I had moved here to San Francisco to do my internship in pediatrics at UCSF. I was the first Harvard student they had had for this program. UCSF had been a non-elite medical institution but they had decided to change that, and part of the change was to hire a first class Chairman, Mel Grumbach, from Columbia. I think my pedigree might have been what impelled them to schedule my first rotation over at the old Children's Hospital in the Richmond District of San Francisco, which wasn't part of UCSF, but they rotated interns through there to get a general middle class children's hospital experience. I think they figured, let the Harvard guy deal with it, and we'll let the others go over there after they've had some supervised training at the big hospital first.
So I was there on the ward with a resident. He was a tall and already balding guy named Jerry, who later opened a community practice in the area. He was the one who was supposed to know what he was doing and to guide me. I remember three cases especially.
Soon after I got there, it was about 3:30 in the afternoon and Jerry told me that a girl with meningitis was coming in. Meningitis is a life-threatening very severe illness. She was coming up to our ward. Jerry told me, “You should be able to handle this. Stick an IV in here and give her antibiotics. I'm going home.”
I had put in some IV's at school, but I don't think I could say I was skilled at it, and I think so-called triple antibiotic therapy was the standard then, and I had a vague idea of the doses. I must have relied on the nurses for help, and I was successful at the end, but it was a bit hair-raising. The kid lived and recovered.
One day we were on rounds and there was a middle teenaged girl in the hospital, a pretty blond middle-class girl with straight hair who was sitting up with the back of the hospital bed raised when the two of us came in for our morning rounds. Jerry told me that she was being worked up for possible TB. It involved some procedures, like putting a nasogastric tube down into the belly and aspirating to see if some TB could be recovered there, and other procedures that I don't remember. Jerry addressed her formally with me at his side and must have asked her if she knew what she was in for. She tried to compose herself and smile and said, “Because I have tuberculosis?” Then she broke down crying. Jerry looked at her and said, “We'll come back when you've pulled yourself together,” and left the room with me at his tail. He made some remark about hysteria and teenaged girls. A little later I came back alone, without informing Jerry, and explained to her that she was only possibly infected with TB and we were doing all this just to make sure she didn't, but that if she did we could cure it with medicines.
The third case was a late teenage boy with cystic fibrosis. CF is an inherited disease once called mucoviscidosis, a name I liked because it described the condition well just in the name. Patients with CF have very viscid mucous – it's thick and sticky – and it accumulates in their lungs and they can't clear it and it gets infected and eventually they die. At this time our patient had lived longer than expected already. His lips were blue. He was in for an exacerbation and was on IV antibiotics. I sat down with him and asked what it was like for him to have CF. He told me that it was OK much of the time, but then he would have these episodes and have to be cleaned out – the therapist came a couple of times a day to clap him hard on the back and try to mechanically mobilize some of that mucus and have it drain out his mouth. When it came out it was all green. He seemed like a normal kid when I was talking to him; he wasn't much younger than I was. Later on I came back and he had a super high fever and was unconscious and shaking, due to the infection. He survived that episode and I left the service after at the end of the month so I never knew what happened to him. Or rather, I did know, I just didn't know the details.
Being a young doctor can be kind of a shock.
Budd Shenkin