I am one of the few OBGs on the planet who spent part of my intern year doing internal medicine - 8 week rotation at the DC VA back in the 80's . We had to do internal medicine and I got assigned to the VA . I learned lots of skills ( including doing my own urinalyses ) - like making cookies for the lab techs so that they would run my teams bloodwork first thing ( we couldn't go home at the end of our shift if we weren't on call until all labs had been run, seen , reported and acted upon - and sometimes results from morning draws got done at 9 pm ! ) . I also learned not to eat the green jello in the cafeteria , and which kinds of mystery meat meals were ok and which were best to avoid . The vets all bunked 4-6 to a room and I remember my senior IM resident wouldn't discharge the healthiest ones because they helped take care of the sickest ones -and most were happy to stay on as patients . The vets were always very kind an polite to me and spent a lot of time outside smoking ( some through trachs ) . They all wore yellow gowns and there was a very complex system in the ED as to who got admitted and who didn't that I never figured out - we just got called with a " hit " when we were on overnight call and you never asked why or what for. There was minimal attending supervision - the senior IM resident was god , and knew pretty much everything . I learned a lot , actually - including how to do things independently ( and when not to )
SMA-7. Goes in a tiger top tube. Coags go in a blue top. CBC in purple top. Funny how I will never ever forget that.
My overarching memory of those wonderful veterans who utilized the VA: They had such a great community. They could have bilateral AKAs but still be yucking it up with each other- in the hallways, waiting rooms, commissary, even the ICU. I don’t think they wanted private rooms!
In regard to your 2nd footnote, I'm a similar generation, graduating med school 1993. It was better to admit laziness than ignorance, a lesson I remember all too well, all too well taught during dressing downs...
My first "close encounter" with a VA system was this past semester when I had 6 nursing students doing their clinical rotations in the local VA. The culture is very different (in a good way) from the typical hospital. The first time I went to check on a nursing student it was a Saturday evening. There was literally no one around on the first 3 floors because all of the outpatient clinics close for the weekend. When a patient dies, all the available staff line the hallway and give a salute as they wheel out the deceased. It is really beautiful.
Oh the VA in the late 70’s !! Almost no real time supervision of housestaff and intense workload, very long hours, and huge
responsibility. HOURS spent starting IVs and drawing blood on “difficult sticks”. One of my interns, in his enthusiasm to do a thoracentesis, did bilateral procedures on a CHF patient one night and dropped both lungs. Fortunately, the patient survived us.
We did entire surgical procedures with only an intern and first year resident in the OR..hernia repairs were most popular. One patient received an entire bottle of lidocaine into the op site before we realized that the pain he was experiencing was coming from the med student leaning over with his elbow in the patient’s groin. Luckily he did not seize. Another cost us an hour while the resident rummaged around seeking “the (hernia)sack” . Finally in frustration we all broke scrub and took off the surgical drapes, to discover the incision was a good 4 inches down the anterior thigh…not sure how the two incision sites were explained to the patient afterward…
The VA still had glass IV bottles after most of the world had moved on. Patients would trundle through the halls with IV poles hung with one or two bottles. At least once a month, one would trip and go crashing down smashing glass, fluids, and pole parts all over the hall. Surprisingly, cleaning it up was NOT in the intern’s job description.
Every year, at least one house officer would contract hepatitis B from a needle stick.
No pagers, so Code Blues were overhead paged. Speakers were everywhere, including in the bathrooms. A Code at the VA often involved racing down the underground tunnel connecting the VA to the county mental hospital next door where someone had received a bit too much Haldol, then pushing the guerney back up the tunnel to the hospital. That WAS in the intern’s job description.
Call rooms were co-ed with a lineup of 4-5 cots with a sink on the wall. That way you could learn from everyone else’s phone calls 😄 To this day I can sleep anytime/anywhere.
We did engage in trench humor a lot. Something that seems completely absent in these more PC times. I do miss that sometimes.
