For me, Christmas really is the most wonderful time of the year – ‘with those kids jingle belling, and everyone telling you, Be of good cheer”. In many ways, I truly believe you cannot over commercialize Christmas. I love everything about it, the lights, the decorations, the crowds, the songs, and the food. But is can also occasionally bring out the ‘crazies.
I had just finished serving my first year of penance upon entering the ‘Anesthesiology fraternity’ – that is I had finished my internship. I call it a fraternity because, back then, there were few women in the specialty and so it very much was like a fraternity. The year also came with its own forms of hazing – another story for another time. During the first year of your residency you are called an intern, not sure where that word comes from. In the dictionary one of the first definitions is the verb form – to confine or impound. Hmmm, seems to fit what we all went through.
Interns could be easily identified walking around the hospital, they were required to wear white pants, white shirts and a short white lab coat. Not only did we have to wear white lab coats – whoever thought that was a good idea in a hospital, but we were the ones with the ‘shortwhite lab coats’. Medical students also wore short white lab coats, but interns could be distinguished from medical students by the stains on ours. Please, don’t ask what the stains were from. After all, one had to begin to ‘learn your place’ in this very hierarchical environment – and it became painfully obvious very early on the esteemed place interns held in medical education – esteemed/unique, there certainly was no one lower. As one advanced in one’s training the lab coats grew in length to designate one’s slow advance up the academic ladder.
As an intern, one gets to rotate through various clinical services in the hospital, experiencing for a brief moment, what each clinical department has to offer in terms of patient personalities and medical disorders. For an anesthesiologist, it is invaluable to begin gaining an appreciation of the types of patients one will be dealing with throughout their career.
As I recall I had spent my first rotation, as an intern, on the Cardiac Surgery service. Here I was, fresh out of medical school, few if any skills, certainly with very little confidence, and yet I was expected to take care of some of the sickest patients that would cross the threshold of the hospital. The service was run by what could only be called ‘a slave master’. Assignment to the Cardiac Surgery service came with task of admitting five new patients every day, five new heart surgeries every day, and five discharges every day – day after day after day. And joy of joys the intern was rewarded with composing 5 admission histories, and 5 discharge summaries every day – day after day after day. An intern never had time to see the surgeries that accompanied each patient, but you were rewarded with being on 24 hour call every third day and taking care of some 20 or so patients at night while your colleagues slept.
The rest of the first year followed a very similar pattern – off to a new medical service for a month at a time, a new set of patients, a new set of diseases, and 24 hour call every third day. Some rotations were a pure joy – oh to have the days back that I spent at Children’s Hospital – back then it was called Children’s Orthopedic Hospital, the OB service at Group Health, scary but fun. And some were month after month of patients who had made poor decisions about their lives and health and ended up at Harborview where we did the best we could for them. But with each rotation one’s appreciation for how privileged we were grew and grew.
My second year of training had started, I had been given a bit longer lab coat, and I was finally doing anesthesia – my chosen profession. I had completed 3 months of anesthesia at Harborview managing critically injured trauma patients, that just 2 years earlier I would have never dreamed I would be able to care for. Back over to the University Medical Center I went for 2 months in the operating rooms, where, as the old saying goes, “if you hear hoof beats, those will be zebras coming not horses”. There was never a ‘normal’ or ‘usual’ patient there. They were, for the most part, patients with very obscure, unusual, nearly unheard of diseases, or patients in which you were changing out old used up body parts – livers, kidneys, hearts – for used but still workable parts.
December had just rolled around, the Christmas spirit filled the air, and I found myself on the Pain Service. Now that’s a name I really never understood. They would continually tell me I was on the Pain Service, but to me it looked like I was on the Pain Relief Service. It was very obvious to me the surgeons were the ‘pain’ service, and we, as anesthesiologists, did our best to stomp out pain.
That month I had the pleasure of working with a senior faculty member named Terry Murphy. Now Dr. Murphy was unlike any doc I had ever come across. He was so funny my mouth would hurt by the end of the day from smiling and laughing as we went from patient to patient. He wore half glasses for reading that sat nearly to the end of his nose and had a hair style that would challenge Albert Einstein’s. He was incredibly bright, was trained in Great Britain so came with a dry wit that was unmatched. He found humor and joy in everything he did, and every person he came across. And that was something to say. Patients with acute and chronic pain can be some of the most challenging, depressed, unappreciative patients one can come across – and for very good reason. Their lives were often totally consumed by their pain condition. It was because of Terry Murphy that I spent the first third of my career working on the Pain Service as a faculty member.
It was, I think, December 19th. Unbeknownst to me a young, 23 year old guy, walked in to the Urology Clinic which was just down the hall from the pain clinic. On the surface he looked like a healthy young guy, an unusual type of patient to be presenting to a Urology clinic. There the waiting room is usually full of aged men who ‘can’t get it out’ and similarly aged women who ‘can’t keep it in’. He came in complaining of testicular pain. A young man presenting with testicular pain can be, on its surface a relative emergency, so he was immediately ushered into an exam room to be seen by the first available urologist. Sue was the nurse in the Urology Clinic, and her boss, John Krieger was the first urologist on the scene. Now John Krieger, if you know anything about him, has very little patience with patients not cooperating with his requests. Well, they got him on the exam table and as John started taking off the kids clothes he just kept complaining bitterly about the pain, refusing to let John take off his pants and underwear. They were getting nowhere fast, so John, finally coming to end of his patience told Sue, “just take him down to the Pain Clinic and let them deal with him”.
The next thing I knew, here was this guy being escorted into one of the Pain Clinics exam rooms by Sue. Sue dropped him off and gave me an abbreviated but as thorough history as she knew. She then turned to leave the room, looked at me with a sly smile on her face, rolled her eyes back and said softly, “good luck”. Sue has incredible insight so at that moment I should have expected things were not as they seemed.
About that time, Dr. Murphy came bustling in to the room per his usual, glasses on the end of his nose, long white lab coat open and flowing behind him. He looked at me and said, “well the good Dr. Ross, just what do we have here”. I filled him in as best I could with the sketchy history I had received. He said, “ok let’s get started and figure this out’.
Dr. Murphy proceeded to take the guys pants and underwear off paying little attention to the patient’s protestations. If a pain doctor is ever side-tracked by a pain patient’s complaints few exams would ever get completed.
Off came his shirt and tee shirt. Belt loosened, pants lower, accompanied by more and more complaints and protestations. The moment of unveiling was about to occur. As the young man’s underwear came down, there, right in front of us, intertwined in his pubic hair were hundreds of strands of silver, sparkling Christmas tree tinsel. That was one of the few times I have ever found myself speechless. Dr. Murphy, on the other hand did not break stride. He pulled his glasses even further down his nose and looked directly at me and said, “Dr. Ross I think we have discovered this young’ man’s problem. I believe he is hard of hearing”. I was stunned and had no idea to what he might be referring. I thought the guy’s problem resided much higher in his head than his ears. Dr. Murphy just smiled, walk up to the head of the exam room table, bent down close to the patients head and said in a very loud voice, “young man, the words are deck the halls!!”
Merry Christmas
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