emergency medicine, intensive care, cardiac care and private ward medicine. Private patients, mostly from the white upper class, were segregated to another wing of the facility and taken care of by their own physicians, only some of whom had academic appointments, and others of whom did not  seem to have read anything current in medical advances since the day they left residency. Although this might at first glance seem to mean that indigent care was second rate, in fact the opposite was closer to the truth, as by default these people were being exposed to the latest and most current thinking that medicine had to offer; along with daily supervision of care by faculty appointed physicians. In counterpoint, for the few mandatory months we were required to rotate through the private wards, most of the house officers eschewed this responsibility because of having no control over case management, coupled with being looked upon by both the doctors and their patients as being lackeys and/or marginally competent nuisances.

  • Who are you?
  • I’m your intern.
  • I want a real doctor. Where’s my real doctor?
  • Probably sitting home watching TV and into his fourth Martini by now. Want me to call him in?

However as just alluded to, some of the private physician’s lack of skill and judgment was typified the day that my Junior Resident found the patient of a doddering old Internist to be in severe congestive heart failure and on the brink of death. He amended the Internist’s tersely inadequate handwritten chart note of an hour before from: “Patient is short of breath. Let him rest” to: “Patient is short of breath. Let him arrest” by scratching in the “ar” in front of the “rest.” What the patient really needed was an urgent transfer to the CCU while the sarcastic forgery was motivated only by the fact that the Resident had become completely fed up trying to salvage and then cover up other people’s less than handy work. In fact, the only thing this aging monument to cavalier medicine was good for, and the only time I ever heard him speak up was usually during some clinical conference. Without fail he would correct anyone who ever used the phrase mitigate against” by suddenly piping up to say “militate. The word is militating.” That solitary fact he had down pat.

His terse interruptions reminded me of one of my private patients, an author and retired English professor who proverbially corrected my mispronounced use of the term ”angina,” every time I used it in reviewing his symptoms. The same brief monologue was reiterated. He said:

  • The word is Latin, ergo the “i” is a hard “i” and not like the soft “i” in the alcohol ‘gin’ but rather like the letter itself; and ergo―an-geye-na. When referring to the female genitalia, you do not say va-gin-a, do you?
  • Only if I am shit faced drunk, sir. Then I call it pussy. Derived from the Old German puse vulva; meaning a pouch, a sack, a scabbard or to stuff something.
  • What you really mean to say is when you are irrevocably inebriated, yes? And pussy is not German. It is derived from the Old English meaning: warm, soft and furry. Ergo pussy cat. Referring to it otherwise is vulgar.
  • OK then. When I am irrevocably inebriated, I like to stuff the warm, soft, furry, pouch of a female Homo sapiens with my pendulous penis. Now let’s get back to talking about the immediate problem with your dolorous cor viscus.

Of course, since every other doctor on the planet mispronounces the word, whenever I subsequently said ‘an-geye-na’ my colleagues skeptically raised their eyebrows, sniggered and shunned me like a pariah. This type of vulgarity, in heralding the end of the classical Latin period in medicine was only the beginning of many more vulgarities to come occurring somewhat in parallel to the same demystification in the Roman Catholic Church.

  • Per omnia secula, secula, seculorum. Amen.
  • Huh? What does that mean?
  • Forever and ever, Amen.
  • Then why didn’t you just say so? And by the way, what does “Amen” really mean?
  • Incontestable truth. No arguments.

Upon this backdrop, the arrival of my Medical Intern group in July of 1973 was as inauspicious as would be a personification of T.S. Eliot’s poetic line “not with a bang but a whimper.” It was like throwing a new cog onto a finely tuned gear that momentarily groaned and tried to reset itself without stopping to wait for the appropriate mechanical adjustment, but then went on relentlessly grinding, remolding and incorporating the offensive little kink. We were mutually introduced, given a cursory orientation, told what was expected of us, given our schedules, handed keys to our call rooms and then told to “go to work.” As joyous a day this was for the Interns ahead of us who were just now being promoted to Junior Residents, it was equally a sad anxiety provoking day for us neophytes. And even though the medical students who would be assigned to work under us were theoretically at the bottom of the totem pole, it was a false bottom because the real responsibilities resided with us. These duties would now include: admitting new patients, writing their orders, rounding on existing ones, coordinating care, ensuring complete and neat charts, collecting data, knowing all the pertinent data, drawing blood, starting IVs, staining slides, and worst of all, every third night having to be on call.

Being on call required staying on premises, sleeping in the building, carrying a pager; and for either twenty-four hours or, worse, for seventy-two hours straight through on weekends to be available for new admissions―while at night being responsible for problems on the entire ward. The Junior or Senior Residents provided backup, but it was conveyed rather sternly on day one that these individuals were only to be called for legitimate questions of management or if a person was too overwhelmed with work to be able to function. It was stated in no uncertain terms that all house officers prided themselves in being able to “suck it up” and that being “overwhelmed” was a relative term one should rarely if ever invoke; or if so, it had better be really and truly overwhelming; like a tsunami of critical illness. This was suddenly the real deal and very serious business. School was finally out for good but now it was going to be a litany of far more pencils, infinitely more books or journals and significantly more teacher’s dirty looks.

I never felt as inadequate as I did on that first day when the full realization hit home that I now had to be a real doctor with real responsibilities for other people’s lives. The closest second to that would come later when I finished training and went into private practice with the full realization that even though I had a bit more experience, I now had no one to back up any of my reasonably solid or sometimes meekly tenuous clinical decisions. I reported as required to one of the general medical wards as my first rotation and was met by a gleeful newly promoted Junior Resident who would be my immediate supervisor. He gave me a patient list that was headed up by an elderly black male who had already been admitted with pneumonia. Then in turning over the pager said:

  • I don’t know if you are Jewish or not―but think of me handing off this pager as being your real Bar Mitzvah―because today, my boy is the day that you truly do become a man. And by the way, it’s very bad form to let your first patient die. So, good luck, and welcome aboard.

Mazel tov

As it so happened my veritable bad luck was to draw the lot of being on call the first night I worked. In being paired with another Intern in charge of another floor, we found ourselves assigned as roommates to one of the call rooms. At about midnight when we had finished enough work to attempt sleep, we opened the call room door only to be met with a spate of truculent curses from the two new first day residents we had rudely awakened. Apparently, they had not been informed of being assigned to other rooms. Nicer rooms. Nicer and better Junior Resident’s rooms. But because actual physical possession of the bed is 10/10ths of the law, we were greeted not with a soft mattress and pillows but rather with hard and harsh castigations.

  • Get the fuck out of here.
  • But this is supposed to be our on-call room; and we have a key.
  • Get the fuck out of here. Sleep on the floor, anywhere. We don’t care. Just get the fuck out of here.

We did find a place to sleep. Not on the floor, but as a close second, in the hardback plastic chairs located in the patient lounge on my ward, leaning back and using a small table for a footrest hassock. That was after cleaning up the filthy ashtrays and food remnants that were pocketed in various spots about the room, then snarling a territorial warning at any wayward wandering patient who happened to come in to satisfy his nicotine fit. Needless to say, we did not get much sleep, or even if we did nod off, one of the two beepers would go off periodically either beckoning us to: retrieve a new admission from the ED, or to answer some nurse’s call for an IV insertion, or an order for a sleeping pill or a laxative. Or worse; for someone whose status had deteriorated and needed us to make a personal appearance, an appraisal, or medical stabilization that could easily take the rest of the night.

That was not bad enough, as by the next day the black man with pneumonia had died suddenly in his sleep, leaving me to wonder why I had ever chosen this profession at all and second-guessing what I had possibly done to cause this person to die. I had no self-esteem, had gotten no sleep, while now having to face another workday, starting it off totally exhausted and fully believing I was an inadequate involuntary murderer. But the Junior Resident was compassionate when I told him how I felt. He said it was just a joke about letting my first patient die, that the man had such an advanced illness he had very little chance of survival anyway and that all physicians lose patients throughout their career. He said that the best you can do in retrospect is to believe in yourself. He added that in always second guessing everything you do for someone you will always find peace or solace if you can honestly say you did absolutely everything you possibly could. He also said you must at all costs retain a sense of humor, because this was the kind of business that above all required a person to have to able to laugh, just to keep from crying.

  • That’s why we are training you and that is how we will train you. I can also tell you for sure; there was nothing else you could have done for that man. It was entirely up to God and the antibiotics we used; so in the end it was obvious that for him, neither one of them worked out too favorably.

About eight months later when I was assigned to the ICU and got a patient with multiple interacting; terminal co-morbidities, this same Resident ripped me a new asshole when I suggested we should just go ahead and let him die.

  • You don’t know enough yet to decide about life and death. You have no right to think like that at this stage of your career. Yes, this man has very little hope, but any hope is enough to give him every benefit of the doubt. And since he is in renal failure, tomorrow I want you to give the group a small dissertation on treating the medical complications of uremia as well as an explanation for the mechanism of renal tubular acidosis. We are going to use this patient as an example of pulling out all the stops in treating every medical complication he might have. This is a major teaching center, for God’s sake. Now in the future, I’ll inform you Mr. “Let Him Go” when I think you are experienced and smart enough to be able to make those judgments. So, while you’re studying tonight for your uremia presentation, think about whether or not you would say the same thing if that man happened to be your own father.

Even though the man did die several days later, the episode did serve to be humbling as well as educational, and from that day forward, every terminal illness served to teach me not only the natural history of numerous disease states, but also afforded me the opportunity to do everything in my power to abort or to favorably modify the end-game; Meet the Reaper.

