Actually, I knew what he meant. After an operation I had once had on my legs, I felt the doctor was too rough when he took the stitches out. But I hadn't wanted to take them out myself. It's good for a doctor to be a patient now and then — makes him more responsive to all the patient's irrational fears. The solution is to tell the patient everything you are doing, even the simple things, because often it is what you take for granted that scares the patient the most.
"Mr. Sperry, you can move around as much as you like. In fact, movement is good for you. You are not going to pop open. This drain is the normal procedure. It lets out any bad juices while you heal. The safety pin is just to keep it from going back inside your abdomen."
All was well with Mr. Sperry, although I had surely given him something to talk about for the rest of the day: how the cruel doctor had yanked his drain and caused the wound to open and bleed.
That was the ward routine: checking drains, changing dressings, answering questions, looking at temperature graphs. Although Marsha Potts was not my patient, I paused in front of her door almost instinctively. She looked worse now, with the daylight exposing her jaundiced color and the skin on her face so tight and drawn that her teeth were bared in a perpetual grin. She was in terrible shape; we were doing all we could, but it would not be enough.
Outside her room, where the grass came right up to the building, the birds paid no attention as they squawked and chattered over bits of toast tossed to them by the mobile patients.
Now, at seven o'clock, the ward had come alive, suddenly filled with breakfast trays and clanging IV poles as people made their way to the bathroom. Nurses scurried here and there, carrying pans, needles, ointments, and pills. Swept into this world, I no longer felt tired, at least as long as I stayed on my feet. There was an exhilaration to the routine; it seemed to say, "No one can die here, everything is under control." In the midst of all this bright efficiency, Roso was out cold from his Sparine. I had to shake him several times to get any response at all. But once half-awake he agreed he was more strong, Doktoor, before sinking back into sleep.
A lab technician asked me to help her draw some blood from a patient with bad veins. She had tried three times without success. Certainly I'd try, and willingly, because it was a source of great comfort to me having these technicians to draw blood in the morning. To nondoctors it might seem a small point, but medical students resented spending most of their time before morning rounds trying to milk blood out of patients; by the time rounds started they hadn't been able to see any of their patients and were therefore ignorant of their latest condition. When the questions started coming—"What’s this patient's hematocrit, Peters?" — you had to guess, because you hadn't had a chance to look at the chart, either. But it must not sound like a guess. Snap back, without hesitation, "Thirty-seven!" as though you'd stake your life on it. It was not a matter of honesty. Better to play the game than to tempt disaster by saying you didn't know, whatever the reason. No one cared whether you had done those twenty-seven blood counts except if you didn't do them. So you shot back thirty-seven so quickly that half the time the professor would pass on without thinking. But if he paused, you were in trouble, unless you could distract him by referring to a recent article bearing on the disease. Of course, if he checked the chart, you lost totally, unless by wild chance the hematocrit was, indeed, thirty-seven; otherwise, you said somewhat lamely that you had another patient in mind. This would bring about the last, fatal pause as the professor leafed through the chart, looking for another question.
"What about the bilirubin, Peters?"
Now you were really up against the wall, faced with an all-or-nothing gamble. If your bilirubin guess was wrong, too, the professor's suspicion that you were lax on patient care would spread like ripples through the hospital. But in the happy event that you were right, you were returned to a state of grace and moved on to the next patient to watch another student get his interrogation. Bilirubin is different from hematocrit in that everyone's hematocrit varies a good deal, whereas the bilirubin value is usually pretty much the same in everybody, except in liver and blood cases. So you decided to gamble, saying, "It was about one, sir." In medical school most of us learned to play the game; if you played it well, you won more than you lost.
In Hawaii, the technicians had lifted this blood burden, and I didn't mind helping them occasionally. Besides, I was pretty good at it. I should have been, after having drawn several thousand blood samples in medical school. We students had started by drawing each other's blood, which was generally a snap, although some of us made it look pretty difficult. Even this exercise had not been without its dramatic moments. One time, after vigorously palpating the arm vein of another second-year student, I had it standing out like a cheap cigar. The tourniquet had been on for about four minutes while I built up my courage, and when I finally pushed the needle in, my friend just disappeared. It all happened so fast. I went directly from concentrating on the needle breaking the skin to staring at a needle and no arm. My "patient" was spread out on the floor in a dead faint. We had all dreaded those practice sessions, but they were easier than having each student draw blood from himself.
I'll never forget the first time I drew blood from an actual patient. It happened early in third year, when we students were beginning ward medicine. As bad luck would have it, our first day on the ward had coincided with a shift change among the interns and residents. To the new residents, the opportunity was irresistible. They decided to check the diagnoses of all the patients, and for this they needed proof — cold facts, incontrovertible laboratory evidence. As a result, we students had to draw about a pint of blood from every patient assigned to us. My first patient, poor fellow, was a chronic alcoholic with advanced liver cirrhosis. His surface veins had disappeared years ago, and I had to stick him twelve times, groping around inside his arm with the needle, feeling each needle point break through unknown inner structures with a sudden, almost audible popping release. Finally, I had had the good sense to give up and be instructed by the intern on how to get the needle into the large femoral vein in the groin, a procedure known as a femoral stick.
Now the laboratory technician was having much the same problem with a Mr. Schmidt, whom I palpated for the usual arm veins as she handed me a syringe. It was obvious why she hadn't been able to get any blood: I couldn't feel a single decent vein in his arm. So I did a femoral stick, and it was over in a flash.
Farther along the ward I came to Mr. Polski, who was a problem for me mainly because I had failed to achieve any real rapport with him. He had diabetes, very poor peripheral circulation, and a deep infection of the right foot. About a week previously we had done a lumbar sympathectomy, cutting the nerves that were responsible for contracting the walls of the blood vessels of his lower legs. But he was showing very little improvement. Because of the pain, he insisted on hanging his leg over the side of the bed, and that merely inhibited what meager circulation he had. At first I had tried the friendly approach, explaining carefully what happened when he let the leg hang over the side. Regardless, every morning when I appeared, there it was hanging down. Switching tactics, I had pretended to be angry, yelling in feigned rage — which didn't change the situation except to make him like me even less. The foot, now black and gangrenous, was scheduled for amputation.
I nodded my head to Mrs. Tang, an elderly Chinese lady with a cancer growing inside her mouth. She couldn't talk, so we just nodded. The cancer was so big that it had dissolved some teeth and the bone of the jaw on the left side, becoming finally an uncontrollable, fungating mass that occasionally broke through the side of her throat. She was like many older Chinese people who thought of a hospital only as a place of death and would not come to us until the very end. There was little we could do for Mrs. Tang but try some X-ray therapy. The cancer got bigger every day, and somehow Mrs. Tang every day seemed less real — perhaps because she couldn't talk, or maybe because she was so resigned.