Part One – There
(Eastern Hemisphere)
CHAPTER SIXTY SIX – YEARS IN THE MEDICAL SCHOOL (PART 1)
I’m returning to my own memories. This chapter will focus mainly on stories about classes in medical school. When I described the beginning of my studying, I already described something on this topic (see Chapter 58), but now I’ll try to think purposefully.
As in any educational institution, there were many excellent teachers as well as mock, alleged figures. Some lectures were interesting, others are boring, but my goal is to try to recall situations that are worth retelling. I’ll try…
The first subject that all future doctors encounter is anatomy. It was taught to us by a very elderly but friendly “grandmother” Arutyunova. Everyone immediately developed a good relationship with her. In my second year, when my wife returned to Tbilisi, we once visited her for the holidays, and she taught Lilya to bake oriental sweet cookies – kada.
I had an incident with histology. There was no electricity, and I reported this to the lecturer, who knows, maybe she’s waiting for a ring signal and wants to go to the toilet.
“I didn’t expect this from you, Neiman,” said the professor.
Damn her false pride, but during the exam she remembered this to me. She wrote “Excellent” on the score sheet with a pencil, erased it, and then wrote “Good” with an ink pen and said,
“I remembered that you are bored in my lectures. You have really disappointed me.”
“Well, now we’re even,” I sighed.
What was left for me to say?
I was worrying of physiology. Vice-Rector Avaliani was waiting for me in ambush, but it was not he who commanded the hunt here, but the head of the Department of Physiology, the old Professor Bazuradze, who very nicely asked me about this and that, praised me and gave me an excellent grade. My evil genius didn’t even look in our direction.
With public items everything was simple. I took the history of the CPSU again (read about this exam in the University in Chapter 24). But now it was not the university, nobody interested in the primary sources. Yes, and I have lost the enthusiasm of youth. I only asked the teacher,
“What’s so special about perestroika?”
He looked at me slyly and without any embarrassment said,
“Listen closely: PER-R-RESTROYKA!!! Have you Neiman understood?”
“Oh, now yes!” I modestly moved my eyes down, “Thank you!”
And I skipped the rest of the social subjects: philosophy, historical materialism, political economy and scientific communism, I didn’t even attend them, because I managed to transfer my excellent grades from the university to the medical institute.
Many teachers knew that I often fly to Moscow to visit my family and ordered me to bring something needed. It was funny when some old medical school fart asked me,
“Nikolai, here’s 5 rubles for you, bring me three kilos of the best chocolates! (That is, for 45 rubles!) Or better – a jar of caviar.”
The caviar was sold in our stores when I was a child. Although, I remember a case, how in the seventies, there was a brisk sale of ten-kilogram tin boxes of Atlantic herring from the basement of the store near us. Each customer took a whole box until the turn came to a poor man, who asked for one herring. The seller, in his hearts, opened the box. The box was filled with black caviar. The sale was immediately stopped. Then it turned out to be part of a big scam called “Ocean”, when boxes of smuggled caviar disguised as herring were exported abroad. And this time there was a claim – the picture faded. In the result the cans ended up in the store by mistake.
Much more interesting are the memories of senior years in medical school, when the subjects became clinical, and instead of anatomical preparations named Vasya, real patients appeared.
It so happened that I mastered intravenous injections in Moscow. In the summer, having nothing to do, I asked to practice in the surgical office of the clinic, which was located on the first floor of our house. Extra hands are always needed, and since there was no need to pay, they gladly took me on.
A young guy, Ivan, a recent graduate, worked there as a surgeon, although he did not look surgical at all: plump, lethargic, and phlegmatic. Behind his back, everyone called him like a small boy, Vanya. When there were no patients, he told me how he famously operated on important patients, who rushed to fall into his magical hands, in central Moscow clinics.
These stories reminded me of the stories of the neighbor’s drunkard, Kotik, about the beauties he seduced, the mistresses of the rich houses in which he made repairs. I listened to both group of stories with interest, not believing in their reality, but suspecting a defense mechanism in the psyche of the narrator. Vanya’s dream was a quiet place in the city health department, and a generous bribe for permission to hospitalize regional patients in the capital’s clinics.
