Good Times in the Hospital: A Medical Memoir

By JAMES G. McCULLY

Good Times in the Hospital is a collection of unlikely stories, poignant vignettes, and humorous anecdotes gathered from a lifetime of experience with real doctors and patients. As the setting moves from Duke University Medical School, to The Mayo Clinic, to an inner-city charity hospital, to a military hospital, to private hospitals in metropolitan centers and rural towns, this inside look at hospital life allows the reader to gradually gain a new perspective on medical men and women: They are not much different from the rest of us. After forty years of medical education and hospital practice, the author concludes that, Doctors are no worse than other people.

As for the patients in these storiesalthough hospitals are engaged in the most serious business imaginableyou cannot find more laugh-out-loud behavior anywhere. This is because when people are seeking medical care, they are vulnerable and reveal their true, inner selves. And, it turns out that the true, inner selves of most people are often some combination of fascinating, inexplicable, and ridiculous.

To paraphrase a quote by Mel Brooks: So long as this old world keeps spinning around and around, every person riding on it will occasionally get dizzy and do something stupid. Good Times in the Hospital reminds us that it is unhealthy to take life too seriously and a lighthearted temperament is just as important as a sound diet. This point of view makes it possible for one book to combine a rare glimpse inside the hospital, an informative look at health care, and an entertaining collection of anecdotes.

There are chapters about juvenile practical jokes among medical students, mistakes by doctors in training, serious life lessons learned at the bedside, hospital affairs that end badly, doctors threatening other doctors with handguns, a girl who tries to stop her grandmas pacemaker with an MR scanner, an identical twin who has the surgery intended for her sister, an old man patiently waiting his turn in a charity hospital emergency room while holding his intestines in his hand, boyhood memories of a doctor who accompanied his father making house calls, a doctor who missed his chance to win a Nobel Prize by not listening to his patient, an intriguing case of domestic abuse, fascinating hypochondriacs, insights into why intelligent people spend their last dollar on irrational treatments, amazing examples of cures by mind over matter, the importance of our attitude on our wellness, and even reflections on the question of medical miracles.

Is it appropriate to laugh at the behavior of doctors attending their patients and entertain ourselves with yarns of patients in their sickbed? Good Times in the Hospital promotes the viewpoint that the best way to deal with our inevitable foibles is to laugh about them. The author says, If you believe that some things are sacrosanct and immune from humor, you are reading the wrong book.

In an epilogue following this rich tapestry of medical tales, the author offers some final thoughts on how to sort through medical advice, a discussion of alternative medicine, the real effect of malpractice lawsuits on doctors, and the responsibility of patients for their own health. This epilogue is a rare opportunity to hear from an experienced, retired physician on such matters. Such frank opinions are virtually never discussed by doctors in practice, who must be circumspect in what they say for fear of alienating their patients, losing their insurance coverage, or becoming the target of a law firm.

Mostly though, Good Times in the Hospital is an insightful panoply of true-life stories that illustrate the best and worst of human nature, a chance for the reader to have some fun and learn a little along the way.

• Language: English
• Publisher: Xlibris US
• Release date: Oct 24, 2012
• ISBN: 9781479735242

Book preview

Copyright © 2012 by James G. McCully, MD.

Cover art by Nils Obel.

