He’s Not an Intern
I went to medical school because I wound up in the wrong line on the first day of college. Hard to believe such a momentous decision could hang on such a triviality. Whatever plan I had for college involved nothing more than a general education, certainly not, as my Mom wanted, following in the footsteps of my Methodist minister father. That I rejected.
The high school guidance counselors suggested trying for Emory. It was academically within reach and, as a church-affiliated school, offered scholarships to the children of Methodist ministers. Even though it was an expensive private school otherwise beyond my family’s financial means, a scholarship made it feasible, as long as I earned some money to help support myself. Emory accepted my application.
The first real day of college was registration, held in the gymnasium, a cavernous, old building with all the basketball hoops pulled back out of the way, the bleachers folded back against the walls, the floor ringed with tables and a mob of people milling around, mass chaos, noise and confusion. I joined a long, snaking line that I thought, in the pandemonium, was the correct line for generic, ordinary college. After standing in the queue for what seemed like forever, I finally reached the head of the snake only to discover it was the line intended for students wishing to sign up for the pre-med curriculum.
Although my memory banks remain foggy on the exact discussion at the registration table that day, I know I walked into the gym with no thought of becoming a pre-med student. I know I refused to go to the back of a different line. I know that when I walked out of the gym, I had officially become a pre-med student. Turned out everybody at Emory was pre-something. Pre-dent, no thanks. Pre-law, hell no. Pre-theology, double hell no. So, I stuck with pre-med.
Then it became about the competition. Mostly friendly, not always. My South Georgia high schools had prepared me poorly to go up against the smart, much better educated, big-city kids from Atlanta and Miami, even New York and Boston.
I kept second guessing the decision to stay in that pre-med line, wondering if I really wanted to go to med school. What I really wanted to do was fly. I’d been obsessed with airplanes since boyhood, able to explain the Bernoulli principle and how a jet engine worked at age ten. Model airplanes sat everywhere in my boyhood room and hung on fishing line from the ceiling, all carefully painted and decaled. I could easily tell the difference at a glance between all the WWII fighter planes, knew all about General Claire Chennault and the Flying Tigers. My grandfather had treated me, at about age twelve, to a sightseeing flight that more or less sealed the deal. What I really wanted was to go to flight school. Maybe.
In my sophomore year, I found out about the Marine Corps early commissioning program. They made it easy. Sign on the dotted line and you became a U.S. Marine, stayed in school, did Marine ROTC, went to basic training the next summer, went to Officer Candidate School the following summer and went to flight school on graduation. Sounded attractive. I could become a Marine aviator. My boyhood aspirations realized. They would help pay for school.
I completed the application forms. Put the forms in an envelope. Put on a stamp. Put on my game face. Walked to the nearest mail dropbox. Put the envelope up to the slot.
Pulled it back. Stared at the slot. Walked up to the corner and back to the dropbox. Stared at the slot. Back to the corner. Back to the dropbox. Back to the corner. Back to the dropbox. Back to my dorm room. Had I mailed those forms then, in 1964, I would probably have become not only a Marine Corps aviator but John McCain’s cellmate.
Having to work made it tougher. But I hung in. Then, junior year, came organic chemistry. Organic broke a lot of people. The year before I took it, a tough prof taught the course. Quizzes with a class average in the 30’s were common. I had a roommate from Hong Kong, new to the U.S., who took organic that year.
Steve struggled with English, especially with colloquialisms. He came back to the dorm room after an organic quiz one day asking, “What this mean ‘lose my ass.’ Everybody say ‘lose my ass.’ Please explain.” I slipped into my role as Steve’s Professor of Patois and explained the meaning of his latest encounter with college slang.
The following year, Emory brought in a visiting professor from Agnes Scott College, across town. The way Dr. Clark taught it, though far from easy, organic made sense. Still, the ranks of med school aspirants thinned after organic.
The university discouraged students from working during the first year, so my first college job was as an admissions clerk at Emory University Hospital as soon as freshman year ended in June, through that summer and for the next academic year. The job itself was not bad. The challenge was kicking out of bed on a Saturday or Sunday morning while everyone else slept in, especially after a late, hard partying and drinking night. The only sound accompanying my footfalls out the door at 6:30 A.M. was the snoring of my classmates. Learning to drink was part of the curriculum and the lessons were sometimes brutal.
I craved involvement in patient care and applied for a position as an orderly. I was inclined toward medical school at that point as an intellectual exercise, but needed to know whether I could handle the trenches, the blood and guts. The training classes started in early summer and mine was the only white face in the crowd of about a dozen. Many of the others were older men who would need to support families on the same pittance.
We learned how to give a bed bath, how to change the sheets with the patient still in the bed, how to take vital signs and much more. The nurses proved exacting instructors. They assigned me to the surgery ward, full time during the summer and part time during the school year, mostly weekends.
