PLEASE DON'T SHOOT THE INTERN

After graduating from medical school, I completed my medical training in a city hospital. I thought it would give me the best opportunity to see a wide variety of patients and the freedom to learn medicine without tagging along behind private practitioners. Many of them afraid to allow interns or residents to care for their patients. Obtaining training in a city hospital wasn't a free for all and provided more freedom to get hands-on experience. One of my most memorable experiences was my rotation in the emergency room. The emergency department was enormous and divided into several sections that included surgical cases, acute medical patients, female and male walk-in or stretcher cases, and an obstetrics section.

One evening I was assigned to the male medical section. As usual, it was full of the sick, the not so ill, and those with imagined illnesses. The patients were minimally screened for the severity of ailment by the admitting personnel consisting of a receptionist, and orderly, who was busy transporting patients. The service was overrun with patients 24/7. My dull gray room was packed that night with patients who sat on uncomfortable metal chairs lined up against the far wall awaiting an examination. The examining area on the opposite wall consisted of a stretcher, sink, and desk, separated by a drawn curtain separating me from the waiting patients. When a patient is called to be examined, everyone moves to the next vacated seat. It was musical chairs without the music.

After examining a patient, I'd pull the curtain open and look around the room before calling for the next victim. I quickly noticed an elderly gentleman who, by comparison, appeared relatively well dressed, with a shirt, tie, and clean, pressed pants. He was seated at least 10 chairs away from the launching chair and sat there quietly with his eyeglasses fogged up and forehead covered with beads of sweat. I walked over and, without saying a word, placed my hand on his forehead. He was burning with fever, and I helped him walk to the examining area. I shut the curtain and asked him to undress. While questioning him about his illness, the curtain was yanked open. A not-so-well-dressed man appeared demanding an examination.

I explained that the sick old guy sitting on the exam table had looked like he was ready to pass out and required my attention before of all the other patients. The not so well -dressed man said he was there before the older gentleman and I should have examined him first. I told him to wait until I finished with the elderly man, and I would then be happy to see him. At that point, he put his hand in his pocket and pulled out a small revolver, pointing it at me. He coldly stated that he would kill me if I didn't do what he said. In my panicked state, I thought about the time and energy it took to arrive at that point in my brief medical career that would be wasted if soon over. Collecting my senses and all the courage I could muster, I coolly told him if he killed me, I wouldn't be able to examine him and make him feel better. Looking at me with an anguished stare, soaked with perspiration, he said that there were people in the room threatening his life. His visions advised him that I had to examine him before they killed him. It was clear that I was dealing with a psychiatric patient and pleaded with him to put the weapon away. After a long pause, he reconsidered his options and slowly handed me the revolver.

I instructed him to wait on the other side of the room and quickly drew the curtain. With trembling hands, reaching for the phone on the desk, I quietly called security for help. During the episode, the patient sitting on the stretcher sat there peaceful and unruffled with a frozen facial expression. Surprised, I concluded he hadn't passed out because of an adrenaline surge he likely experienced from observing the whole event. I then described the intruder to security so they could identify him and take him to the psychiatric unit. I handed the gun over to them, finished administering to the patient with the fever, and called for the next patient.

Happily, I haven't had any more experiences like that.

BUG CURES STROKE

During medical school, I had a clinical rotation at the old Veterans Hospital in Washington, DC, in the 1960s. It was initially a private girl's school built-in 1930 that had been converted to a Veterans Hospital after World War Two. Its structural design didn't change very much when it became a hospital. The dormitory rooms became patient rooms with minimal changes. There was no air conditioning, and in the summer, it was hot and sticky. On Friday nights, many of the week's patients were discharged, and many vacated hospital beds were available. One evening on a sweltering summer night, I was assigned a newly admitted patient to evaluate. During summer, weekends usually presented with a surge of homeless veterans in the emergency room, recovering from a week of inadequate nutrition and the overconsumption of cheap alcohol.

My patient, a middle-aged male, admitted from the ER with a stroke diagnosis, was unresponsive to verbal and physical stimuli. He lay in bed with his eyes shut, unable to give a history of his illness. He was breathing comfortably, and vital signs were normal, but his extremities were flaccid. They fell to his side when lifted and released; however, all his reflexes were brisk and healthy when checked with a reflex hammer. Writing in his chart, next to the bed adjacent to an opened window, a sudden strange fluttering sound was occurring behind me. As I stepped away, a giant brown cockroach about the size of a baseball landed on his bare abdomen. His eyes immediately opened wide. His back arched upward off the bed, seeming to levitate as he rose upwards to jump out of bed, running out the room. I ran after him shouting for him to stop so I could finish my examination, but he escaped down a stairwell, and I lost sight of him. Embarrassed, I had to report that the exam was incomplete because a roach seemed to have cured a stroke, and I lost the patient. Later that evening, the intern informed me that security had found him and instructed me to finish my examination. He hadn't had a stroke, but he remained a guest of the hospital over the weekend. Admitting the homeless on weekends to feed, bathe, and dry them out (detox) was a service to the community and a way to keep medical students on their toes. I doubt that there are any therapeutic roaches curing strokes these days in our modern VA system.