To browse the artists work including a major exhibition

by the Smithsonian Institution’s Museum of Natural History in

Washington, DC, see: www.nilsobel.com

Library of Congress Control Number:     2012919433

ISBN:   Hardcover     978-1-4797-3523-5

  Softcover     978-1-4797-3522-8

  Ebook     978-1-4797-3524-2

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Rev. date: 02/27/2013

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Table of Contents

PREFACE

MEDICAL SCHOOL

The Bread Mold Lady

A Lesson In Germ Theory

Jugular Veins

Mayonnaise

A Drink of Water

The Indian Chief

My Fifteen Minutes as a Psychiatrist

A Case of Shingles

My First Mentor

The Organ Recital

INTERNSHIP AND RESIDENCY

Chitlins in Hand

Mind Over Matter

Some Days Are Better Than Others

Babies Having Babies

ARMY MEDICINE

Fighting the War in Alabama

Military Medicine

HOSPITAL PRACTICE

Warts

The Story of Sara and Clara

Priorities

An Incident in a Rural Georgia Hospital

Medical Staff Meeting

The Narcissist

House Calls

The World’s Worst X-ray Technician

The Miracle

A Magnetic Resonance Scan for Grandma

Laughing at a Patient

A Bullet in the Head

Instructions For a Surgery Nurse

Workman’s Compensation

Haves and Have Nots

An Affair to Remember

EPILOGUE

Straight Talk for the Health-Conscious

Drive a Blue Chevrolet and Live Longer

Doctors and Lawyers

Moderation

DEDICATION

This book is dedicated to my wife, Marion. Fifty years ago, she climbed into a car loaded with all of our worldly possessions and headed off to be the wife of a medical student without a dollar in his pocket.

For four years, she taught school all day and earned my tuition to Duke Medical School. She raised our children without my help for the following six years while I interned in Atlanta, lived on an Army base in Alabama, and finally finished my medical education at The Mayo Clinic.

Then, her troubles really started. When everyone addresses you by the moniker doctor, day and night, year after year, you have about as much chance of retaining your humility as Al Gore has of winning a Nobel Prize. (Oh, wait, that actually happened—bad example.) The point is that being a doctor’s wife sounds better than it is, and Marion tolerated it far better than I could have ever done.

I made the living, but she made the living worthwhile.

So long as this old world keeps spinning around and around, everyone riding on it will occasionally get dizzy and do something stupid.

—Mel Brooks

PREFACE

No one will care what you know until they know that you care.

—Sir William Osler

Doctors occupy a special place in our imagination. This is not because they are special themselves. It is because we encounter them under special circumstances in the context of our hopes and fears, during those times when we are vulnerable to sickness or worse. Because strong emotions and clear thinking are rarely found together, our stereotype of medical men and women bears little resemblance to reality.

There are so many myths about medical doctors that there is little room for facts. Most stereotypes are wrong. It makes no sense that an idealistic young student who once embarked on eight arduous years of study to do something important with his life would later develop into an arrogant, greedy old man. Of course this could happen and probably has happened, but this is not the story of the hundreds of thousands of physicians in America.

At an age just beyond their teens, in a fit of youthful enthusiasm, they made a decision to pursue a dream. A quarter century later, physicians arrive at middle age wearing long white coats in the center of a life and death drama—an intimidating situation they had anticipated only in the vaguest terms.

I have heard them reveal their innermost thoughts in the doctors’ lounge when there were no patients, no lawyers, and no journalists around to impress. They sincerely want to meet the high expectations of their patients every day. Meanwhile, their patients have no appreciation for the randomness and chance that affects wellness, the complexity of illness, and the unpredictable nature of treatments.

Having survived the fierce competition for entrance into medical school, doctors are disciplined, hard working, and confident. At the same time, after decades of struggle against the grim reaper himself, they are far more humble than they appear.

They don’t think they are gods. Physicians develop an air of confidence that may be mistaken for arrogance. Their patients need to view them as infallible; no one wants their cancer treated by a regular person like themselves. This persona of confidence is in conflict with an awareness that they are engaged in a losing battle. As a result, all physicians live with an internal tension, a tension that they must hide from the world.

Those who live with a disconnect between their appearance and their reality have a profound problem that will extract a great price. Doctors tolerate this occupational hazard because they are often rewarded with the satisfaction that comes from success against great odds.

They aren’t in it for the money. Staying in school eight years longer than everyone else while you’re young, working under enormous stress for forty years, and carrying a pager when you are sixty years old is a lousy plan for getting rich.

They don’t play golf every Wednesday afternoon. They don’t make patients wait for hours in the waiting room while they carry on with nurses in the back office. They don’t intentionally use big words to feel superior or to confuse laymen. They don’t all have illegible handwriting. They have no singular traits or temperament—whether good or bad. They have the same strengths and weaknesses as the average person.

Someone once said, Doctors are no worse than other people. Amen.

The symbol of the medical doctor is the caduceus: a snake coiled around a staff. This image had its origin in an Old Testament parable about an infestation of snakes that was driven off by a staff empowered by Jehovah. As a physician, I appreciate this link with the Almighty, although my wife fails to see the resemblance.

