My very first clinical clerkship was in surgery at the Royal Victoria Hospital.
It was two months filled with learning, new experiences and colourful characters. Perhaps I learned so much because I never left the hospital. We worked under conditions which are now unthinkable.
The surgical team was, for some reason, very short handed that month. We were only a chief resident, a junior resident, two medical students, (me & Jack) and an intern who didn’t count for much. This poor soul had already failed one rotating internship and was on her way to failing another. Hers is a tragic story. But at that time, with the cruelty of youth, I saw her only as someone who increased my workload by her incompetence.
The nurses on the service had declared that they would not take this intern’s orders without another signature assuring them that the orders were o.k., a precaution usually limited to medical student. They would, however, take those of the two students as long as someone countersigned them sooner or later. While this was a vote of confidence for us, it meant that the intern could never be left alone on call. That meant that Jack and I worked a call schedule of “one in two.” The difficulty of a one in two schedule cannot be overstated. We began rounding at 7:00 a.m. and never left the hospital before 7:00 p.m. the following evening. Since it was November, I only saw the sun through the begrimed windows in the stairwells.
The nights were quite busy and to make matters worse, ours was the first year that there were a large number of women in the medical school class. The hospital had not realized this and there were only four beds for female students. Many nights we actually slept in tag team fashion, one girl slipping into a bed as another was called out, or bunking down in the ward’s visitors lounge with a flannel sheet on the faux leather couches.
After 36 hours of work, I used to walk out of the hospital into the cold night air. The taste of that clean air, unburdened with the stinks and disinfectant hospital smells was like wine.
I flew down the long hill to my married student’s apartment, where my husband David met me at the door, kissed me, undressed me, and put me in the bathtub. Later he would wake me, rinse me off, take me out, and dry me off. Roused by the bath I would eat what he put in front of me. I would attempt at that point to make intelligible conversation. Soon after, however, I would fall senseless into bed. I slept deeply all night but had many vivid dreams caused by REM rebound.
After a few weeks of this I was feeling quite sorry for myself. When I finally got a whole weekend off, I was beside myself with excitement. David and I went out for lunch and we walked along Ste. Catherine Street. I went to visit my shoes.
It may seem strange to visit shoes, but these ones were very particular. They were beautiful Italian leather, oxblood-coloured, low-heeled, lady-doctor shoes. I had noticed them in the store window many months before. At over $100 for the pair, they were well above the budget for students in 1979. I did go and visit them periodically, just to drool. David, of course, found this terribly amusing. He did not understand the passion that wonderful footwear could raise in this woman.
That day, as we approached the store we saw a sign: A 75% off sale! I raced into the store and accosted the salesman. “Those shoes,” I pointed to the low heeled oxblood coloured shoes, “Are they on sale?” The salesman looked down his nose at me. “Those shoes, Madame, never go on sale.”
I was crushed. I thought those shoes were mine! Here I was deprived of sleep, decent food and sex. Not to mention leisure, reading and intelligent conversation. I wanted a present! I believe this feeling of deprivation and entitlement is what drives some surgeons into debt as they buy themselves expensive presents to make themselves feel better about what can be an untenable lifestyle. My darling husband looked me in the eye. “Buy the stupid shoes” he said. “We just got your student loan.” So armed with funds from the provincial government I bought the shoes. The next day I wore the beautiful red shoes to work. They looked fabulous.
That day, we had an operation with a surgeon, whom I shall call Dr. O. M.
Dr. M. was a short intense bulldog of a man, unpleasant to house staff and hard to please. This morning, we were operating on a young man with a vascular malformation of his bowel. This meant that somewhere in the endless loops of his intestines there were abnormal vessels which could periodically start bleeding. Nowadays we have all kinds of sophisticated techniques which locate and destroy the abnormal vessels without surgery, but then, there were only two ways of dealing with it: Wait and hope that the bleeding would eventually stop which it usually did, and support the patient with fluids and blood transfusions. Or try to find and remove the offending piece of bowel.
According to John, our chief resident, at that time surgical opinion advocated a conservative approach, since the malformations tended to be multiple and repeated surgeries would progressively eviscerate the patient.
Dr. M. however, was not a patient man by nature. Waiting around for the bleeding to stop did not appeal to him. He had already operated on this patient five times: three times to remove pieces of bleeding intestine, and twice when the bowels became obstructed from twisting around scars from previous operations.
Usually there was enough work to keep us busy on the ward and I didn’t always have to go into the OR. But Dr. M. needed a second assistant on this case, as there was going to be a mess. So I was delegated to go.
Suited up in the OR, I was next to Dr. M. who had the table adjusted to his height. While this was fairly comfortable for me, I was standing on a low stool, John, who was very tall, had to stoop all during the operation. Dr. M. liked a wide field to operate. He kept flapping his elbows and standing more and more in front of me until I was leaning back off balance holding onto my retractor for dear life. Suddenly Dr. M. said “OOPS a bleeder.” He had cut through one of the abnormal vessels he had hoped to find. He moved neatly out of the way of the spouting blood vessel but it caught me full in the face. The blood splashed off my glasses, down my neck inside my gown and into my new shoes!
“May I scrub out?” I requested.
“No” said Dr. M. “I need you here.”
The circulating nurse took pity on me. She came over to me with a hot sponge, removed my glasses., to clean them. She then changed my mask and sponged off my face and neck. An hour later, when I got out of the OR I was able to shower most of the blood off in the mould-encrusted showers of the intern’s residence. But my shoes, my new shoes had been filled with blood! I showed them to Jack. “My new shoes” I mourned. “They’ll be ruined.”
“Maybe not” said Jack practically. “They are blood coloured.”
That night David and I worked hard on those shoes. We sponged them and polished them and tried to resuscitate them. I did wear those shoes for another two years, but they were never quite the same again.