Sunday, July 22, 2007

Oldtime Medicine From the View of an Amateur

The nice thing about having lived a half dozen decades is that one has a wealth of stories to call upon. And some I have actually learned from.

Back in the middle sixties, green as grass and fresh out of college, I decided I wanted to volunteer at the county teaching hospital. At that time, the only air-conditioned parts were the ER, delivery and surgical suites. I chose ER. After all, the writer in me suspected some life stories would come in each week, as they did. No, I didn't write about them, but I experienced. From 3-11 p.m. every Monday for nine months, I volunteered in the emergency room.

That time in history was a little different. Even 10 years later I really enjoyed making the chief hospital administrator blanch as I related some of the things the ER staff had me doing. Ha!

They ran me through my paces, saw what I could do and then started adding on. Consider me like a corpsman in a field hospital who turns out to be steady, reliable and trainable. Such persons are given a lot to do they wouldn't otherwise. And this was a teaching hospital. The nurses were mostly old war horses. The doctors were brand, spanking new. Teaching staff didn't often come through on my shift. I was taught during that period just like everyone else. They started me with patient forms, only I didn't just fill out paper forms. I was doing temps and blood pressures from the first day. For the first two weeks, a nurse would slip in pehind me periodically to double-check my reads. When they turned out to be okay, they nodded in satisfaction and quit checking. After all, it's not exactly rocket science.

They oversaw my learning how to prepare a patient for examination. They taught me how to set up sterile trays for the doctors. I shlepped bedpans, of course. Twice that I remember, we had burn patients and the LVN had me assist her in scrubbing off the burned skin. One woman had fallen asleep holding a cigarette, I remember, and all the nails came off when we scrubbed.Made the bottom of my stomach prickle, but I didn't let on and I didn't slow down. Remember, I had basically just walked in off the street. Medicine had always fascinated me, however. I was learning every week. And mostly, I loved it.

The whole staff just accepted me. Another pair of hands, ignorant but teachable. Can follow directions. Good. Now go do this. And I did. Those of you working in medicine today are probably shuddering. But hey, this was 40 years ago.

One thing--in that nine months I volunteered, Monday nights did not have a single serious car crash, shooting or stabbing between the hours of 3 and 11. Staff took to rubbing my head for luck. When I became a medical writer a few years later and came back to the ER to do a story on the newfangled triage system, the same calm hit the ER. Staff begged me to come back for a few more days.

Oh we were busy enough. The usual broken arms and legs and insect bites and sickness, not to mention the one or two botched abortions that came through each evening, the young women in various stages of risk from sepsis setting in after a back alley butchery or perforated uterus from a badly wielded coat hanger. All of them, always, calling for their mommas. Who usually weren't there. Those, of course, usually went straight through to Ob-gyn.

The worst, the absolute worst thing I ever did in the ER was about halfway through. We had a patient that needed some sort of procedure they seldom did. I was instructed to get the tray, covered in a sterile sheet under an exam table, and set it up. I didn't miss a lick. Set it up perfectly. Whatever it was, I remember it involved a large mixing-bowl size stainless steel bowl. I was overseen as I set it up, but I did it right. And then--- At that time, sterile gloves came in sizes, each pair enclosed in papery-plastic sleeves. Not sterile. I glanced at the waiting resident and grabbed the right size gloves. And I dropped the non-sterile package right on the tray. I still remember the resident's visceral "NOOOOOO" as the gloves fluttered down. And decontaminated the whole setup. He didn't yell at me. Why, I still don't know. Turns out, there was a second setup in the ER. And he had me set that up, too. And I never ever made an error about sterile procedures again. I still wince when I think of it.

I learned most moms with a sick or injured kid had to be given the instructions at least four times, because fear or their pain over their kid's pain made them a little deaf. This was before the easy, designer drugs of today. Didn't get much drug addiction crap. Isn't that WONDERFUL?

Two memorable experiences--the night the big, dirty fat lady came in with a wound on her leg. She apparently had a small bladder. I know I carried a number of bed pans for her. I couldn't help but notice how the dirt marked the creases in her neck like little mud lines. I had to shift her on and off the pan. In other words, I had to handle her quite a bit. Meanwhile, she had this deep, round wound in her leg bigger than a silver dollar. It was red around the edges, but the reason she probably didn't have blood poisoning (no streaks) was that the wound was filled full to the brim with whitish maggots. Fly larva, eating the proud flesh and keeping her healthier than she would have been otherwise. They still hadn't dealt with her and her menagerie by the time I left that night. I drove home, opened my apartment, took one step inside and closed the door. I stripped to the skin right there and went straight to the shower.

I kept wanting to see a delivery, and finally, after nine months, a resident who had been in the ER and just shifted to Ob-Gyn, came down and told me to come upstairs. He had a delivery for me to watch. I went upstairs, "suited out", put on sterile gloves and a mask. The woman was near the end of delivery and very tired. The doctor actually had me pour the disinfectant over the vaginal area--hair, no time for shaving. She didn't want to push. Staff encouraged her, and finally she did.
The baby was born. Bluish white, like a carving. The doctor picked her up and flicked one of her feet. She drew in a breath to cry in outrage, and I watched life bloom over her, rosy red from the head to the feet. No longer a statue. A living, breathing, life-filled baby girl. Miraculous. Beautiful. Awesome. I learned later this woman had had five previous stillborns.

About two weeks later, my boyfriend shattered his legbone and had a 10-inch plate installed. He was in the hospital a week, and somehow, I never did get back to the ER.

I had told them I wanted to see a live birth before I left, and I guess I really, truly meant it.

As I say, about five years later, I became a medical writer for nine years. I was invited in on many procedures and some operations, and worked with doctors both in my county and Southwestern Medical School. I loved it, and I always checked back with my docs to make sure I was accurate. Bonus for that was that when my second son was born by C-section, the anesthesiologist was the current county president of the medical society, and he left my arm free so I could scratch my nose during the surgery. A very big plus, I thought.

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