Secondarily, it taught me better judgment and widened my perspectives. Taking care of someone in the downward irreversible spiral staircase leading to death is sometimes like holding back a flood by sticking your finger into a cracked dyke. These situations serve to occasionally allow for the earlier interception of a reversible clinical problem in someone else who might die the same way; if not for the physician’s personal experience, anticipation and diligence. As physicians, we never “let people go” unless they are terminally ill, or brain dead. As a rule, we exhaust all resources to save people. Then again, sometimes people simply die no matter what you do.

One exception to not letting someone go occurred during my training when I was a Senior Resident and finally let a twenty-eight-year-old man bleed to death. He was a hard-core alcoholic with cirrhotic liver failure that caused the portal hypertension resulting in massive recurrent bleeding from esophageal varices. His liver was dead, and the rest of his body was trying to catch up. It was also before technology advanced to the point of liver transplantation. My heart went out to him initially because had no family or friends and I fully believed his environment had conspired to provide such little hope in life that finding solace in booze was his only means of escape. The real problem was, as it is with most dangerous addictions, that the escape eventually does become permanent. But in taking a protracted course, as the ship slowly sinks; the addict also sucks too many other people or other valuable resources into the vortex along with it. That is of course unless the addict does everyone a big favor by inadvertently taking a lethal overdose. Being naively enthusiastic, I spent time with him, counseled him, got him briefly to go to AA, and arranged for social service support; but to no avail. He always coupled the vacant eyes of a lost hollow soul with the inadequate personality that had already put him beyond reasonable reach. There was simply no humanity left inside the thin remnant of his human shell. As with any addiction, I eventually came to recognize his look as the same predictive look of recidivism I would encounter repeatedly in clinical practice, especially when counseling against tobacco use. When you tell someone they must stop smoking, their eyes immediately glass over vacantly then either roll up or glance to side. Their facial expression suddenly becomes a blank mask. This lets you know immediately, simply because they do not want to, that there is no hope for that person to break the habit.

This man then, had multiple admissions due to relapses of the drinking habit that caused repeated massive bleeds. It finally culminated in a hospitalization that required 28 units of blood and depleted our blood bank. With every possible treatment option exhausted, the case went beyond even the gastroenterologist’s or surgeon’s ability to stop the crimson flood, such that even the best minds on the subspecialty medical staff capitulated and gave up. They unanimously pronounced that there was nothing else to do. If he kept bleeding; he would eventually die. His intern called me one night to tell me the patient was going into shock and should we “just let him go?” After I gave him the same lecture that I had received two years earlier, then telling him I would handle the rest, sent the Intern to bed. After he left, I pulled the curtain around the young man’s bed, sat holding his hand for the rest of the night, and let him peacefully die. He could not be saved, either in body or in soul, and we desperately needed the bed and the blood for people we could help. It was a judgment made in the context of reasonable experience as well as one sanctioned by the academic staff. It also let my intern entirely off the hook, in a situation where any plea I might have made for help had a pre-ordained denial by the powers that be. Don’t call us; we’ll call you.

Ironic, I thought, that this man with nothing at all going for himself had understandably fallen under the spell of evil spirits, but that the likes of the Grateful Dead’s Pigpen Mc Kernan, who had the world by the balls, died exactly the same way at the age of twenty-six. He chronically poisoned his own liver with a mixture of Strawberry Kool-Aid and Ripple wine. Believe me. At that young age this is very hard to do and, requires an enormous quantity of fermented grapes mixed with sugar water to accomplish the task. It was said by some eyewitnesses that Pigpen started drinking at breakfast; and that breakfast lasted pretty much all day. One of the most difficult problems to deal with as a physician is the addicted patient. The cure rate is only about thirty percent and after you do all that you can do, there is still only so much that you can really do. The rest is up to the patient. The only thing understandable about it all is the fact that each addiction is the indifferent demon that does not care at all: whom, what, where, when, how or why. Hollywood, the music industry and Mount Everest are littered with the corpses of dead addicts.

In the lobby of St. Luke’s hospital in Manhattan, there is a large statue of the hospital’s namesake, standing in front of his mascot, an ox. Saint Luke, a healer himself, is the patron Saint of physicians and surgeons, who was also a famed iconographer who specialized in portraits of The Virgin Mary. His own iconic mascot is usually considered to be imagery representing sacrifice, and possibly the ultimate sacrifice made by Jesus. But don’t ever tell that to a Hindu. They believe the cow is sacred, but not necessarily its owner.

The first and last time I saw this statue was when presenting myself for duty. But for some strange reason, I never went in or out the front door after that day. This somehow created an inadvertent disconnect between my call to a supposedly high vocation and its necessary guiding light. From that point forward the hospital only became a generic base for my practical clinical education, as I never again thought of any associated spiritual implications or ramifications.

There were too many situations to come along in the future in which there was nothing fair about who lived or who died, about what age it happened, about who got what terrible disease and who did not, or about who really deserved to die and who did not. There was no logic to it, no discernable divine plan, and no last minute intercessions from some divine being or Saint for the many hapless people I saw who had fervently prayed but who then had their prayers go up with the same smoke of their cremated remains.

By the time I had survived my first day at St. Luke’s Hospital not only did I never believe I was going to make it as a physician, and in taking little solace from the good saint’s inspiring statuary and legacy, simply concluded by muttering to myself:

  • Holy Mary Mother of God, why did I do such a ridiculously insane to myself?

As expected, no one answered. And then my beeper went off again.

I then spent the next thirty years of my life sacrificing myself to night call; to the point that not only did it literally nearly kill me, but it also to eroded or destroyed most of my intimate interpersonal relationships. It then secondarily caused me to change my religious orientation as I began to direct all my subsequent prayers from Jesus, instead to Hypnos, the Greek god and patron saint of sleep. Keep the cow. I would rather take a Valium and a get a few extra REMs.    

 

 

To sleep: perchance to dream; ay there’s the rub.

(Shakespeare)

 

 

 

 

 

 

 

Miami Bleach

Miami Beach 

My roommate M. once attended a medical conference in Miami Beach and happened to overhear a conversation on the street that offers an insight into Jewish interpersonal relationships.

Two little old Jewish ladies passed each other on the street. One looked at the other, calling out in a startled voice:

  • Myrtle, Myrtle. Is that you? I haven’t seen you in so long I almost didn’t recognize you. In fact, now that I’m really looking, I can see that you don’t even look like yourself. In fact, you look terrible. You lost weight, your color is gray. You’re pale. And your hair never looked like that before. It used to be so radiant. It doesn’t even look like the normal hair that I remember. What happened? What happened to you and your lovely radiant curly red hair? Now it’s stringy and blond.
  • Oh, Sylvia. It’s so nice to see you, again too. And yes, I’ve had a terrible time. I got cancer and had chemotherapy. I nearly died. In fact, I have no blood cells and all my hair fell out too, so I had to go get a wig.
  • Myrtle. I’m so sorry to hear about that and I’m certainly glad you survived the cancer. So as far as your hair is concerned, don’t worry. Your hair looks so natural; no one will ever notice the difference.

Jewish Sex

Jewish Sex 

A  widowed Jewish lady living in Miami who was about eighty years old had the habit of going down to the beach every day with a blanket, an umbrella and a cooler full of ice cold drinks. She was dressed in an old-fashioned one-piece bathing suit

One day she spotted a skinny little old Jewish man, dressed only in a small  pair of black swim trunks, walking along the shoreline. She called him over to her blanket and then proceeded to attempt small talk with a person who turned out to be a man of very few words.

  • Nice day, yes?
  • Sure, yeah. Nice day.
  • Nice blue sky, yes?
  • Yeah, yeah. Nice and blue.
  • Nice waves too, yes?
  • Beautiful water. Gorgeous waves. Yeah, yeah.

Then she opened the cooler and said:

  • Want a cool drink?
  • Yeah sure. Nice and cold.

Nudging him closer under the umbrella she said:

  • Nice cool shade, yes?
  • Yeah, yeah. Nice shade and a nice cool drink.

Just then two small kittens walked by, and the woman having become increasingly frustrated by his terse inarticulations along with trying to prompt more than only single word responses, pointed to them, and said:

  • Pussy cats, yes?

With that the little man jumped up, ripped off the woman’s bathing suit, threw off his own trunks and slam-bang fucked her silly into the hot sand. After he was done, the startled woman, sat up, dusted the sand off her bottom, turned to the man and said:

  • My god. I haven’t had such good sex like that since my poor husband died twenty years ago; and even then, it was nowhere near as good as this. But let me ask you something. How in the world did you know I needed that?
  • My dear lady. How in the world did you know my name was Katz?

Jewish Mothers

 

Jewish Mothers 

One thing that could be said for Medical School was that it was a great repository for Jews and Italians. If a Jew did not go into “wholesale” and an Italian did not go into “organized crime,” there were few other avenues open for these groups to succeed in financially. Because of a long tradition of bias and the closed doors of WASP society, they gravitated to Medicine or Law as areas where individual effort tends to be recognized or valued more than heritage.

Both groups are highly goal oriented, having been pushed hard by their families. The only difference is that Jews verbally preseverate more about success whereas Italians tend to resort to the physical punishment of a Baccala swat to stimulate interest in books.

