The third year of med school was divided into quarters, not semesters. I had one quarter off so in the summer of 1967, I got my first taste of real clinical medicine. Third year med students were given the opportunity to work in the emergency room at Community East Hospital under the supervision of the four doctors employed by the hospital. I began working as an extern, a student functioning as a physician. I examined and treated trauma patients, sutured simple lacerations, and treated adult and pediatric medical problems, all under the guidance of the attending physicians.
I worked the day shift, Monday through Friday, from 7 am to 7 pm. The experience I gained as an extern was invaluable. At the IU Med Center, common things like poison ivy, sprained ankles, and scalp lacerations were seen infrequently. In the ER they were seen multiple times each day. Three months of exposure to everyday medical problems in the ER was as good as any lecture, hospital round, or seminar. The remainder of the school year, I externed at Community East one night a week from 7 pm to 7 am.
The Fall quarter, 1967, was spent on General Surgery. In September I had a clerkship with Dr. J S Battersby, the most adept surgeon I’ve ever seen. I was one of his two students that month and got one-on-one teaching every day. I made hospital rounds with Dr. Battersby’s resident and intern, scrubbed with them in the operating room, and learned so many things.
October was spent on the general surgery ward at the Indianapolis VA Hospital. My resident was Dr. George Ward who had been in the military after med school and returned to do a surgery residency. He was great. To give his students a unique experience, he permitted each of us to do an operation on our own. Mine was a below knee amputation of a gangrenous foot. Dr. Ward guided my every move to make sure everything went smoothly. My time was also spent either making rounds on the patients under our care or observing and assisting in other operations. Surgery was something you loved or hated. I wavered on the “don’t like side.” I never hated it. However, true surgeons love to be in the operating room all hours of the day and night, and I couldn’t see myself doing that.
My first night “on call” was at Robert Long Hospital, the main hospital for the IU Med Center in 1967. I slept very little that night. I was asked to draw blood, start IV’s, insert Foley catheters in bladders, and check on patients who the nurses were worried about, all in the middle of the night. I “slept” in a dungeon-like call room with other students on other “services.” They got very little sleep, too. The next day started at 7:30 am so regardless of how much I had slept or how tired I was, I had to be present for rounds, go the operating room, and see patients in the outpatient clinic. No next day off for us. Call was every third night and was responsible for chronic sleep deprivation. I got used to that schedule quickly because there was no choice.
My next surgery rotation was at Marion County General Hospital (MCGH), the Cook County hospital of Indianapolis. I spent a month there under Chief Resident, Dr. Robert Jacobs. He was a Columbus, IN GP who gave up practice to become a surgeon. My November ‘67 rotation was midway through his 5th and final year of training. Dr. Jacobs loved the OR so my fellow students and I were busy all the time—hospital rounds, operating room, clinic—there was little down time. VA and General hospital patients were much different than people I saw at Community East. Socioeconomic stratum was the defining factor. That month I learned a lot, but my interest in being a general surgeon faded.
At “General” the ICU was busy. All major trauma in Marion County went there—auto accidents, shootings, assaults, etc.—so the beds were always full. Dr. Jacobs and his junior residents, Drs. Kronner and Hoo, didn’t get much sleep because there was no shortage of patients. When I was finished with patients in clinic, I spent time in the OR watching Drs. Jacobs or Kronner do an 8-hour neck operation/dissection for cancer or remove gall bladders, appendices, hernias, ruptured spleens, colon resections, and colostomies. There was little I didn’t see, including the patient with a bowel obstruction who was so dehydrated and thirsty he drank his own bath water. The learning experience that Fall quarter of 1967 was a bit overwhelming. Surgery is a busy, busy specialty that rarely has down time.
Winter quarter ‘67-‘68 was my first exposure to delivering babies and diagnosing and treating female med-surg problems—OB-GYN. My residents were Dr. Frank Johnson, who became director of the Marion County Health Department, and Dr. Tom Ferrara who later delivered my brother’s three kids. These two were talkers, storytellers, and great teachers. I delivered several babies on my own at MCGH, and assisted with deliveries at Suemma Coleman Hospital, a private hospital at the Med Center. What stands out most in my mind were the number of single girls (age 13, 15, 16) having babies, and the depressing, poorly lighted, open, post-partum ward run at night by one student nurse.
GYN outpatient clinic was interspersed with OB. Here I gained experience doing pelvic exams, PAP smears, and treating sexually transmitted diseases. I learned about ovulation, contraception (the very early days of birth control pills), infertility, menstrual problems, and menopause. Today, knowledge about these topics is far more diverse than in ‘67-‘68. I liked OB-GYN, but not enough to do it alone every day.
The final quarter of year three was Internal Medicine and Pediatrics. Two months were spent at the VA hospital and one month at James Whitcomb Riley children’s hospital. At the VA, my attending physician was Dr. Dana Shires, a nephrologist (kidney specialist) who had just come to IU from the University of Florida where he was on the team that invented GatorAde. He was very intelligent, but most of the time talked over my head to the intern.
One memorable patient at the VA was a man with a “saddle embolus.” During rounds, we came upon a man in shock (low BP, semi-conscious) and in pain. He had severe pain in both lower extremities, they were pale in color, and the pulses in both feet and groins were absent. The resident, Dr. Don Pell, thought the patient had a large blood clot at the end of his aorta blocking blood flow to both legs—the previously mentioned “saddle embolus.” He did indeed have that and had emergency surgery to relieve the blockage. Regrettably, the results weren’t as good as had been hoped.
Every day at noon, I was supposed to attend a noon lecture. The subjects varied day-to-day but were common, practical topics. I had a quick sandwich and soft drink during the talk, but when my ward was busy, I was unable to leave to attend. Regrettably, I missed a lot of those talks.
The last month was Pediatrics at Riley Hospital. Riley was old, small, crowded, and very busy. The Peds Dept. had only 4 full time faculty members, but the chair was world renown behavioral pediatrician, Dr. Morris Green. Rounds with him were amazing. His knowledge was endless. The former department chair, Dr. Lyman Meiks, came out of retirement to conduct rounds and teach several days a month. His teaching was from a practical/practice-oriented perspective and was easier to incorporate into future situations. I learned how to do a complete newborn exam, routine well-child care, and treat all sorts of infectious diseases. Recognizing when a child is sick is half the battle. I loved peds and internal medicine. They were both challenging and interesting, but not enough to do either full time. I liked the variety of seeing both adults and children and never being bored.
By the end of year three I had ruled out several specialties. I was beginning to lean toward Orthopedic Surgery from my experiences at Community East. The eight or so orthopods on staff used the ER for fracture reductions, cast changes, or whatever; I observed them working more than any other specialists. What they did looked like fun; but appearances have perspectives that change after deeper exposure.
I was exposed to so many different things the third year it was a bit overwhelming. There was so much to learn. Some classmates made it their mission to make you feel inadequate; not as blatantly as during the first two years, but it still occurred. During casual discussions, a fact I had not heard about would be mentioned by a classmate whose sole intent was to make himself look smart and you feel uneasy. I wasn’t always successful in ignoring those attempts.
I was learning as I went and feeling more and more comfortable in my role. It takes a long time and repeated exposure to feel confident in dealing with patients and families and instill in them confidence in you. It does come, though. If it doesn’t, you choose a specialty like pathology or anesthesiology where your patients are either asleep or dead. I enjoyed living patients and tried to get to know them as well as I could. Being comfortable, confident, and personable strengthens the physician-patient bond. That bond contributes greatly to a positive outcome for most illnesses.
Year four was altogether different, but was also more of the same. It follows next.
