Part One – There
(Eastern Hemisphere)
CHAPTER SIXTY SEVEN – YEARS IN THE MEDICAL SCHOOL (PART 2)
Let me continue a potpourri of stories about life in medical school.
While studying ENT (otorhinolaryngology), a funnier episode occurred. It seemed to me that I had some kind of hearing problem, because I often asked again when my wife told me something. Perhaps I was just immersed in reading, but testing my hearing right in class was interesting and not difficult.
The teacher reacted favorably to this test. He plugged one of my ears with a plug through which I couldn’t hear anything, and inserted a device into my other ear that made noise and crackled, in a word creating interference. Then he stood behind me, so that I could not see his lips, and said a word loudly to the whole class. Through the noise and crackling, I distinguished some kind of hissing, whistling sound “kss”.
“What could it be?” I thought and, be it or not, I said,
“Sex!”
Our whole group roared with laughter.
“What’s the matter?” I was surprised.
“I told them that it’s impossible to hear the word with the ear under these conditions.
Don’t worry, with such hearing you won’t need a hearing aid in your old age.”
“Well, we’ll live and see!”
Once during a gynecology class, our associate professor, an old doctor, took us to examine patients. To inspect them, which is conditionally said. All patients was categorically against student hands, and private patients even objected for students to stand next to the gynecological chair.
Having shielded the patient with a screen, our assistant professor plunged his hand into her and described to us that he was palpating benign tumors, leiomyomas, which are rarely multiple and located, as they are now.
At that time, ultrasound was just becoming part of modern research methods, and MRI did not even exist. The research was done “by touch”. Therefore, I wanted to touch and remember, for diagnosis. And I sincerely asked permission to palpate this patient.
The patient naturally protested,
“It’s too much for a male student to pick at my vagina!”
I was offended,
“You are right! Don’t let anyone except your doctor!” I said, “Here he is, excuse me, he’ll die, and no one will know how to treat you anymore!”
There was deathly silence. The associate professor’s face turned red and stretched out. And then, unexpectedly for everyone, the woman said,
“I’m sorry. I was wrong. I allow this student to examine me.”
The assistant professor immediately blossomed and began preparing me for the process.
“Roll up the sleeves of your robe, Neiman. Wash your hands thoroughly. Now wipe them with alcohol. Now rub your palm against your palm to warm up the fingers of your right hand and begin your inspection. Describe your sensations to us. Just don’t be like the student who said …It’s wet… and dark.”
Everyone laughed. I acted carefully and according to protocol.
“Three smooth, round tumors at 9, 12 and 5 o’clock, reminiscent in size and consistency of young potatoes.”
“Well done! They are called tuber-like tumors. There is no need to remove them if they do not interfere with patient’s private life or they cause bleeding. Have all of you remembered it? This is in case I die. So that everyone knows how to treat it!”
We began to applaud the old doctor in unison.
Obstetrics and gynecology interested me. It was a narrow field of surgery and a large number of patients were young women. Some of them were healthy, they just needed assistance during childbirth, while others, due to their age, were treated with good results. Therefore, the work took place in a more optimistic and joyful atmosphere. Isn’t it great?! The difficulty lay in distribution and employment – only highly connected people were hired there. But I tried, and I wrote two articles – one on the classification of tumors, and the second… statistical. I wanted to examine the materials from the maternity hospital for obstetric paralysis – damage to the nerves of the brachial plexus as a result of traction during childbirth by the baby’s hand. This topic was not entirely “decent”, since it revealed shortcomings in medical care, and who wanted to identify shortcomings?! But the main thing was access to medical histories, and there it was a matter of technology. However, most of the charts were written in Georgian, and I needed an assistant for the speed.
With almost no hope of success, I turned to everyone I knew, and many of my former pupils, whom I trained in physics, studied at various courses. One day, to my surprise, a slender, pretty girl of Slavic appearance, but with black hair, came up to me and introduced herself as Ira. She came on the recommendation of my former student.
“What about Georgian?” I asked her.
“I speak, write and read fluently.”
I was amazed. It turned out that her dad is Russian, and her mother is Georgian. Ira studied for some time in a Georgian school, then moved to Moscow, where her father died, and her mother… went into business and stayed to live there, and Ira got a job at a medical institute in Tbilisi and got married.
“I want to be independent, to leave my husband, but nothing is working out yet,” Ira complained to me. – Without my mother’s financial support, I can’t do anything yet, and marriage is in the balance… My son and I are running back and forth to Moscow… Are you married?”
“Yes, we have a happy marriage, we have a daughter, but we also travel back and forth between Moscow and Tbilisi.”
“Nice guys are always busy,” Ira sighed, and we began to develop a plan for working with medical histories.
