Martin Duke
Mystic, Connecticut, United States

How sweet the silent backward tracings!
The wanderings as in dreams—the meditation of old
times resumed—their loves, joys, persons, voyages.
— Memories by Walt Whitman (1819–1892)¹

It is now more than sixty years since I was in medical school (1950–1954). Most of the classes I attended and many of the people I came in contact with have either been forgotten or are increasingly difficult to remember. However, the memories I do have continue to be a source of pleasure and reflection as the years go by.

An instructor in one of my laboratory sessions was Dr. Otto Loewi. It is embarrassing to say that the name of this 1936 Nobel Prize laureate, known for his discovery of the chemical transmission of nervous impulses, meant little to me at the time. I wish it had been otherwise. Lectures by Dr. Severo Ochoa and by Drs. Dickinson Richards and André Cournand, all later Nobel prize winners, also did not carry as much weight with me as they should have, wrapped up as I was in the daily grind of keeping up with my studies in anatomy, physiology, biochemistry, pathology, therapeutics, and other courses, details of which have long since been forgotten. How little I really knew, and what missed opportunities these were.

While taking a clinical clerkship in medicine, my preceptor lambasted me one day for the poor history and inadequate physical examination I had performed on a patient, telling me bluntly that unless I improved I would never be a good doctor. It took me a long time to recover from this dressing-down, well-intentioned as his comments might have been. During my clinical rotation in pediatrics, I had a discussion with the chairman of the department of pediatrics about a small boy I had seen as a patient on the wards of Bellevue Hospital. The boy had told me when I examined him that there were bugs and insects under his bed. Because he had been admitted to the sometimes far from clean wards of a large and old city hospital, I had accepted his account at face value. However, it was explained to me that the boy was actually experiencing visual hallucinations due to atropine overdose. A look under the bed indeed satisfied me that no bugs or insects were present. I had learned a valuable lesson—to avoid preconceived ideas and biases when examining patients.

While on the medical wards of the 3^rd Division at Bellevue Hospital, Dr. Ludwig Eichna taught me how to use the stethoscope properly when listening to heart sounds and murmurs. I particularly remember being with him at the Thursday Night Cardiac Clinic one winter evening when we were examining an elderly Chinese gentleman together. As the patient was about to leave the room at the conclusion of the examination, I noticed Dr. Eichna reach into his pocket for some money and say, “Eng, it is cold out. Take a taxi home tonight.” That moment made a deep impression upon me. Kindness and consideration can be as important as heart sounds and murmurs in the care of patients.

Dr. Elaine Ralli, an internist and expert on metabolism and diabetes, once stopped speaking in the middle of a lecture and fixed her eyes on one of my classmates seated in front of her. He must have read her thoughts, for he left the room and returned a few minutes later, now wearing a tie. Dr. Ralli had made her point and the lecture continued with no further comment. Not only were students expected to learn the facts and information needed to become doctors, but we were also expected to show respect for our patients by dressing and behaving responsibly as members of our profession. And according to Dr. Ralli, that meant that the male students dress properly by wearing a tie. Dress habits may have since changed, but showing respect for patients by our appearance and behavior surely has not.

The former collegiate All-American basketball player Dr. Ernest Vandeweghe was a resident at Bellevue Hospital. I always wondered how he found the time and energy when not on duty at the hospital to play for the New York Knickerbockers (the Knicks) professional basketball team in home games at Madison Square Garden, as well as in some of their out-of-town games. I was also amazed at the ability of one of my classmates to keep up with his medical school studies while performing original research after hours on an assay for SGOT (serum glutamic oxaloacetic transaminase), one of the first tests of its kind for diagnosing heart and liver diseases. Another classmate enjoyed immediate popularity and notoriety among us for the cartoons and illustrations he drew on blackboards before lectures, representing with humor and skill the various subjects we would then be studying. In particular, I have fixed in my memory the drawing he made of the olivary bodies in the brainstem, represented by him as the olives in a martini. With all due respect to my instructors at the time, there is truthfully little else I  remember from my course in neuroanatomy.

