In the 15 years we've lived in Chattanooga, we've unfortunately found too many reasons to be down on the city -- there's a lot of unrealized potential here, but the local power brokers seem to be content in keeping the area clinging to its historical past instead of seeking employers for the quality graduates the two local colleges are turning out. But just when you're feeling lousiest and ready to totally give up hope on the area, something pleasant and totally unexpected happens -- last December we discovered that Sharon Farber, M.D. (and SFWA member) had moved here. Now, neurology and writing seem like mutually exclusive occupations due to time demands. We still don't know when she finds time to write, but we're glad she was able to find some time in her 20-hour days to write about her first 36-hour day.
- - - - - - - -
My First 36 Hour Day

by Sharon Farber

illo by Jeanne Gomoll After learning that I would begin my third year of medical school on the neurology rotation at St. Louis City Hospital, I thought it prudent to learn the actual location of that hospital. Thus, the day before the semester began, a very good friend (who was to commit suicide only two years later) volunteered to drive me down there.

We exited the freeway and started down Lafayette (which is pronounced with three equally accented syllables, not "Luh-fett" as it is in Chattanooga). As we drove past a row of what looked like abandoned slums, in what may be most charitably described as a blighted neighborhood, smoke began to pour from a window.

My friend continued to the end of the block. "There's the hospital," she said, with a bored wave of her hand. "There's the neuro wing; there's where you can park so your battery won't get stolen." She swung a u-turn and headed back to the freeway.

As we again passed the derelict building, flames were leaping out the window, and we could hear sirens. I wasn't quite sure what it meant, but it seemed to be an omen of some kind...

The next morning I showed up bright and early, wearing a brand new short white coat, and carrying a black bag full of undented medical instruments. I had just spent two years cramming my mind with all manner of important and trivial facts, with no way yet of deciding which was which. I knew anatomy, pharmacology, biochemistry, and pathology. I had not the foggiest notion how to draw blood, start an IV, write a prescription, diagnose an illness, convince a nurse that I was only a subtotal idiot, or discern if a patient was just trying to get drugs.

In effect, I'd been dropped into combat without basic training...

The neurology / neurosurgery intensive care unit was located in the most ancient part of the hospital. It was considered an ICU because it had on-duty nurses, a couple of heart monitors, the capacity to handle respirators, and a window air conditioner. It was laughably primitive, but had this virtue: by starting my clinical training at City, I developed such low standards that every hospital I've been in since has seemed like Paradise.

The team was already rounding when I and the other third-year presented ourselves. We were one student short, and the residents immediately began to squabble over us. In a hospital where there was one transporter, no dispatch, few nurses, and few orderlies, medical students were prized possessions.

The resident with first dibs chose the other student. Here it was, my first day on the wards, and I already felt like I was back in grammar school, being picked last for kickball. I realize now that it was nothing personal; he was a big mean-looking guy, which meant it was safe to send him out at night to bring back food. My team had to make do with munchies from the machines, when those were working or when we could find enough change. (I later had some consolation when an intern nicknamed my fellow student The Robot, and told me that I was more fun.)

The important stuff over, we turned our attention to the patients. Three of the six in the ICU beds were occupied by gunshot wounds -- two victims of a local drug war and a young man who had been inefficient in his suicide attempt (it took him almost a day to die). We looked at his CAT scan, with its linear track of bone and metal fragments through a brain destroyed by the shock wave of the bullet.

"Like jello, you know?" said the chief resident. I did not know that he had only one month to go in his training, and felt like anyone about to get sprung after eight years in prison. I thought he was the fount of all wisdom, and a man to be scrupulously emulated. (One of the drug war veterans was contemplating singing to the police, and the chief was convinced that the local hoodlums were planning to spray the ICU with bullets. He used to duck every time the door opened.)

The chief looked at the CAT scan, he looked at the interns and residents (who were also marking time, pending promotion into higher planes of existence), then turned his attention upon the lowly students.

"See the exit? By the time you finish this rotation, you should be able to tell the difference between a .22 and a .38 by the entrance wound."