Jewish:

  • What will happen to you if you don’t study? You’ll never be a mensch. You’ll always be just a nebbish, a schlemiel, and a nobody. You’ll live in a hovel. You’ll have no money. You’ll have to use food stamps. You’ll have to move back home. All the neighbors will laugh at a son who moves back home to live with his mother. You’ll never find a good wife. What kind of a son should put such a heavy weight of such embarrassment on his own mother? An Albatross on his mother’s neck. Why would you want to be such a nobody? And why would I want to raise such a nobody to be such a nobody’s nobody? You’re killing me. You know that? You are literally killlll-ling your own mother.

As opposed to Italian:

  • Shut up and study. If you get another C, I’ll bust your head open.

Verbal abuse. Physical abuse. Whatever.

I still think I would rather be occasionally swatted with a dried fish than continuously nagged half to death. The fact is, I really knew very little about the Jews. They were a minority at every level of my educational experience to whom I did not pay a great deal of attention; and far before I knew had Jewish ancestry. (2% DNA).

In grade school, I knew the boys occasionally wore funny hats that were okay to snigger about, but not to their face, or also that they got really mad if the school bully yanked one off their head and stomped on it. They also had weird rules about food and hygiene. Their Priests were called Rabbis, and even though they never got the holidays right, they still always went around saying they were the chosen ones.

Our own Priests usually set that one straight by telling us that they were not chosen at all, that they did not believe in Jesus, that they were responsible for having the Romans kill him. Furthermore, anyone who did not believe in Jesus could never get to Heaven anyway; which would be good as then the only Jew living in heaven would be Jesus himself.

Then when I found out they never had a Christmas tree, but rather called their holiday plant a “bush”, I really did feel bad for them. After puberty however, “bush” took on a completely different meaning for me, at the secular level.

At Duke, the jocks periodically beat up the nerdy intellectual Jews or tossed them around like footballs.

Imagine my shock then when I discovered that all the Jewish boys were circumcised, and that I was too. When I asked my mother about it, she said it had nothing to do with religion and that she had it done to me because the Pediatrician said it was the right thing to do, Arbitrarily just like that: and only because it “would be better for me in the long run.” Nothing at all mentioned about personal hygiene, or disease prevention. She also assured me that it did not mean I was secretly Jewish.

It was another shock when I found out that her 6th great grandfather was a Sephardic Jew, making the circumcision more like the crypto-Jewish secret rituals that 17th and 18th century Jewish refuges practiced in Appalachia.

When I got to Medical School and befriended Michael., I learned a quite a bit more about Jews and Judaism. However, but being exposed to Michael as a non-religious Jew, I still do not believe I got the so called “kosher” version of the facts.

He told me the following:

  • Good Jews live by the rules.
  • The rulebook is called the Torah. Orthodox Jews obey the rules.
  • Most Jews are not Orthodox, so most Jews forget about the rules.
  • The entire culture of the Jews revolves around the anatomy of the chicken.
  • A chicken’s ass is called a tuchus. A tuchus, conversely, is anyone who behaves like an ass.
  • A beautiful ass is called a nice tush; but not a nice tuchus.
  • Chicken soup is a panacea. If offered some by a Jewish mother, do not refuse it under penalty of intense preseveration about its virtues.
  • Kosher means that a Rabbi blesses food, but most Jews don’t really care what they eat or if it ever got a blessing.
  • Chickens are good. Pigs are bad. Bad food is pig food or chazerei.
  • The ‘ch’ in chazerei must be pronounced as though you are nearly choking to death.
  • Jews traditionally avoid pigs, but most Jews do not really care what they eat. Bacon is OK, unless you are orthodox. A BLT is a “nice sandwich.”
  • Orthodox Jews who bring attention to themselves by wearing a Yarmulke and ear braids are stupid and deserve to be abused.
  • Having to eating Gefelte fish and Matzos is one of the rules.
  • Eating Gefelte fish and Matzos reinforces the concept that Jews are quintessential masochists as both are tasteless forms of food.
  • Mogan David wine is another obligatory holiday torture. But it isn’t really wine.
  • A non-Jew is a Goy.
  • A bad Jew is a Kike.
  • If a Kike happens to be a rich uncle then he is really a good Jew.
  • Bad Jews buy Mercedes cars, because Mercedes invented Zyklon-B for Hitler’s gas chambers.
  • It is OK for Jews to have sex with Goys but they cannot marry one.
  • It is preferable to avoid Goys and stick to your own kind; unless you want to use them for sex.
  • Jewish women only have sex as a duty to procreate the race.
  • You can tell how many times a Jewish mother had sex by counting the number of her children.
  • It is mandatory to have a Jewish son.
  • It is a curse to be a Jewish son.
  • A Jewish man is lucky, then, if he has only daughters because then his wife will still be obligated to have sex with him.
  • A good Jewish son is called a doctor or a lawyer.
  • A good Jewish girl will marry a doctor or a lawyer.
  • A shyster is a cheat who might even try to screw another Jew.
  • It is still OK to marry a shyster, as long as he is rich and never gets caught, like Bernie Madoff.
  • A Bar Mitzvah is a party thrown for a thirteen-year-old boy that signifies he has become a man.
  • A Batz Mitzvah is the same party given to a girl that signifies the day she officially becomes a Princess.
  • The bigger the Mitzvah; the richer the father.
  • A Princess is only a Princess until she marries. Then she becomes a professional shopper and begins to avoid having sex.
  • Jewish women hate to cook; they only do Deli. This is known as whining and then dining.
  • Deli is Jewish for: breakfast, lunch, and dinner.
  • Chutzpah means having balls. Real chutzpah is killing your parents and seeking a plea bargain because you are an orphan.
  • It takes a lot of chutzpah to tell a Jewish woman to cook.
  • A Yenta is a gossip.
  • Most Jewish women become Yentas just before the birth of their first grandchild at which time they automatically become a pain in the tuchus.
  • A Mikvah is a ritual bath.
  • Orthodox Jews will not have sex unless a woman first sits in a Mikvah. Regular Jews think this is stupid because if she happens to be horny, it is completely self-defeating masochism.
  • Orthodox Jews have different plates for every category of food. Regular Jews think this is impractical; and like to eat deli off the same paper plate.
  • A Putz is a foreskin and also refers to someone who is as stupidly useless; as is the foreskin in general.
  • A Putz in gorgle is a foreskin stuck in your throat. Being more of a curse, it is not equivalent to getting a blowjob.
  • A Schlemiel or a Schlimazel is a person with perpetual bad luck.
  • Historically, the Jews have always had bad luck; as well as a penchant for perpetual suffering, aimless wandering, and passive acquiescence to sado-masochistic torture.
  • The perfect 50th Wedding Anniversary present from a Jewish man to his wife is an around the world guilt trip.
  • Sometimes it is worse to be Jewish than it is to be Black.
  • Perseveration is the national language of Judaism.
  • A Jewish Christmas = Chinese food and a movie.

That’s the short list

It is also the short list of the fifty or so new words I had to learn to become an honorary Jew.

All this preparatory homework helped considerably for the one occasion I was invited to a Bar Mitzvah given by a friend of Michael’s father. The man was obviously wealthy because the party it was given at a private country club, and was extremely opulent in its scope as well as the number of guests. Having never been to one, it was interesting to observe the way tradition and religion became a perfect rational blending with modern hedonism. But I think the father took it to extreme when he attempted a literal consummation of the manhood concept by introducing a belly dancer as the finale to the show. Apparently, it was going to be her job to deflower the poor thirteen-year-old boy later in a motel room after she wiggled around an hour or so for the guests.

It was  hilarious watching this woman chase after the poor frightened skinny little boy who ran around the catering hall as though his very life depended upon a successful escape. He was quick too. Chunky butted Fatima with her clacking cymbals, gyrating navel and her pendulous heaving breasts, with pastie covered nipples, never did catch the new little man.

I did have to admit however that it was better than the stilted Catholic ceremony of Confirmation that not only had nothing at all to do with manhood, but was followed at home by a boring little cake and ice cream party along with the obligatory smiley face poses for the family album. Yes, a few forced smiles, posed with the same Pastor who tried to feel my mother’s tits several years later at a cocktail party. He was exposed for the lecher he really was when Wild Turkey being a bit stronger than Mogan David, lit him up and strengthened his resolve.

At least a Bar Mitzvah signifies something practical as opposed to an affirmation that a boy is now a bona fide lieutenant in the army of God, along with the Confirmation ceremony’s reaffirmation of chastity, sanctity, holiness, and piety. That is unless the young boy wants to participate in the secret Catholic rite of passage to manhood by bending over and pulling his pants down for the Jesuit who taught him sexual hypocrisy at Wednesday night Catechism.

Because it’s all about manhood anyway, the Confirmation party could have taken Aunt Rose’s Christmas theme to even a more adult level by having a stripper jump out of a giant white coconut cake replete with whipped cream and Maraschino cherries dolloped on her nipples. That way after having put on a brief but overdone reactive façade of false offense, even the perverted Pastor would probably admit to being furtively pleased.

Michael’s family had a summerhouse on the South Jersey shore, and although I would rather have been in the Hamptons, I did decide to visit there one summer weekend. That was when I found out what it really meant to be a Jewish son who had to suffer the slings and arrows of an inquisition inflicted by the Torquemada of Beach Haven, New Jersey.

Queries by Jewish mothers are like those tactics used by a prosecuting attorney. After being subjected to several malpractice suits, I learned the hard way that the best defense is to offer little in the way of voluntary information or elaboration. The best answer is always a simple “yes” or “no;” or a better answer yet is to say: “I don’t know” or “I just can’t remember.”

Politicians being investigated for corruption or scandal are masters at this defense.