During the second year of medical school, I had fallen behind in my studies in pathology because of a lengthy hospital stay for severe back problems. I had failed the final exam in the course, which meant that I was faced with the possibility of having to take the second year over again. The kindness of the chief of pathology Dr. William Von Glahn in arranging for extra tutorial sessions and in allowing me to retake the exam—this time with a successful outcome—has never been forgotten. Dr. Sherwood Lawrence, the director of student health and well known for his studies in immunology and the “transfer” factor, is also fondly remembered for the courtesy and consideration he always showed me when making house calls during the time I was housebound with severe and incapacitating infectious mononucleosis. I was living alone at the time and he sometimes prepared a meal for me during these visits. This was a meaningful moment in my medical education, not because I ever fully came to understand the intricacies of Dr. Lawrence’s research, but because I became aware of how much personal contact through a house call meant for a sick person, a message I would carry with me during my years of medical practice.

I recall the days when we students would clumsily practice on each other: taking blood pressures, percussing chests, listening to heart sounds, palpating abdomens, and hoping that we were seeing in the eyes and ears what we were supposed to see with the ophthalmoscope and otoscope. I remember the awkwardness and embarrassment we felt on examining our own stools as part of our parasitology and preventive medicine course with Dr. Harry Most, particularly when an occasional parasite or parasitic egg was found. We convinced ourselves that these findings were due to the food we were eating at local greasy spoons. As part of this course, we also made home visits with public health nurses to poor areas that then existed in the vicinity of the medical school and hospital, sometimes a shocking experience for us, whose lifestyle was more comfortable.

I took an elective clinical clerkship at the newly opened Institute of Rehabilitation Medicine, now called after its founder Dr. Howard Rusk, where I helped with the physical therapy of injured and paraplegic coal miners. Detailed group discussions were held on every patient, with each meeting attended by individuals from the many disciplines of medicine including internists, physiatrists, urologists, neurologists, psychiatrists, orthopedists, nurses, social workers, speech therapists, physical therapists, occupational therapists, and others when needed. This was truly an eye-opener for me and was an important opportunity to observe the best of multidisciplinary medicine at work.

Although student activities outside of classes and clinics were limited at the time, I participated with pleasure in two Gilbert and Sullivan operettas performed by the Medical Students Club—Trial by Jury in 1953 and Patience the following year. The performers, many of whose voices were excellent and of professional quality, included fellow students, their wives, and nurses from the Bellevue School of Nursing. Rehearsals were few and depended upon the vagaries of the schedules of the participants. Faculty sponsorship helped in obtaining the finances for costumes, scenery, and the auditoriums where the performances took place.

Time spent courting my future wife during my third and fourth years of medical school was limited to weekends because of  Juli’s work during the week as a social worker and my class schedule and attendance at clinics. When morning classes on Saturdays were completed, we would often meet for a matinee movie or Broadway play—tickets were then inexpensive and readily obtainable—followed by supper at a Horn & Hardart Automat (nickels went a long way in those days), a subway ride back to Juli’s apartment, and another subway ride for me late at night to my apartment in Queens. With rare exceptions, Sundays were a day of study. Juli would bring over food for lunch and an early supper before returning to her apartment while it was still light outside. My four years at medical school ended with two lasting memories—Juli and I were married on June 6, 1954, while I was still officially a medical student, and three days later I received my medical degree at graduation exercises with my wife, my parents, and my new parents-in-law in attendance.

By some miracle, I had emerged as a doctor, grateful to the guardian angels that watch over and guide medical students to prevent them from doing harm to themselves and others, and hopeful for many more memories in the years ahead.

Reference

1. Whitman W. Leaves of Grass: The “Death Bed” Edition. New York: Modern Library; 2001, p. 627.

Image credit

Image courtesy of the Lillian and Clarence de la Chapelle Medical Archives at NYU