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  CHAPTER 2 Internship

  Phil Drummer was about to begin a surgical internship at the Philadelphia General Hospital. This internship was a time honored, rite of passage for a surgeon, entailing a full year of intense training at a medical center. Upon satisfactory completion of this first year, an intern was then permitted to take the next step up the educational ladder, with that step becoming a resident. In the simplest of terms, an intern dwelled at the bottom of a vast educational food chain within the confines of an academic teaching hospital.

  During internship the newly crowned physician was called a house officer, because he or she basically lived in the hospital, venturing home only a few nights a week in order to sleep. Interns were required to “take call” every other or every third night. The basic rule of a call night was simple, that being to never leave the hospital setting during your shift. For instance a Monday night call would require reporting to work Monday morning at 5:30 a.m., then toiling through the day and night caring for patients. No sleep was guaranteed during this shift. Monday night would simply blend into Tuesday morning. Work would then continue through Tuesday evening until about 6 p.m. Then the weary intern would wander home, eat and collapse into bed. Every other night call meant that the process would simply repeat itself the following Wednesday morning. The intern’s creed during this punishing year was also quite simple, that being “Eat when you can and sleep when you can.”

  Adding to the misery of the year was the job description of an intern. Basically put, the intern carried out the most vile and distasteful functions necessary for a medical center to function. Atop their daily list was the dreaded chore of starting intravenous lines and drawing blood. Also included was wound care, dressing changes and emergency room management. Every patient admitted would require a physical exam, which had to be meticulously logged into a computerized system, in compliance with hospital regulations. Adding to the computer crunch were daily patient progress notes, again being the responsibility of the intern. The intern quickly learned that life on the bottom of a totem pole was cruel, especially when their lowly position was considered a privilege to possess.

  The intern was only one small cog of a teaching institution’s surgical team. On the top of the pyramid sat the elder professor, or attending surgeon. This physician was usually a middle-aged surgeon who for multiple reasons decided to work and teach at a medical center. Most attending surgeons had a research interest, and this intellectual itch could only be cared for within the confines of a teaching institution. An unwritten agreement existed between the attending and resident staff, allowing the residents to do a fair share of the work, while in return receiving the knowledge passed down by the attending. This symbiotic relationship formed the basis of a teaching hospital, having been in existence for hundreds of years.

  Below the attending was the chief resident, who was in the fifth and final year of surgical training. The chief resident was the so called “right hand man” of the attending, carrying out their most trusted chores, in return for permission to perform their surgical procedures. This resident position was coveted, since it represented the end point of a five year battle to the top. Between the chief resident and intern lay multiple layers of junior residents, who were completing their second, third and fourth years of surgical training. They formed the vast mid level management position of surgical teams throughout the hospital network.

  Unfortunately all residents were not created equal. There were good chief residents and bad chief residents. There were lazy junior residents and motivated junior residents. Lastly there were competent interns and incompetent interns. Every surgical team had its own inner dynamics depending on the personalities involved. This surgical team, put together randomly by an administrative scheduler, was ultimately responsible for the smooth and safe care of thousands of patients a year. Trusting patients who travelled from near and far to the prestigious Philadelphia General Hospital, in order to place their health in the system’s capable hands.

  For whatever reason the residency calendar began and ended on July 1st of a calendar year. That day marked the yearly move up the ladder for each resident. Like clockwork the medical student became an intern and the second year resident became a third year resident. July 1st marked the promotion of each physician, along with the challenges associated with it. Therefore, July was a dangerous time to be in a teaching hospital. In July, a tired and nervous intern would be starting your IV and performing your rectal exam. In July, a new second year resident would be controlling your medications overnight in the surgical intensive care unit. In July, a newly crowned chief resident would be performing your surgery for the first time in their career. Therefore, a good general rule was to avoid being a patient at a teaching hospital during the month of July.