One of my tasks that summer was to apply Witch Hazel compresses three times a shift to a man’s massive hemorrhoids. I had only a vague idea what a hemorrhoid was so gulped with shock on first looking at these slimy, gray-pink lumps the size of lemons bulging from the man’s rectum. Here was a wealthy, high-powered Atlanta businessman laid low by the most mundane of ailments. All his money and influence could not protect him from the veins in his rectum deciding to go on strike.
I had probably not yet run across the word cachexia when assigned another patient that summer, a middle-aged man with terminal cancer. Sparse, brown hair clung to his always sweaty forehead. His sunken eyes, small orbs peering out from deep in a gaunt face, seemed to reflect despair and resignation. His joints stuck out from his stick-like extremities like a pig freshly swallowed by a python. When I would turn him or move him during bed baths, he weighed about as much as a garden hoe.
He never seemed inclined to talk much, made few demands. After several weeks of this, I came in one day to find him gone. The nurses hardly mentioned it. Just shrugged.
Working on the surgery ward, dealing with surgeons, naturally led to the idea of becoming a surgeon. I asked one of the vascular surgeons to let me go to the OR. The case he allowed me to watch was a woman undergoing an aortobifemoral bypass graft for occlusive vascular disease, obstructed arteries to the legs. The kindly nurses told me what to do to stay out of trouble—stand over there, don’t touch anything. I couldn’t see much but one scene riveted itself into my memory banks.
The aorta lies in the retroperitoneum, a space behind the abdominal cavity. In order to access the aorta and graft it to the occluded iliofemoral arteries that supply the legs, the surgeon had to move the abdominal contents, mostly the intestines, out of the way. So, he took the woman’s intestines, mainly her small bowel—coiled, wet, slippery, pink tubing many feet long—and struggled to put the bowel into a transparent plastic bag, about the size of a small, kitchen garbage bag.
When he finished, a plastic bag of guts hung over the side of the table, fastened securely in place with sterile clips, as he went about dissecting the retroperitoneum and preparing the aorta for grafting. I can still see that bag of guts hanging over the side of the table.
The summer before senior year I requested a transfer to the Emergency Room. I thought the job might prove more interesting. And it was. My primary function was to help the general surgery residents who covered the ER. I would room the patient and take their vital signs, retrieve any x-rays and assist with any procedures.
In those days, the mid-1960’s, all the men working at Emory Hospital wore the same uniform: white trousers and a short sleeve white shirt, supplied crisply starched by the hospital laundry, with a hospital logo over the left breast pocket. The only way to know who was who was that the residents were all white and the orderlies were all Black, except for me. The ER residents of course knew I was just a college student and an orderly.
That summer a new orthopedist, Dr. Hunter, a recently retired Army Colonel, joined the faculty and began to visit the ER periodically when on call. Dr. Hunter, a friendly, jolly man, had a salt-and-pepper crew cut and a middle that was getting out of regulation.
In the course of my orderly responsibilities, I would frequently retrieve the films on someone with a suspected fracture, and, in the treatment room, snap a film into the x-ray view box for him to review. Sometimes, he would ask me a question about it. The film might look fairly normal and he would say, “What do you see?”
I would stare at the x-ray, knowing it was a film of the radius and ulna but not much else, seeing nothing obvious amiss.
“Looks OK to me.”
“Don’t you see the fracture?”
“No, Sir.”
“Look at the medial aspect of the radius.”
Medial/lateral—these are concepts from week one of medical school, but I had no idea what he was talking about.
“Run your finger along the medial aspect of the radius.”
I would invariably put my finger in the wrong spot.
“Jesus, Son.”
Or, sometimes, a grossly obvious fracture might stare out at me, and he would say, “What kind of fracture is that?”
“I don’t know, Sir.”
“That’s a Colles fracture. You’ve heard of a Colles fracture, haven’t you?”
“No, Sir.”
“Jesus, Son.”
One day an ambulance delivered us an auto accident victim with a broken leg. Dr. Hunter came in to help. After things settled down, I joined a group gathered in the large, main treatment room finally applying the cast. Helping Dr. Hunter were two surgery residents who frequently covered the ER and knew me well. Dr. Hunter kept up a running patter, cracking jokes but also teaching and asking the residents questions. Then at one point he turned and asked me a question, an orthopedic question.
One of the residents looked at him and said, “Dr. Hunter, he doesn’t know the answer to that, he’s just an orderly. He’s a college student.”
At that, Dr. Hunter threw back his head and laughed, and laughed and laughed. When he at last regained control of himself, he looked at me, flashed his endearing smile and said, “Jesus, Son, you have no idea how glad I am to hear that. All this time I’ve been thinking you were an intern. In fact, I’ve been thinking you were the dumbest, damn intern I’d ever seen.”