This wonderful essay thrust me into my late ‘80s Pediatrics internship at Boston City hospital. Attendings were people we interacted with three times per day - morning rounds, where we were flayed (or rarely, praised) for our unsupervised actions the night before, a half hour extemporaneous lecture on the blackboard, and sign-out. The rest of the time we were trained by the second year who seemed to know so much. I remember being told on day one - “don’t worry, we assume you know nothing.”
We learned medicine by doing everything ourselves - blood draws, IVs, TPN orders, urinalysis, and CSF gram stains. We bagged hard-to-ventilate preemies by hand all night until the attending came in the morning, and ran codes in the ER with the chief resident sitting quietly in the corner.
The lack of attending supervision made us independent, able to see the likely course of a kid’s hospitalization from the moment we admitted him, and appreciative of uncommon presentations of common diseases. Pneumonia presenting as abdominal pain is one example.
I think this experience made us better docs and I am grateful for it, although I was so, so tired. There was no work-life balance — just work.
As I sometimes despair at the apparent lack of personal Involvement in their patients of our trainees seemingly welded to their computers and unwilling to actually examine their patients, I try to remind myself that the practice of medicine has evolved along with the complexity of the patients.
It’s amazing how vivid memories become when you are scared out of your mind. The start of my internship was effectively delayed for awhile because I was assigned to the bone marrow transplant unit. It was like stepping into a lunar landscape. My attending understandably would not allow me to get anywhere near the patients. It took me a few minutes to even figure out how to get in the front door. Thanks for the memories!
Bravo! I have the same kind of nostalgia for Bellevue in the late 60's, only the wards were 30 beds, no screens, no curtains. Disposable (sharp) needles were still in the future. Cardiac resuscitation was just developing. The defibrillator cart was the size of a small SUV. Loved it!
My VA experience was Fort Miley in San Francisco. It had million dollar views of the coastline. While on call on the weekends I learned to shoot my own portable chest X-rays as there was no technician on duty.
Ah yes. The VA Spa's were special places. We called the 12 bed rooms in the Durham VA The Big Top. Somehow the VA Canteen Store survived after they stopped selling cigarettes in the 90's.
Lakeside VA, Chicago, first rotation as a third year medical student at Northwestern, requested then first rotation there as an intern 2 years later. Medicine is so humbling in how much it teaches you you do not know, even when you pass a benchmark. You think you have mastered something when they put an M.D. after your name, when in reality you have just moved to the lowest rung on a new ladder, to start all over again, The Climb. House of God was The Bible. Crystal violet on our fingers because we did our own gram stains, ran down 6 flights of stairs to find long lost x-rays for middle of the night comparisons. So many mistakes, so high up on the learning curve. The attendings knew so much and were so patient with us.The patients were gracious, so much multifactorial disease to understand. We stayed over every third night and sometimes I would stay the next night because my patients were so complicated and unstable I wanted to help with the outcome and learn from it. Four years after that I pushed my emergency bronchoscopy cart through the tunnels under the old Boston City Hospital, running into the homeless, both humans and dogs. Those are formative years/experiences/friendships and I remember it all so fondly.
Thanks for the essay, Dr Cifu.
I was an Intern and Resident at Charity, in New Orleans.
We learned by doing.
We learned because we had to.
We taught ourselves and each other.
That became a habit.
It was excellent training.