Vanya usually received patients very reservedly, without much asking,
“What are you complaining at, woman? (Or man)”
“I’m complaining at hemorrhoids (Or – it hurts, it burns, there is blood, etc.)
Ivan usually wrote all this down and, without raising his eyes to the patient, said monotonously,
“Get on your knees, lower your panties and spread your buttocks.”
Hemorrhoids were common thing, and I heard this phrase several times a day, but the first time I could barely contain my laughter. Firstly, I imagined the reaction of a Tbilisi patient to such proposal, and secondly… the woman knelt on the floor.
“What are you going to do there on the floor? Get up on the couch.”
The woman climbed onto the couch and knelt with her butt towards the wall. Perhaps she felt shy.
“It’s not getting any easier hour by hour!” Vanya was phlegmatically indignant, “Should I go out, drill a hole in the wall and inspect you from there?”
The woman, continuing to hold her buttocks, raised her head and looked at the doctor with the meaningless look of a cow. I, internally dying of laughter, (“Fairy hut, turn your front to the wall, your back to me!”) decided to come to the patient’s aid,
“The doctor wants to take a look at the hemorrhoids that are causing you pain and discomfort.”
That helped. The woman turned around on the couch, so that the entire sheet was wrinkled and askew, but the “object” was ready for inspection. Ivan looked up from his notes, glanced at the hemorrhoids without getting up from his seat, and prescribed treatment.
When the patient left, Vanya turned to me,
“You, Dr. Neiman, although you are my future colleague, are here in student practice, so speak to patients only at my request, otherwise you will go and do injections.”
“I don’t mind learning that too,” I said, “I don’t have much experience, and to be honest, none.”
“Really?” he was surprised, “Masha! We have a specialist in IV here!”
Masha, a pretty nurse in a starched uniform, dragged me into the next treatment room, where a woman with huge veins and bruises on her elbow bends (pits of elbows) was already sitting.
“They pierce my veins all the time,” she complained.
“We’ll be careful,” Masha said in a confident voice and nodded at me, “Come on, please!”
And without any fear or difficulty, I inserted the needle into the vein and adjusted the system with the antibiotic.
This was my first time trying an IV needle. Masha showed me her thumb, then pointed the same finger over her shoulder, towards Vanya’s office, grimaced and pocked the same finger down.
“Often the veins are not visible, but can be felt. By carefully inserting a sharp needle, you will always install the system on our not terribly ill patients.”
She turned out to be right. Anyway, this summer I learned how to deal with my needles and other people’s veins.
In general, I didn’t complain about my hands. I remember that back at school, I carved out parts on machines during labor lessons, together with a couple of second-year students and a couple of handy classmates. These handicraft skills have, at least once, brought me unexpected income. It happened in medical school. One student brought a set of imported jewelry for sale. These were earrings that she wanted to keep, a necklace and a bracelet. The earrings cost 30, the bracelet – 50, and the necklace – 90 rubles. All elements were repeated: turquoise balls made out of wound fishing line interspersed with “golden” ones.
All the girls in the group really liked the look and color of the earrings, but 30 rubles per an earrings was a bit expensive. “15 that would be just right!” they said.
And suddenly it dawned on me – I need to buy a bracelet and a necklace, take them apart into balls, make earrings out of them and sell them for 15 rubles each. So I did. I bought the material, purchased golden chains, balls and various locks for earrings (all this cost pennies in haberdashery stores) and literally in two hours I made twenty pairs of earrings, and in design all were slightly different from each other. The next day I compensated for my losses, gave to my wife and sister cool jewelry, made eighteen students happy and upset only one person – the owner of a sample for 30 rubles. Previously, she was the only girl in the city with unprecedented earrings, but now there were not two or three of them, but twenty, and all from her close circle. An unexpected bummer…
In my third year I felt terribly tired. It became somehow difficult to constantly study, work, build an apartment and travel to Moscow back and force. And I came up with the idea of taking a sabbatical to give myself a break. But too much free time is also bad, and for now I decided to gain experience in complex procedures and management of serious patients, and went to work in the intensive care unit at the hospital closest to my home. I encountered many difficult and unusual cases there.
