I’ve sewn up several vaginal lacerations women have acquired during a far too vigorous session of Feely Meely. Rings, fingernails and improvised sex toys can slice through the vaginal wall and, like scalp wounds, vaginal lacerations can make a woman bleed like a stuck pig.

The reasons I hear for the injury are rarely truthful but often entertaining. One woman, sporting an impressive rip in her vagina, claimed neither she nor her husband could retrieve her contraceptive sponge after intercourse. They called the neighbor, another man, over to help and he tore her trying to get it out. That was their story and they were sticking with it.

Lust and alcohol often lead to calamity. I got a call at 5 a.m. on a Sunday morning from the emergency room about a university co-ed who was bleeding rather steadily from her vagina. The ER physician told me she had a long tear that was bleeding steadily and he didn’t feel comfortable trying to repair it. I told him I’d have a look.

One of the nurses followed me into the examination room which smelled of fresh blood, stale cigarettes and beer breath. The young woman, an attractive blond who might have been a cheerleader, was sitting on the table sobbing, because the boyfriend had dropped her off and disappeared. I asked her what happened.

“Well, he had his fingers in me and all of a sudden I felt this sharp pain and I started bleeding.” I thought to myself Yeah and his knuckles drag on the ground when he walks.

When I put the speculum into her vagina I saw a small artery pumping blood from a 3-inch gash in the right vaginal wall. Most times I can fix these in the ER but sometimes it’s much easier to take someone to the operating room where the lights are better, the instruments are plentiful and accessible, and the patient isn’t squirming.

I did a quick history and physical examination, asking the usual questions. Have you ever had surgery? No. Are you allergic to any medicine? No. Have you had anything to eat or drink in the past few hours? No, not since about midnight. I called surgery to set up a room and talked briefly with the anethesiologist. However, when he asked about recent oral intake, she said, “Does the six-pack I drank at 4 a.m. count?” Yes, it does, because general anesthesia increases the risk of vomiting, aspiration and pneumonia, making a spinal the preferred anesthetic.

We took her to the operating room and got her onto the table. I stood in front of her holding her steady while the anesthesiologist did her spinal and she blubbered about her useless boyfriend. When she was numb, the anesthesiologist gave her intravenous medicine to make her sleepy and the sobbing ceased. It took about 30 minutes to fix the tear and I made sure there was no bleeding before we left the room. She would likely be sore for a week or so but there would be no lasting damage.

But her troubles were just beginning. I walked out to the desk and the OR secretary said, “Her father is in the waiting room and wants to talk with you.”

Father? Uh oh…

I walked out to find a man who looked a lot like Dick Cheney but far more unpleasant. “So what happened and why did my daughter need surgery?”

I fudged a little and said, “Well, sometimes women can have really heavy bleeding and we need to do a quick surgical procedure to get it under control.” I think he knew there was more to the story than I was telling him, but he just grumbled and appeared to be as satisfied as any father would be under the circumstances.

It turned out he’d driven 700 miles to take his darling daughter home for spring break. I surmised that was one very long car ride home. If I was her, I might have opted to ride in the trunk rather than submit to an inquisition or, more likely, her dad’s stony silence.

Image credit: (C) Can Stock Photo

The world lost a great woman and an even greater nurse this week, the likes of which we will probably never see again.

Dorothy Leasure Teesdale was the nursing head of Blodgett Memorial Medical Center’s Labor and Delivery unit in Grand Rapids, Michigan—one of the two hospitals in which I did my residency. She was not an administrative toad like many head nurses I meet today. Dorothy was a strong, caring woman whose priorities were patient care and her nurses, probably in that order.  She stood up for nurses and residents when they were right but called them on the carpet when they were wrong.

Dorothy didn’t take shit from anyone, including physicians.  One of the more notoriously cavalier obstetricians started a repeat Cesarean section one morning before the nursing staff was ready to attend to the baby.  This was long before operating rooms mandated safety “time-outs” before anyone laid a hand on the patient.

Dorothy confronted the physician—all six-feet four inches—after the case, noting it wasn’t the first time he’d skirted the rules.  When he tried to argue he hadn’t done anything wrong, she planted her feet and refused to back down. They yelled at each other for 45 minutes while several of us residents down the hallway watched and cheered her on.  He finally relented and apologized.  “I know you’re right and I shouldn’t have done that!”

