Tales from the Emergency Room (9 page)

Important People

My training hospital was situated on the west side of Manhattan near Columbus Circle.

Motorcades were frequent in the vicinity. On a cold evening on my way back from supper at a nearby restaurant I stopped to watch JFK’s motorcade pass the hospital on 58
th
Street. There he was as frequently noted in the press waving to everyone while wearing only his business suit. Given what we know now about his general health, one wonders.

Another time, a little farther east toward mid-town Manhattan, I was delighted to watch the Pope ride by on his way to yet another religious gathering I suppose.

On October 4, 1965, my wife and I were privileged to be at Yankee Stadium to hear Pope Paul VI celebrate Mass. We were communicants of St. John the Evangelist parish in White Plains, NY and had recently increased our giving to $1.00 each week from 25 cents. (As a medical resident I was earning about 26 cents an hour.) Our contribution increase had nothing to do with getting tickets to see the Pope. Ever fearless, my wife called the Monsignor Hartigan to see if any tickets for the Mass were still available. To our utter amazement (and amusement) the Monsignor had two tickets which we were able to use. Off we went very happy about our good fortune to an event we will never forget. Thank you Monsignor Hartigan where ever you are!

Another Important Person

Lincoln Center for the Performing Arts was built while I was in training. It was just a couple of blocks away from the hospital on Ninth Avenue. The House Staff at the hospital agreed to be doctors in attendance at performances at the Center. We were given tickets for the performances we were covering, two aisle seats in the last row. So, we were always quick to sign up to cover. Peggy would accompany me and we had great evenings at the theater that way, for free. One night Jackie Kennedy and entourage arrived while I was on duty. I remember her waving to the crowds as she took her center seat down front while facing the back of the theater. (The theater has no center aisle.) It was a medically uneventful evening but ever since I have had fun explaining how at one time I was Mrs. Kennedy’s doctor.

The most memorable job I did have at a performance was being called during intermission to the ladies’ room. This area seemed palatial and featured very loud, continuous flushing sounds. It seems that my “patient” had fallen off her very high stool at the mirror. Only her vanity was injured, thankfully. Never having been in such a place, the experience was an eye and ear opener for me.

Clutz

My best friend in training was Dick Clutz. He was working in surgery and eventually went on to have a very successful career in surgery in a well-known New England college town. (Once, he even treated my mother-in-law for an infected eye, a stye, while she and Peggy’s father were attending a college alumni reunion.) In training we did many things together. Not long after we had begun our internship (PGY1 for the more modern crowd) we went to pick up our paychecks. Even though we were earning about 26 cents an hour at the time, any money coming in was extremely important. At the pay teller’s window, I got my check with no trouble. However, the teller informed Dick that the “computer” refused to accept his name. So, no check. As we stood there we all went through any number of possible solutions until we found the right one. The paymaster machine would accept “Klutz”! Dick was able to get paid and he went by that spelling of his name thereafter, getting his check regularly much to everyone’s amusement. Dick is anything but a klutz! I have no idea how he was able to cash his checks but I suppose he just endorsed them with his new name.

As usual however, I did not have the last laugh. My father had recently died and so one day when Dick was with me, I was summoned to the medical staff office and presented with a large envelope from our family’s lawyer. It contained a copy of my father’s last will and testament. At the bottom it said, “The entire estate, ‘Hilara B. Hermance’.” The remainder, “William E. Hermance, MD”. We were sitting on the stairs outside the office at the time and I thought Dick would fall down the stairs laughing.

Santa Claus

I was asked by the nurses to be Santa Claus at their Christmas Party. They had a complete outfit for me, beard and all. I sounded a lot more like Dr. Hermance than Santa, but it was all in good fun. The main thing I remember about that episode was how hot I got in the costume. Now when I see a Santa I wonder just how uncomfortable he is in his red and white outfit.

