“OH CHRIST, SMITTY, YOU CONTAMINATED THE TUBE. DAMN YOU!”


The words might not be completely accurate, as this happened in the operating room of Presbyterian Hospital, when I was an intern, 37 years ago.  I spent the worst 24 days of my internship helping two cardiovascular surgeons during my surgical rotation.  I scrubbed on 12 cases, and was thanked on only 5.  That 41.6% rate is entirely accurate.  I am formal when it comes to thanking people, I count things, and I would bet any amount of money on those statistics’ being accurate.

I despise being called “Smitty.”  The older of the pair was in his 50s, and I got some perverse pleasure out of the fact that he had made a pass at the most beautiful ward clerk in the hospital and had been politely stuffed.  I knew that, because she told me.  She also told me one night, “It’s a shame you’re married, Mike, or I’d take you home with me.”  She was gorgeous, but I had been married 3 years to the same person I am married to today. Besides, I was chronically tired.  If I had been “taken home,” I would have certainly have slept …..and done nothing else.

The partner was in his late 30s, equally irascible, and ultimately had a nervous breakdown.  It was foreseeable, and it was to my credit that when I heard the news, I felt sorry for him.  The two surgeons beat up on me, as did their scrub nurse who, as we said in the Navy, “wore their stripes.”  They drove me to tears one day, and a visiting doctor from New Zealand, who wanted to become a cardiac surgeon, not only left the OR in the middle of the case, but I heard later he said he would never be a heart surgeon.

The only thing I could do well in the OR was answer their questions about anatomy.  The two would point out vessels and ask what they were, or where they came from, and I would spit out the answer like it was the easiest thing I had ever heard.  There was nothing they asked about anatomy I didn’t know.

I was a “Little Person.”  Oh, I had potential to earn money, power and influence, but as an intern making $10,000 a year, on call every third night (worse in the Denver General Emergency Room, I was a little person.  These guys had power over me, and they intimidated the hell out of me.

And that’s why I contaminated the tube.  They were going to put a chest tube in a patient in an unusual manner, and I was shown how the tube was to be held.  I didn’t understand completely, but I was too scared to admit my ignorance.  So, the tube was handed to me, and WHAP!  The sterile tube hit me in the nose, a most definitely non-sterile area.

This is why in 1978 a plane crashed in Portland, out of fuel, killing 10.  There was a problem with the landing gear, and while the pilot addressed it, the co-pilot noted the fuel situation.  Rather than forcibly confront the pilot, who was known for being….unsavory….the co-pilot chose to stay silent, and the plane crashed.  Aviation has addressed this problem in 1980 with Crew Resource Management and it has saved lives.  Medicine would do well to do it, too.

The Little People are the ones who can’t defend themselves, and I learned early in life from my mother that I was never to beat up on those who couldn’t defend themselves.  We were well off enough that once a week a black cleaning lady came to the house.   This was in the 1950s and early 1960s, when being a black woman was a whole lot different from how it is now.  If they knew that in my lifetime Michelle Obama would be in the White House, they would have dropped dead from shock.

Florence and Tillie were to be called that, and I was to treat them well at all times.  I was to say “Please,” “May I?” and “Thank you.”  They were “Little People.”  I could have told my mother lies about them, and they would have lost their job.  It never crossed my mind; my mother had power over me.

As a Navy doctor, I had to keep space between me and my enlisted corpsmen and chief, because I was an officer.  Still, I did well enough that the few times I went to the Chief’s Club in Subic Bay, in the Philippines, I never had to buy a beer.  I usually had 2 or 3 put in front of me.  I outranked them, and we all knew it, but I respected them for who and what they were, and they appreciated it.  We helped each other.  And we had a good time doing it.

During my residency, I “lost it” one stressful night in the Emergency Department.  The next day, I apologized to the nurse.  She appreciated it.  Like most, I don’t like to apologize, but deep down (or not so deep down) I knew I was wrong.  It only hurts for a little while.  I learned that apologizing defuses a lot of tough issues.

In my practice, I wasn’t always the greatest guy, since I was chronically tired and too busy.  But I thanked people.  I said “Please,” and I asked nurses often what they thought of the patient. I treated them as …. people.

I cleaned up after myself after spinal taps, and if one reads  Code Team, one will understand that I wasn’t afraid to clean up after patients, either. That astounded nurses.   I realized that social workers, dietitians, PT, and OT could help my patients.  I talked to all, and asked them what they thought.  I learned a lot, including the notion that people like to be asked what they think about something.  It is flattering, respectful, and makes one feel wanted.

Because the nurses weren’t afraid of me, they told me things I might not have been aware of. They learned about neurology; I learned about nursing.  I learned that abnormal cardiac rhythm strips were destroyed, because the nurses were afraid of telling the doctor on call, for fear they would be shouted at.  How does that make you feel about cardiac care?  Bad heart rhythm, throw away the evidence!

In 1992, I took a leave of absence.  I had an outpouring of good wishes from the hospital staff, which frankly surprised me.  I received several cards, which I still have today.  But there is one that I treasure most of all.  It came from a Dietitian, a young woman who was going to leave the hospital too, to go to pharmacy school in Washington State.  She wrote a simple note:  “You were always good to the ‘Little People.’ “

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