As I mentioned in a prior post, my attending on the medicine service was an infectious disease specialist by training, and he persuaded me to select the infectious disease service as one of my electives. It was one of those instances where an angel guides you on the right path, though that is something that only becomes apparent to you much after the fact. Just like my medical school requirement to spend an entire semester on parasitology, this rotation would pay off in a big way when I ended up spending time working in Indonesia. I’m getting way ahead of myself, so let me go back to ID, as we referred to the infectious disease service. Unlike most of my other rotations, the ID service was in the pediatric unit of County hospital. It was a relatively new building with modern amenities, such as air conditioning, and a very different culture from the main hospital, Unit 1. The head of the program was a worldwide expert on polio, which looked like at the time was going to be eradicated as one of the scourges of the world. (It was unthinkable at the time that people would willingly keep their children from getting vaccinated! However, due the anti-vaccine hysteria, we now have lost herd immunity against the disease in our country, and it is only a matter of time before someone from Pakistan or one of the other three countries where the disease still exits gets on a plane, brings it to our shores, and we once again see thousands upon thousands of children and young people become paralyzed, some to die. We still can’t cure stupid!)
Being on the pediatric service brought back memories of medical school days when I thought I wanted to be a pediatrician myself, and happily, some of the skills I learned at the time stayed with me, which helped a lot now. I hadn’t lost the ability of starting IVs or drawing blood from small children or babies, and I enjoyed the slower pace of clinical work on the service, which allowed sufficient time for conferences and teaching rounds that on Unit 1 were considered luxuries we wanted, but for which we could rarely find the time. The only two flies in the ointment in ID for me were the night nurse on the unit and my teaching attending. The night nurse was a tall, blond German woman, Mrs. Muller, who resembled Nurse Ratchet from “One Flew Over the Cuckoo’s Nest” in both demeanor and appearance. She had the particularly irritating habit of calling me in the middle of the night to report that Johnny So and So just wee-wee’d 50cc. of urine. This report was neither of clinical or emotional interest to me, nor to any other house staff, but despite several discussions regarding this topic, I couldn’t get her to stop. This was until I happened to be in the nursing office one day, and while the secretary was on the phone talking to someone else, I flipped through the rolodex on her desk (long before you carried your contacts on your phone) and jotted down her home phone number. That afternoon, when I knew she would be home and likely asleep, I called her number, and reported, “Mrs. Muller, this is Dr. F. I just want you to know I just wee-wee’d 255 cc”, and hung up. That was the last middle of the night call I received from Mrs. Muller.
The attending physician on my ID rotation was a very bright, energetic doctor who made a big name for himself helping to develop one of the then hot new antibiotics. He was also a very short gentleman, and tended to overcompensate for his lack of height with a loud voice and the cadence of a drill sergeant, attempting to intimidate the house staff and the students on the service. He always wore crisp, white button down shirts, a regimental tie, and a freshly starched white coat with sharp creases. He carried a clipboard, on which he would periodically scribble something while looking at you with some disdain while you were presenting cases to him. His teaching style was definitely long on fear and intimidation and short on sympathy. We were on rounds with him one day as the resident was presenting the case of Brandon Perry, a cute black 3 year old boy who was hospitalized with recurring fever for which we had not yet found the cause. Young children were kept in beds with high metal bars on the side which could be lowered, but which made them look like they were in cages not unlike at the zoo. Brandon was standing up in his bed, holding on to the bars, his young face looking at first puzzled, then taking on the dismissive sneer of the street as the attending rattled on about the differential diagnoses of fever of unknown origin, and spilled the contents of the urine jar hung on the side of his crib on the attending’s coat, at the same time saying, “Don’t listen to him – he don’t know s—t!” I don’t think any of us had seen a grow man get so red in the face or stomp off so fast as the attending did. Had it not been for witnesses, Brandon may not have been long for the world. As it is, he received extra cookies and ice cream from everyone on the team.
One of the members of the ID staff was a world expert on poisonous snakes, even having had one named after him. For this, and other reasons, we became the place everyone called for advice when they had a snake bite case to treat. Being essentially a desert, there are lots of different kind of rattle snakes all around Southern California. However, snakes will not bother people unless they are surprised or threatened. I quickly learned that there are basically two types of people who get snake bites. First are young children who are naturally curious, and don’t know any better than to approach a snake. The second is usually some young guy with lots of tattoos and a certain amount of alcohol in his system who comes to the ER saying, “I don’t know what happened. Me an’ my buddy just found this snake, and we were tossin’ it back and forth on this stick, when all of a sudden, for no reason it bit me.” Yep, we still can’t cure stupid!