Duke University School of Medicine - Aesculapian Yearbook (Durham, NC)

Page 26 text:

maids and orderlies. Furthermore, warmed or cooked food is injurious to the stomach of a medi- cal student. For these reasons, medical students are barred from the hospital cafeteria. We found that the natural, healthful diet of the medical student consists mainly of aged ham-and-cheese on rye sandwiches, preferably served at room temperature. These could be had in abundance at the Dope Shop, and were usually consumed in room M-110, the ancestral home of the Duke Medical Student. Also very early we became acquainted with the vast, liquid spectacles referred to as medical school dances. Our class seemed to have an inherent naturalness at these affairs, and we always attended in large, loud numbers. lf the first year had been one of bleakness and feeling-as-though-it-will-never-end, the second year was one of adjustment and relative tranquility. We had finally come to the study of human illness and its causes, and it seemed to us that such study was entirely appropriate in the training of a physician. Human illness turned out to be an animal acting in a certain way, its cause was a wheel, and the universe was the biggest wheel of all. We all laughed at the wheels until we began to think seriously about disease, at which point this concept became very useful and strangely modern. Beyond the wheels were the pots, endless pots, pots on the wall, pots on the table, pots on the Hoor. They contained cases. At first glance these were merely foul smelling, hopelessly tangled wads of viscera, but more careful inspection revealed that they could tell a story as clear as any in medicine. Autopsies were interesting, but they would have been more so had we been able to understand our prosectors. Our questions were usually answered with bows, smiles, nods, and perhaps the phrase, smooth and glistening, or passive congestion. In pathology, as the material from the first year was incorporated into the study of illness, we began to see our profession as a unified whole. For the first time, we could site some concrete reasons for choosing medicine as a career. Bacteriology and Pharmacology both contributed large amounts of valuable information to our growing stores of knowledge, they also contributed considerable amounts of useless informa- tion. The latter was entertaining, so it was really not useless. In addition to teaching us their own fields, which they did nicely, the faculty in these disciplines performed the important function of complementing our knowledge in other areas. Thus physiology became much more meaning- ful because of pharmacology, and pathology more meaningful because of bacteriology. Perhaps the most significant thing of all is that we came into contact with the remarkable faculty members who constitute these departments. What can be said of dog surgery? Almost every Duke student looks back on it with a great deal of pleasure, and those in our class are no exception. Everyone scrubbed for fifteen minutes except the professor, and he scrubbed for three minutes. We wisely attributed this reduced cleans- ing to intrinsic asepsis on his part. There was the surgeon whose patient died under the blade, not a Bard-Parker, but a Gillette blue blade. There was the first assistant whose integrity had al- ways been impeccable who crept down the hall with a dead dog, heading for the refrigerator. There was the giggling anesthetist whose patient expired in the midst of the giggles. Then there was the professor. Why do we love dog surgery? Because of the marked reminiscence value. We sadly regret its passing, for it was a time of fun and the acquisition of more than a little knowledge. Hematology sticks in most of our minds as basically a course in cover slip pulling. It was so encouraging to pull hundreds, until at last a masterpiece is achieved, one in which each red cell is exactly 8 microns away from every other red cell. The best part came when the preparation came back graded D minus , it seemed to make the effort worth while. What kind of cell is that? A myeloblast. How do you know? Why because of the nucleus and the cytoplasm. What about it? The texture, man, the texture. Thanks. And so it went. It might be thought that what is learned in the course in physical diagnosis is how to make a diagnosis from physical examination. This is not true at the Duke Medical School, certainly it is not true when referring to the class of 1960. The knowledge that we acquired from this course was on a more basic, perhaps primitive, level. We mastered such things as how to strike the ples- simeter finger with the percussing finger 2 times out of 3, how to avoid shining the ophthalmoscope PAGE 22

Page 25 text:

