Fortunately, Dr. Harding, or Big John, as the residents called him, took very little notice of me the next morning. After a perfunctory handshake, he directed his attention to the senior resident, Art Hestry. Art led us up to the ortho floor to make rounds on our patients. At Mayo, rounds are made twice a day. The attending surgeon accompanies his residents on rounds every morning except Sunday. The residents make rounds by themselves every afternoon plus Sunday morning.
As we stood outside the first patient’s room, Art gave Dr. Harding a brief summary: “TKA, day 2. Hemovac out. Up today. Doing well.” This apparently meant something to Dr. Harding, who nodded and strode into the room. I shuffled after them wondering what the hell a TKA was.
By staying in the background and keeping my mouth shut, I managed to make it through rounds without making my ignorance too obvious. But I was a sober, frightened young man when we finished rounds that morning. I had a lot of catching up to do.
To make matters worse, there was the matter of the Saturday Morning Conference. Dr. Burke had warned us that all residents were required to attend this conference. I made my way to the hospital auditorium, where the conference was just beginning. One of the senior residents was presenting cases. I was in awe of his self-assurance and his command of orthopedic jargon.
“This is a fifty-two-year-old farmer, status-post right medial meniscectomy thirty years ago. He presents with a ten-year history of progressive DJD of the medial compartment. Dr. Coventry did a closing-wedge UTO last Wednesday.”
I sat there in a daze, certain I was the most ignorant orthopedic resident in the history of the Mayo Clinic. I feverishly scribbled notes to myself: “UTO—??” and “Check X-rays on John Svendsen.”
I was familiar with this type of conference from medical school. Cases are presented, then some unfortunate junior resident is asked a series of complex questions that he stammers through and always gets wrong. The senior resident or attending then gives the correct answer. Embarrassing the junior resident is considered a good thing. It is supposed to encourage him to study harder.
But I was another story. Although I had been an excellent student in medical school, I had very little exposure to orthopedics. After hearing the impressive qualifications of my fellow residents, I began to think my problems went beyond mere inexperience. Compared to the others, I felt orthopedically anencephalic. I felt brain dead with the plug pulled. I felt so ignorant that had anyone called on me even my questioner would have been embarrassed. The entire department would shudder if they discovered this moron was one of them.
At one point, Jack Manning, who was sitting behind me, leaned forward and asked how many UTOs I had scrubbed on. I pretended not to hear him. He might as well have asked how many UFOs I had flown on. At least I knew what a UFO was.
I don’t think it is possible for a person to shrink down any farther in his seat than I did that morning. By the end of the conference my head was below the seat back. As we were leaving Jack said it looked like I was melting. But at least I hadn’t been called on. My secret was safe for another week.
Even though the conference was over, I slunk out of the auditorium with my head down, still afraid someone might call me back and ask me under what circumstances would a hemi-arthroplasty be preferable to a total shoulder replacement? I would have thrown myself on the floor and asked them to shoot me and put me out of my misery.
And misery it was. In less than twenty-four hours I had gone from the euphoria of beginning my career as an orthopedic resident at the Mayo Clinic to the feeling I was a counterfeit, an impostor who had infiltrated this society of brilliant surgeons. Once my ignorance was discovered I would be told to report immediately to the director of the residency program. I would be ushered into a dimly lit room lined with cherrywood bookshelves crammed with faded, leather-bound medical treatises from the 1700s. A somber-looking Dr. Burke would emerge from the shadows and tell me a mistake had been made, a terrible mistake. He would then hand me an ornately carved wooden box.
“Go ahead,” he would say. “Open it.”
I would lift the lid and find a twelve-inch, pearl-handled dagger, its blade glinting wickedly, resting on a tiny satin pillow.
For the good of the residency program, for the good of the Mayo Clinic, for the good of every orthopedic surgeon who had ever picked up a scalpel, I would be urged to “do the right thing.” Dr. Burke couldn’t promise anything, of course, but if I “played ball,” if I was “a team player,” there was a chance my body would be given “first table” in the cadaver lab.