When queried by an attorney the problem is that if you open even one door just a small crack, then all the windows in the house get blown open and the track of questioning becomes a nightmare of open ended pitfalls that spew forth in a geometric proliferation.

Here is how an innocent conversation goes completely wrong.

(How it should have gone)

  • So, what do you boys do with your free time on a Saturday night?
  • I don’t know. Really nothing much. Usually we study more of what we already studied so we can all get better grades than anyone else.
  • Good boys!

How it went instead:

  • We usually go out to bar.
  • Why do you go to a bar?
  • To have a drink and maybe meet a girl.
  • Why would you want to waste your time drinking and what kind of a girl do you think you might meet in a bar?
  • But what’s wrong with having a drink. Beside that we study so much anyway we never get to meet any women.
  • You want to waste your time getting drunk and meeting a girl in a bar? Do you know what kind of a girl hangs out in a bar? Not the kind of girl that works hard and studies and who wants to get ahead or get a decent husband. You’ll meet the loose kind that smokes and spreads her legs for anyone.
  • That’s kind of the idea.
  • Don’t be facetious. I’m serious. Nice girls, at least nice Jewish girls never hang out in bars and drink and smoke and pick up men. You might even get a disease.
  • Jewish girls can get a disease too.
  • Not the nice ones. Not the kind I’m thinking about. Not the good ones. You know the kind, Michael. Girls like Kathy up the street. Why don’t you call Kathy up and go out with her to dinner and a movie?
  • Mom, Kathy weighs 90 pounds and has Ulcerative colitis. She can’t even eat popcorn at the movies much less have a steak for dinner.
  • Then why not Cynthia. You know Cynthia. She’s a gem, a doll, a darling. Her mother says that all the girls in the dorm think she’s just adorable. The last time I spoke to her, her mother said she was even making all her own clothes.
  • Great. You want me to go out with homely Cynthia wearing her own knitted pants suit.
  • Don’t talk like that. Her mother and I were best friends. When your father was sick she came and visited. None of your father’s other so-called friends came over. She comes from a lovely family.
  • That doesn’t make Cynthia any prettier or more debonair.
  • Now you’re being rude. And how many beers did you drink anyway? Is that what’s making you talk like that? Beer? And is that what you are learning about in that school? How to drink in bars. How to drink beer. How to drink beer and find a goyisha smoking slut for a wife. How to drink beer and become a drunk like some Irish. What kind of a drunk shikse wife do you think you’re going to find in a bar anyway? Nice girls don’t hang out in bars. Not nice Jewish girls.
  • No, ma. They all stay home and make their own clothes. Could we please stop talking about this ? I think I have to leave now ; go back to school and study.

A similar situation occurred many years later when I leased my office for two days a week to a Jewish physician who used it on the days I was not there. He had a relatively domineering mother who even went as far as arranging vacations for him at the Club Med, especially to improve his chances of meeting the right girl. He did in fact meet the right girl. She was Jewish. She was a business entrepreneur. She was rich. She was pretty and she was personable. She played golf and tennis, as did he. Perfect, yes?

No. The fatal flaw was that she was in her forties, but even worse she was not interested in having children…and for mother that was “over and out.”

One day B’s mother appeared in the office, which also happened to have a private back entrance, inquiring if her son had come in yet because he had promised to meet her there at that time for whatever purpose.

  • No Mrs. B., he’s not here yet. He didn’t come in.
  • But it’s four o’clock and he said he would meet me here at four.
  • Mrs. B, we’ve been here all day and he hasn’t come in yet.
  • But how do you know he didn’t come in the back door? Sometimes he goes in the back door to do work in the back.
  • Yes, Mrs. B. but we have been using the office all day and I know he is not in the back.
  • But how do you know. When was the last time you went in the back? Maybe he came in the back door when you were not looking.
  • Trust me, Mrs. B. he did not come in the back door and he is not working in the back. I just came from the back and he is not there. Maybe he’s just a little late. Why don’t you just sit in the waiting room and give it a few more minutes.
  • He’s never late for me. Are you sure he’s not in the back? He never minds if I go in the back when he works in the back. You don’t mind if I just go back to have a little peek for myself, do you?

With that, she burst through the inside door to the office without permission, went in the back to look for herself, only to discover that indeed, he wasn’t there. Then she came back out to the front, said she couldn’t understand why he wasn’t there; and went into the back room again…just to be absolutely sure about it.

 

No, no.  A  thousand times, no

 

 

© Photo  Keep the Faith

 

http://www.salon.com/mwt/feature/1998/03/src/13faith.gif

Easily Understood Universal Medical Advice: Don’t Do It

https://youtu.be/pcUWF8_QpJE

Don’t Do It…….

Hey, I was under the weather and I wasn’t getting better

So, I went to get a physical check and when I went to the Doc

It was a heck of a shock

He told me told me boy you are a miserable wreck

He said your liver’s all swollen and your stomach’s got a hole in it

From drinking too much for too long

And there’s a good indication

You got bad circulation cause your blood pressure’s almost gone

And you got no reflexes in your solar plexus when I tap you on the top of your knees

He said your pulse ain’t steady and your lungs getting ready to collapse every time that you breathe.

And at the rate you’re going all the tests are showing that boy you’ll never live to get old

But I came up with a plan to make you healthy again

But son you got to do what you’re told

And then he told me

If you dig it…Don’t do it

And if you like it, better leave it alone

And if it’s too much fun that ought to clue you son

That you’re probably doing something that’s wrong

And I’m surprised at you and all the things you do

Boy cause that ain’t what your body is for

And if you think it’s bad so far wait til after this guitar

Cause the doctor said a whole lot more

He told me cut out your boozin’ quit those drugs you been usin’

And don’t be smokin’ no cigarettes

And you know, love on a stranger now days boy,

Man, it’s just like playing Russian roulette

And get that grease out your diet; better boil it don’t fry it

And don’t chew no more barbecue

I wouldn’t tell you no lie so take this rule, and apply

My son, now listen to what you got to do

And then he told me

If you dig it…Don’t do it

And if you like it, better leave it alone

And if it’s too much fun that ought to clue you son, ha, you’re probably doing something that’s wrong

And if it’s too good to ya well don’t let it fool ya cuase you’re playing in the danger zone

And I kept waiting and waiting for the man to finish but the sucker just went on and on

And then he told me better cut out all sweets

And don’t be cramping yo feet

In them pointy toed I-talian shoes

And he said boy look it here you’re gonna damage you’re ears

Playin’ them loud rock, rhythm, and blues

And if a rabbit won’t eat it buddy you don’t need it

That’s the rules of your new menu

You better get you a pen, I ain’t gonna say it again

Cause there’s a whole lot more that you need to do

You need to lose some weight,

You need to stand up straight

Boy your posture is a terrible disgrace

You need to suck in your gut you need to tuck in your butt

You need to clear them zits up off-a your face

And then he told me

If you dig it…Don’t do it

And if you like it, better leave it alone

And if it’s too much fun that ought to clue you son

Yeah, you’re probably doing something that’s wrong

And if it’s too good to ya don’t’ let it fool ya

Cause you’re playing in the danger zone

And I kept waiting and waiting for the man to finish

But the sucker just went on and on

and on and on and on and on….

  

Little Charlie and the Night Cats

Big Break Album

Alligator Records 1989

Copy right: Printed without permission

 

 

Assumptions

Assumptions

I don’t need no doctor

‘Cause I know what’s ailing me

I don’t need no doctor

‘Cause I know what’s ailing me

All I need is my baby

You don’t know I’m in misery

(Humble Pie)

Late in my career I went back to school for a Masters Degree in Medical Management. This was a paranoid backup plan I had worked out if Managed Care would one day put me out of business. At least I would then have the credentials to go into hospital management. Because I still a clinical medical practice to take care of, it was a grueling enterprise that took five years. But if I learned anything at all by this endeavor, it was that all assumptions are: False, Limiting, and Reversible.

It was a lesson I should have already empirically learned on the wards at the VA hospital when I had to take care of a man who had an unusual complication of long-term alcohol abuse in which the cerebellum in the brain becomes affected similar to how it scars the liver in alcoholic cirrhosis. This often-irreversible syndrome requires a great deal of alcohol consumption over decades to affect the brain.

Because the cerebellum controls balance, this man literally had the gait of a drunken sailor or a sea-sick landlubber, which made anyone who saw him, feel compelled to stand by for a catch in case he fell down. He looked like the protagonist in the Monty Python sketch, “The Ministry of Silly Walks.”

After the diagnosis was secured I was assigned to explain his problem. After a very lengthy, diligent explanation about how alcohol had damaged the back part of his brain, which included drawings and visual schematics, he looked up at me when I was finished and said:

  • So, what kind of doctor do you think you are?
  • I’m not really a doctor yet. I’m still a medical student.
  • Well mister, you’ll never make it in this business, so maybe you should think about doing something else.
  • Why do you say that? I’m only interested in helping you understand what’s wrong with you, so you can change your habits. This might prevent further trouble. Some of your balance issues might even improve if you stop drinking. If not, it can only get worse.

Of course, I had assumed he knew what I was talking about and that my carefully studied little lecture had made enough of an impact to inspire a trip down the road to total sobriety. Nothing was further from the truth, because the opposite reaction had  caused him to completely lose any faith, trust, or confidence he might have had.

