The View from the Vue (17 page)

At that point I walked down to the staff dining room and brought up a plate of bread and butter and a glass of milk. Mrs. Rosenbaum devoured the whole thing while she had an animated conversation with my wife for the next hour. I filled in the charts.

Over the next five weeks Mrs. Rosenbaum remained cheerful and well-fed. She exclaimed loudly over the meals my wife brought her, and repeatedly remarked how nize it vus dot a wife should come be mit her husbin. Then, when my wife would tell her how much better she looked, she’d smile and really act as though she believed it. Actually, she looked lousy: yellow, pale, wasted, and old. But cheerful.

Finally it was time for the surgeons to try again. We arranged to keep Mrs. R. on our ward right up until the operation, so she wouldn’t have to go for a veek mit strenjihs. The night before the procedure, she wasn’t allowed to eat solid food, so my wife brought her some chicken soup. As she gratefully acknowledged receipt of her supper, she reached under the bed and, with a flourish presented my wife with a big ribboned box. Myra opened it. Inside were several aprons. My wife was speechless.

“Mrs. Rosenbaum,” I said. “Where did you get the aprons?”

“Mein sohn,” she answered proudly. “He voiks in a apron fect’ry. So I told him to get them for me to giff your wife, she should heff sump’n nize to use t’ teach d’ kids in.”

“I…I didn’t know you had a son,” said Myra. I hadn’t known either.

“Oh yiss,” said Mrs. R. “But you don’t neveh see him, ’cause he goes to voik at fife
A.M.
So he comes visit me foist.” She patted my wife on the hand. “I vanted you should heff sump’n t’ remember me mit,” she said.

“They’re just beautiful, Mrs. Rosenbaum,” said my wife. “And it was so nice of you to want to give them to me. But I’d have remembered you anyway. I’ll see you after the operation, and I’ll bring you some more chicken soup.”

Mrs. Rosenbaum just smiled at Myra. “I von’t forget you, dear,” she said.

The next morning, the surgeons had barely opened Mrs. Rosenbaum’s abdomen when she suffered another heart attack, so they closed up the incision and sent her down to the morgue. Somebody suggested that she couldn’t have been saved by anything short of a complete body transplant. I didn’t argue.

The Dumping Syndrome is a well-known medical entity. It occurs in people who have had their stomachs removed, usually because of intractable ulcer disease. The name derives from the tendency of food, in these patients, to cause intestinal hypermobility when it hits the small intestine without first having been altered in the customary fashion by gastric digestion. This hypermobility then causes the ingested food to be zipped down the pike—dumped, as it were—and in the process some impressive diarrhea is produced. Those who suffer from the condition don’t speak of it in kindly terms.

At The Vue, all of us on the house staff suffered from a dumping syndrome, too. What was dumped on the Bellevue doctors was, to be specific, patients. To be even more specific, it was unwanted patients from other hospitals. As I’ve already mentioned, Bellevue Hospital was never allowed to refuse admission to a patient. Not for any reason. Thus any person who came to The Vue and was found to be in need of hospitalization was forthwith admitted. Though not a single intern or resident would have admitted it out loud, we viewed this policy as a source of pride. Frequently, though, we also considered it a source of severe irritation, and we weren’t the least bit bashful about giving voice to that sentiment.

Our irritation arose from the fact that the staff at every other hospital in the city knew the way the game was played, and the rules were all in their favor. Private hospitals or municipal, it didn’t matter. They were all aware that the gates of The Vue never swung shut, and that was all the ammunition they needed. It meant that any time they didn’t wish to admit a particular patient, they had only to shove him or her into an ambulance and point the vehicle toward First Avenue and Twenty-sixth Street.

It was really just that easy. There was no necessity for fancy excuses, so that at least 95 percent of the transfer slips read simply, No Beds. The commotion that the average Bellevue intern produced upon receiving a patient from Puspocket General with a No Beds slip was truly impressive. He shrieked. He howled. He beseeched the Almighty to strike dead the miserable prevaricating camel driver who had perpetrated the heinous crime. At least once a week, an intern in this situation would dial Puspocket’s administrative office, assume his sweetest manner, and say, “This is Admitting. Would you please give me the census on Male. Medicine?” Then, when the administrator would tell him that Male Medicine was only 76 percent full, he’d identify himself, and in his most righteous and wounded tones, would demand to know why, in that case, they had seen fit to send a patient to The Vue with a No Beds slip. At that point, the administrator would apologize for the “error” and rapidly hang up, leaving the intern with nothing to do but splutter and then go and work up the patient who, of course, had already been officially admitted to Bellevue.

