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THE INTERNE REMARKS
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1. City Hospitals get all the "crocks"...that is, patients
who are really what we call chronic, medically typified as
chronic, heart disease cases and others for thich cures are
unknown, and the only treatment, therefore, is palliative
for instance, cancer patients who are pretty far gone ...they
really have no place in a hospital, but should be at home
Because of lack of attention they may feel neglected, and when
anyone does come around to treat them they may possibly think
that they are about to be "knocked off" That, at least,
is the only explanation I can think of for the myth of the
"black bottle" you mentioned just now, though I personally
have little knowledge of it. At any rate, you can be assured
that the myth, if it exists, is just that and nothing more.
2. Many things a doctor does, and has to do, is psychological
especially with "crocks", children, and nervous patients. Some
patients, for example, come into the hospital and there is no
actual treatment to be given for a number of days, during which
time the diagnosis is made but if they're not given some
sort of medicine, and this applies chiefly to private cases,
they feel they're being gypped. So the doctor gives them a
placebo (pronounced Plaseebo), a sugar coated pill, or flavored
water, to make them feel good. Color in medicine, you know,
has one value only, and that is when the doctor prescribes
more than one medicine, so as to distinguish the kind. As far
as curative value is concerned, there is none, since all colors
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are syrup, and are used mainly to make the medicine palatable
for kids.
3. There are many evils arising out of the system of private
_practise which would quickly be eliminated if medicine was
socialized. In itself, you know, medicine is the most social
profession there is. I'll tell you a little more about that
later on. But you know, one big thing the average layman can't
get in his head is the fact that no matter what is wrong or
right with him, when he calls the private doctor, that
doctor's job is not so much to help the patieht as it is to
make the patient feel that the doctor is earning his two dollars.
You call a doctor, for example, and tell him you have a cold.
In all probability you pay him his fee, when he calls, for
telling yoU what you just told him. You can treat a common
cold just as well as he can, and if that's that the case is,
under socialized medicine, that is if he's a real doctor, he
would say you have a cold and goodbye. But under private
medicine that's not enough. He has to earn his two dollars.
Therefore he gives six prescriptions to prove that his
knowledge is important, and he may make a case of pneumonia
out of a common cold. Remember, the doctor is selling know-
ledge that is intangible, whereas a prescription is something
ordered over the counter And on the other hand, consider
the cases that occur where the sympton may seem to indicate
only a cold, but the person hasn't got the two dollars to go
to a doctor or can't afford to throw away money on something
trivial, while actually an expert opinion will prevent the
ravages of serious illness by making a correct diagnosis
4. If you're looking for interesting characters, let me tell
you about "Zucky", our ambulance -driver. Zucky's been driving
but about 15 years and he's seen thousands of patients in all
stages of illness, so naturally he's an expert. He takes
one glance at an emergency case and says "OK, Doc,-cardiacl"
or "OK, Doc-phlebotonnyl" Zucky knows all the technical terns,
and he is naturally very cheerful, so it's great to have him
around. Whenever the interne proceeds to insert the needle
to draw blood, Zucky instructs the patient how to make a fist,
takes his pulse and says "Pretty good" and in cardiac
cases, he'll usually sit around with the relatives and cheer
them up. "This his first attack?" he'll ask them. And he'll
reassure them: "He'll get over it, they always do". And he'll
relate stories of other cases, and say "We did this we did
that" But Zucky's in his prime when he gets an emergency
maternity case I'll tell you about one experience I had
with him
When you get an emergency call on the bus, you know, the
interne's judgement reigns supreme. On a maternity case he
has to decide whether he should deliver her at hone or take
her to the hospital. Of course all the necessary equipment
is on the bus, but if the case is a difficult one, a heart
case or something of that sort, it's always safer in the
hospital. Once I had an emergency call, and found it was a
maternity case that was just about on the borderline I
could have delivered her right there but I decided to bring
her to the hospital, because it's always best to do so if you
can. Incidentally, there's a custom that if an interne is
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forced to deliver in the bus while on it's way to the hospital,
in other words if he's been guilty of a mistake in judgement,
he has to treat the whole interne staff to beer and sandwiches.
Well, I had this patient, and Zucky was driving, when I saw
she was beginning to bear down. So I hurriedly whipped out
a can of ether to stop the contractions a little and I palpated
to see how far gone she was. Zucky hollered out: "How many
fingers, Doe?" I said "3i". When it's four fingers then you
know she's ready to deliver. So Zucky knew at once what the
situation was. "OK, Doc!" he sang
siren going of course, I ought
to blow his siren, even without an
of power that typifies most of the
out, and he started the
to tell you that Zucky loves
excuse, it gives that sense
bus -drivers and we
raced against time to get the woman to the hospital. Well,
we made it, and I saw her into the elevator, and was making
out my slips on the case, when a nurse came over to me and
said: "Hey, she just delivered in the elevator!"
5. Speaking of nurses, they are a very much maligned group.
Not only are they overworked and underpaid, but they are
constantly spied upon, even at their own parties or affairs
which they may hold outside the Hospital. One swell character,
speaking in reverse English, is a Superintendant of Nurses
here, an old lady who attends all the nurses' functions merely
to see that they don't "smoke, drink, or neck", as she bluntly
puts it herself. I was told by one of the nurses once that the
Student Government, that is, the nurses own association, ran
an affair and didn't care to have any of the Supervisors pres-
ent, but invited the Superintendent and her immediate Assistant
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as a gesture of courtesy. When the Superintendant received
her invitation, she asked "where are the invitations for
all the other Supervisors?" So when the nurse told her that the
student body decided not to invite them she replied that there
was no Student Government except in name, and that she would
decide who was to be present and who was not. That's just an
indication of the kind of regime nurses live under. "Scouts",
as they call the spies, are everywhere of course. When a
nurse does anything the supervisor doesn't apptove of, she is
"Campus" which means she is confined to her room for as
many days as the supervisor decides, and cannot leave it
except at mealtimes. Later, of course, she has to make up
the lost time. Under such conditions, you can understand
why the general attitude of all workers up to the interne is
antagonistic toward that fine doctrine of "service to hpmanity"
which excludes the hospital workers themselves from human
consideration. Of course, many of the workers, particularly
the old Tamany type, feel this resentment about inhuman
conditions of work but are equally antognistic toward union
organization, and like to beef as individuals, or else look
at the whole situation from the angle of "pull" which is
true enough of the Tanany people, who got their jobs that
way in the first place...