  • That’s just what I’m saying, pretty boy. You can’t possibly know what you’re talking about. Like I said, I been drinking hard for over thirty years.
  • Correct. That’s the point.
  • Not really. The point is that you can’t be right, because this is the first time in thirty years something like this ever happened to me. So, it can’t be the booze. Now what’s really wrong with me?

What I really wanted to say was:

  • Well, perhaps you can’t ever cure being Irish.

Unbelievably, déjà vu came knocking thirty years later when our next-door neighbor in the Hamptons presented to the hospital with liver failure associated with ascites. This is a condition in which the liver is so scarred it cannot properly function, subsequently causing the abdominal cavity to fill up with clear yellow serous fluid. In being a serious sign that portends a very poor short-term prognosis, it can even make a man or woman look ten months pregnant.

Usually the kidneys shut down next or nearly unstoppable upper G.I. hemorrhaging occurs expressed as continuous vomiting of blood. This is a result of extremely high pressure in the varicose veins located in the lower esophagus that dilate because the liver doesn’t work; causing back-pressure into the spleen; which also enlarges.

His predicament was no surprise, as I would notice him regularly wandering around his yard, starting to drink beer at ten a.m., which he conveniently kept perched in front of him on the home-made shelf provided by his expanded abdominal girth. Meanwhile, his wife, who had smoked her lungs to death, was inside their house attached to an oxygen tank.

As a perfect pair, the couple was a veritable monument to self-inflicted abuse.

When he was hospitalized with cirrhotic liver disease, I saw him briefly when I stopped by his bed for a courtesy call, but was taken aback when he asked me what was wrong. He said his doctor told him he had liver failure. When I reaffirmed that his problem was the result of years of drinking to excess, he dismissively parroted the man at the Boston V.A. by saying it could not possibly be true for the same precise reasons I heard many years before. He said he had consumed beer all day long for well over half a lifetime but this was the first time something like this had ever happened to him; ergo alcohol could not be the problem.

Saying nothing more than “good luck and get better,” I walked away because I had seen that that movie once  and it wasn’t very good the first time around. In this case he wasn’t even Irish. He was just an ignoramus.

Enough said about assumptions.

My mother put it differently whenever I did something that I assumed had seemed like a good idea at the time; but turned out just the opposite.

  • But mom. I thought…
  • Yyou know what thought did, don’t you?
  • No mom, what?
  • A man thought he had to fart.

Anyone who studies medicine comes to know it as a discipline in which two great truths are axiomatic:

A: Never make assumptions.

B: Never, say never.

Especially never assume that a patient knows what you are talking about or understands anything you are saying without soliciting your own personal validated feedback. One must ask at the end of the visit:

  • Did you understand what we discussed and do you have any other questions?

As far as patients are concerned, they believe that too many doctors speak a foreign language, but are often afraid or too intimidated to ask for an understandable translation. They simply nod their heads like dumb jack-asses, or worse, talk through the explanations without listening, then go home to tell family or friends:

  • The doctor didn’t spend any time with me at all. And he didn’t tell me anything either. He’s an incompetent boob.

That is, assuming the doctor really takes the time to speak plainly, or unless the patient has taken it upon himself to become an overnight Internet expert about his own personal health; in which case, the only medical advice he weeds comes form Dr. Google.

So, there it is. Just another one of life’s many negative feed-back loops.

 

The father is Jim Beam

intranet.tdmu.edu.ua

Pacemaker Sex

Pacemaker Sex

The prior story about a female Resident getting fisted by the electronically paced flailing arms of a D.O.A. John Doe paled in comparison to what happened to my loan shark friend, Chubby.

One of his sideline enterprises was to pimp women to local clients including police officers, lawyers, bankers, and a few other unsavory fellow shysters. The women were not a consistent cadre of reliable girls from a “stable” but instead were usually indiscriminately pulled off the local sidewalks or out of grocery store parking lots. For this reason, the women were also not consistently available, such that when something suddenly came up, he would place phone calls to line up the Johns.

He solicited sex from just about any woman he saw and when he scored would temporarily procure them for his client base until the women got tired of it or did not need the money anymore. he said:

  • Doc, you can’t believe how many housewives are broke and what they’ll do for a buck, especially when economics is bad. Recessions are always good for me.

The going rate in the 1990s was about one hundred and three dollars an hour for intercourse and thirty-three dollars for oral sex, although he once got a staggering one thousand and three dollars out of a retired but impotent eighty-year old business tycoon and former CEO of a major US steel company who paid just to have the girl sit naked in a chair and talk to him for an hour. The arbitrary rounding on the price was based on a superstitious love of the number three.

Several years later, this same tycoon was indicted in an insurance fraud scheme in which he tried to smuggle a vintage Mercedes-Benz sport coupe out of the country after reporting it stolen; an act that everyone who knew him and how much money he was worth thought to be stupidly perplexing in its perverse logic.

Chubby said:

  • I don’t know, doc. It’s like he just got a soft spot in his brain.

Later in life, Chubby happened to have had a heart attack. Several years after the fact he then had an AICD (Automatic Implanted Cardiac Defibrillator) implanted for unexplained fainting that later turned out be related to poor blood flow in the posterior cerebral circulation. Even though the essential point was that implanting it was probably not necessary, it was done anyway because of uncertainty about the possibility of lethal ventricular arrhythmias. This underscores the fact that sometimes medicine, for all its sophistication is nothing better than a guessing game.

These electronic devices are set to deliver sequential shocks of about 15 to 30 joules of direct current internally to the heart which will reset the cardiac rhythm if a life threatening one is detected. The shock is not at all comfortable. It can also be felt by anyone who happens to grab hold of the victim who might be collapsing when the arrhythmia then secondarily causes his blood pressure to bottom out. Some spouses have stated they suffer from the guilty dilemma of deciding between letting their loved one fall down, as opposed to being exposed to the shared experience of internal electrocution. Personally, I thought the original contract called “For better or for worse.”

Chubby reluctantly accepted to have the implant but said he would feel much better about it if we were going to put in a pacemaker that would give him a permanent erection instead of an electrocution.

  • You doctors are all numb. Forget Viagra. With modern technology yez should be able to do a better job with boners.

One afternoon I received a frantic call from him. He said he wasn’t sure what had happened, but he thought his device had discharged.

  • Doc. I think my thing went off.

When I asked the circumstances, he said he had picked up a tried and true regular at the supermarket, a local housewife who had already been paid thirty-three dollars for blowjob.

As she was in the middle of the head-bob he said he was suddenly lifted two feet off the bed, that all he saw was a bright white light, and that his hair stuck straight out off his head. At the same time, the girl had been blasted and fell across the room, then banged her head on the bedroom door.

She got up screaming that he was a crazy demented pervert and what a shitty way that was get off, as she bounded out the door, following that diatribe with a statement that no matter what he might ever pay her, she was never coming back.

  • Doc. The woist part of it was I lost my thirty-three dollars and didn’t even get off. But oh, what a thrill!

As all the data is stored in memory, when one of these devices fires it is customary to interrogate it to see if the shock was appropriately sensing a real event. So, when Chubby came to the office to let me look at it, I discovered that the trigger for the shock was a paroxysm of not a lethal ventricular tachycardia but rather a harmless one that had originated in the atrium. Perhaps the excitement had over stimulated his epinephrine producing adrenal glands as well as his testosterone loaded gonads.

The device was fooled into doing its job by a rapid heart rate that was associated with an abnormally wide configuration of its cardiac complexes. It was essentially acting appropriately in an inappropriate situation; as was the housewife whore when she perceived she was being perversely abused.

I felt compelled to share this story with a colleague at the specialty hospital I had customarily referred not only Chubby, but also numerous other cases for AICD implants. Although the implanting physician, Joe, was amused, he then told me he had a story that might be even better than mine.

He queried:

  • You know how the Japanese perfected the art of autoerotic asphyxiation?

With me answering in the affirmative, he then told me about the wife of one of his patients who had brought that art-form to a new escalated jaded height. He said her affect was a little rough around the edges. She also tipped the scales at an estimated 250 lbs.

Apparently, her husband had suffered a heart attack, and then required an AICD implanted, but because of his relative debilitation, along with a lack of stamina she became accustomed to screwing him in the female-on-top sexual position.

On one occasion, the device discharged but instead of reacting negatively this woman immediately derived a great deal of pleasure from the experience. I suppose it was like having a mini electric socket inserted into the vagina, which in her mind was better than any orgasm she could achieve by using a conventional AA battery powered vibrator. Or perhaps her blubber not only attenuated electricity but then also made her threshold for sexual stimulation much higher than that of her average contemporaries.

But the perverse thing about the whole scenario was that the woman then educated herself about shocking devices. Then each time she went with her husband to the clinic to have his device was checked, she would beg the doctor to turn down the rate sensor on the AICD, so that there would be a greater probability of the thing going off when she climbed on top to rev up the sex.

So here is this poor bastard with a bad heart to begin with, losing consciousness as his heart is fibrillating, while he is getting jolted; as simultaneously his lovely fat wife also gets a DC shock jolt as she sinks into the stirrups to giddy-up the old dying horse. If nothing else, at least this was a clear-cut situation of her ability to turn the worse for him toward the better for herself: A classic combination of both positive and negative feedback loops.

Not only does it go to show that everyone has a different threshold for pain, but also gives great credence to the aphorism: To each his own.

I said to my colleague, Joe:

  • Yes. In the category of interesting clinical pacemaker anecdotes; you win the gold medal.

Medical School: “Obstetrics and Gynecology.” But Not Misogyny

Why Not Obstetrics? 