I still remember my first night watch. A child was drinking water from a high stone fountain, slipped off it and hit his chin on the granite edge. Somewhere in the breathing system there was a rupture, air went under the skin, and the boy was inflated like a balloon. The doctors on duty gathered in the intensive care unit, the chief surgeon of the hospital, Professor Kipiani, who was also a pianist, artist, speaker and toastmaster, arrived and asked to speak out. The team was silent.
Then I, taking the offer at face value, said,
“I would check to see if the ribs are intact, if they have punctured the lungs, if there is a pneumothorax, and would do a bronchoscopy.”
“I completely agree, colleague!” said the professor, “Sorry, I forgot your last name.”
“This is our new paramedic, Neiman, a third-year student,” intervened the head of the intensive care unit, Temuri.
“I thought he is our new head physician,” Kipiani laughed, “But I completely agree with him. Get a portable X-ray and a pulmonologist with a bronchoscope here immediately. (And then to me) How are you related to my late neighbor David Neiman?”
“A grandson.”
“What kind of doctor do you want to become?”
“A surgeon.”
“Great! If a child is diagnosed with pneumothorax, I will take you with me to the operating room. Temuri, will you let him go?”
“Why not? Nick is the head physician today.”
The child’s lungs, however, turned out to be fine, but the trachea was slightly torn in two or three places, and he was treated for subcutaneous emphysema by inserting several needles under the skin to allow air to escape.
But I still ended up in the operating room. In the department there was an unknown young man who was picked up on the street, considered drunk and was transfused with solutions and… Checking all our patients at night, I noticed that his neck did not bend, his arms and legs were tense, in a word, and I suspected a cerebral hemorrhage. I went to report to Temuri, and he was fast asleep, tired. I told him that I wanted to call a neurosurgeon for a consultation. He muttered,
“Go ahead!”
Then I went to call the operator. It turned out that we did not have our own neurosurgeons, and she, after hesitating, gave me the phone number of the person on duty at the Ministry of Health. But I was not shy about authorities. I called, woke up some person and urgently demanded a neurosurgeon to our hospital for possible craniotomy and evacuation of the hematoma. Gradually the duty officer woke up, figured out the situation and promised to send a neurosurgeon from the Central Hospital.
“Who am I talking to, colleague?” he asked.
“With the paramedic of the intensive care unit,” I answered.
“With a paramedic?” he was amazed, “What, the war has started?”
“Everyone is providing emergency assistance to patients. Thank you for your assistance.”
“You’re welcome, colleague,” he chuckled, “Meet the neurosurgeon, the helicopter is probably already landing.”
Indeed, the neurosurgeon soon arrived and confirmed the suspicion of a hematoma. The patient was sent to the operating room, Temuri released me to assist. The night was just top notch! Later, Professor Kipiani joined us. Just in case, he washed his hands, put on a sterile gown, took a sterile forceps and imposingly lit a cigarette, holding a cigarette with them. You won’t believe it – the ashes fell straight into the opened skull! It just hissed in patient’s brains.
“That’s OK, it’s sterile!” professor said embarrassedly. “This often happened during the war. Let’s wash it out now.”
I thought that it was not without reason that the person on duty at the Ministry of Health asked about the war.
“What kind of war did you have in mind? 1812? I operated in Afghanistan, and no one smoked in the operating rooms there,” the neurosurgeon said gloomily.
“That’s it, that’s it, I’m quitting smoking! What’s your name, excuse me?”
“Doctor Alaev from the Central Hospital.”
“And you?” the professor turned to me.
“Paramedic Neiman,” I reported.
“Ah, I didn’t recognize you right away. War hero and “new head physician”, a match has been made! I should have guessed! Well, I’m getting older…” he sighed.
After the operation, Alaev and I smoked, recording the protocol in the chart.