The History ofthe Class of l96ll It all began in the austere, stern environment of room M-I ltl. How appropriate a place to commence the study of a profession which is characterized by attention to detail, foresight, and cleanliness. The huge black blades of the window fan were beating out their inellectual refrain- squeak, squeak, squeak. A very unusual fan this, for it was able to distribute odors and cigarette smoke evenly throughout the gloom without moving the air pereeptibly, thus preserving the incu- bator-like quality of the place. The young men and women seated in that room four years ago were to become the class of 1960 at the Duke University School of Medicineg namely, us. All in all, it was a sobering moment. The Dean was the first to speak to us. We appeared to be listening intently to what he had to say, actually we were looking intently, for what an eye-full was this man! He greeted us, told us of the wonders that lay ahead, and in general behaved in a deanish manner. He also complimented us and told us what a select group were were. Actually, in many respects this was the first time in our respective lives that we had been recognized as worthy and significant hu- man beings. It was also the last time that such occurred. The next speaker was the head of the department of anatomy, and he made us a little uneasy for he talked less about the glories of the future, and more about the realities of the present. He even suggested that there might be hard times ahead. We shrugged this off as a likely story and turned our heads toward the first year. The Dean had streaked us out on the agar of the Duke Medical Center, and we had but to grow. Anatomy turned out to be basically the negotiation of a peaceful co-existence with four other people, three living and one dead. The relationship with the latter proved to be by far the most intimate, if not very long lasting. We soon found that there is considerably more to dissection than is readily apparent. Take, for example, the matter of the removal of the skin from the cadaver. To the casual observer, this seems simply a matter of stripping ofi' the skin. much as one would peel an avocado. This, however, is not so, for the skin must come oli in just the exact thickness. We were all rendered tense and tremulous by the emphasis placed on the importance of this, and as a result most of the first specimens removed were markedly fenestrated. Feelings of guilt and inadequacy were heavy upon us. However, we soon recovered and adopted less subtle, more de- finitive methods of skinning. This also cut down significantly on annoying details of anatomy which cluttered the dissection. It was at this point that we learned that in the busy life of the physician, it is sometimes necessary to temporarily lay aside detailed, precise, thorough methods and take short cuts. We had been in medical school for 45 minutes. Although gross anatomy occupied most of our time, there were histology and neuroanatomy to be dealt with. lt was in these areas that those of us with liberal educations were way ahead. Per- haps way out would be a better phrase. One of us was so liberal in his orientation that he soon left school to write the great American novel. More power to him, wherever he is. As the depart- ment of anatomy was the first to view our class, it was also the first to take a dim view of our class. We sensed this, because some of us failed anatomy. Fortunately. most of our losses were not per- manent, thanks to the do-it-yourself course given in the summer. After this less than glorious debut, we proceeded on to physiology and biochemistry with more trepidation. ln anatomy, a new fact was uncovered with every stroke of the blade, but in bio- chemistry the facts did not turn up so easily. For example, after hours and hours of laborious chemical procedures, we were able to look an egg in the eye. and know that it does indeed con- tain cholesterol. At the rate of one fact every six hours, it takes a long time to learn an apprecia- ble amount of biochemistry. The records we kept of our physiology labs sounded more like menus than anything else-frog legs, turtle hearts, rabbit chitterlings, rat kidneys. All these yielded their secrets unto us. And soon the first year was over. Looking back over it we said that in anatomy there were too many facts and not enoJgh thinking, in physiology too much thinking and not enough facts, and in biochemistry too much thinking and far too many facts. It was good to look back on the first year, and it got better. There were other things learned that first year. Very early in the year we discovered that the medical student has much smaller calorie and vitamin needs than do interns. residents. nurses. PAGE Zl

Page 27 text:

light into one's own eye, and how to avoid fracturing one's metaearpal bones when setting the tuning fork in motion. We also learned history taking at this time. Some of the eompendiums we recorded were indeed tributes to the endurance of modern fountain pens. Here too, we lirst became acquainted with the bright young men, the rising medical stars, the nouveau long coats. These folk talked in a peculiar tongue in which they exchanged ideas by referring to them rather than expressing them. This form of communication has been labeled journal jumping. Many of our class began to speak this language even then, it seemed to them to be the only thing to do. The second year was rounded out with a battery of lectures that was astounding. Preventa- tive medicine, public health, legal medicine, dentistry, MEND, Markle scholars, psychiatry, ob- stetrics, surgery, physiatry-all had their rather lengthy say. Our intake of knowledge was some- what limited because of severe gluteal fatigue. ln addition, there was that fairly non-descript entity, the sophomore elective. lt was so non-descript that it was forgotten entirely by one of our class, and he was forced to divide his time between golf and sleep. The class energy, which had been so well directed in the early part of the second year, had been thoroughly dissipated in at least 39 different directions by that year's end. We were ready for the clinical years. lt would be very diflicult to state how the class of 1960 reacted to serving on obstetrics and gynecology, since individual reactions were so different. One thing that is certain is that we in- deed did serve, another is that the teaching program given by the senior staff was excellent. Most of us managed to deliver at least one baby, and this cannot fail to be a memorable experience, even for one totally unimpressed by this area of the practice of medicine. We still cannot understand how it could be impossible to locate the medical student when the pelvic examination was to be done on his patient, yet when hemoglobin time rolled around, he was snared and spirited to the ward with IBM-like efficiency. Then there was the student who happened to come upon a mother giving birth to her baby in the dark recesses of Prevost, and who at this point found out that stu- dents were not allowed to call for precipitation trays. We are glad that OB 8: GYN is not given in the fourth year, for some astute, more perceptive than average senior might observe that running fourteen consecutive urines was of questionable teaching value and be tempted to point this out. All in all though, the quarter on OB 81 GYN was an entertaining and dramatic one, and perhaps the best part of all was listening to the captain of the OB team, a truly amazing man from any point of view. Our class was undoubtedly exposed to more psychiatric radiation than any other in the history of the Duke Medical School. In addition to absorbing the direct rays emitted from the quarter on psychiatry itself, we were also exposed to a marked increase in background spookery. thrown in while on other clinical services. Whether we admit or not, the effect has been profound, many irreversible cerebral mutations have been induced. Even those of us who consider psychiatry in the same realm as phrenology have been overheard making guttural, non-committal noises and thoughtfully repeating their patients' last sentence. Things such as chronic fatigue, low back pain, headaches, and history of hysterectomy point our diagnostic noses toward the psyche just as surely as dyspnea points it toward the hean. However reluctantly, we have learned our lessons well, we only hope what we have learned is true. Psychiatry is a field of great potential-some might say, all potential-and we are glad that our class will contribute several members to this area of medicine. As doctors, of course. Howland ward is the only place in the hospital that can compare with M-l IO in aptness of thought. It too has a big black fan that goes squeak, squeak, squeak without moving air. But all this is beside the point. We observed an incredible array of disease processes in this ward. any one of which would have been enough to send the average house officer on any other service into orbit permanently. The pediatric house staff is imperturbable, however. Why get excited about systemic nocardiosis when there is a patient in the next bed with hypertensive adrenogenitalism? Perhaps the most impressive thing about pediatrics was the violence with which the young folk get sick. Fever means 42 degrees, epilepsy means status epilepticus, heart trouble means murmurs that are audible across the room, eczema means no normal skin-children seem to be moribund or well, with little in between. Of incidental interest to us was the fact that a half pint of blood PAGE 23