The Sex Change

I was just out of medical school, an intern, when I went to my usual medical clinic assignment. Had it been a snowy, cold and icy day, all the little old ladies would have been there, but this was in the summer. There was a new patient to see. I walked into the examining room after a brief look at the chart. A nice looking young lady greeted me and I took her medical history. Then I went hunting for a paper hospital gown, having explained that she would have to partially disrobe. When I returned to the room, there she was sitting in a chair by the examining table naked from the waist up. And, she wasn’t female. Now I had a nice looking young man for a patient. I was not as good then as I am now hiding my reaction to such surprises but I did the best I could and finished the exam. Neither he nor I mentioned his “sex change” and the visit came to a successful close.

Leprosy

Dr. Freston was the “grand old man” of medicine in my training hospital. We made rounds with him once a week. One day he took us to see a patient on the ward, but in a single room. The patient’s wife was attending closely to him and both she and the patient apparently knew Dr. Freston well. The man had the classic “lionine facies” of leprosy but to our eyes was not otherwise deformed. Of course, we all examined him, listened to his heart, etc. until we were treated to his diagnosis. Our attending began to discuss the case in the hallway when suddenly no one but he and I were present. I looked around and said, “Where has everyone gone?” Dr. Freston knew that they had all gone to wash their hands and their stethoscopes. I have never been sure that he appreciated my remaining at his side or simply decided that I was just too dumb to go and wash. After everyone reassembled however, the lesson became clear. Leprosy is a very difficult disease to contract. Dr. Freston pointed out that the patient had been married to the same lady for many years and she had had many children with him. No one saw her taking any particular precautions. I began to feel a little better, but, just in case, I did wash up later on.

The Giraffes

When I arrived at Roosevelt Hospital, the areas for the patients who were unable to pay for medical care, the wards, were still in use. A great many sights, sounds and odors were encountered on the wards which were not present in the private and semi-private areas. One day, while on rounds, we came down from the third floor on our way to the medical ward by way of the gynecology section. The aroma there was quite strong. Without hesitating, my fellow resident and good friend, Chuck, marched up to the first nurse he saw and said, “Which way to the giraffes?” I had to hurry into the hall so as not to burst out laughing in the nurses’ station. The place really did smell like the Barnum and Bailey Circus side-show area.

Thankfully, by the time I came out of the Service to resume training, the area had been converted to offices and laboratories and included the first Intensive Care Unit in New York City.

I Never Make a Mistake

Chuck had a droll sense of humor indeed. On rounds one day an elderly woman patient indicated that she thought Chuck had said something in error. He drew himself up to his full 6'2" height and said, “My dear, I haven’t made a mistake since 1958, or was it 1957?” Once again I was reduced to laughter. I’m not at all sure that others in attendance “got it”.

When We Hear Hoof beats . . .

Many years later after Chuck had become my internist/cardiologist, he prescribed medicine for me. I developed a rash and other symptoms. I knew what it must be but I called him to announce that I had apparently come down with a virus. His comment was, “When we hear hoof beats, we do not think of zebras.” I was having a reaction to the medicine, of course.

Years later, I arrived unannounced in Chuck’s office complaining of chest pain which had developed while I was driving into New York City. I was just passing his office so I decided to stop there. When he decided that he was sending me to the hospital, I said that I would drive right there. Peering over his glasses, he said, “It is not good form for someone who may be having a heart attack to drive himself anywhere! We will have Peggy come and get you.” Thankfully, in the end there was nothing wrong with my heart, but I did endure an overnight in the cardiac care unit.

Neurosurgeon Zapped

I was an intern rotating through surgery when I was asked to assist at brain surgery. Since I was third assistant I stood at the left of the surgeon. My job, I was informed, was to touch the end of the surgeon’s probe with a little electric wand which would send an electric impulse down into the probe and cauterize whatever the probe was touching. I had been at that for awhile when suddenly, the surgeon, having received a shock, threw his hand up on the air, dropping the probe. This, of course, was my fault, just as it was the second time it happened. By then, even I was beginning to wonder. With the third shock the surgeon began to examine his glove closely along with all the rest of us. Well, there was a minute tear in his glove on the hand holding the probe. Naturally, he had to rescrub while we waited. All the time I was trying to hide my satisfaction that it had not been my fault and the surgeon deserved this little inconvenience for yelling at me. The patient actually survived quite well despite all the fuss.

