THE FIRST PATIENT

While revising some of my files I came across this post from 2011, made a few minor changes and decided to re-post it. 

It was an experience not to be forgotten.  We were in our third year and our small group was in a general medical clinic; we were to see patients, examine as necessary, and then report our findings and treatment plan to the medical resident or staff physician.  After all these years the specifics of the clinic are rather vague, but two things are still very clear to me.

It was hot and humid early September, and we were dressed per school requirements, shirt and tie plus the short white jacket that identified us as lowly students, recognized not only throughout the hospital but in the surrounding neighborhood.  I entered a small exam room (no air conditioning) and introduced myself to my patient, and elderly, rather wrinkled woman whose problem has been long gone from my memory.  What is not gone is the absolute, awful, knock you down, odor of her breath, enhanced no doubt by the heat and closeness of our quarters.  Unfortunately It was necessary for me to examine her throat, and when I approached her with tongue blade and flash light (trying hard to overcome basic physiology by only breathing out) she signaled me to pause for a moment while she removed a huge clove of garlic from her mouth which I swear was the size of a tangerine…Ok, maybe a walnut, but I can tell you this, even the most Italian of all Italians would have been done in by the dear ladies breath.  As for me, I did not get near a piece of garlic for days…Ok, maybe hours.

A LIFE IN MEDICINE -8- “KG"

The Mother of all years

Dr. Kenneth Goodner, the chair of the Microbiology Department, was affectionately referred to as KG (NEVER to his face!) As freshmen all we heard from the sophomores in the fraternity house was KG did this, KG did that, KG said this: KG stories were notorious. He was totally off the wall and unpredictable, every medical students worse nightmare. So, it was with tense anticipation that we entered Dr. Goodner"s world of microbiology to learn all about the life and habits of “germs”, and how to identify them by looking and by testing.

A KG classic: We are given a slide hosting an unknown microbe. The slide is treated with a “fixative” that is dropped on the unknown (marked with a check on the end of the slide), heated briefly over a flame, and examined under a microscope. On more than one occasion the slide is marked on the wrong side, so the unsuspecting student fixes nothing and then proceeded to char the unknown specimen with the flame. The lesson? Do not take anything for granted!

The class would break down into small groups for conferences and oral testing. My first question from KG was, “who has the most influence on public opinion? This is in a microbiology class!!! I answered, “the press”, and was told no, it was Arthur Godfrey, as he made a mark in his little book. Or, he would as a true or false question, and if the first student’s answer was wrong, he would as the next student the same question.

But I must admit, KG provided some much needed levity in a demanding semester. And he did leave us with one bit of wisdom that I have never forgotten. He advised that everyone should become an authority on at least one subject, no matter how trivial, and as the years passed I came to appreciate that more and more. (To support this admonition KG invited every student to participate in the annual microbiology hobby show, where we all displayed the objects of our passionate interests, and you can be sure that we all had one.)

A LIFE IN MEDICINE -7 - laying on of hands

Prostate exam! Me!! NO WAY!!

At some point in this mother of all years we were taught the fine art of the physical examination. This was accomplished by dividing the class into small groups that met separately. The female students were discretely assigned to their own group, after all, this was 1962. Doing our very best to look cool and professional, we fumbled with otoscopes, stethoscopes, and hammers as we made our way over each others body. We practiced on ourselves before we were turned loose on some unsuspecting patient. I looked into my partner’s ears, eyes, nose, and throat. I felt, or at least tried to feel cervical and axillary lymph nodes, and thyroid gland, and of course he reciprocated. We thumped each others chest and palpated abdomens, doing our best to outline the liver and feel the spleen. As far as the genitalia were concerned, I don’t know if we skipped that or if I’m just repressing a bad memory. The rectal exam? That’s another story. Our preceptor asked for a volunteer on which he could demonstrate the technique, (was he serious!?!?) After a period of uncomfortable silence one of our group, who shall remain nameless, reluctantly stepped forward, and before we knew it, he was on the exam table in the knee-chest position with his bare butt up there for all to see. Like a trooper, he allowed the preceptor and each of us to perform the appointed task. The first prostate I ever felt belong to my brave classmate. I often wonder what would have happened if no one volunteered.

