Much of my second year of general surgery training was spent at the Minneapolis VA Hospital. It was a bread and butter, common kinds of surgery, place. There was a great deal of work; so, the idea of stealing cases was absurd and unnecessary. The concept for the residents was to do useful work and to refine our technique. The goal was to turn out competent, confident, general surgeons with genuine concern for the patients. The boss was Dr. Humphrey, a big, jolly, enthusiastic pragmatist. When we made mistakes, he corrected us and helped us to understand and to improve. When we did well, we all had little celebrations; it was about being a surgeon—and a doctor—were supposed to be. About a third of the year was spent back at the mother ship—U of Minn Hospital and in the St. Paul Hospital ER.
We got to see and to treat the lowest circles of society: homeless, unclean and lice ridden, alcoholics, addicts, and criminals, lots of criminals. I learned an essential element of being a doctor there which was every person, however odious and malbehaved, was a human being and should receive the best of care we could provide. It is difficult–but not impossible–to treat a wounded gang-banger responsible for several murders, a prostitute with loathsome sores, a schizophrenic responsible for terrible injuries to children, etc.
At St. Paul’s, we had a DDT chamber for the bums who came in jumping with lice. The nurses were old hands. The patient would walk in with bright lights at his or her back which illuminated the halo of flying fleas. The nurses kept a broom each to herd the gentleman or lady gently into the DDT chamber for a thorough delousing. Then, they were strongly encouraged to shed every article of clothing into a receptable that happened to have a direct link to an incinerator a floor below. They then received a co-ed shower and a brisk brush scrubbing. Finally, they got a new set of old but clean clothes and were ready to be examined and treated.
At the VA, tuberculosis was rampant. TB bacilli show up as red rods on Ziehl–Neelsen staining, hence the common appellation of “red-snappers”. One of the most common questions we asked when hearing a history of a new patient was, “does the old vet have red snappers.” We relatively healthy lads did not want to get the red snapper disease, but we also wanted to give good care. A crucial question therefore was, “if I see an old vet unconscious on the floor, Dr. Humphrey, what should I do?”
“CPR.”
“Mouth-to-mouth???”
Then Dr. Humphrey would demonstrate how he preferred to perform emergency resuscitative therapy safely. He had us all gather around. Then he indicated an invisible old vet lying face-up on the floor of the hallway. He raised his size 14 foot off the floor then brought in down on the invisible chest.
He pushed his foot up and down rhythmically and said in a dead-pan voice, “Out with the bad air; in with the good air, repeat.” He looked at each of us and said, “repeat after me—out with the bad air, in with the good air.”
“When do we quit, Dr. Humphrey?”
“When you get too tired to keep going or when the patient is dead.”
“Who makes the pronouncement?”
“You do. You are the doctor, the decision maker.”
With that useful preparation behind me, I was ready to enter the navy and be a surgeon—having patients of my own. No Dr. Humphrey to help, no fine and experienced surgeon to back me up. The moment of truth was fast approaching. It was time for Vera an I to pack up or family in a reasonable size van and to head for California. We realized that it was time to find out where Port Hueneme was located and to learn the correct pronunciation for the town—not “Port Juanenema” as we had been calling it, but “Port Wine-eeme”.
I ask whether or not it is disrespectful for medical personnel to speak lightly of their patients with all the very serious problems, difficult histories, and propensities for evil. Remember, the people who have to get up in the night and have to endure bad smells and foul images and to hear seriously bad language day after day might just be humans also.