I am one of the few OBGs on the planet who spent part of my intern year doing internal medicine - 8 week rotation at the DC VA back in the 80's . We had to do internal medicine and I got assigned to the VA . I learned lots of skills ( including doing my own urinalyses ) - like making cookies for the lab techs so that they would run my teams bloodwork first thing ( we couldn't go home at the end of our shift if we weren't on call until all labs had been run, seen , reported and acted upon - and sometimes results from morning draws got done at 9 pm ! ) . I also learned not to eat the green jello in the cafeteria , and which kinds of mystery meat meals were ok and which were best to avoid . The vets all bunked 4-6 to a room and I remember my senior IM resident wouldn't discharge the healthiest ones because they helped take care of the sickest ones -and most were happy to stay on as patients . The vets were always very kind an polite to me and spent a lot of time outside smoking ( some through trachs ) . They all wore yellow gowns and there was a very complex system in the ED as to who got admitted and who didn't that I never figured out - we just got called with a " hit " when we were on overnight call and you never asked why or what for. There was minimal attending supervision - the senior IM resident was god , and knew pretty much everything . I learned a lot , actually - including how to do things independently ( and when not to )
SMA-7. Goes in a tiger top tube. Coags go in a blue top. CBC in purple top. Funny how I will never ever forget that.
My overarching memory of those wonderful veterans who utilized the VA: They had such a great community. They could have bilateral AKAs but still be yucking it up with each other- in the hallways, waiting rooms, commissary, even the ICU. I don’t think they wanted private rooms!
Thanks for prompting me to reminisce!
In regard to your 2nd footnote, I'm a similar generation, graduating med school 1993. It was better to admit laziness than ignorance, a lesson I remember all too well, all too well taught during dressing downs...
My first "close encounter" with a VA system was this past semester when I had 6 nursing students doing their clinical rotations in the local VA. The culture is very different (in a good way) from the typical hospital. The first time I went to check on a nursing student it was a Saturday evening. There was literally no one around on the first 3 floors because all of the outpatient clinics close for the weekend. When a patient dies, all the available staff line the hallway and give a salute as they wheel out the deceased. It is really beautiful.
HERE ARE THE KEYS, LOCK UP WHEN YOU'RE DONE , EPISODE 8
INTERNAL MEDICINE ICU, CIRCA 1975 , MIDNIGHT
Erik, well into his 2nd month as 2nd year Internal Medicine resident , and now the senior MD
on site , has been called to the ICU . The just admitted patient with an acute inferior MI has
developed complete heart block and a pulse of 36 . Erik is on the phone ( landline) with the
Cardiology Attending ....
ERIK
Hello, Mitch , Erik in the unit . Got a guy with an inferior Mi
and complete heart block . Think he needs a temporary pacer
INTERIOR , MITCH'S BEDROOM , MIDNIGHT
MITCH
That sounds right , go ahead and put one in.....
ERIK
Eh, I've never done one .....
MITCH
They're not that hard to do
It's silent for a moment , as Erik regains his composure
ERIK
I'm sure they're not, but you gotta show me the first one...
Silence for another 10 seconds
MITCH
I'll be there in 20 minutes , hang some Isuprel if you need to...
Oh the VA in the late 70’s !! Almost no real time supervision of housestaff and intense workload, very long hours, and huge
responsibility. HOURS spent starting IVs and drawing blood on “difficult sticks”. One of my interns, in his enthusiasm to do a thoracentesis, did bilateral procedures on a CHF patient one night and dropped both lungs. Fortunately, the patient survived us.
We did entire surgical procedures with only an intern and first year resident in the OR..hernia repairs were most popular. One patient received an entire bottle of lidocaine into the op site before we realized that the pain he was experiencing was coming from the med student leaning over with his elbow in the patient’s groin. Luckily he did not seize. Another cost us an hour while the resident rummaged around seeking “the (hernia)sack” . Finally in frustration we all broke scrub and took off the surgical drapes, to discover the incision was a good 4 inches down the anterior thigh…not sure how the two incision sites were explained to the patient afterward…
The VA still had glass IV bottles after most of the world had moved on. Patients would trundle through the halls with IV poles hung with one or two bottles. At least once a month, one would trip and go crashing down smashing glass, fluids, and pole parts all over the hall. Surprisingly, cleaning it up was NOT in the intern’s job description.
Every year, at least one house officer would contract hepatitis B from a needle stick.
