Late Night Rounds

The old Hennepin County General Hospital (formerly Minneapolis City Hospital) was a magnificent hodgepodge of a place, butting a few small modernized areas up against a big 19th century edifice with 30 bed wards where patients were separated only by drawn curtains. When the spaceship Medical School dropped me off there I was to begin my first clinical clerkship, which was surgery. Up until that time I had spent years cramming data into my definitely overcrowded pudding of a brain and I was looking forward with mixed dread and anticipation to what was to come.

The trouble was that I really didn’t know what was to come and ran headlong into my first conflict right away.

The four of us who were starting that clerkship together were issued some green scrub suits that were obviously made for some sort of creatures who were seven feet tall and whose knuckles dragged on the floor as they shuffled along. We four were human-sized and were forced to adapt by rolling up pant legs and pinning down waists.

The resident charged with orienting us took us to the outpatient clinic where he informed us:

• we would all be working until six pm in the clinics that day
• one of us would need to be designated as being on call that night, and by tomorrow morning we needed to provide the resident with our call roster for the next month
• the on-call person would follow the surgical resident all night and do work ups on all admissions
• instead of going home and going to bed the next morning like any person would do in a sane environment, that same on-call individual would be expected to make rounds with staff, attend clinics and lectures, and finally end the next day around six pm where they would be released to their families.

I couldn’t believe it! Barbaric! Who could function on such a schedule? What had I signed up for, anyway? A life of gloomy servitude loomed before me with no time for friends or anything other than medicine, really.

As I wandered the semi-dark and ancient halls of the old building that night I heard Diana Ross and the Supremes several times on radios around the hospital since this was 1964 and they were just breaking big. I ran errands to the laboratory, blood bank, emergency room, and surgical wards while stopping from time to time to roll up the damned cuffs on those scrubs from hell.

Next day I showed up for morning rounds, and the other three students came up to ask how the night had gone. I leaned back in my chair like the seasoned veteran that I now was and began listing the amazing things I had seen and done. It was a childish performance, looking back, but bloody fun at the time.

However, something had happened beyond my bluster and boasts. The events of that night had sunk a hook into me, and this turned out to be a serious addiction that took years to come to grips with. The addiction to the drama of night-time in a busy general hospital. The bad coffee, the three a.m. meals in the cafeteria, the camaraderie, the blood and the tears. And sometimes, the fear.

And all of this with a soundtrack that at least on that first night starred Diana Ross and the Supremes.

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From The New Yorker

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The singer Tony Bennett gave his last performances in New York in August of this year, in concert with Lady Gaga. The venues were sellouts. This, in spite of the fact that he has advanced Alzheimers’ disease, and often doesn’t know where he is or even who he is. But put him in front of an orchestra, and he didn’t miss a beat. There was an article about the concert on the CNN website recently.

Bennett is one of the true craftsmen of popular singing. His technique was so good he was one of the few that Frank Sinatra looked up to as a singer. High praise from another master.

What an interesting organ is our brain. Somehow the complex business of performing is still possible, even when daily life is often a washout. Those old paths must be worn so deep that they are the last to be erased by dementia. Remember that line in the chorus of “Big Yellow Taxi” by Joni Mitchell? Where she sings: “You pave Paradise and put up a parking lot?” Isn’t that what happens to people as dementia runs its course?

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From The New Yorker

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There is a variation on the theme of telling lies that occurs in some mental illnesses. The true memory of an event is gone, has been erased somehow, and the person’s brain goes into a sort of anxiety mode and fills in the gaps with new material. Material which is not true but is believed to be so by the patient. In this way the state of their disability is masked or obscured from them. The name for this is confabulation.

We were taught this as medical students during our psychiatry clerkship, that we might understand how we could be led astray in taking a patient’s history. No malice or harm was intended by the patient, but what we had been fed in our conversation with such a person was, well, little more than flapdoodle.

I suspect that my own brain is occasionally serving me up a plateful of this stuff, and how would I know the difference? I have a reference person who lives with me who can correct my recollections when I stray too far, but that covers just the last thirty years … how about all of the time before I met her?

Fortunately, no one’s life, property, or reputation depends on what I remember and how I remember it. So if my brain is from time to time making up parts of my story, my best hope is that the new tale is at least interesting.

(Wouldn’t that be a sort of hell on earth – to be forever telling one’s stories but they are so irredeemably boring that no one can stand to listen to them? A never-ending view of people’s backs as they hustle away from you. )

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