We mastered the very basics, the finer points of the physical exam would have to wait for our 4-6 week rotations in the specialty clinics next year.

A LIFE IN MEDICINE -6- the apartment

To understand the apartment it is necessary to know that it existed to serve one simple purpose. It was a place where Gene and I could study, sleep (when possible), and occasionally eat. That’s it! In our entire year there we had one “social occasion”, and that consisted of a few classmates and student nurses, and as I recall, it was very subdued gathering. The most exciting moment was when my girlfriend called me to say hello and one of the student nurses answered the phone.

What little cooking we did consisted of whatever frozen delights my mother provided, plus generous amounts of Dinty Moore stew, a very faithful staple.

We were not especially neat, and house cleaning was not a very high priority for either of us. As a result considerable dust collected throughout the place in the course of the year. But we did wash dishes and managed to keep critters out of the apartment (at least that we saw). Neither of us had a desk. Studying consisted of reading text books, notes, more books, and more notes, and then repeating the process indefinitely. To accomplish this, we each had a large, well used and previously owned easy chair with accompanying side table to hold books, notes, ashtrays (we both smoked so there was an added environmental element in addition to the dust. Did I mention the dust?) and coffee cups. The chairs faced each other from opposite corners of the living room.

I don’t recall having sheets for the beds. My sleep wear for the entire year consisted of scrubs and a single sweatshirt. The daily dress code consisted of slacks, oxford shirts, tie, (in those days, narrow), and a sport coat. We scoffed at overcoats, so the walk to the college was much brisker during the winter months.

Burned into my memory are the all nighters we pulled for our final exams in the first and second semesters of that year. The year was 1962, before the 60’s that everyone remembers, and the drug culture it brought. So it was easy for me to obtain Dexedrine from a pharmacist friend (it was not controlled then like it is now). We would start studying in the early evening, take our pill around 11 PM, and work through the night fortified by coffee and cigarettes. After taking the morning exams we would crash all day and start all over in the evening. We did this for 3-4 nights at the end of each semester. After the last all nighter that spring I promised myself I would never do that again..and I haven’t.

If I close my eyes, I can see Gene sitting in his red chair, almost obscured by clouds of dust and smoke, broken intermittently by his arm reaching out for the cup of thick, muddy coffee that was always there.

A LIFE IN MEDICINE -5- the second year

I'm gonna be a doctor!

Seasoned by the first year, my classmates and I were prepared for the avalanche of material we were expected to assimilate during this overwhelming year. This was undoubtedly the most demanding of the four years because of the voluminous amount of material which included: pathology, hematology, pharmacology, laboratory medicine, and microbiology. Like the first year, we were kept busy all day every day with labs and lectures. All of this was rendered palatable by one small course inserted in the midst of everything else, we were taught the fundamentals of the physical examination where we were to use, for the first time, the symbol of our trade, the stethoscope.

There is a lot to remember about this most memorable of the four years at Jefferson, the first of which is the apartment I shared with Gene Doo. We decided to move out of the fraternity house and found the apartment at the end of year one. While Gene returned to his home in Honolulu for the summer, I moved into the apartment and made it a “home” for us. I spent the summer working in one of the ENT labs being paid for doing basically nothing. As I recall I wasn’t paid much. Our apartment was about two blocks from the fraternity house so we could easily continue to get our meals there. It wason E. Pine St. in what was to become a very fashionable neighborhood in Philadelphia’s Society Hill. But in 1962 Society Hill existed only in the minds of the city planners, and rents were still affordable. It was on the second floor, and consisted of a kitchen, bath living room and 2 small bedrooms. Now, almost 50 years later, I remember little of our day to day life in that dusty abode, but certain memories persist, fodder for my next post.