What manner of patient was it that caused such ghastly ructions to reverberate through the halls of The Vue? You may be certain that no municipal politician or television actress was ever dumped onto The Vue after having being told there were no beds at the hospital of his or her choice. However, most respectable institutions looked with general disfavor upon addicts and prostitutes, and an inordinate number of these individuals found themselves riding meat wagons on a one-way trip to the shore of the East River. Nor was there often room at the inns for ninety-year-old nursing home denizens who happened to contract pneumonia. And, of course, it goes without saying that persons deficient in both money and health insurance were provided very rapid motorized bums’ rushes. Sometimes, the fact that a patient needed admission in the middle of the night constituted sufficient grounds for transfer: Why should a Puspocket doctor stay up all night when the Lord in His kindness and mercy hath provided Bellevue interns?

But there is some good in even the worst of things, and this was certainly true of the Bellevue dumping syndrome. It should be apparent from what has been said that a prime motivating factor behind many dumps was the laziness of the dumper. Hence, difficult cases were frequently stuffed into an ambulance and sent to The Vue; it was easier to do that than to try to figure out what was wrong with the patient. We received some of our most interesting cases in this fashion, and although routine dumps sent us into memorable tantrums, we never so much as whimpered when the meat wagon from Puspocket disgorged a fascinoma at our feet. At these times, in fact, our emotions ran close to downright gratitude.

Alberta Cowens was such a patient. She easily qualifies as the most spectacular dump I ever received.

The Cowens saga began for me on a January night shortly after I had begun a senior medical-student elective on obstetrics. The service was short one resident, so they decided to utilize me in that capacity. Giving me the tide of sub-resident, they taught me the necessary skills and then plugged me into the vacant slot to help cover the labor and delivery suite. My sense of self-importance promptly assumed record proportions.

Fortunately for me and for the patients, my first week was a pretty quiet one, allowing me to concentrate fully on each woman as she came in and labored. As the second week began, the workload remained light, and about eight o’clock one evening I found myself totally patientless, a rare condition at The Vue. I sprawled on an unused stretcher and listened as the nurse told me stories about Jamaica, her native country. In the middle of the Kingston market, between the fruit venders and the hat weavers, the doors to the delivery suite swung open, crashed into the walls, and the aide from A.O. pushed in a stretcher with a black woman on it. She was holding her protuberant belly, and her facial expression indicated that there had been days when she had felt better. The aide handed me a slip of paper, which on inspection proved to be a transfer note. It read, “Premature Labor—No Beds.” I sighed, and turned to examine the patient.

She was complaining of pains in her belly and was in her thirty-fourth week of pregnancy. It quickly became apparent, however, even to inexperienced me, that she was not having uterine contractions, so she could not be in labor. I proceeded to check her thoroughly from shoulder blades to pubis. I listened to the baby’s heartbeat, which was perfectly normal, and I poked and jiggled all over her belly. As I moved the baby around, she told me that that made her pain worse. I said I was sorry, promised to be more gentle, and furrowed my forehead so as to look properly cogitative. Then I did a pelvic examination.

After I completed my maneuvers, Mrs. Cowens told me that she was thirty-five years old and that this was her third pregnancy. The trouble had started during her fourth month, when she had had an attack of severe abdominal pain, nausea, and vomiting. At the time she and her family had been living in Houston, and she had gone to the emergency room of a hospital in that city. There she had sat, doubled over, for an hour and a half, after which time she was shown to an examining cubicle. Here she waited for another forty-five minutes. Finally the doctor came in.

“He was young, and in a mighty big hurry,” Mrs. Cowens recalled, and I felt my cheeks get warm. “Can’t say I really blame him too much, though. The place was packed with bad-sick people; you know, shootings, and heart attacks, and stuff like that. He just read what the nurse wrote down on my paper, and said real fast that bellyaches and vomiting were normal for pregnant women. Then he started to leave.”

