My Clock Has 24 Hours
Hospital rounds:
Doctor North at the bedside of Mrs. Elizabeth Cook " in Albemarle Hospital.
Doctor North and his wife Doris. His first telephone call of the day is often from "the Gasser," a female patient who'd talk twenty minutes if he'd listen.
In his office Doctor North dispenses a "conglomeration of science and philosophy" to a troubled patient.
A recent glandular-infection epidemic added hours to the doctor's day.
Joe Tuttle was one of the victims.
'The walls of the author's examining room are papered with "drawings" contributed by his young patients.
An evening at home with Doris, the dog Koko and, on the phone, "the Gasser," of course.
By E. H. NORTH JR., M.D.
Photographs by Bill Shrout
A small-town doctor takes you on a fascinating journey covering one complete day in his busy life.
Five A.M. The phone beside my bed was having a convulsion. I left my beautiful dreams and returned to the land of the living, specifically to Elizabeth City, North Carolina, where I practice internal medicine. As I groped for the insistent instrument, I once again muttered a curse on Alexander G. Bell - he should have an electric cowbell around his neck.
"Hello."
"Doc?" It was a woman's voice.
"Yeah."
"You awake?"
"Oh, sure. I always get up before sunrise."
"Doc, are you sure you're awake?"
"Yeah !" ---
"Are you going to be in the office today? 'Cause if you are, Marv wants you to check him over."
Marv? Marv. Oh, yes, he was an infrequent patient-a farmer. "What's his trouble?" I asked.
"Oh, Marv ain't sick, but it's raining and, he can't work out; so he thought it would be a good day for you to check him over, since he ain't been checked for a couple of years."
"Yes, I'm planning to be in the office today, but why call me at this unearthly hour just to know that?"
"Well, gee, Doc-I wanted to get you before you left for the hospital." "At five o'clock in the morning?"
"Yeah, Doc. Marv will see you later, O.K.?" "O.K."
I fumbled the phone back onto its cradle, fluffed up the pillow and settled back under the covers. But it wouldn't work. I was semi-awake now and too irritated to relax. There was nothing to do but to get up and get started. A day that started on such a sour note was bound to be a killer, I'd better meet it head on.
Half asleep, half awake, I ran through the early-morning routine-dog out, cat in (or was it vice versa?), coffee on, thermostat up. The activity stirred my circulation and, by the time the pot was perking, I felt halfway human.
What the heck, I thought, if it's going to e a lousy day, I might as well louse it up but good. I'll fill out some insurance forms.
So, dripping coffee through the living room, I walked to the study, where I settled down to do some of the paperwork that they never told us about in medical school. Seems that nowadays every patient has anywhere from one to five insurance policies that require copies of the copies-in triplicate. Insurance is fine, but I occasionally begrudge the four or five hours that it takes out of each week to keep up with the blanks.
I labored away, putting the correct answers in the indeterminate little empty spaces until seven o'clock, when a dull thud against the house signaled the arrival of the morning paper.
I went out to get the paper. A glance at the headlines indicated that even the news was sour. The Russians had launched another one; our latest had fizzled on the pad. The cost of living was up, and the price of corn was down. There was one cheerful note-Rex Morgan in the comic strips was about to make a diagnosis in his latest difficult case. Gee, what a doc! Encouraged by the progress of cartoon medicine, I walked to the stove to pour another cup of coffee At that point there came the sound of a bedroom door opening, and out drooped my wife, Doris.
"Good morning," said I.
"Grunt," said she.
"Coffee?" said I.
"Um'm," said she.
For the next ten minutes there wasn't a sound from either of us. We've been married twenty-three years, and I learned long ago to keep quiet until she had finished her first cupful. Finally she took her last swallow and came alive.
"Breakfast?" she asked.
"Yeah, might as well."
"How do you want your eggs?"
"Cooked. "
"Ha-ha."
While she cooked, I went back to the paper. Just as she put the eggs in front of me, the phone rang. It was "the Gasser" - who had earned her nickname rightfully. She'd talk twenty minutes if I'd listen.
I deliberately picked up a piece of burned toast, took a noisy bite and crunched real loud into the phone. But she never even noticed. The eggs were getting cold, so I edged in the thought that I'd come around to see her, and wouldn't it be more fun to tell me all of these things in person? She hung up after I'd promised to drop by before going to the office.
I quickly disposed of the rest of the toast and frigid eggs and headed for the shower. Just as I entered the bathroom, the phone burst forth again, and I shouted over my shoulder, "I'll take it in here."
That's a family joke. We don't have a phone in our bathroom-like some of my colleagues. What's more, we never will. I still believe that certain things should remain kind of private. But before I turned a faucet; Doris was at the door, telling me there had been an accident nearby and the highway patrol was taking the victim to the hospital. The patient was in bad shape, and they suggested that I get there at once. Back went the soap and the powder. I pulled on my clothes and was out the door in four minutes.
