“So tell me, Mr. Jones,” he said in his deepest baritone, “how long have you been feeling this way?”
We all burst out laughing, picked up our scalpels and got to work.
The Peds Ortho Blues
In the winter of 1985 my classmates and I were turned loose on the unsuspecting wards. At the time we were “baby clerks,” fresh out of two years of sitting in our medical school’s darkened lecture theatres and still struggling to make sense of the countless thousands of pages of physiological facts floating around in our heads. My own clerkship rotation schedule kicked off with a one-month stint on the notoriously busy pediatric orthopedics service. I wasn’t the least bit worried. In fact, I was confident I’d be making more saves than Hippocrates and Grant Fuhr combined.
On the first morning of the rotation I arrived on the ward at 8:30 sharp. A quick search of the area failed to reveal any doctors, so I made inquiries at the nursing station. A harried-looking ward clerk stopped stamping requisitions long enough to inform me the team had finished rounds an hour ago. Since then the house staff had gone down to the ER to see some consults and the surgeon had headed off to the outpatient clinic. I decided to check out the latter.
When I got there I was surprised to find the waiting room already full. Inside there were four rooms. The orthopod saw patients in three of them while the plaster technician applied casts in the fourth. One of the examining room doors was closed. I could hear muffled voices behind it. I walked over to it and was poised to knock when the door suddenly banged open. I was nearly bowled over by a short, 40-ish, balding fellow with thick glasses. He was wearing greens, a lab coat and purple clogs. He thrust his right arm out, shook my hand briskly and said: “Hi, I’m Dr. Stone. You must be my new clerk. Glad to have you aboard! You can just follow me around for now.”
Without further fanfare he rushed into the next room, expertly grabbing the file out of the plastic chart rack beside the door as he went by. Upon entry he pulled a small tape recorder out of one of the pockets of his lab coat and proceeded to dictate a note on the child he had just seen. He paused for a second to introduce himself to the new patient’s parents and shake their hands. He then resumed dictating. When he was finished, he slipped the tape recorder back into his pocket and nodded at the parents. Thus cued, they launched into a description of their child’s problem. Every so often Dr. Stone nodded his head and grunted knowingly. When he figured he had enough to go on he scooted over to the examining table where the little girl was sitting and began twisting her left knee in every possible direction.
“No need to worry,” he declared a short while later. “This problem should correct itself as she grows. I don’t think she’ll require surgery. Please bring her back in six months for a recheck.” He fielded a few questions before doing a nimble 180 and blasting out the door, his trusty tape recorder already in hand.
As this pattern was repeated umpteen times over the course of the next two hours, it became excruciatingly clear to me that I knew next to nothing about real-life pediatric orthopedics. Eventually we took a five-minute break while Dr. Stone went down to the operating room to sort out a glitch in his schedule. When he returned he dispatched me to the plaster room to learn some casting skills. The tech was a jovial fellow with a terminal case of verbal diarrhea. He seemed to be hell-bent on giving me the entire two-year cast tech course in an hour and a half. By the time I left the clinic my head was spinning.
After lunch I returned to the ward. There I was introduced to the rest of the peds ortho team: a cranky intern and an even crankier resident. They both looked as though they hadn’t slept in weeks. Apparently the service was chronically short of house staff, and this month wasn’t going to be any different. The resident divided the ward patients between the intern and me and told us to see them, review their charts and write progress notes. The afternoon passed uneventfully.
At 5:00 p.m. we met to do sign-out rounds. When rounds were completed I picked up my knapsack and walked to the door with a relieved smile on my face. Survived my first day on the wards! Piece of cake!
“Where are you going?” asked the resident.
“Home,” I answered.
“You can’t go home – you’re on call tonight. Didn’t you see the schedule?”
My smile evaporated.
“No, I didn’t. Live and learn, I guess. Who’s on call with me?”
“Well, normally we put you newbs on with an intern or a resident, but right now we’re so short you’re going to have to take call by yourself.”
That didn’t sound too enticing.
“Who’s going to be my backup?”
“Dr. Stone.”
“Oh, that’s good.”
“Not necessarily. He takes call from home, and he doesn’t like to be contacted unless it’s for something really big.”
Oh, crap.
About 10 minutes after they left I was paged to the pediatric ER to see a girl with a broken upper arm. I tried to recollect what the chatty plaster technician had told me earlier about casting a fractured humerus. Something about an army-navy sling with sugar tongs. Or was it sugar buns? Whatever. I doped out a reasonable facsimile and went to town. Putting the contraption on was quite a battle – the child was developmentally delayed and she kept swinging her broken arm all over the place. I could feel the bone fragments grinding against one another whenever she moved. I had to keep reminding myself not to wince. The final product was no Michelangelo, but I was pleased nonetheless.
“Bring her to the fracture clinic next week for a recheck,” I said to her guardians in my most impressive doctor voice.
“Why does she need to come back again so soon?”
“Okay, make it a month.”
Half an hour later I was back to see a teenage wall-puncher with fractured knuckles. I wasn’t sure about the angles the various joints were supposed to be cast in, so I perused the bible – Salter’s textbook – and started slathering plaster on. The end result was a hand cast the size of a boxing glove. It was a miracle the guy could lift his arm off the stretcher.
“It’ll get lighter when it dries,” I chirped optimistically. “Come see us in the fracture clinic in a month.”
“That long?” he said dubiously.
“Okay, make it next week.”
An hour later emerg called me to see a 9-year-old with a fractured femur. Geez, isn’t that the biggest bone in the body? I scurried into the plaster room to find a stoic but uncomfortable little boy waiting for me on a stretcher. His father lunged out of his chair and shook my hand like I was the Messiah.
“I’m so glad you’re here! I’m Mr. Singer and this is my son Jake. The emergency room doctors didn’t want to give him anything more for pain until you assessed him.”
“Oh. Well… .”
“Have you had a chance to look at his x-rays yet? How serious is the break?”
“Er… .”
“Is he going to need surgery? Will you have to operate tonight?”
“Um, well, I’m not actually the surgeon. I’m the medical student.”
His eyes widened and he gasped. He looked horrified.
“When will the surgeon get here?”
“I’m not exactly sure. They tell me he doesn’t come in for every case. How about if I examine your son and then call Dr. Stone to see what he recommends?” Mr. Singer didn’t appear to be too thrilled with that plan. His nostrils flared and his eyebrows began to knit together ominously. “I expect he’ll come in right away for a major case like this, though,” I added hastily.
After the examination I telephoned Dr. Stone. I described the fracture to him and asked if there was anything he wanted me to do before he arrived.
“Oh, I don’t need to come in for that,” he replied. “Just put him in a Thomas splint and admit him to the ward. I’ll look at him in the morning when we do rounds. If you have any trouble with the splint, I’m sure the emerg doc will give you a hand. Good job! See you!”