I would revise the symbol for modern healthcare providers. My design for a medical emblem might be a stethoscope flanked by those two masks seen over a theatrical stage: the face of drama, and the face of humor.

Both drama and humor are highly dependent on context. The narratives in the following chapters are noteworthy only because they come from the real life experience of real people engaged in the most serious business imaginable.

To my surprise, while working among doctors and patients for forty years, I found a treasure trove of unlikely, poignant, and amusing anecdotes. I assure the reader: I couldn’t possibly make up such parables from scratch any more than I could make a pearl from a grain of sand.

The hospital care of the sick and injured is a serious matter. Is it really appropriate to laugh at the behavior of doctors attending their patients and entertain ourselves with yarns about patients lying in their sickbed?

I don’t believe it is healthy to take life too seriously.

Everyone has role models. One of my foremost role models is a man named Robert Wilson. I learned of Mr. Wilson in a small book entitled, Famous Last Words. Each chapter in this little booklet describes the last words spoken on this earth by various individuals, both famous and unknown.

My favorite quote was by a man who lived long ago in colonial America. In those days, most people died at home in their bedroom. Robert Wilson was on his deathbed. At the foot of the bed, there was a small gathering of his family engaged in what was called a deathwatch. This term is no longer used much, but it simply meant that a group would sit around in the bedroom of a dying relative during his final hours.

At one point, one of his family suspected that Robert might have passed away in his sleep: he might be gone. She pulled the covers off of the foot of the bed and felt his feet to see if they were cold and lifeless.

His feet were warm, so she said, He’s not gone yet. No one ever dies with warm feet.

Robert opened his eyes, and said, Joan of Arc did. Then he breathed out his last breath.

Of course, he was making a joke about a martyr who was burned at the stake, and those were his final words.

If you don’t think it is beautiful that this man could find humor in his own deathwatch, you are reading the wrong book.

MEDICAL SCHOOL

Nothing is so certain to perpetuate ignorance

as a failure to investigate the facts.

—Ralph Waldo Emerson

The Bread Mold Lady

One of my medical school professors had taught at Duke since before the discovery of penicillin. By the time that I arrived, Dr. George Baylin was near retirement. He was a crusty old curmudgeon, an exceptional teacher, down to earth, irreverent, and a goldmine of interesting personal anecdotes.

He told us that when he was a student there was a special hospital ward reserved for patients with osteomyelitis (infection in a bone). These unfortunate souls were sequestered away from the others because their osteomyelitis was always attended with a terrible odor. The infection in their bones would eventually tunnel its way out through an open wound in the skin. The drainage from these wounds was a foul business indeed.

One night, a new patient was admitted to the osteo ward. She was a middle aged, African American lady from rural North Carolina. The following morning, young George Baylin, along with a small group of other students and their professor made their rounds to check on the progress of the patients.

The new patient had a bone infection in her shin. When they pulled back the bed covers to examine her leg, they were surprised to see that although she had a tract through the muscle of her leg, it was free of drainage and without any odor. They had never seen a patient arrive on the ward with such a clean wound from osteomyelitis. The professor asked her how she had been dealing with her infection before coming to the hospital.

She said that her grandmother had told her to stuff moldy bread into the hole in her leg. Soon after she began this home remedy, the bone pain subsided, and the wound drainage cleared up. The moldy bread treatment had helped, but had not cured her, so she had come to the hospital to see if the doctors could do more.

The group of doctors laughed at her story of stuffing moldy bread into the holes in her leg, and then they began the standard medical treatment—a very crude and ineffective treatment—that involved surgically removing infected tissue, pouring nitric acid into the wounds, and packing the tunnels with gauze laced with silver and other heavy metals. This rarely resulted in a cure, but it was the only useful treatment known at the time.

A few years later, Dr. B. picked up a newspaper and read that a new miracle drug called penicillin had been discovered in England. He took this as very good news. However, as he read the story of how Alexander Fleming made this discovery, his heart sank. Dr. Fleming had been working in his laboratory with a number of common bacteria. He had all sorts of these microbes growing in culture dishes. Then, he took a vacation for two weeks.