For an elective rotation in Obstetrics and Gynecology I signed up for a thirty-day stint at The Providence Lying-In Hospital. What better way to get exposure than to be in a place dedicated entirely to the biology of the human female and her reproductive system?

Sleeping quarters were provided in a building that also housed female nursing students on the floor above us. Imagine fifty horny nursing students locked up in the same building as three or four male medical students  being almost as good as a seminary student getting to live in a nunnery. At first, I could not imagine what stupid logic went into that demographic, but as time went on I came to understand the point to be moot and irrelevant.

Things got off to a bad start, when on the first day I was assigned to an Obstetrical surgery case; a hysterectomy. The problem being that as no one had taken the time to teach us how to do a sterile scrub and don, the attending surgeon went berserk at our awkward fumbling. This delayed the case while exposing his own paranoia that the operative field would be contaminated. He threw us out of the operating suite.

This illustrates one glaring fault about medical training, especially in a nonacademic satellite facility: Not knowing how much the student does or does not know and usually assuming that he knows more than he actually does; without really asking first; or sometimes not seeming to really care. In this case, the seasoned nurses came to our rescue by kindly showed us how to scrub in and put on a surgical gown.

There is also another glaring deficiency in the tritely overused expression that in procedural medicine all you need to do is to: “See one, do one, then teach one.” I doubt that anyone would agree this axiom should apply to cardiac valve surgery.

Nor did it apply to the situation I found myself in when I had only assisted at several post delivery episiotomies, a procedure whereby the lacerated vagina and perineum is sewn back together after the baby rips it apart while coming through.

The vagina happens to be a very accommodating organ; as both birthing baby heads and “fisting “perverts have empirically discovered; but like everything in life there are always certain limits.

The OB Resident, having been completely exhausted by his duties, delivered a baby, then turned to me and announced as he took off his gloves:

  • Hey, I’m really tired. I’m going to bed. You sew her up.

This was the same resident who had previously taught me to carefully suture so as not to hook the bladder or the bowel and to pay extra special attention to the final purse string cinching by making sure that the vaginal opening at the perineum was nice and tight.

  • That’s what I call ‘the husband stitch’ and there are probably a lot of grateful men out there who don’t even know why their sexual satis-friction is all because of me.

Yes, unless the husband happens to be thirteen-inch-Long John Holmes and it won’t ever fit in there again. Or if so, maybe it just gets stuck.

So, there I was, expected on my own limited experience, to sew up a lacerated vagina as well as to correctly place the husband stitch and make this mother neo-virginal again. I had a serious crisis of confidence and whimpered softly to the vacating Resident:

  • Please come back. I’ll do anything for you. I’ll even send a copy of your personally autographed photo to all the happy husbands so you won’t have to live in un-adored anonymity anymore.

No such luck. Yet once again the senior nurses talked me through it, although to this day I have no clue as to where the stitches really went, or how tight the final cinching turned out. I had nightmares for weeks about a crooked vagina, a loose vagina, an ultra-tight vagina or a nasty vaginal-rectal fistula which would be followed by having to deal with a vendetta from a very ungrateful husband; not to mention litigation.

To back up a bit, this OB rotation was organized into weekly segments that included:

  1. Prenatal clinic
  2. Postnatal clinic
  3. Routine check up clinic
  4. One of many potential routine problems clinic
  5. VD clinic
  6. Labor and Delivery
  7. Obstetrical night call

Also, no matter what weekly clinic we were assigned to, we had to be on standby call every third night for labor and delivery. So, although there are probably some perverts out there who might think that unlimited access to peering at female gonads could be fun, better think again.

This activity is cold, indifferently clinical and involves handling women who would rather be doing anything else than have a frigid slime covered speculum pushed up their crotches, or an equally slimy finger stuck up their rectum; and sometimes simultaneously. They do not like it and they do not like you for doing it.

Next, not everyone looks like a Playboy model, as well as the fact that one is required to examine ages that range from nine to ninety, including all builds, shapes, sizes or body types with levels of hygiene that range from the immaculate to the totally neglected.

There is nothing worse than examining a three-hundred-pound woman who does not believe in soap and water, or who may have a yet unidentified species of fungus growing within the folds of her breasts or her labia.

Then, although the “Routine Check Up” clinic was relatively innocuous, there was always the dread of discovering the unknown surprising disease entities lurking in the cracks at the “I Think I Have a Problem” clinic: Yeast, gonorrhea, herpes, chlamydia, syphilis, vaginitis, urethritis, cystitis, trichinosis, and chondyloma. It was a great day indeed if the symptoms were only related to a benign ovarian cyst.

Women of all ages, from all walks of life; from rich to poor; ugly to beautiful, anorectic to obese, hygienic to unbathed with a wide assortment of troubles; with the best part of it all sometimes having to tell the parent of a minor that her good little supposedly virginal daughter had recently been up to quite a bit less than good and wasn’t really virginal anymore. Or worse: knocked up.

Of course, this was the era before HIV and because condoms were not necessarily all the rage, VD and STDs were more a nuisance than a death sentence. But it was still at a time when teen-age sex was quite verboten or severely stigmatized; especially so in Providence, Rhode Island which being a suburb of Vatican City, had no nightlife at all and in 1972 had little to offer a date but a front seat six pack followed by a back seat boogey.

It all became a female genital blur. Pretty pussy, ugly pussy, hairy pussy, shaved pussy, clean pussy, dirty pussy, messy pussy, sweet pussy, sour pussy, pregnant pussy, laboring pussy, lacerated pussy; and then various combinations or permutations of adding to that: big lips, small lips, large clits, little clits, and crotch zits. After the daily assembly line of “pussy galore” I would fall off to sleep at night with visions of pussy-plums dancing in my head.

Now top that off with taking care of women in every stage of pregnancy, finally culminating in the counter-joy of having to listen for hours on end to a large open labor ward housing a dozen or so women who all raise their voices in completely non-syncopated timing as they scream out the raucous chorus of the opera known as the: “The Throes of Parturition.”

And although a baby’s birth can never be timed for perfect convenience, some of the attending Obstetricians would add an alcohol drip to the usual regimen to time the delivery by more propitiously delaying its occurrence from the middle of the night toward a reasonable hour the next day.

This made the operatic chorus all the more interesting for the added feature of having a room full of inebriated laboring women and the interesting quirky things the booze did to their personalities. Some of them became quite psychotic and had to be restrained. It was atavistically primeval.

Then on to the delivery room, where although a rapturous joy for the parents, I found nothing joyful at all about the gush of pee, blood, baby, baby shit, mommy shit, amniotic fluid, placenta; and then secondarily the effect that gallons of all of these body fluids did to the only pair of shoes I owned.

It got so bad that I cancelled a weekend tryst with the woman I was dating at the time by making up some lame excuse, and then told her I would call her back in a few days. She did not take it well, then made oblique references to the fact that I was probably cheating on her with some nurse or nursing student in Providence, while she was alone, lonely, and horny back in Boston. I could not at all get through to her that worse than that; I simply had no desire whatsoever to see her naked, much less do anything else with her body parts or any woman’s body parts for that matter. Like writer’s block, I had developed a serious case of libido block that could be best characterized as nothing more than a bad case of female genitalia burnout.

She said:

  • Sure. I’d believe that just as much as I’d believe you didn’t want me anymore because you and that stupid roommate of yours were gay. I knew that anyway. Goodbye and good luck.

No chance of cheating anyway, as even the female nursing students had also evoked as much negative libidinous attraction as alien body snatchers that came out of vegetable pods. Add to that the fact that their recreational drug of choice at the time was Quaaludes (“Sopors”), which did not exactly make them a boat-load of fun at social gatherings. There is nothing like going to a party where everyone passes out, and truthfully speaking, date rape with a limp dish rag was not my cup of tea.

Yes, lets all get to the point where not only do we not know what we did, or who we did it with, but also do not remember if we even liked it. My preference for pussy was to have it alert, awake and even faking interest if necessary; but not semi-comatose and diffidently snoring.

Despite my girlfriend’s innuendos, it was not even a case of latent homosexuality because I knew I did not harbor the slightest hint of homosexual tendencies. I honestly and truly liked pussy! It was just a simple case of overexposure resulting in a negative feedback loop. Too much of what otherwise might have been a good thing, so to speak because it just wasn’t the Hugh Heffner presentation.

After the OB experience in Providence, I also knew that I would never look at sex and the human reproductive cycle in the same way; and that if I ever chose the OB-GYN discipline as my medical vocation, I would probably want to eventually go ahead and just have myself neutered.

Pussy Galore: No problem for Agent 007

Photo: clothing.cafepress.com

 

Medical School Third and Fourth Years: Clinical Rotations

Clinical Rotations

The third and fourth years of Medical School are entirely clinical involving monthly rotations through various subspecialties. The exposures focus on medicine and surgery, including certain required subjects as well as some leeway for choosing electives. This is designed to expose the student, especially in the third year to a wide variety of basic elements, while forcing him/her in the fourth year to begin thinking about making a final decision on choosing an Internship. Although there are several choices, the critical choice boils down to whether someone wants to be a thinker or a cutter. It also exposes the student to certain disciplines he will then automatically weed out potential future careers.

For example, when I had to spend thirty days on an in-patient psychiatric ward, I knew I would never be able to make a career out of the abstract qualitative issues associated with the mysteries of the scrambled brain. These were hard core cases, such a as incurable Schizophrenia and sometimes it was difficult to tell the inmates from the screwy attendants taking care of them. In this case, I chose to fly over the Cuckoo’s nest. 