The Robot and I exchanged slightly worried looks.

The chief then proceeded to dig into his pocket and pull out some bullets.

"Now, this is a .22," he began with enthusiasm. "Low velocity, low impact. If you really want to cause some damage, you need something steel-jacketed, like this. And here's a .38 with a dum-dum carved on the head so it'll explode..."

Fifteen minutes into my first day as a student doctor, I was beginning to realize that things were not quite as I'd expected.

After rounds, two things happened. The air conditioner in the doctors' conference room broke (never to be repaired), and I was assigned to follow a patient who lived in a car, drank a lot, and had the rigid form of Parkinson's Disease. As he was not yet frozen solid, I was unable to deduce that he had any trouble moving.

My patient's main complaints that day were that his gums were bleeding and his teeth were falling out. I immediately ran to my supervisor with the conclusion, "He's got scurvy."

The resident sighed, "Ask him how often he brushed his teeth."

I dutifully went back and relayed the question.

"Once a month," my patient replled.

With the bad luck that would plague me throughout my career, I was chosen to take call that first night. I later learned to a lways carry a toothbrush and scrubs and, when at City, my own soap and hand towel as well. And plenty of deodorant. The women's bathroom had no door, the shower had no curtain, and there was probably no water anyway. What with no showers, no air-conditioning, and ninety-plus weather, I actually found myself grateful for my dust allergy.

That night we saw what I later realized was the usual boring assortment of head trauma and alcohol withdrawal seizures.

The formal medical history and physical, as taught to second year medical students, includes an in-depth study of the current illness, a thorough listing of all previous medical or surgical problems of the patient and all his relatives, and then something called the Review of Systems, in which the eager student lists every possible symptom the patient could ever possibly experience, just to be sure nothing's missed. (For instance, here are some questions that we were told we must ask every single patient, on this randomly chosen subject: How often do your bowels move? Do you strain? Does it hurt? Can you control your bowels? Is the stool hard, soft, liquid, pellets, formed? Is your stool dark and tarry, bloody, or light tan? Does it float, or stick to the toilet?)

My first complete patient work-up had taken six hours, and I felt highly skillful to have pared it down to only two hours. I wondered how I'd ever manage to work up more than one patient in a day. Thus, I was pleased to finally be able to see how a real live doctor on the frontlines did a history.

"How much do you drink?" my resident asked, writing while he spoke. "When'd you stop? Why? You take any medicine? Any medicines make you sick? The History of Present Illness and Past Medical History over, he went to the Review of Systems.

"Hey!" he shouted, grabbing the patient by the lapels and shaking him back awake. " Your heart OK? How 'bout your lungs?" (I will skip the next morning, when I was given ten minutes warning that I had to present this patient to the professor. It was not the most humiliating experience of my entire life, but it seemed so at the time.)

illo by Jeanne Gomoll I spent the rest of the night watching my resident work. As I didn't know anything, the only way I could help was by taking samples to the lab. He showed me how to fill out the forms. If you didn't fill them out just right (including signing them in triplicate and stamping in two separate places), the lab techs would throw away your samples. An abandoned dumb-waiter shaft in the lab was later discovered to be full of old tubes of blood.

Every time I walked past the gunshot victim in ICU bed three, he would say, "Waitress, I want a tunafish sandwich."

Still being new and idealistic, I understood my responsibility was to go to the bedslde and try to orient the patient. "You're not in a restaurant, sir. You're in the neurology / neurosurgery intensive care unit of St. Louis City Hospital Number One, and I'm a medical student."

"I want a tunafish sandwich!"

After a few days, I hit upon the most practical response.

"I'm sorry, sir, this is not my table."

Either I looked like hell or the chief felt sorry for me, but he sent me home after only 32 hours. I managed to find my Dodge Turkey where I had left it. The car next to mine had the hood open; the battery had been stolen.

I felt it was an omen of some kind, but wasn't quite sure what it meant...

- - - - -

NEXT: I get yelled at for finding a dead body.

All illustrations by Jeanne Gomoll

back to previous article forward to next article go to contents page