Mrs. Cowens smiled and shook her head. “That kinda got me mad,” she said. “‘Doctor,’ I told him, ‘I’ve had two babies already, and I
never
felt pains like this before. And by my fourth month, I was always finished vomiting. This pregnancy just doesn’t feel right.’

“The doctor was almost out the door by then. He looked back over his shoulder and hollered that every pregnancy is different, and I shouldn’t worry about it, and I oughta register for care in their clinic.

“Well, there wasn’t much I could say to him since I was all by myself in the room then, so I got up and went on home. My husband was mighty angry, let me tell you; why, he was all set to take me right back there and
make
that doctor at least give me an examination. Or else he wanted to call up a private doctor, and that made me laugh. ‘You know we don’t have the money for that,’ I told him. ‘Let’s just wait and see what happens. Maybe it really will get better.’ Besides, we were going to move to New York less’n a month later, and I figured I could go see a doctor when we got here.”

However, the job that was awaiting Mr. Cowens didn’t work out for another three and a half months, so the family didn’t move until Mrs. Cowens was almost eight months along. During this time her abdomen progressively enlarged, and the baby began to move—but not in the usual gentle, fluttery fashion. The movements seemed to her to be especially strong, and often were followed by knife-like pain under the ribs, bouts of cold sweat, and vomiting. But since the symptoms never persisted long, Mrs. Cowens did not again seek medical care in Houston. Upon her arrival in New York, she registered at a prenatal clinic and had an appointment there for the following week. However, a renewed attack of lower abdominal pain caused her once again to seek care on an emergency basis. Upon her arrival at the prenatal clinic, she said the doctor there had dismissed her with a glance as a routine case of premature labor, and she had been loaded into the meat wagon and shipped downtown to The Vue.

I told Mrs. Cowens that I thought nothing was seriously wrong. I further explained that her baby was lying transversely in her uterus, which I thought might be due to the fact that her cervix was displaced far forward, indicating that the uterus was tilted at an abnormal angle. Thus I supposed that the baby was wedged in unusually tightly, causing the fetal movements to be more painful than average. The nausea and vomiting I attributed to this same uterine trauma. It was really a beautiful explanation. However, as things turned out, it was completely untrue. Fortunately Mrs. Cowens remained satisfied that my intentions had been good, and never held my diagnostic disaster against me.

I suggested that Mrs. Cowens try to get an earlier clinic appointment at the other hospital, but she shook her head. “Don’t want to go to them no more,” she said firmly. “It’s a little outa the way, but I want to come here and have my baby. It’s the first place they ever gave me an examination and tried to tell me what’s the matter. Fact is, I want you to be my doctor.”

I promptly set a new record for head size. My conscience whispered that it might be proper, after all, to inform my petitioner of my true lowly status, but I silenced the nagging voice with the thought that if the Bellevue obstetrics department had seen fit to permit me to function as a doctor, then there was no reason why I should not do just that. So although the residents assigned to the delivery room did not customarily go to the Clinic, I told Mrs. Cowens that I’d be delighted to take on her case, and asked the nurse to arrange a clinic appointment for her the next afternoon.

When I arrived at the Clinic to see Mrs. Cowens, I passed Julian Armstrong, one of the senior residents. “I’m going to work up a lady I saw in labor and delivery last night,” I said to him. “That’s okay, isn’t it?”

Julie grinned. “Sure, that’s great,” he said. “One less for us to do. Have a good time.” As I walked away, he called after me, “If you want, holler when you’re done, and I’ll check her out for you.”

I thanked him and went into the examining room, where Mrs. Cowens received me warmly. Her attack of pain had gone away shortly after she had left The Vue the night before, and had not returned. I reexamined her and found her physically unchanged from the previous examination. So I filled out her chart and went to look for Julie Armstrong.

Julie was busy. He walked quickly into the room, greeted the patient, and scanned the chart. Noticing my report of a transverse fetal lie, he perfunctorily felt the abdomen, and grunted in assent. “Don’t forget to give ’er iron and vitamins,” he said, as he charged out the door.