On the Neurology Service, I knew that spending a career dealing with irreversible neurologic damage or chronic demyelinating diseases would make me suicidally depressed and that I would end up in the psychiatric ward anyway; without a real stroke, but equally incapacitated.

Hematology seemed too abstruse, and because it paired with Oncology was even more depressing than Neurology. I had a great deal of difficulty dealing with the depressing diagnosis of “cancer” knowing instinctively I would never be able to tell anyone they had it. The: “C” word. Or worse yet: the “Big C.” A bad one. Already spread everywhere. Metastatic and incurable.

Endocrinology seemed the most logical as it dealt with clearly defined human positive or negative feedback loops; but I found its scope too limiting. All glands. Not much fun. It would be like spending a lifetime adjusting a thermostat.

Pathology was a turn off after seeing only one autopsy. Bodies smell horrible because they have a sickeningly sweet odor when refrigerated. They also have a spooky color: Clay blue-grey.

Then when not cutting little specimens into pieces after extracting them from a corpse, the rest of it is spent squinting through a microscope to define well after it was too late to be of real assistance, what really happened to the person in question.

There is little satisfaction in telling the corpses’ doctor:

  • Hey, nice going. You were right about what he had but he died anyway.

Or

  • Hey, nice try but you royally fucked this one up. You had absolutely no clue whatsoever as to what it was that finally killed him.

Nephrology was too wrapped up in acid-base metabolism because I was never very good with ions and pHs. Beside that, if you look at the kidneys sideways, they curl up and die. This introduced the added negative feature of having to take care of dialysis patients; which for some reason offered no appeal. I think it was the machines, the constant smell of uremia, and the fact that all the patients are puffed up on enough steroids to make them look like pumpkins.

Pulmonary was boring. The lung. Oxygen: in. Carbon Dioxide: out. That’s what green plants do, only the opposite. Or maybe get a tumor or a blood clot. Maybe stiffen up. Mostly get infected or destroyed by chronic nicotine use.

Gastroenterology raised the exciting specter of spending a lifetime looking up peoples’ butt holes, and scoping other dirty orifices, or as necessary in Urology, if dealing with diseases of the penis, urethra, and bladder, offering the great opportunity to delve into some other equally enthralling orifices.

  • Yes. The bad news is that your prostate is larger than a grapefruit. But the good news is that it is still smaller than a watermelon. And the indifferent news is that none of that has anything at all to do with your erectile dysfunction.

Or

  • Oh, kidney stones. Take this little plastic cup home with you; filter every drop of your piss through a kitchen strainer, then save anything that looks remotely like a small meteorite, put it in the cup, and bring it back to me. That is, if the excruciating pain even allows you to get off the floor to go and pee in the first place.

Or

  • Sorry madam. But after six vaginal deliveries, bladder prolapse is an anticipated end game.

Pediatrics was out of the question simply because it broke my heart to see sick children; especially in the academic environment of seeing them referred for the worst childhood diseases; some of which were hopeless or incurable. There is nothing worse than having to deal with a child on chemotherapy or having handle those who suffer the world’s worst congenital deformities or inborn errors of metabolism.

Surgery was an extremely attractive option to the point I became enamored of going into plastic surgery. But after standing on my feet for long complicated general surgery or vascular cases and after seeing the gross disfigurations or severe burns that the plastic surgeons dealt with, I soon abandoned that plan. Who knew at that time what lay ahead for the lucrative side of plastic surgery or that that soon a physician could make millions by adding or modifying lips, tits, cheeks, chins, noses and buns or by sucking out the unwanted fat pads and dough wads from the cadres of obese overeating Americans who were too lazy to want anything other than an instant cosmetic fix. Then, there is the issue of being dissatisfied with your genetics. The only thing I ever really wanted to know about certain cosmetic repairs, is how much obligatory disclosure there might be on the part of the prospective spouse to tell his or her fiancé about whatever anatomical part was fixed before the prospective child was born with the same deficiency.

  • Honey. This baby has no chin. Are you sure it’s really mine?

Michael had a hand in talking me out of surgery because he said it was less than cerebral. He said if a monkey could be trained to be an astronaut, then given enough time any Simian could even learn to operate. Being too smart to be a surgeon, he suggested I should stick with something in the domain of Internal Medicine. Fate may have intervened, as when I became older my eyes got worse, I needed bifocals and developed a cervical disc related neuropathy that reduced my fine hand-finger coordination.

Nobody can put a great deal of faith or trust in a surgeon who can’t see, feel, or properly tie and cut knots. Or worse, one who develops tremors.

Not wanting to be bogged down in generalities, and with diminishing choices, I gradually became enamored of Cardiology. The heart is not only complicated in that functioning primarily as a pump; it also has numerous other highly technical and interacting components to deal with: muscle function, chambers, pipes, valves, as well as an electrical system.It was a veritable gold mine for the intellect as well as having antiquity’s mystical aura as being the organ which is the repository of the soul. Most of the body’s other organs also think highly of the heart’s central importance, come to terms with having to depend upon it; and if possible avoid getting it too upset.

Later on in my career, however, I never ceased to marvel as to how many people could care less about their hearts or souls and more about what was in their wallets, or as equally superficial, who were especially fixated on how they looked. Over the several decades after the great depression America became a society obsessed with youth and a quest for materialistic wealth. It was a quest that left a spiritual vacuum in the souls of many of the seekers and the perpetual impossible dream of turning back the clock on the natural aging process. This obsession has progressively manifested itself in the worship of empty headed, uneducated teenaged Hollywood icons, their wastrel lifestyles and the materialistic trappings that goes with their territory or Hubris.

In this eternal quest for youth and prestige small fortunes are spent on plastic surgery, fraudulent cosmetic products, ineffective diet and weight loss plans, spas, automobiles, houses, clothes, and jewelry while at the same time having no attention paid to physical and/or spiritual health. I have had patients who are driving Bentley or Mercedes Benz automobiles, then complain about the co-pay on an office visit dedicated to the ideal management of their cholesterol, or bitch about the cost of a diagnostic exercise test designed to see if their arteries are seriously plugged. Yet these are the same people who will think nothing of spending fourteen hundred dollars to tune up the carbureting heart of their fancy car.

One of the more extreme absurdities was the three-hundred-pound cigarette smoking diabetic who came in for a medical preoperative clearance to get his droopy eyelids cosmetically repaired. My diagnostic assessment was: What’s the point?

I have also seen people who have had breast implants, face lifts, nips, tucks, putty fills, hair transplants and wrinkles botoxed to oblivion, who also never once in their lives paid any attention to their blood lipids, only to then present to an emergency room in the throes of a massive heart attack. In the Cardiology trade, we label this diagnosis: Drop Dead Gorgeous.

What a very different philosophy from that of the Native American who venerated: age over youth, the counsel, advice, and historical perspectives afforded by the village sage, as well as the desire to live in harmony with his environment; taking only what he needed while leaving the rest for someone else. At a time when almost no one lived past forty, wrinkles were a sign of prestige. The old wizened shaman became a societal asset as well as a valuable cultural resource for helping the tribe to avoid potentially fatal pitfalls or for guiding young people to productively safe futures.

In our society, the tail of naïve youth wags the dog of lifetime experience as we discard our surfeit of wrinkled up old people like they were second hand clothes earmarked for the Goodwill Industry recycle bin.

 

 

Make be beautiful,

Make me thin,

Make me look like her or him.

Make me young,

Make me hot,

Make me something I am not.

 

 

   Photo source  www.impawards.com/1999/drop_dead_gorgeous.html

 

Medical School: Physical Diagnosis

Humility

The teaching system is structured in such a way that it eases a medical student into the process of doing a patient’s history and physical examination. The student then, although not expected to be brilliant in deducing diagnoses, is at least expected to begin to think about at least one diagnosis that can be isolated to a single major organ system.

We were first required to start with blindfolded examinations of each other; then write down what we felt to be significant findings, only then to suffer the double humiliation of the proctor not only pointing out everything we had missed, but also pointing out all our own personal physical flaws.

The first humiliation, for example, was that we all made gross assumptions that skipped important details. For example, most of the medical students did not even first state the gender of the person. This was followed by our omissions of simple facts such as the fellow student we had just examined might be wearing glasses, had a beard, or wore earrings. All of this underscored a basic tenet in medicine that one should never overlook the obvious and also that one should never assume anything.

When I began my first presentation of an examination of a fellow student, I was stopped after the first sentence.

  • So, first of all, was the person a male or a female? Even blindfolded you can tell if a person has breasts, or buttocks, or a penis or not.
  • Well, yes but….
  • Then why didn’t you first say that the person you were examining was a female? There are many important medical issues that depend entirely upon gender you know.
  • Uh, yes but…I didn’t think I should…I mean she’s a fellow student. Wouldn’t she object to being groped?
  • But nothing and grope nothing. This is an objective clinical exercise, not a course in sexual harassment. So just because you might be embarrassed about this means you can sit there and tell me that someday you might miss a breast cancer? The medical examination of the breast is entirely clinical and is not the equivalent of fondling. At least it had better not be.

When I told my mother about this experience she shrugged it off as being nothing that should bother me too much. She trivialized it as she reminded me that her near-sighted brother Bobby had also learned his physical anatomy by the Braille method, albeit at night in the back seat of a car, yet never once seemed to have any problems with gender identification. She said:

  • Forget the tits. That’s how your Uncle Bobby discovered that women have three holes.

