Weekends at Bellevue by Julie Holland Read Free Book Online

I performed the breast exam, feeling for lumps, and the vaginal exam, feeling for ovaries, as best I could, and then it was time to insert the speculum. I was supposed to slide it in closed, then open it up once it was inside the vagina. My big gaffe, which I’m sure was profoundly uncomfortable for the model, was that I removed the speculum without closing it first. I realized that I’d hurt her, and felt like a buffoon. As I apologized profusely, she was kind and sincere, understanding my mortification. (I still remember her to this day, and would again like to apologize and thank her for not yelling at me. I would’ve yelled.)
    E very July first is New Year’s Day for medical students—the first day of the new academic year. Recently graduated medical students become “doctors,” and second-year medical students become the much anticipated “third-years,” when the clinical rotations begin. No more lecture halls; it’s finally time to learn on patients.
    And so, in the summer of 1990, things finally got interesting. I left the classrooms, the endless labs, and the solitary studying. It was time for me to enter the hospital, and it was baptism by fire: I was assigned to surgery. I knew nothing—nothing practical, that is, nothing of any use to a surgeon. I didn’t know how to draw blood. I didn’t know how to order medications or labs, or how to check the lab results, or even where the lab was. I was worse than useless: I was a burden, plagued by the constant anxiety of “I’ve never done this before.”
    But the surgery residents had been where we were, and they knew the deal. They were used to teaching clueless kids in July. They knew the best patients for teaching were those who could not complain. At Albert Einstein hospital in the heart of Northern Philadelphia, that meant either a patient who was unconscious or was simply unaware that they could’ve asked for someone other than a medical student to provide their care.
    A tremendously obese woman was brought into the emergencyroom by her family because of some sort of a boil on her belly. The cyst was enormous and angry red, with striations of scarlet spidering off its center. The patient was feverish and somnolent from the infection, which we would later diagnose as necrotizing fasciitis, requiring multiple surgeries to “debride” or remove the infected tissue. She was put on oxygen and given something for the pain, and then we swarmed in like ants on a melon rind. Her blood needed to be drawn, her cyst fluid to be cultured. She also required an arterial blood gas, an exquisitely painful procedure where a needle is inserted into an artery, as opposed to the standard venous draw adequate for most blood work. The surgery resident showed a group of us how to locate the artery by feeling the pulse prior to inserting the needle. Since this woman was nearly comatose, she wouldn’t mind if I didn’t get it on my first try. I was surprised to see that my hands had a fine tremor as I fished around for the artery. (When I attempted this on a conscious patient the next day, he winced stoically at first, then eventually tore his arm away, screaming and swearing at me, and I had to enter into complex negotiations with him for cooperation.)
    Taking a history to establish what was wrong with a patient was much trickier than cramming for exams. They didn’t know the names or dosages of their medications. They pronounced their diagnoses in a way that confounded me as to what they actually had. A patient told me she was just getting over her “flea bites” which, after some detective work, turned out to be phlebitis. Another man reported he was taking “peanut butter balls” for his seizures. The ER docs had a good laugh over this, translating “phenobarbital” for me. When I asked a patient, “Where were you shot?” I got aggravated when he answered, “Right down on Broad Street,” which is the information his friends might’ve appreciated. I, on the