 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.
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My First 36 Hour Day
 by Sharon Farber 
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.).
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 |
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