I went back to the doctors’ lounge and began copying the list of patients on Dr. Harding’s service. I planned to go back and review the chart on every patient. I had just finished copying the list when Art Hestry came in.
“Mike,” he said, clapping me on the back. “I’m going up to the Twin Cities for the weekend. I need you to cover for me. I’ll do rounds this afternoon before I leave, but you’ll have to make rounds tomorrow.”
He must have seen the look of horror on my face. “Don’t worry. If you have any problems, just call one of the senior residents, they’ll help you.”
He laughed, handed me his beeper, said, “Heck of a deal!” and sailed out the door.
I stood there for several seconds, staring at this horrible thing, this beeper that rested in my still-outstretched hand. Gingerly, as if I were holding a vial of nitroglycerine, I clipped it to my belt. I was terrified that at any moment it might go off and a frantic nurse would scream, “Doctor, come quickly! Mr. Arnold’s TQF is trans-debilifying on his acute dorsi! His TKA is UTO’d! For God’s sake, hurry!”
I spent the rest of the day reviewing charts, slowly gleaning bits of information, jotting down on my ever-present index cards things like “TKA="Total" Knee Arthroplasty,” “ORIF="Open" Reduction Internal Fixation,” “UTO="Upper" Tibial Osteotomy.” Some things, however, defied my best efforts to decipher them. “Patient is TTWB,” I read. Too tired with bending? Three times without bleeding? Terribly thirsty without beer? How in the hell did I know? Of course I could have asked the nurses, but they would have thrown me out the door for practicing medicine without a brain.
At six o’clock I pulled into the driveway of our small frame house on the outskirts of Rochester. My wife, Patti, met me at the back door. Patti and I were both Chicago kids, West Side Irish, born at St. Ann’s Hospital at Lavergne and Thomas. Over her parents’ strenuous objections, Patti had married me in the summer before my junior year in medical school.
“So,” she said, throwing her arms around my neck, “how was your first day as an orthopedic surgeon?”
I cringed. I realized that only by the farthest stretch of the imagination could I be considered an orthopedic surgeon. There were medical students who knew more orthopedics than I did. I kissed Patti and mumbled that my first day was “okay.”
“Then why the sad face? What did you do—operate on the wrong leg or something?”
“Aw, I don’t know, hon. I feel so dumb, so out of it. I don’t know the first thing about orthopedics.”
Patti rubbed the back of her hand against my cheek. “That’s why they have residencies.”
One of the third-year ortho residents, John Stevenson, was giving a party that night. He had been thoughtful enough to invite the first-year guys. Patti and I left our twelve-month-old daughter, Eileen, with a babysitter. At eight o’clock we rang the doorbell of the Stevensons’ apartment.
“Come on in,” said the guy who answered the door. “John’s in the kitchen.”
The place was packed. It took me five minutes to find John. I handed him a six-pack of Olympia. He thanked me but said he hoped he wouldn’t need it. There was a keg in the kitchen.
Patti and I stumbled around, listening to snippets of conversation about things called IM rods and Putti-Platts and ACLs. God, how I longed to find someone who could talk about the Vikings or the North Stars. At least I could speak the language.
We passed one of the residents on the h
and service. He was talking about an operation they had done on a woman who had cut off her thumb in a lawn-mower accident. He said they removed her big toe and sewed it on her hand. I looked around. No one was laughing. The guy was serious.
In the kitchen I finally found Bill, Frank, and Jack. They lifted their glasses in greeting and we introduced our wives.
Alice Chapin, a strikingly beautiful woman, was a redhead, like Bill. I learned later that she had given up a promising career in public relations to move to Rochester. She had just gotten a job at the Rochester Public Library.
Jack Manning’s wife, Sue, had warm hazel eyes and short brown hair. She was even more athletic looking than her husband. They had married right out of college. Jack told us they were expecting their first child in March.
“March?” Bill said, counting the months on his fingers. “When did Sue get pregnant, last night?”
