Edited by Paul Berczeller
An excerpt from Dr. Peter Berczeller’s memoir, The Little White Coat.
Michael Reese Hospital. Postcard by Curt Teich. 1950. No known copyright for Curt Teich postcards printed before 1964.
After Cook County, my group and I moved over to Michael Reese Hospital—a pile of old buildings on the near South Side—for our surgical clerkship. Each of us was assigned to a resident and told to stick to him full-time except, in the words of the chief of the training program, “when he’s taking a crap.” There were no formal instructors this time around; we were exposed to the old style monkey see, monkey do approach to medical education. I had never worked with a resident before, and I was full of apprehension. But Mel Levinson turned out to be the ideal older brother, even inviting me to stow my possessions in his room and use the extra bed during our nights on call. Even if I hadn’t been told to stick to him like glue, I would have done it anyway. I learned something new from him every time we made rounds; putting down tubes, changing dressings, suturing the knife slashings the South Side was notorious for when we got called to the emergency room on Saturday nights. Mel quickly became my latest idol.
After the surgical clerkship at Michael Reese, I felt much more secure about being on-call for emergencies, so when a job covering nights at a private hospital on the near North Side opened up, I grabbed it. Nowadays, it would be unthinkable to have a medical student work unsupervised in taking care of patients, but at that time in Chicago it was not unusual; at least in small, non-teaching institutions like Manor Hospital, which “belonged” to Chicago Med, meaning that jobs there were handed down from one generation to the next.
Two of us were on duty at any one time, and the work, every third night, consisted of a few histories and physicals on preop patients, followed by coverage of the emergency room during the night. I took care of cuts and bruises on my own, and called for the surgeons or orthopedists if a patient came in with an acute abdomen or a fracture. My partner and I slept in a double-decker bunk bed in a tiny alcove next to the emergency entrance, and I’ll never forget the sensation of being shaken awake by the cold hands of a Chicago bluecoat standing over me. “Hey Doc, we just brought in an accident victim; hurry up and take a look,” was the half-heard greeting as I tried to orient myself to my surroundings. Three or four cops (my memory has assigned them all that burly, red-faced look) crowded shoulder to shoulder, pallbearer fashion, in one corner of the Emergency Room. The patient (or patients) lying there on their ambulance gurneys; the whole bunch—flatfoots and accident victims—looking to me for guidance. At first I wondered why the police ambulances kept coming to us. There were several large teaching hospitals in the area, so it would have made sense to use their much better facilities. Later on, I understood what was going on when I caught the hospital administrator handing some bills to the bluecoats as they were leaving. A pittance compared to the money the hospital and its doctors would be reaping from the insurance companies.
Once in a while, the police brought in someone they picked up at home, what we would think of nowadays as a 911 call. Most of the time, nothing serious: a brief fainting spell or a black eye resulting from a 3 AM tussle between a couple who either loved each other too much or too little. Still, one patient who was brought in straight from her house, stands out in my memory. She must have drawn her last agonal breaths on the way over, because she was still warm and completely lifelike. A protuberance in her belly suggested she was about six months pregnant, and she had a sweet little smile on her face. According to her husband—he was the one who looked more dead than alive with his shocked, pained, rigid face—she had keeled over suddenly, with no prior warning. It didn’t take a medical genius to discover the cause of death. Her left leg was twice the size of the right, the swelling extending to her groin, which suggested that a shower of clots had migrated to her lungs, killing her in the process. Her husband rounded out the picture for me. “Do you think it had something to do with the leg, Doc? She showed it to our doctor a couple of times and he kept telling her it was a pulled muscle.”
Obstetrics rotation at Michael Reese Hospital
Everyone who has been through medical school has a storehouse of anecdotes about the rotation on obstetrics. Internal medicine may have passed by in a haze of indigestible facts and theories, and surgery may be remembered as endless hours of standing around the operating table, holding on to the retractors which keep the wound open so the surgeon can have a clear view of what he is doing. Obstetrics, in contrast with internal medicine, appears deceptively simple. Most of the time, the obstetrician is there to help the mother do what comes naturally; pop out the baby. Still, there is a sneaky side to the process; it can turn on you from one minute to the next and, before you know it, you’re in a hell of a mess. The umbilical cord becomes wrapped around the baby’s neck, or the afterbirth starts hemorrhaging; before you know it, obstetrics turns dead serious.
Still, delivering babies is a playground for students. The first time I did an episiotomy—an incision to enlarge the vaginal opening to prevent a tear—in the late stage of labor, I felt I was finally in the midst of the action, not just an observer. This was again at Michael Reese Hospital, where I was doing the first part of the obstetrics clerkship. The special atmosphere of the delivery suite hit me as soon as I walked in; when I checked my clothes and shoes in at the door, as if I were being processed into jail. Then I traipsed around in pajamas masquerading as a scrub suit, paper slippers on my feet, spending 24 hours at a time in a kind of twilight zone. Sleeping very little, but never completely awake either. I found myself constantly falling in and out of bed, in the meantime checking for the dilatation of the cervix or holding a bawling newborn in my arms. There is something intimate about the delivery suite, aside from the unusual living arrangements. Spending time in a place where babies are born is a different experience. From the very first, a sense of familiarity engulfed me, déjà vu bringing on the suggestion that any one of the groaning ladies who couldn’t wait to drop her precious load could be my own mother. At the same time, I felt a kinship with the babies who kept arriving at the end of the assembly line around the clock. Fellow emigrés from a warm place who, I liked to think, were wailing not so much out of the shock of arrival, but because they had very recently been abruptly expelled from the only home they had ever known.
PETER H. BERCZELLER, MD, was born in Vienna, Austria in 1931. He attended The Chicago Medical School and received his MD there in 1956. He was a practicing internist from 1960 to 1992, at which time retired from private practice. He was also on the Attending Staff at New York University Medical Center and Clinical Professor of Medicine at New York University School of Medicine for many years. In addition to multiple contributions to the medical literature, he is the author of several books dealing with medicine and one novel. His 1994 book, Doctors and Patients: What We Feel About You was released by Simon and Schuster. He lived in the Dordogne, in France.
PAUL BERCZELLER, son of Dr. Peter Berczeller, edited and reviewed this piece.