No pagers, so Code Blues were overhead paged. Speakers were everywhere, including in the bathrooms. A Code at the VA often involved racing down the underground tunnel connecting the VA to the county mental hospital next door where someone had received a bit too much Haldol, then pushing the guerney back up the tunnel to the hospital. That WAS in the intern’s job description.
Call rooms were co-ed with a lineup of 4-5 cots with a sink on the wall. That way you could learn from everyone else’s phone calls 😄 To this day I can sleep anytime/anywhere.
We did engage in trench humor a lot. Something that seems completely absent in these more PC times. I do miss that sometimes.
This wonderful essay thrust me into my late ‘80s Pediatrics internship at Boston City hospital. Attendings were people we interacted with three times per day - morning rounds, where we were flayed (or rarely, praised) for our unsupervised actions the night before, a half hour extemporaneous lecture on the blackboard, and sign-out. The rest of the time we were trained by the second year who seemed to know so much. I remember being told on day one - “don’t worry, we assume you know nothing.”
We learned medicine by doing everything ourselves - blood draws, IVs, TPN orders, urinalysis, and CSF gram stains. We bagged hard-to-ventilate preemies by hand all night until the attending came in the morning, and ran codes in the ER with the chief resident sitting quietly in the corner.
The lack of attending supervision made us independent, able to see the likely course of a kid’s hospitalization from the moment we admitted him, and appreciative of uncommon presentations of common diseases. Pneumonia presenting as abdominal pain is one example.
I think this experience made us better docs and I am grateful for it, although I was so, so tired. There was no work-life balance — just work.
As I sometimes despair at the apparent lack of personal Involvement in their patients of our trainees seemingly welded to their computers and unwilling to actually examine their patients, I try to remind myself that the practice of medicine has evolved along with the complexity of the patients.
I always look forward to these essays and the comments they generate. Thanks for sharing your experiences.
Did you crank any beds up to orthopedic height?😉
:-)
It’s amazing how vivid memories become when you are scared out of your mind. The start of my internship was effectively delayed for awhile because I was assigned to the bone marrow transplant unit. It was like stepping into a lunar landscape. My attending understandably would not allow me to get anywhere near the patients. It took me a few minutes to even figure out how to get in the front door. Thanks for the memories!
Bravo! I have the same kind of nostalgia for Bellevue in the late 60's, only the wards were 30 beds, no screens, no curtains. Disposable (sharp) needles were still in the future. Cardiac resuscitation was just developing. The defibrillator cart was the size of a small SUV. Loved it!
My VA experience was Fort Miley in San Francisco. It had million dollar views of the coastline. While on call on the weekends I learned to shoot my own portable chest X-rays as there was no technician on duty.
Ah yes. The VA Spa's were special places. We called the 12 bed rooms in the Durham VA The Big Top. Somehow the VA Canteen Store survived after they stopped selling cigarettes in the 90's.
Lakeside VA, Chicago, first rotation as a third year medical student at Northwestern, requested then first rotation there as an intern 2 years later. Medicine is so humbling in how much it teaches you you do not know, even when you pass a benchmark. You think you have mastered something when they put an M.D. after your name, when in reality you have just moved to the lowest rung on a new ladder, to start all over again, The Climb. House of God was The Bible. Crystal violet on our fingers because we did our own gram stains, ran down 6 flights of stairs to find long lost x-rays for middle of the night comparisons. So many mistakes, so high up on the learning curve. The attendings knew so much and were so patient with us.The patients were gracious, so much multifactorial disease to understand. We stayed over every third night and sometimes I would stay the next night because my patients were so complicated and unstable I wanted to help with the outcome and learn from it. Four years after that I pushed my emergency bronchoscopy cart through the tunnels under the old Boston City Hospital, running into the homeless, both humans and dogs. Those are formative years/experiences/friendships and I remember it all so fondly.
So reminiscent of my experiences at the Shreveport VA - one learns a lot and quickly in the trenches. Thanks for another memorable essay!