The biggest surprise was Linda Wales, Frank’s wife. Linda was an architect. In her crisp blouse and tight skirt, she was as sophisticated and polished as Frank was simple and rough-hewn. They had married when Frank was in medical school and Linda was getting her graduate degree.
John Stevenson, passing by, noticed I was drinking a Coke.
“Don’t you want a beer, Mike?”
“Nah. I’m on call.”
“On your first night? Junior residents only take call in-house. You can’t be on call.”
“Art Hestry went up to the Cities for the weekend. He gave me his beeper and left me on call for our service.”
“He what?” John then called over several other senior residents. He introduced me, then told them Art had left me with the beeper for the weekend.
They all laughed. “Typical Art,” they said. “Heck of a deal!”
A minute later, just as I found the pretzels, my beeper went off. I was so startled I almost dropped the bowl. The operator instructed me to call the ortho floor at Methodist. Oh, God, I thought, this is it. Someone’s going to tell me I have to rush over to Methodist Hospital and perform some emergency operation I’ve never even heard of.
Heart pounding, I held my Coke over my head and squeezed through the crush of people in John’s kitchen. I found a telephone in the bedroom, closed the door, and dialed the number.
“Dr. Collins,” I said to the nurse who answered.
“Dr. Collins?” came the puzzled reply. “We were looking for Dr. Hestry.”
“I’m covering for him.”
“You are?” she said. “And this is Dr. Collins? I don’t think I know you.”
“Well, I just started today. I’m Dr. Harding’s junior resident.”
“Oh. Okay,” she said reasonably, and then went on very businesslike. “I’m Ann Cheevers, the nurse taking care of Mrs. Wiltshire. Can we get her up?”
I frantically searched my memory. Mrs. Wiltshire. Mrs. Wiltshire. I vaguely remembered the name. I stalled and finally mumbled, “Mrs. Wiltshire…?”
“Yes, Mrs. Wiltshire, in 7214. She had a TKA three days ago.”
TKA, I thought in a panic. Oh, yeah, total knee arthroplasty.
Well, at least I knew what it was, but could we get her up? I hadn’t a clue. I didn’t know if “we” always got people up on the third day or if we never did. Mrs. Wiltshire was probably the wife of the president of Switzerland or something. What if I did the wrong thing? I could see the headlines of the Rochester Post-Bulletin the next day:
IDIOT JUNIOR RESIDENT MISTAKENLY LETS
WIFE OF SWISS PRESIDENT WALK ON THIRD DAY. LEG FALLS OFF.
I’d be finished. My career at Mayo would have lasted one day—although I would have to stay in Rochester for years while the malpractice trial dragged on. “Tell the ladies and gentlemen of the jury one more time, Doctor, how you crippled this poor mother of ten who had just won the Nobel Peace Prize.”
I had been silent for quite a while when the nurse finally said, “Hello? Are you still there?”
“Uh, yeah. I’m still here.”
“Well, can we get her up or not?”
There was no point in thinking it over. There was no way I could rationally discover an answer. Instead, I did the smartest thing I could have done: I threw myself on the mercy of the nurse.
“Look, Ann,” I said, “I’m new and I honestly don’t know. What do you usually do?”
This was her chance. She probably had been humiliated more than once by some egotistical resident. Now was her chance to get some payback.
I waited. She was silent for a moment and then must have taken pity on me. She let the opportunity to humiliate me pass. It wasn’t the first time a nurse had helped me and it wouldn’t be the last.
“We usually let them up. She’s been doing fine. I think Dr. Hestry just forgot to write the order.”
“Oh. Okay. Then it’s fine. You can get her up.”
“Thank you, Doctor.”
I let out a long breath. “I owe you one, Ann.”
“That’s all right,” she said with a laugh. “So where’s Art?”
I wasn’t sure if “covering” for Art meant lying for him, too. “Art? Oh. Well, Art is, uh…”
“Yes?”
“He…Well, he can’t come to the phone right now.”
“Yes, of course. I suppose he’s desperately ill. Tell him I hope he feels better soon.”
“I will.”
“Tell him a couple aspirin and an ice pack on the forehead tomorrow morning might help.”