When he returned the laboratory, he noticed that some of the old culture dishes had started growing visible colonies of a different microbe in the midst of the bacteria. Around each of the new, unwanted colonies, there was a halo of dead bacteria. It appeared that the bacteria could not live next to the colonies of the microbe that had accidentally gotten into the culture dishes while Fleming was on vacation.

He transferred the mysterious microbes to their own culture dishes, put them in a warm place, and let them grow until he could identify them. They were a well-known fungus called Penicillium, a common bread mold.

The bread mold was killing the bacteria. A few years later, another scientist learned how they did it. The bread mold was making a substance that was poison to bacteria. He named it penicillin. Alexander Fleming got the Nobel Prize in Medicine in 1945. Later, his queen knighted him—penicillin had saved hundreds of thousands of military and civilian lives by the end of World War II.

Professor Baylin ended his story with the sort of rhetorical flourish that made him so popular with my class of students: If we had listened to that bread mold lady and taken her seriously, any one of us could have won that Nobel Prize. Instead, we laughed about her foolish home remedy. Years later, at a class reunion, we all got together and discussed our great missed opportunity. Then, we stood around in a circle and kicked each other in the butt.

A Lesson In Germ Theory

Back in my day, the first-year medical students never went onto the hospital wards with the patients. The first year consisted entirely of classroom lectures, laboratory, and library time studying the basic medical sciences, including anatomy, pathology, physiology, biochemistry, and microbiology.

Microbiology is the study of bacteria, viruses, parasites, fungi, and all the other nasty pathogens that cause infectious disease. You stare endlessly through a microscope at these microbes. You learn to collect them from wounds, blood, sputum, spinal fluid, and other body fluids. You smear them onto petri dishes and place them into warm ovens to grow into visible colonies. You collect them from the colonies, stain them for identification, and place them on slides so you can stare at them through a microscope some more.

As we arrived in the microbiology lab one morning, our professors announced they were going to use us as subjects in a study of hospital-acquired infection. They suspected that some hospital patients acquire infections after they are admitted to the hospital. This was an important concern, because the bacteria in a hospital have already been exposed to many antibiotics and they are resistant to treatment.

This is well established now, but in 1962 this was just speculation. Our professors were going to be the first to research the theory of hospital-acquired infection. They wanted to learn whether hospital workers transmitted infections to patients. We were going to be the guinea pigs in this study.

Their idea was that first year medical students have never been exposed to hospital bacteria, whereas we might acquire these pathogens in the coming four years. The bacteria that we carried on our skin and in our noses during our first year should be the same as those carried by patients outside the hospital. The bacteria that we would carry four years later should be typical of hospital workers. Our professors were going to prove that being inside a hospital for four years would change our bacteria from ordinary germs to hospital germs.

They told us they were going to swab the inside of our noses and keep a record of what sort of bacteria lived on people outside the hospital. Then, four years later, they would swab our noses again and find out if we had acquired a new set of bacteria as hospital workers. This would confirm the notion that hospital workers acquire more dangerous germs and transfer them to their patients.

In the morning, eighty guinea pigs in white coats lined up and passed by the professors, who stuck cotton swabs up our noses, then smeared each of the swabs onto eighty petri dishes.

That afternoon, we all gathered in the medical school amphitheater for another lecture on microbiology. We soon learned that we were in for a little surprise.

The same professors who had put the swabs up our noses were smiling among themselves. With obvious pleasure they told us that they were not really studying our nasal bacteria this morning. They had thrown away the petri dishes after we left the morning class. What they had actually done was paint the inside of our noses with fluorescent dye. Then, they switched off the lights in the amphitheater—leaving us in a total darkness.

After a few moments with the lights out, they turned on ultraviolet black lights that cause fluorescent dye to shine bright green in the dark. We looked around at each other and were horrified to see that we had smeared the dye from our noses all over our faces, our hands, and our clothes. Some students only had a little dye on their face and hands. Others had dye smeared all over them; their neckties were shining bright green. Forgive me, but there’s no other way to say it—we were looking at bright green snot, glowing in the dark, and it was all over an entire roomful of future doctors.