She could be quietly effective as well.  An older, rather brusque physician was dragging his heels on surgically delivering a mother whose infant’s monitor tracing was looking ominous, she walked behind him and quietly said, “The last time you waited, the baby died.”  Mom was in surgery fifteen minutes later and the baby did well after being resuscitated.

The most important lesson Dorothy taught me was about parenting, not obstetrics.  My first child was a boy.  I’d wanted a girl because I did not relate well to men in general and the fact that he was awake every two hours for six months was wearing on me.  One morning she asked, “How is the baby?”

I said, “The little bastard never sleeps.”

She snapped at me and said, “He’s not a little bastard; he’s your SON!”

I was a little surprised but I was more ashamed of myself.  After that I looked at my son differently and it became easier to try being a nurturing father. I sometimes took him to the unit on the weekends, riding in a carrier I wore like back-pack, with him in the front drooling and making faces.  The change came in handy when his little brother arrived and they became old enough to wale on each other as toddlers (and teenagers).

I’d wanted to tell Dorothy about that when I went to see her two weeks before she passed away, but I didn’t want to cry.  So, thanks, Dorothy, for what you taught me thirty-one years ago.  We will all miss you, but I’ll always remember what you taught me.

Image: St. Catherine of Siena, patron saint of nurses (C) Can Stock Photo

The relationship between resident physicians and clinic patients is tenuous at best. Inner city minority patients rarely trust a predominantly white health care system. Poor folk have social and emotional problems beyond the capacity of clinic social workers to solve. In turn, residents view many of the patients as non-compliant, difficult and sometimes just stupid, even though they were often just doing the best they could.

But we should not be so quick to judge.

Jennifer was single and pregnant,  living in a small town about 30 miles from where I was doing my residency.  We first met when she came to the hospital at 27 weeks with what appeared to be premature labor. We got her uterus to settle down with injections of terbutaline, a medication which often prevents contractions but gives one wicked tremors and a fast heart beat. We don’t use it much anymore because of the side effects and it really doesn’t do anything for actual premature labor.

I discharged her after a few days with a prescription for terbutaline tablet and saw her in the clinic every week. She didn’t like how the medication made her feel and threatened to quit taking it.  I told her the baby would likely have lung problems if delivered early, but I promised she could stop once she got to 36 weeks.  She reluctantly agreed, but complained about the side effects every time.

Over the next several weeks I started seeing her as a lonely, frightened young woman instead of a difficult patient. She had social services looking after her in the clinic and her mother supporting her at home, but it wasn’t the same as having the father of your baby taking care you.

She stopped taking the terbutaline at 36 weeks, but her due date then came and went without labor starting.  Now she was irritable and wanted me to induce her labor.  Back then we waited until women were at least two weeks past their due dates before intervening; that did not make her very happy.  But finally, she delivered a healthy baby boy. I hugged her when we were finished and when she went home.

I saw her in the clinic a few weeks later with abdominal pain; she’d developed an infection in her uterus.  She cried when I said she’d have to stay in the hospital for a few days of IV antibiotics. This on top of a newborn baby at home was just another kick when she was already down.  I promised I’d make her body feel better, but my heart ached knowing I couldn’t make her life better.  Her infection resolved and she returned home.  I finished my residency and moved on to a different world.

Twenty years later spent the summer working at the hospital and clinic in the town where Jennifer had lived. One day my nurse said, “There is someone in the waiting room asking if she can see you.”  She had heard my name in town and wondered if I was the same person who’d taken care of her. I immediately recognized her last name and went to meet her with a mix of excitement and trepidation.

Jennifer looked like the same woman I remembered as a resident. We hugged each other tightly like old friends.  She said she was doing well, still single but much more settled.  She pulled a photo out of her pocketbook and handed it to me, saying, “I want to show you a picture of my son.” Her “baby boy” was now a six-foot-tall Marine and she was justifiably proud of him. I hope she was as proud of her own accomplishment as I was of her.

There is always hope if one has a little faith and a lot of love.

Photo credit: Can Stock Photo

Memory is wonderful, mysterious and sometimes completely unreliable. We start to remember things around two years of age but something called childhood amnesia makes recalling most of those memories impossible. The recorder may be running but there are Nixonian gaps in the tape.