I must say that we collected interesting data, but we never published an article. But the department of gynecology warned me that even if I publish a book, they would not allocate additional space for me, but I started studying orthopedics, and I began collecting materials on the treatment of obstetric paralysis, and not on its occurrence. However communication with Ira did not end there, it simply was temporarily interrupted.
The rotation in anesthesiology and resuscitation went like a dream. Everyone around was in constant stress. During our practice, all patients in the intensive care unit died, except one, who had tetanus. His body bent into an arc with a wolf-bared mouth, tied to a bed and entangled in tubes with solutions, gradually gave way to the normal image of the patient. He overcame the infection with simple saline solutions. For the remaining patients, no modern treatment methods helped. Before our eyes, they left one after another – poor and rich, important and ordinary people.
The head of the department of neurology died of a stroke. He once told us a cute joke,
“One neurologist was an avid balloonist. One day, flying in the fog, he got lost and, finally seeing a garden and a gardener under the balloon, he shouted from above,
“Tell me, please, where am I?”
“You are in a hot air balloon,” answered the gardener.
“What are you, a neurologist?”
“How did you guess?”
“Your answer is absolutely accurate, but no one needs it!”
Now the professor could not speak, and silently passed away, knowing absolutely exactly the area of the damage to his own brain.
In relative proximity to the professor, a drunkard with cirrhosis of the liver and huge varicose veins of the esophagus was slowly passing away. He had already bled from them more than once, and he lay white as a linen, receiving another portion of someone else’s blood from the bag. Just the teacher showed us the American Sengstaken-Blackmore probe for stopping such bleeding, with inflating balloons on the sides, which, in theory, should compress the veins from inside of the esophagus. The patient just coughed, and blood appeared on his lips.
“Forward!” the doctor commanded and began to push the probe into the patient’s throat.
“No, no!” the patient shouted, resisting with all his might.
His muscles tensed, the veins on his forehead bulged.
“Hold him!” the assistant ordered, continuing to push the probe.
How could an anemic patient overcome several student volunteers who piled on him? The man’s eyes rolled back and a fountain of blood came out of his mouth.
“Eh, we didn’t have time to inflate the balloons!” the doctor said, “But it’s a pity.”
“I have a feeling that we killed him,” I muttered.
“What are you, what are you! You are mistaken!” the doctor objected, “He killed himself with his drunkenness…”
Many years have passed, but my delusion only intensified after observing how they work with this probe in the country of invention. In all successful cases, the patient was given anesthesia, intubated, and then the probe was installed and the balloons were inflated.
One day during a rotation in radiology, we observed an interesting procedure. An elderly woman who previously held an important position in the local government was brought to the Central Hospital. I even once met with this powerful lady on the topic of apartment, and now she, an elderly pensioner weakened by heart disease, was taken to the ultrasound room to try to remove an embolus (thrombus) from a branch of her pulmonary artery with a catheter before going on the usual thrombolytic treatment, relatively contraindicated at her advanced age.
This procedure became possible thanks to the fact that the son of a very famous and popular professor in our city had an internship in France working with pulmonary catheters, and was a unique specialist in our Republic. I saw him as a boy. Once in my childhood, my dad took me to their home for a consultation with his father, who listened to my heart for a long time and assured us that the noise in my heart was functional and would go away with age. And I was surprised to find his son of my age, sitting on the kitchen cabinet, wearing a T-shirt, but without panties.
A grown-up boy, still of my age, but already in panties, and even dressed as a model, put on a blue robe from a package and opened a black leather “diplomat”, in which unprecedented gold instruments glittered against the black velvet surface.
The whole procedure had the character of a session of a fakir or magician. The students watched with bated breath, and an unshaven radiologist in a stretched sweater under a stale, opened robe looked sullenly at the elegant young doctor who was operating in his diocese in a businesslike manner.
I liked the actions of the “Frenchman”. Without any complains, “Why didn’t they take a vein? Why don’t they pour the solution?” he resolutely entered the vein, set up an IV and put the patient to sleep with an injection of sleeping meds. The start was promising. But we never saw the triumph of modern medicine. No matter how much the doctor tried in the lung, he was never able to get to the right place and evacuate the embolus.
“It’s not enough to have gold tools!” the jealous radiologist exclaimed in his hearts, “One still need golden hands!”
I heard once a similar reproach in surgery. The girls could not make out the bad handwriting of one neurosurgeon. They were afraid of his caustic remarks and showed me the recording before asking him directly. It was some kind of Arabic script, and I just shrugged my shoulders. There was an opinion among surgeons – the more difficult it is for the prosecutor to read your records, the safer it is for the doctor. The girls nevertheless gathered their courage and turned to the neurosurgeon for clarification.