“Well, your professor is an asshole,” he said, “He found himself a good ashtray! What did he say about the head physician?”
“That’s what he calls me. This night I, a student, got involved in two stories thanks to my activity.”
“So it was you who called the ministry?”
“Yep, it was me. And you… are you a war hero?”
“I have a medal. But they also fired me because I operated on and saved an Afghan prisoner of war…
“Then the professor isn’t such an ass. He’s right – you are a hero!”
“What is your name?”
“Nick.”
“And mine name is Oleg. Drop the title. Let’s be acquainted, paramedic Neiman!”
All sorts of stories happened in the intensive care unit – from unusual but minor situations to scandals all over the city.
Our doctor, a pretty young woman, Lali, fell in love with a handsome guy who was recovering from a brain injury. He developed a rare but well-known complication – hypersexuality. He pestered all the women in a row, but she believed that his feelings for her were sincere. No matter how much the doctors around her told her, no matter how much her best friend Nana persuaded her that her feelings were an obsession, a fiction (no one knew the term countertransference at that time), Lali took a vacation, took the patient to Leningrad with her own money, and arranged him for treatment in Psycho-Neurological Institute named after Bekhterev. They cured him there. Lali thought that they would get married, but he apologized to the woman for the feelings that he caused her with his illness, and left in an unknown direction.
The poor thing fell into a severe depression, did not work, did not eat, did not bathe, and then received treatment and returned to the intensive care unit for work. While on duty, she begged the nurse to give her an IV-injection to end the pregnancy and handed her a syringe with a concentrated potassium solution and a tranquilizer. Death occurred almost instantly. It was not possible to save Lali, and the nurse was put on trial…
Another, not so tragic story is connected with my ability to read fortunes using coffee grounds. In Georgia, they often drank (probably still drink) Turkish coffee, which is roasted, grounded and processed to boiling in a cezve – a special pear-shaped saucepan. They can “read the fate” by the sediment at the bottom of the cup. I don’t know what professional fortune tellers are guided by, but any person with a good imagination and a loose tongue will tell you bunch of foretelling, looking at the pictures formed by grains of coffee on the walls and bottom of the cup.
I made good use of this social communication tool, but I always tried to turn a fortune telling into a joke. Once, a young doctor Nana, with whom I was friends and knew not only from work, but also as the girlfriend of my young course mate, brought her student friend to the intensive care unit.
“We have business, we are going to Gori in the evening, and Lali will replace me for the night,” said Nana, “Could you tell fortune for my friend?”
I refused, I resisted, they begged, insisted, in a word, they made coffee, drank it, and the student handed me her cup.
I had to create a fog, because I knew nothing about her and saw her for the first time in my life. I spoke in general phrases that can impress everyone, because everyone interprets them in their own way and for themselves.
And so, in the process of hanging noodles on the ears of a stranger, I say,
“Two souls live in you – one is pure and holy, and the other is vicious. And the black soul wants to destroy the white one.”
At these words, the student – bang! – breaks down and faints. Nana fusses, brings her to her senses, the girl sobs and says,
“I won’t go! This is a sin!” And she tells that she planned to go with Nana to Gori to have an abortion in secret.
Then Lali came, and together with Nana they persuaded the student not to spoil her reputation, not to complicate her life and not to change her mind,
“Are you fool? You will get rid of the child, “restore” your virginity and get married well. But with a child, who will marry you? Only someone in pursuit of your dowry, and not for love.”
They left at night. Everything went well. The girls shared with me, since, as fate would have it, I witnessed the secret trip. And everything was fine for a long time, until Nana’s young boyfriend left her and married her student friend.
“Sorry,” he said, “You are older than me and more experienced. You had men before me and there will be men after me, but now for the first time I have love for a pure, naive girl, a virgin.”
Nana was telling me this story and cried. I felt sorry for her…
After my sabbatical leave, I threw myself into my studies with renewed vigor. I changed departments of therapy and surgery. I liked both of them much more than those which taught my previous course. And I learned from them more willingly.