  July 1st was near and Phil Drummer was getting nervous. Several days after graduation, he reported to The Philadelphia General Hospital for mandatory paperwork.

  The PGH was a short walk from Phil’s apartment complex at 42nd and Spruce Street. The hospital complex itself was massive in scope, encompassing six city blocks in one direction and three in another. It represented one of the first hospitals in the country and sat adjacent to the University of Pennsylvania campus and medical school.

  The hospital infrastructure consisted of a sprawling hodgepodge of buildings. Each building was connected either by a direct hallway, underground route or above street walkway. If desired, a physician could enter the complex at 40th street and exit on 34th street, without ever leaving the confines of the facility. The center was a mixture of ultra-modern wings and outdated open hospital wards. Pavilions were frequently named after a physician who spent an entire medical career at PGH, thus gaining immortality by the passage of time.

  The Department of General Surgery sat on the sixth floor of the Kirby Pavilion, which was named after a general surgeon from the 1800s who also practiced Veterinary Medicine. Doctor Kirby was famous for curing a patient and then examining their mule team prior to leaving the hospital. The Kirby building was an ancient complex, left standing only for architectural and budget constraint purposes.

  The department’s main office was dank, tight quartered and depressing. Only scattered windows let in filtered light, which struggled to get past adjacent taller buildings. An outdated heating and air conditioning system frequently malfunctioned, producing variable ranges of temperature within the facility. Upon entering the office Phil took two steps and stopped at the receptionist’s desk.

  “May I help you?” asked the young secretary, with a smile.

  “Hi, I’m Doctor Drummer”, responded Phil with an eye on the attractive woman. “I’m going to be a new intern in July and am reporting for duty as ordered.” Phil smiled with his subtle attempt at humor.

  “Doctor Drummer, yes we have been waiting for you,” replied the secretary now with an added gleam to her eye. “Please have a seat and I’ll see if Doctor Barnes is available.”

  As the secretary arose Phil admired her physique and the fact that she called him doctor. She turned the corner and walked down the hallway with a calculated, curvaceous gait.

  Phil sat down and looked around the waiting room. Some information posters hung on the wall and a small coffee machine sat in the corner. A single low table was to his side and had a few medical magazines on it. “Wow,” thought Phil, “What a dump.” The Surgical Department at the PGH was known worldwide as it historically trained the best of surgeons. Its residency was a coveted position sought annually by hundreds of over qualified medical students from across the land. “This is the best they can do?” thought Phil.

  At that moment the young secretary turned the corner smiling with a middle-aged woman. The secretary sat down neatly keeping her eyes on Phil at all times. The older woman was one of the many residency coordinators Phil had seen in the past. She was not as thrilled to see Phil but offered her handshake with a welcoming smile, while taking Phil back to her office.

  She informed Phil that Dr. Ba
rnes was unavailable and in surgery that morning. Then for the next 30 minutes she succinctly informed Phil of his required duties prior to starting work on July 1st.

  Phil was given a PGH employee handbook laying out the bylaws of the hospital. He was informed of the necessary paperwork to be completed regarding personal information. He was instructed to report to the occupational health department regarding necessary immunizations. Also necessary was a trip to hospital security for a photo ID and security clearance. Lastly he was asked to report to the Information Technology department for clearance and instructions regarding the hospital’s computer system. Phil coldly felt like he was starting a job, which by the end of the lecture, was true.

  “Any questions?” asked the coordinator.

  “Yes,” said Phil, “When do I meet the other interns from my year?”

  “June 30th,” was the matter of fact response. “Doctor Barnes will be hosting a reception that morning in the conference room at 6:00 AM.”

  Phil smiled wondering why general surgeons always meet at the crack of dawn. Perhaps some curse was thrown upon the profession by a sadistic Greek god ages ago.

  “We will send you a confirmation email and text regarding the reception,” said the now inpatient coordinator.

  “Great,” said Phil. “I hear we have a wonderful intern class.”