“Look carefully, this “S” is the fraction “C”, and this is…”
Clearly, there were Sp/C – abbreviated spinal cord and Hd/B – head brain.
“Sh” fraction “B”? – asked one of them, mistaking “Sp” for “Sh”.
“You see,” the doctor grinned, “There are two types of brains: the spinal brain and the… shitty one!”
One day, our urology assistant professor was examining a patient, who was having trouble urinating, and decided to palpate his prostate. For the patient, this procedure presented a great psychological problem. He was from a distant Azerbaijani village, and in the Soviet Union there were many jokes about the greatly exaggerated tendency of Caucasians, especially Azerbaijanis, towards pederasty and homosexuality. The majority had a negative attitude towards this. Apparently the patient.
Firstly, he was embarrassed to take off his underpants, and secondly, he did not want to get into a knee-elbow position. When he was persuaded, he kept looking around, checking what would be inserted into his anus, and whether the doctor had bad intentions.
At this time, another assistant professor, a well-known scoffer, entered our treatment room and approached a colleague to discuss a change in the duty schedule at the hospital.
When the teacher, resting his left hand on the patient’s pelvis, inserted his finger into patient’s rectum, the guest extended his right hand and placed it on the other side of the pelvis.
“Hey, dohtur, what are you doing?!” the patient shouted in horror that he had been tricked, but the cry was drowned in our hysterical laughter.
After the New Year, our proctology teacher, who saw private patients at home, told us a funny story. It was the first of January, he had not completely sobered up after a night of feast and did not at all expect that his wife would wake him up, informing him that two patients were waiting for him in the hallway.
Indeed, there was a man and a woman sitting there. He vaguely remembered the man; the other patient was unfamiliar to him, and as a rule, he did not accept unprepared people. However, she assured the doctor that her husband had been treated by him and taught her to cleanse herself thoroughly before the examination.
“Please, we are suffering,” said the patient.
In a complacent mood, the doctor agreed, which he could not forgive himself for later, and, placing the woman in the knee-elbow position in the treatment room, plunged his finger into her rectum. Oh God! The patient apparently lied. In complete rage, with a dirty glove, the doctor jumped into the waiting room and yelled at the man, “What is this?”
“It’s shit,” the man was confused.
Then the angry doctor grabbed him by the arm and dragged him into the treatment room,
“What does it look like?”
“It looks like a naked ass!”
Hearing the new voice, the woman turned around and screamed hysterically. It turned out that this man was a completely unrelated patient who also wandered in for an appointment at an odd time. Fortunately, the conflict was hushed up…
In the past, a cancer diagnosis was tantamount to a death sentence. The patient was not told the diagnosis hiding it from him (or her); relatives on the contrary were informed, but not right away, they were slowly prepared.
One day my mother asked me to help a forwarder Misha from her work, whose mother was found to have “something bad” on an X-ray of her lungs. In addition to coughing with blood, her ribs hurt badly, but I decided to start with the professor of medicine, and Misha and I went to show him the picture. Misha stayed waiting in the car, and I went into the professor’s office.
Irakli Alexandrovich examined the X-ray and sighed,
“Despite the terrible quality of the image – it is not focused on either the lungs or the ribs – it is clear that this is cancer, not tuberculosis. If it is not possible to redo the picture, show it, just in case, to an orthopedist.”
Without delay, we moved to the Institute of Orthopedics, where I had previously worked while doing science after university. Here I had my own person – deputy director, professor Chichiko Kartvelidze. His office occupied part of the hall, separated by opaque glass partitions, and was open at the top, that is, conversations inside the office could be heard from the outside, where Misha remained standing.
And I came into it for a consultation.
“Well, how is it in the chicken coop? Have you already sit all chicks on your laps?” he greeted me in his own manner.
I unfolded the picture and asked his advice, what can be done?
“What to do? To cook khashlama!”
“Boom!” The sound of a fallen body was heard. It was Misha who lost consciousness because khashlama meaning boiled veal brisket, which is usually served at funerals in Georgia. May I name my actions a help?
In my fifth year, just when I was studying Orthopedics, an amazing event happened. One orthopedic doctor got missing. Everyone had the feeling that it is forever. How many people do you know who disappear in broad daylight? By the way, I experienced similar stress in my youth when a young philologist student disappeared. All his acquaintances walked along the popular student route from the University to Lenin Square, showing his photograph in all the shops and food places, until they discovered that he had gone to a second-hand bookstore after lectures on the day of his disappearance. At this point his trail ended, as if he had entered another world by entering an old book…
Nothing was known about the doctor from the New Year until early spring, until… I’ll better tell you the whole story in the next chapter.
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