The second humiliation came with the fact that all of us then had our own physical imperfections glaringly pointed out to us; dermal scars, a murmur, a curved spine, acne, a sloped shoulder, a missing pulse, an old fracture, crooked teeth, glasses, or braces; you name it. The worst part about it was that we were all only about 21 years old. By the time the proctor was through with me I thought I was should just cash it in and apply for the job of being a cadaver for the class of 1974.

It was the beginning of a lifetime dedicated to thinking morbidly of even the slightest personal ailment, a thought that unfortunately played back into my mother’s perverse tendency to always look for the worst in people. Noticing all the things wrong with someone or painting worst-case scenarios for diagnostic outcomes does not make for an optimistic outlook on life. By the same token, it does also constantly remind one that life is indeed very short. This thinking can either work beneficially by making one always try to live in the moment or it can backfire by incubating a ridiculous urge to live life to extremes.

In my case, it did not take more than a few clinical deathbeds prompts to instill a desire to do everything I wanted while I was still young. I did, in fact, try more than few risky ventures or at least  stupidly attempting some of them twice; like scuba diving the 130-foot-deep Maracaibo reef in Cozumel with no prior experience, being swept out to sea into the fishing lanes while scuba diving an ocean inlet on an outgoing tide, sailing and tipping over a Hobie Cat in a full October gale without a wet suit in 60-degree water, taking psychedelic drugs; smoking hashish, trying cocaine and attempting to snow ski…for the first time. And then when I became a House Officer, attempting to screw every nurse in sight, without condoms. Damn the V.D. Full speed ahead and fire all the torpedoes.

The second phase of Physical Diagnosis comes in learning to logically format and to then scribe all the elements of a comprehensive approach to diagnosis; Age, Gender identification, Vocation (or not), Chief complaint, Past Significant Medical History, History of Present Illness, List of Medications, Social History, Family History, Surgical History, Allergies, Review of Systems, Physical Examination, Differential Diagnosis, Plan for Diagnostic Testing, and Therapy.

Then one must write a set of Orders to be carried out the actual implementation of the Diagnostic preposition and Care Plan.

At the end of this process I realized I had watched too many doctor shows on television because this was nothing at all like the relatively easy, carefree approach to medicine enjoyed by the likes of Dr. Kildare. It was also not even close to the equally irrelevant focus the actors had on each other, but not on their patients, in the complicated soap opera lives enjoyed by the likes of the cast on General Hospital. These people spent all their time perusing sex when they weren’t screwing over all their other friends or relatives physically, emotionally or financially; but somehow never seemed to get down to the real business at hand: like taking vital signs and emptying bedpans.

  • Doctor. Your patient in Room 3 has a fever.
  • What was the exact temperature, nurse?
  • I don’t know doctor. But not as high as the hots I have for you.

Nothing at all like that, this new aspect of Medical School, being very difficult, was the first time I doubted my vocation. Unfortunately, it would only be the first of many self-doubting or soul-searching episodes as little did I know how bad things could ultimately be or how humiliating things were about to become.

First, when doing any clinical rotations, the student is expected to wear a shirt and tie, put on a short white jacket that designates the inferior rank of neophyte, as opposed to the long white coat that comes only when rising to the rank of an Attending Physician. One also then must carry around about twenty pounds of ancillary tools in a little black bag, or in the coat pockets of the white jacket, including a stethoscope, ophthalmoscope, reflex hammers, tuning forks, note pads, pens, calipers, EKG rulers and of course the Little Red Book.

I felt like a G.I. going off to battle or as uncomfortable as I was at any time I ever had to put on a tuxedo.

If I had ever thought a Cub Scout uniform was bad, having to dress like a cross between a Bus Boy and a Good Humor Man was nauseatingly stilted and made me feel as though I would be infinitely better off instead standing stiff legged still in front of a drill Sergeant. with a little round wooden dowel shoved up my rear end. Cinch tied like a wild bucking bronco under his first heavy saddle; and saddened by the reality of having to ditch my soft comfortable hippie togs for a suit that made me look like a fumigator, off I trudged to the hallowed halls of the hospital wards.

My first real test in clinical medicine was being rotated to a hospital to examine a patient with liver failure, after which I wrote up the findings per protocol and then presented the case to a proctor in front of a group of five other students. I thought I had done a pretty good job. The proctor however, did not. My paper was a monument to how much red ink can actually be held in a ballpoint cartridge and how close a graded paper can come to being a Jackson Pollock masterpiece. I had missed just about everything pertinent: spider angiomas, everted navel, ascitic fluid, liver size in centimeters, rhinophyma, etc.

Then to make matters worse, when I attempted a verbal defense in front of my fellow students, the proctor jumped down my throat like that drill Sergeant would have done anyway, as he proceeded to rip me a brand-new asshole. If I ever did have that little plug up my butt, this was when it would have hit the ground with a hollow empty thud as my knees turned to jelly and sphincter tone suddenly failed.

He said:

  • Do you know who I am? Do you know who I am? You don’t even know who I am, do you? Well let me tell you, then. I am Dr. Frank Iber, and I am a full Professor of Medicine at Tufts University Medical School. So, when I speak or when I critique; you will remain silent and do nothing but listen and learn. Your examination of that patient was a disgraceful example of incompetence. As such, we shall now proceed to go back to show both you and your fellow students how superficially incompetent your evaluation really was. And when we are all done with that, you will take your paper back home, then you will re-write it, after which you will also memorize the section in DeGowan on all the signs of liver disease for a verbal quiz, which I will administer at my personal discretion.

And so, we did. And so, I did. And so, he did.Bad enough I got the proctor with the bad temper and the inflated ego, but he also happened to be a national expert in Gastrointestinal Diseases who also wrote the textbook section on “The Liver.” I guess then this rotation was both the bait and the trap, eh?

It was stupid of me to have been mollified into assuming everyone was like the jocular, philosophical proctor who taught us all to be HIPPAYs. In retrospect, I guess that professor, with his pleasant affect and his all- forgiving non-offensive mentoring personality must have been a Psychiatrist.

To make matters worse, I really did not know who Dr. Iber was until I looked him up in the school directory, and thus learned a painful lesson about the mysterious hierarchies of the world of Medicine. Some people are, in fact, more important than others and obviously not ashamed to let you know it. Doing background research ahead of time, if nothing else, could have at least ensured me a few ingratiating brownie points.

I was hurt, humiliated, embarrassed, demoralized, angry, and ready to quit school. However, Michael propped up my badly bruised ego, having encouraged me by the reassurance that everyone goes through it, and that after the first time it can only get better.

It was just another game that had its own set of rules, with a peculiar set of standards that had to be learned; such as the correct timing for self effacing groveling or the tossing of dust on and over ones bowed, scraping head. Once you know the rules, it becomes infinitely easier to play the game. I was not so sure, but then again, the alternative would have been meeting a real U.S. Army Drill Sergeant and having to trade in my Little Red Book for a Big Brown Duffle Bag along with a one-way ticket to Southeast Asia.

It did take a while, but I got over it and I did improve.

My roommate Michael. said it was just like learning to drive. Scary at first, and you might hopefully have only a few minor accidents, or get a few tickets, but after you get the hang of it and learn to play the game, it’s just as easy as learning anything else. But to me the length and breadth of medical knowledge seemed as insurmountable as a successful climb to the peak of Mount Everest; even with the added benefit of having some extra oxygen canisters on board.

Michael also helped with the proactive part of things by proceeding thereafter to point out the best clinical rotations to take in the third year of school as well as the pitfalls of each one, the peculiarities of the proctors, the nice ones, the mean-spirited ones along with all the important signs, symptoms, facts, or trick questions to anticipate as each one came along.

When you come to think of it, the scary thing is that in just over twenty-two months of clinical training, the Medical student goes from the floundering, blubbering naive state I found myself under the hawkish scrutiny of Dr. Iber, to becoming an Intern in a hospital where he or she has the responsibility of making decisions that can mean the difference between life or death. Because Internships begin in the summer, there is an insider’s facetious mantra in all the academic medical training programs that is unknown and secreted from the general public..

            “Just don’t ever get sick in July”

The failsafe here is that the rigid pecking order ensures constant supervision at every level. The Attending supervises the Fellows and the Residents; then the Fellows and the Residents supervise the Interns. But Interns will always at times find themselves in situations in which the decision to be made must be expeditious and solely his own responsibility. That is when the “Yell for help” becomes the credo of not only the real neophyte; but also of everyone else in the teaching hierarchy.

Then the more he is exposed to disease, dilemmas and disasters, the better trained the physician becomes as he slowly rises to the top of the medical food chain and finally gets to wear that long white coat: Full Attending Physician or Professor of Medicine.

One thing I came to learn for sure was that there is no shame in admitting “I just don’t know” because in Medicine when pride supersedes humility the unintended consequences might be permanent harm or even death. No one in medicine knows everything. But everyone does know something. And just as is it at the highest levels of any professional performance, there is always someone who is better at something than anyone else is. Even Tiger Woods could lose and eventually every icon becomes old, tarnished or simply out of date. Just ask Jack Nicklaus what he thinks about that.

At least I got the drift that when finally getting to the top of this academic world, I could still reserve the right to be somewhat nice or pleasant about it; and also learned that compassionate constructive criticism was probably a better way to teach a subordinate than abject self-promoting narcissism.

 

 

Ask and it shall be given unto you

Seek and you shall find

There is assurance of salvation

And blessings when you knock

(The Bible. Hebrews 11:6)

 

 

     Jesus:  http://www.carmelwagga.org.au