My life, at least that which I can remember most clearly, starts around age five. I can recall the house in which we lived, the neighbors on either side of us and significant events like Gaynell Wright’s surprise birthday party or Anita Tillman giving me my first kiss. But anything before that is largely gone, save for a few unforgettable moments that emerge from the fog that remain because they were either traumatic (being scared witless by a loud motorcycle engine when I was two), or they touched my soul on a very deep level.

I’m almost four years old and we are going to watch the fireworks somewhere outside of town, away from the insistent glow of street lights. It’s very dark; the only thing I can see out the window are thousands of tiny, winking lights in the trees—fireflies whose numbers will dwindle in the coming decades. We stop by the side of the road, parking behind a long line of cars. He stops the engine and kills the lights, but leaves the radio on for amusement or just to pass the time until the fireworks begin.

Losing one sense often enhances another; I cannot see but I can hear and that makes all the difference. Three gentle electric guitar chords, followed by piano triplets reminiscent of “Chopsticks” but haunting, ethereal. Then a soft voice crooning:

My love must be a kind of blind love

I can’t see anyone but you…

But it’s the background refrain that stays with me forever.

She-bop-she-bop, doo-bop-she-bop

Doo-bop-she-bop, doo-bop-she-bop

I don’t remember the fireworks or the trip home, or anything else for the next year. But whenever I hear the Flamingos singing “I Only Have Eyes For You”, I remember brick streets and iron lampposts, the shadows of people from a small Midwestern town gathering by the cornfields and a sense of peace that would be lost for forty years.

Photo Credit: Canstock Photo

I became a hospital orderly the summer before my seventeenth birthday. I’d been a busboy at a local restaurant but seventy-five cents an hour wouldn’t be enough for college and medical school. One of my high school classmates worked a part-time as a hospital phlebotomist and suggested talking with someone in administration, but whomever I met with wasn’t interested.

However, in late spring 1971, the hospital was looking for orderlies. I applied and was accepted.  I don’t remember my training beyond learning medical abbreviations and why one should never let go of a thermometer when taking a baby’s temperature rectally. Yes, we used glass thermometers with red tips for rectal temperatures; the oral thermometers had blue tips, and they were all kept in stainless steel containers of alcohol—separately, of course.  (Do you know the other difference between an oral and a rectal thermometer?  The taste…)

I learned how to make beds, give baths, serve and collect food trays and other things that made the nurses’ lives easier. I kept track of patients’ intake—a standard hospital cafeteria glass of liquid was 240cc–and output—measuring urine emptied from a bedpan or a Foley catheter bag. I answered call lights and took reports or requests back to my nurse.

That summer I worked the midnight shift on one of the medical floors and it was one of the best times of my life.  The nurses and other aides treated me as a responsible adult instead of a “useless” teenager. Nurses with more seniority worked the coveted 7-3 shift; supervisors were conspicuously absent at night. While the patient to staff ratio was more than double that of the day shift, the patients were usually sleeping and not much trouble.

The man I worked with taught me more about patient care than any physician. His first name was Paul; I don’t remember his last name.  I couldn’t tell you how old he was—I’d guess late 50s or early 60s. Everyone looks old when you’re 17.  He had lived through the Great Depression and served in World War II, acquiring life experiences I couldn’t imagine. If he’d seen terrible things, you would never have known it. His face was worn but kind; he reminded me of the man in Norman Rockwell’s Freedom of Speech.  But what surprised me most was that he was an older white guy who didn’t seem to notice that I was a darker skinned kid with kinky hair.

Paul talked to me earnestly about the night’s routines: how often to check on the patients; who needed their temperatures and blood pressures taken; what to do when the occasional call bell rang.  He took the job seriously and would never think of violating the trust of those who depended on him.

One of our patients was a bed-ridden elderly lady, Winnie, who had developed an enormous bed sore in her back while residing at a local nursing home.  She lay in a fetal position because of permanent muscle contractures.  Her eyes would open but she didn’t speak or react.  Yet Paul was very careful to tell Winnie what we were about to do. “We’re going to turn you to your other side, now, Winnie,” or “We need to clean you up a little.” He was always gentle; he never rushed patient care or treated it as a necessary evil for a paycheck.

I never thanked him for what he taught me because I didn’t realize how important that experience was until many years later.

I think anyone contemplating medical school should have to work as an aide for six months minimum. If you can’t approach people at their most vulnerable with understanding and compassion, without being irritated or disgusted, then you shouldn’t be in medicine.