The second professor of the department of therapy, Irakli Alexandrovich, treated me well, always talked during breaks in lectures, and once suggested that I rack my brains over one case.
“I’ll tell you honestly, the patient is a private person, and all information should remain confidential, but the case is difficult, therefore, as always, it is of interest to thinking people.”
I happily agreed. The problem was with the heart – a woman of about fifty was diagnosed with aortitis – an inflammation of the aorta, and for successful treatment it was necessary to try to determine its nature. If it was an autoimmune disease – to treat with steroids, and if it was infectious one, then – with antibiotics, antifungal or antiviral drugs, respectively.
The difficulty of poor (undersubsidized) medicine was that not all tests could be ordered and performed, so it was necessary to juggle the collected data. For example, “aortitis is not caused by Neisseria, the causative agent of gonorrhea, because the patient denies that she has ever had gonorrhea; aortitis is not caused by Treponema, the causative agent of syphilis, because the patient denies that she has ever had syphilis, and the Wasserman reaction is negative; aortitis is not caused by Koch’s bacillus, the causative agent of tuberculosis, because the patient denies that she has ever had tuberculosis, the Mantoux test is negative, and an X-ray of the lungs does not reveal foci of previous tuberculosis.”
I gave a short list of arguments, and there were many of them, believe me. But since they all boiled down to denial, and the result was a vicious circle, it was necessary to talk with the patient again and again, in the hope that some new information would emerge that would lead to a diagnosis. It was like looking for a cabinet key frozen in a thick layer of ice in the freezer.
That’s what I did. I often came and talked with the patient about life. The woman talked to me with pleasure, it was boring in the hospital, and she liked the doctor – a young man, and not an immature student.
From conversations I learned that she had been married for a long time, her husband was a general, commander of the district’s missile forces. They lived in the north for a long time, and they have two children – a boy in a college and a girl finishing school. But I kept getting closer to the topic of health – who was sick with what, how were they treated, were there any injuries?
“Yes, my daughter was hit by a car. She received all the blood from her brother. A lot of.”
“Well done brother!” I said, “Why though did he give a lot of blood, and not everyone has gave little by little?”
“He and his sister have the same blood type.”
“Do you and your husband have another blood type?”
“That’s not the point, we are Rh-positive, and they are Rh-negative.”
It sounded like a gunshot. This couldn’t be happen!
“If they are Rh-negative, then one of you are Rh-negative too. This is certain.”
The woman seemed embarrassed for a moment.
“This is due to the fact that in the north my husband was heavily exposed to radiation, and even went bald for a while. He also had problems with his blood, and they gave us injections…”
“No matter how much you irradiate yourself, neither your blood type nor your Rh factor will change,” I thought and asked,
“Has his hair fallen out a lot? Did he get completely bald?”
“No, he walked around kind of pockmarked, as if a moth had eaten his hair, and then it passed.”
“And it was no longer possible to get pregnant…”
“Yes,” she blushed, “How did you guess?”
“According to Rhesus. I understood that the children are adopted, but don’t worry, I won’t tell anyone about it.”
I went to Irakli Alexandrovich and asked,
“Can your patient have a modern test? Immunoassay for spirochetes.”
“This is the wrong direction, Neiman. Wasserman’s reaction is negative, and the family is very decent. The patient wouldn’t lie. They have two children. What is your assumption based on?”
“On the story about her husband’s baldness. He was allegedly irradiated, but his baldness looked like syphilitic one. And then everything passed. But one of them, and maybe both, did not complete their treatment.”
“I can’t believe that the woman is lying…”
“She doesn’t lie. She does not know. She thinks that she was being treated for radiation. But her husband could have lied to her then.”
The professor thought about it,
“Okay, I’ll try to get her the right test, but you understand, the results are not shared with anyone!”
“Of course. It is possible to treat a patient with penicillin without telling her anything in detail. Why do they need drama in their family at that age? In this case, I’ll probably will treat her husband too from the old irradiation.”
We both laughed. It’s good when teacher and student understand each other!
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