The lights came back on. The microbiology professors didn’t need to explain to us that the lesson was about hand washing since everyone contaminates their hands with the germs from their nose all the time, every day. Some are worse about this than others, but even the most fastidious person is guilty.

I later learned that the microbiology professors repeated this lesson every year on each new class of students. Most of us forgave the professors for this embarrassing ruse. It was good for us and seemed to make them very happy. As an added bonus, the guys got to see the girls in our class covered with snot—something we brought up at every opportunity for the next four years.

Jugular Veins

Some of the department chairs at Duke Medical School had been there since the day the school first opened its doors. To the freshmen students, they were larger than life. Stories circulated about their exceptional medical talents and accomplishments. This reinforced the impression that we were mere mortals in comparison.

They were an exclusive club of about a dozen individuals. No one had ever seen them eating in the cafeteria, going into the restroom, or scratching an itch. In the summer, they never broke a sweat. In the winter, when everyone else’s shoes were wet from the snow, their shoes were perfectly shined. They dressed like a Hollywood version of Sigmund Freud, with thick, gold watch chains exposed over their impeccable three-piece woolen suits and their beautiful neckties from London.

We idolized and feared all of them, but mostly we were terrified of Dr. Stead, the chairman of the Department of Medicine. Dr. Eugene Stead was tall and lanky. He had the penetrating eyes of a great bird of prey, and these large, deep-set eyes were shadowed beneath an enormous forehead and bushy eyebrows. His nose was not really a nose; it was more of a beak. His entire demeanor struck fear into your heart. Mostly, though, it was those eyes, those x-ray eyes that could see right through your skull and reveal that you knew absolutely nothing about medicine.

Dr. Stead was chairman of the most important department of one of the finest medical schools in the world, but he had never passed the examination to be board certified in internal medicine. This was because he had never taken the test. Long ago, when he completed his residency training and it was time to be tested for board certification, he had declined, saying, It makes no sense to take the examination. Who could possibly examine me? I’m sure that some of his peers resented this show of hubris. No one could argue with his position, however, for he knew more about everything than anyone else. In spite of his eccentricity, he was offered the chairmanship of the Department of Medicine at a very young age.

Although the department chairs rarely walked among us, they did have to move around the hospital as they directed the affairs of their department. This put us at risk of meeting them in the hallways, or god forbid, being confined with them in the elevator.

One of my classmates once told us: This morning, I was going up to the third floor, carrying two handfuls of urine specimen cups, and I decided to take the elevator, rather than carry all that stuff up the stairs. My hands were full, so I pushed the elevator button with my elbow. When the door opened, there was Dr. Stead, alone in the elevator. He smiled at me and held the door open so that I could climb aboard without spilling my load of specimens.

Then, Dr. Stead spoke to me. (At that point in our curriculum, none of us had ever spoken to Dr. Stead.) Pointing to the elevator buttons, he said, ‘Which floor, doctor?’

Third floor, please… Dr. Stead… sir.

With this, the great man leaped forward and stuck out his arm, stopping the elevator door just before it closed. Holding the door in one hand, he leaned back and pushed the emergency stop button on the elevator wall. In a slow, sonorous voice, he intoned, ‘This elevator is going down, doctor,’ and he pointed to the lighted red arrow pointing down above the elevator door.

Then, he stepped out of the elevator and gestured for me to follow him out into the hallway. He looked me in the face, and then he turned to look up at the ‘down’ arrow outside the elevator, indicating that I should have seen that this elevator was going down before I pushed the ‘up’ button in the hallway. As he stepped back inside, leaving me out in the hall, he said, ‘Next elevator, doctor.’

Just before the door closed, he looked me straight in the face, smiled, and said, ‘Don’t worry, doctor, I did the same thing earlier today.’

This story swept through the students’ lounge, the library, and the cafeteria, adding a touch of humanity to the myth and lore surrounding the great chairman of the Department of Medicine. This was important, because we all knew that soon, during our third year of medical school, we would be sitting in discussion groups led by Dr. Stead, and we would be required to discuss medical topics with him.

When that time came, we sat down with him in a small group, in a small room. Each meeting was focused on the chart of an actual patient that was currently in the hospital. Together