“Well, I’m sure Art would never—”
“Good night, Doctor.”
I hung up the phone and breathed a sigh of relief. I had passed my first test—barely. I went out to the living room and thanked John for inviting me. Then Patti and I headed home. I wanted to get a good night’s sleep. The next morning I had to make rounds on every one of Dr. Harding’s patients—by myself.
Chapter Two
The next day
The moment of truth had arrived. Art was out of town, Dr. Harding was sleeping, and rounds needed to be made. That left me, the greenest rookie imaginable, in charge.
We had fifteen patients on our service. Most of them had hip or knee replacements—operations I had never even seen. I just wanted to get through the morning without making some terrible mistake. I decided to make rounds so early that the patients would be too sleepy to ask me any questions. I was terrified one of them might ask me something like “Doctor, when can I resume dancing (or driving, or sex) after my hip (or knee, or shoulder) replacement?”
I couldn’t just say, “Beats the hell out of me.” I would have to come up with an answer. “Well, Mr. Spencer, resumption of activity following total hip replacement depends on a myriad of important factors.” I would stroke my chin and pace slowly back and forth at the foot of his bed. “One must consider the integrity of the neuroprocesses, and the coefficient of friction of the metallic implant—not to mention the specific gravity of the synovial fluid. These are very complex issues. I will ask Dr. Harding to discuss this with you on Monday morning.”
It was 4:57 A.M. when I pulled into the parking lot at the west end of Methodist Hospital. As I walked in the back door, the security guard at the desk looked up from his magazine. “Emergency, huh, Doc?”
“Ah…” It was easier simply to agree. “Yeah, emergency,” I said—which was true. If I didn’t make it through rounds that morning I would be unemployed, and for me that would be a major emergency.
I went into the doctors’ lounge and was panicked to find there were no computer lists. I found out later they weren’t printed until 6:30 each morning. I had the list from the day before, but what if some French diplomat or Arabian sheik had been admitted during the night? What if he called Dr. Harding at the symphony or the golf course later that day demanding to know why no one had shown up to treat the green fungus on his femur?
My footsteps echoed down the dark halls as I made my way to the ortho floor. One of the nurses saw me pulling a chart from the rack.
“Is anything wrong, Doctor?”<
br />
“No. I’m just making rounds.”
“Making rounds—at ten after five?”
“I wanted to get an early start.”
She shook her head and went back to her charting.
I stood outside the first patient’s room for several minutes, carefully reviewing the chart, checking outputs, vital signs, progress notes, and therapy records. Then I let out a slow breath and went in.
“Mr. Radcliff?”
No response.
I tried again, a little louder. “Mr. Radcliff?”
Finally, I reached over and shook his forearm. “Mr. Radcliff!”
“Huh?”
“Hi, Mr. Radcliff. It’s Dr. Collins.”
“Who?”
“Dr. Collins, remember? I’m one of the residents with Dr. Harding.”
“Oh, yeah. Dr. Connolly. Is something wrong?”
“No, sir. I’m just here to check on you. Mind if I take a look at your incision?”
And so it went, patient after sleepy patient. I had a list of things Dr. Harding wanted done. (“Get her drain out tomorrow.” “Change his dressing.” “Put him in a cast.”) Things went pretty well until I got to Lavinia Allenbaum’s room. Mrs. Allenbaum was an eighty-two-year-old woman from a nursing home in Byron. She had fallen in the bathtub and fractured her hip. Dr. Harding had fixed it four days earlier.
She was sitting up in bed, picking at her blanket, as I entered the room.
“Good morning, Mrs. Allenbaum. I’m—”
“You’re a no-good, lying son of a bitch. That’s what you are.”
I jerked to a halt. I felt like I had been slugged in the stomach. “Mrs. Allenbaum, if I have done anything to—”
“You’ve done everything. You and the rest of them. This is the worst hotel in Milwaukee. I’m never coming back to this place again.”
The worst hotel in Milwaukee? Well, that explained things. Maybe I shouldn’t take it personally when she said I was a lying son of a bitch.
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