Edited by Paul Berczeller
An excerpt from Dr. Peter Berczeller’s memoir, The Little White Coat.
Image by Stephanie Pratt from Pixabay
My group and I were assigned to the Chicago Maternity Center at the end of the obstetrics in November 1955. Despite the recent training at Michael Reese, nothing could have prepared me for the tour of duty at the decrepit building on Maxwell Street, on the near Southwest side. It was located in the middle of a run-down area whose chief claim to fame was the open-air market—anything from live chickens to cut-rate brassieres could be negotiated there—deployed on Sunday mornings. By then, the Maternity Center was already fifty years old, and its entire raison d’être had always been to provide deliveries at home for poor women. This was to be our base for the next two weeks; on-call full-time, no breaks in between. The drill was easy to understand: the first week, we played nurse, the second week we were to play doctor. There was no transportation provided; either one of us owned a car, or our team of two team traveled by bus or train. Even the sleeping arrangements were a revelation; a room with a long row of beds, something out of Snow White and the Seven Dwarfs. An old-fashioned telephone was affixed to the wall of the entrance; every time it rang, it meant all of us were one step closer to going out on a call. Meals were not provided; the only sure source of food was the 24-hour Polish sausage stand across the street. I squeezed down the sausages for breakfast, lunch, and dinner, accompanied by the onions which were guaranteed to give me heartburn as soon as I swallowed them.
Frank Brennan—a second-week Northwestern student—was my boss. When we first met, I must have come across like a wet-behind-the-ears infantry replacement reporting to his battle-hardened sergeant on Iwo Jima. At that point, a shower must have been an antediluvian memory for Frank, because he looked—and smelled—particularly grungy. Besides, the deep shadows around his eyes coupled with his droopy red lids spoke for any number of nights without sleep. No hello, just an urgent question which must have been uppermost in his mind: “You got a car?” As it happened, I did, and before I knew it, I was his new best friend.
The telephone kept ringing all night long, so that, even in my half sleep, I could calculate how close Frank and I were to having to get out of bed in the barely heated dormitory. I slept with my clothes on and kept my coat on the floor next to me, so bed to car took no more than five minutes. We were warned not to accept any food at the homes of our patients; there was too much likelihood of it being spoiled. In fact, the first time we went out I saw dishes covered with mold in the bathtub, and flies were infesting the place even though it was winter. A good reason for stocking up on Polish sausages before leaving; we never knew when we’d be having our next meal.
Frank showed me the ropes in a hurry. My job was to boil the gloves (there were no disposables at the time) and dry them on strips of newspaper. I was also in charge of giving the pre-delivery enemas to our patients. He was the obstetrician and concentrated on what was most important; checking for dilatation of the cervix (a way of telling how soon the baby will be coming out) and, of course, the delivery itself. I had never given an enema in my life. Back at the Center, we had been shown how to do the procedure, but not where to insert the tip of the tubing. Our first patient was a black woman in her mid twenties, Miss? Mrs.? Saunders. There were three or four little children milling about while we were going about our business; she was a “multip,” a lady who had already given birth several times and was likely to push her baby out without complications. In preparing her for the enema, I turned her over on her side as per instructions. The room was dark, and when I was ready to insert the tip, I depended on feeling my way, without actually having a look at where I was going. As I lifted the bag and allowed the fluid to flow in, the patient came up with what I thought was a dumb question. “Doc, what kind of enema you giving me?” she asked in a matter-of-fact way. “Why, a rectal enema of course,” I answered impatiently. By this time, she was giggling. “Doc,” she said, “you ain’t in my rectum!”
Sometimes we’d be holed up in those projects for days on end. While waiting for our patients to finally go into real labor, we spent our time sleeping (those helpful newspapers we brought along serving as bedsheets) or chatting with the people who came to visit the expectant mother. We were not allowed to leave without permission from the center. Even if our patient had labor pains only every twenty minutes, we had to stay there and wait it out. Calling for backup was allowed only if there was maternal bleeding or the fetal heart rate was on its way down. Only then would a resident and nurse be sent to take over. Luckily, nothing of the kind ever occurred on our watch, and, later rather than sooner, the baby would arrive. Most of the time, Frank had very little to do except to greet it with open arms, leaving me with the mopping up chores. First, I clamped the cord and severed it, then I waited for the placenta, the afterbirth, to appear and made sure it was intact. My job was also to put everything we had brought along with us—instruments, fetal stethoscope, and so on—back into the big black cases we dragged around with us like a ball and chain.
When Frank ended his tour of duty, it was time for me to perform my first delivery on my own. She turned out to be a grand multip—a lady who had already given birth five times—living in one of the distant South Side housing projects. Before we left the center, I took a quick look at her chart and was relieved to see there had been no complications with her previous deliveries. The ride to her home took more than an hour, so I had plenty of time to teach my new assistant—Patrick was his name, another Northwestern student, who had the kind of don’t-know-what-to-expect look on his face I must have worn just a week before—all he needed to know for the moment; not neglecting to mention the proper location for an enema tip. It felt good to be rid of the scut work—the worst of it was boiling and drying those gloves; they got so sticky that a couple of fingers usually had to be left out in the cold—but what was just an annoyance before was already eclipsed by a new worry. It was no surprise that the many doubts I had about myself in the past were coming back to me now. It wasn’t only the delivery I was worried about; somewhere along the line I had heard—or read—that grand multips are more likely to bleed after the placenta slides out. The womb—overstretched by the many previous pregnancies—may not shrink down as it should and clamp down on the open blood vessels. In my very brief experience, I had seen just two patients in shock; the blood pressure tumbling way down after a major hemorrhage, both times because of a bleeding duodenal ulcer. Both had been treated in the hospital though; lots of help available, the blood bank rushing to cross match the transfusions, the works. Now I found myself rehearsing the drill and feeling the panic of the situation in advance, while at the same time making rational plans for the eventuality of a serious complication of delivery.
Ms. Simpson—Evie as I came to know her—was very reassuring. She was a hefty black lady in her late twenties, with the usual bevy of little kids jumping up and down on her bed. There were no men around; all the nativity scenes I was involved in for the entire two weeks had only mothers or grandmothers or female neighbors as a supporting cast. She led me through the whole process. She kept track of the frequency of her labor pains, and also suggested how often I should do examinations to check on the widening of the cervix, the neck of the womb. Evie even gave me a few minutes’ advance notice of the main event. When she yelled “baby comin’ out,” I was all ready to catch it. The afterbirth came next as it was supposed to, and there was no bleeding afterwards to spoil the party.
When women tell you that you are the best, it is never clear whether they really mean it, or if they are just trying to boost your morale. Evie must have picked up on how nervous I was; patients have a sixth sense about the confidence levels of their doctor. “Believe me Doc,” she said right after, as she smiled at what was now her sixth child. “None of the ones they sent out from Maxwell Street ever did as good as you!” High praise from a grand multip, even if it may only have been meant to make a shaky beginner like me feel better about himself by the end of the rotation.
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.