The Appendectomy

Also while I was rotating through surgery I was roused one night to go to the operating room. I was told that I was going to perform an appendectomy under close supervision, of course. I don’t remember feeling at all nervous about doing this and proceeded to perform the operation to everyone’s satisfaction as well as my own. When I went to check on the pathology report however, I was more than a little chagrined. I had removed a normal appendix—someone else’s pre-op misdiagnosis. Interestingly, the patient’s symptoms subsided immediately thereafter and I heard no more about the case. I have wondered whether the situation was explained to the patient or not. I would have felt obligated to do so but others may not have felt that way. I did learn that sometimes this sequence of events with the symptoms does occur, for which there is no good explanation.

The Lipstick Sign

On one of my earliest hospital rounds we came across a lady on the wards sitting up in bed with her makeup on. After her case was presented, the attending noted that he had not visited her bedside before but that she would be going home soon. He knew that because she had her lipstick on—hence the “lipstick sign”—a sure indication that she was doing well and would soon be discharged. Ever after I have noted how patients took care of their looks, especially the women and, indeed, a little makeup indicates that they are getting ready to go home. Men are likely to start shaving again.

I learned another important lesson when we came upon a woman who would not eat. When asked why since she was doing well otherwise she told us that she was taking 83 pills a day and simply had no appetite. We scrambled to rearrange her medications with the help of the attending, eventually getting things down to about a tenth of that number. She began to eat and shortly went home with the short list of pills. When multiple people write orders this situation can arise. I always remember my partner calling the nursing home in Georgia where his mother-in-law was when he would hear that she was not doing well again. He would get her doctor to review her medications and convince him that certain ones were not necessary. She would invariably improve for a while after his intervention.

Memorable Dinners

One of my professors in training invited a group of us and our wives to dinner at his apartment. His wife, the same woman who thought she had caused the Great East Coast Blackout, produced an all white meal (on purpose). I remember that, indeed, all the food was white and so was everything on the table. Very artistic and very enjoyable. My wife and the hostess eventually became quite friendly and when we would go to the big city allergy conventions she would urge my wife to sit with her in the hotel lobby and “vatch”. To this day, my wife and I enjoy watching passersby and so have maintained the tradition.

Another time, my wife and I and several other couples were invited to dinner at the house of one of our colleagues in training. Peggy was pregnant with our daughter. She would get nauseated if she went too long without eating something. She was seated next to a table with an enormous bowl of black olives. Dinner was served very late. At one point I glanced at the olive bowl and saw that they were all gone. There were only a few pits in the bowl. Eventually we made our escape and while we were driving home I asked about the olives. She had eaten them all. When I asked what had become of the pits she produced from her purse a napkin full of olive pits. It would have been embarrassingly obvious that she had eaten them all so she secreted the evidence in her pocketbook!

Purple Penicillin

I was an intern in pediatrics when the case of a little girl who needed penicillin but who was said to be allergic to it was presented to us. She had had penicillin before without trouble. (Of course, it would likely be a subsequent exposure which would cause the problem.) But she had had penicillin since the first exposure without a problem. It was noted that the drug, given orally, was in the form of purple syrup. We contacted the manufacturer who supplied us with the material in the vehicle. (Today, it is hard to get a company to do that because of liability problems.) Sure enough, when the patient was given the syrup alone she reacted to it but she did not react when given penicillin alone. We all thought we were geniuses of course for suspecting this in the first place. The patient recovered fully and went home never to eat anything dyed purple again we hoped.