  The coordinator smiled, not wanting to prolong the meeting. “Any other questions?” was her next terse line.

  “No, but thank you for the help,” said Phil politely as he got up remembering his dad’s advise never to burn any bridges. He then extended a parting handshake in saying goodbye.

  “Nice meeting you Doctor Drummer,” said the interested young secretary as Phil walked out.

  “A pleasure meeting you,” said Phil with a wave goodbye. “See you on orientation day.”

  Phil then spent the final few days of June preparing for internship. He uneasily smiled for an I.D. photo at the hospital security department. He stoically received a booster shot for hepatitis prophylaxis at the student health office. Then, he happily received a laptop computer from the Information Technology office.

  On the eve of orientation day, Phil sat alone in his apartment. He was attempting to hook up his new computer to the hospital web site when a knock rattled his door.

  Upon opening the door Phil greeted his friend and apartment mate from across the hall. Jim Turner was a veterinary student at the University of Pennsylvania. He was born and raised in central Pennsylvania having grown up on a dairy farm. After college he worked as a vet surgical assistant for ten years, then decided to apply to vet school. At 32 years of age he was the oldest, and seemingly most brilliant student in his class. Turner was polite, somewhat portly and a bit reclusive. He was a technophile and was some way or the other connected to every satellite over North America. His quirky passion was drinking a large glass of whole milk at every meal. When on the farm it was straight from the cow, when in Philadelphia he would settle for the pasteurized brand from the nearby Acme market.

  “Are you ready?” asked Jim with a down home grin on his face.

  “You bet,” said Phil extending his hand for Jim to enter the apartment.

  Jim entered the small corner apartment on the seventh floor of the Greycliff apartment complex. Phil’s apartment consisted of a galley kitchen, small living room and a single bedroom. Turner and Drummer shared the same floor for the past two years and formed a great friendship during this time. Having both grown up in Pennsylvania they had a common bond.

  “Just trying to hook up to the hospital hub on the new computer,” said Phil, “Having a problem getting recognized.” Phil knew this would peak Turner’s interest and immediately help rectify the computer glitch.

  “A new laptop?” said Turner as he rapidly approached Phil’s desk. Then with geek like envy Jim Turner eyed the laptop while saying, “The latest and greatest, nice.”

  “Compliments of the PGH,” replied Phil knowing that Turner would immediately offer his help to solve the connection problem, which he did. Within twenty minutes Phil’s computer was up and running, seamlessly communicating with the innards of The Philadelphia General Hospital. The final preliminary step leading into his internship was now complete.

  Phil smiled proudly at the laptop like a new father in the nursery. The crisp computer screen was bright and inviting. He leaned back in his chair with his hands clasped behind his head saying, “Life will never be the same.”

  High fives were happily exchanged between the two Pennsylvania products, who then proceeded to watch a Phillies baseball game well into the night, unaware as to how prophetic Phil’s words would soon be.

  CHAPTER 3 Orientation Day

  Surgeons by and large are antisocial creatures. They start a workday too early and end too late. They practice their trade behind a mask in a sterile environment, closed to the public. Their schedule is overbooked and subject to instant change. They thrive on physical and mental challenges and the associated adrenaline rush. This frenetic schedule over time produces an individual who is brash, productive and confident. It also creates an alpha wolf who only socializes with the pack to exert dominance. Therefore surgeons do not enjoy meetings or gatherings. They prefer to be moving and producing as opposed to standing and conversing.

  Surgical orientation began at 6 a.m. on June 30th. Phil woke up at 5 a.m. being unaccustomed to the early rise. The streets of West Philadelphia were empty as he walked through the Penn Campus. Orientation was in the department of surgery office that morning.

  Upon entering the department office Phil thought he was there on the wrong day. The office was dimly lit and not a soul was in sight. In the cramped office the smell of coffee permeated the air giving Phil hope that his calendar was correct. After a brief pause the door opened behind him and a tall, somewhat confident young woman walked in.

  Cathy Finley was a slim 5’8” tall with brown hair and brown eyes. She wore fashionable glasses and minimal make up. Her facial features were individually plain but together created an attractive appearance. Born and raised in New England she was well educated and cultured. Having spent two years earlier in the Peace Corps, she would be the oldest intern of the group at age 27. Phil immediately recognized her from a group email sent to him by the surgical coordinator.

  “Hi,” said Phil extending his hand. “You must be Cathy.”

  “Yes I am Cathy, Cathy Finley,” was her response while firmly shaking Phil’s extended hand. “You must be Phil Drummer.”

  “I am. It’s a pleasure to meet you,” replied Phil hoping she was somewhat normal in light of the year ahead. “Brown medical school, right?” asked Phil.

  “Yep, and you are from Penn,” replied Cathy looking around for anyone else in the room.

  “Right,” said Phil “I love the city so much I didn’t want to leave.” An awkward moment went by, allowing Phil to appreciate the lameness of his comment.

  At that moment the door again opened and Frederick Riles III entered the room. Frederick was sharply dressed in pressed pants and a starched shirt. He wore a bow tie and had a professorial appearance despite his young age. His shoes were well polished and comfortable in appearance. He walked with a sure gait cultivated over time. He stepped up directly to the two other interns.

  “Hi, Frederick Riles,” was his polite introduction to Cathy with a bow. They shook hands extending greetings. Fred smelled manly of expensive cologne.

  “Another Penn boy,” said Drummer patting Riles on the back.

  The department door opened again with a member of the cafeteria staff entering the room. Dressed in white pants and a short sleeve shirt the dietary worker wore a hair net over his head. He carried a tray of donuts and pastries that did not look fresh at all. He was whistling a jazz tune and moving as if the young interns did not exist.

  “Cookie! What’s up?” said Phil recognizing the cafeteria worker.

  Cookie was a popular member of the cafeteria staff. He worked at PGH for the past 1
5 years serving up breakfast, lunch and dinner to the resident staff. He was a 36 year-old thin male with a fantastic smile despite lacking a few teeth. He was a tremendous worker always on the move. Outside of the hospital he was Terrance Jones, a proud father of four.

  “Hey doc,” replied Cookie. “Got some good chow for you here.” He quickly moved across the room depositing the tray of goodies on the table. “Enjoy.”

  “Thanks my man,” said Phil shaking Cookie’s hand. Cookie obliged.

  “Gracias,” said Riles attempting to belong, but Cookie did not respond as he left the room.

  For the next 15 minutes the three interns shared some donuts and coffee wondering why they arrived so early. Two secretaries then wandered in with a smile as they reported to their work area. The young receptionist who met Phil several days earlier wore her favorite skirt and blouse outfit, a fact that caught Phil’s attention even in the early hour.

  The time was 6:30 a.m. when Dr. Michael Barnes, the Chairman of the Department of Surgery entered the room. He approached the group from the opposite side of the room with a broad smile on his face. He walked quickly.

  “Sorry I’m a tad late,” said Barnes who then employed the oldest excuse known to the medical profession. “We had a bit of an emergency downstairs but things have finally settled down. It’s a pleasure to meet you all.”

  Behind Barnes was Chief Resident Pete Larson. Larson had one year left in his residency and knew the PGH system well. He was planning a plastic surgery fellowship in Southern California the following year. He had sandy blonde hair and was a tad overweight for a soon to be plastic surgeon. He appeared fatigued.

  “Welcome to the Philadelphia General Hospital,” said Barnes with his arms extended in a welcoming fashion. “I know that some of you are Penn grads and know the hospital well. For those of you who are new to the PGH, we welcome you. You are in for a fabulous year here in Philadelphia.” Barnes smiled and looked around the group waiting for a response. The three interns just nodded back at him.