The ambulance was screeching to a stop as I drove up the emergency-room entrance. As the driver opened the door, I was beside him.
But there was no need to rush any more. It was another D.O.A.-cut, bruised, battered and dead -a well-dressed, middle-aged man who would never finish his trip. One curve too many, one push too many on the accelerator, and the curtain came down.
The highway patrolman was waiting as I climbed out of the ambulance. I told him that his man was dead, and together we set about the identification. The victim's wallet was filled with numerous cards and scraps of paper. I searched through them, thinking that the little personal things carried by each of us are rather pathetic when the game is over - little bits of paper forevermore without meaning. I had a queasy feeling too; examination of a dead man's papers is like looking into his soul-and I've got no business there.
My part was now done, except for calling the victim's wife. We live on a tourist route, so I am not exactly a novice at calling relatives to tell them that some of their folks are dead. But I still detest the moments in which I must bring dreadful news to some family. Finally the operator got a line cleared, and I heard the phone ring. A lady answered and said that she was the party that we wanted. I gulped, took a drag from the cigarette and began talking. I let her down as slowly and as easily as I could-then waited while the horrible truth came home. There came the usual "Oh, no!" -followed by nothing. After the period of silence, she exploded into questions. Who did I say I was, and where and how did it happen? I told her what the patrolman had told me. At last her hysteria ran down, and she asked, "What do I do now?" I suggested she come to our town with a relative and make arrangements about the car and funeral. She agreed and said she would be down later in the day.
After I'd hung up, I sat for a few moments thinking what cold things statistics are. By now one more number would be up on a blackboard-one more X to mark a spot. There would be a few headlines and obits. Then it would be over-over for everyone except the woman to whom I had been talking.
My morbid ramblings were interrupted by the emergency-room nurse, who reported that she bad a man who had cut his finger. When I saw him, I wasn't the least bit surprised. He was one of the butchers from a local supermarket. Seems like every time they have a special on hamburger, one of the meat men nicks a finger or two. The cut was bloody but minor, and in fifteen minutes the butcher was on his way back to work. There were no more emergencies, so I decided to make the rounds on my patients in the hospital.
I've never known where the term "hospital rounds" originated, but no matter where they are performed-big town, little town, medical center-they follow a rather definite pattern. The first step in the ritual is to let the hospital telephone operator know that you are aboard and available if needed. Then comes a visit to the X-ray and laboratory departments to check on yesterday's pictures and today’s lab work. After that, it's time to get down to business at the chart desk or nurses' stand. Here the physician examines the patient's chart-temperature, pulse, respiration, nurses' notes, lab and X-ray reports- while the charge nurse (the head gal) gives an oral report of the patient's progress. Now the doctor is ready to visit his patients. A visit means anything from a pat on the back to a complete history and physical examination. Then back he goes to the chart desk to revise his "orders" or to plan new procedures. If all has gone well, the "rounds" are finished; the doctor checks out with the switchboard and leaves.
But things rarely go that well-and this day was a good "for instance." I made it to the chart desk without interruption; but as I sat down, I was accosted by the chief of staff who reckoned that I had completed a report that was due for the staff meeting that night. I reckoned that I hadn't-and further reckoned that I didn't even know what he was talking about. He reckoned right back that I'd better get to remembering. To help me along he reminded me that the report was something I had volunteered to do at the last meeting.
Me and my big mouth, I thought as my memory returned. Now I had to get a committee meeting sometime that morning. The first place to look for the committee members was the coffee shop, and luckily they were there. So, over a cup we cussed, discussed and finally agreed on what we would present. But all of us now were thirty minutes behind schedule.
I returned to the desk to be greeted with two phone calls and an anxious female. The phone calls were quickly handled, but the female wanted to know exactly what had happened to her cousin-ten times removed-and on what day and at what hour he would recover. I explained to her that his case had been discussed with his immediate family and it would be slightly unethical of me to divulge all of the facts to her. Her response was spontaneous and routine.
"You mean that it's fatal. He has cancer, doesn't he?"
"No, madam, I don't mean anything of the sort. Now, you go find his wife, and she'll tell you all about it if she wants to." I quickly grabbed a nurse and told her that I needed her to help me examine a patient. She winked, and I winked back, and together we marched away down the hall in a most professional manner.
For a change, all of the patients were doing well and were cheerful-even the crotchety old gent with an ulcer. A recent coronary thrombosis was on his way to an evident recovery. A man who had had a kidney stone had passed it during the night and was completely free of pain for the first time in days. The elderly diabetic woman who had taken Insulin for years was now being converted to tablet medication. Just the thought of no more needles was sufficient to make each morning a new adventure for her. Another woman, recovering from pneumonia, was well enough to begin wondering when she could go home, and a man who recently had been in heart failure was breathing more easily. That was the entire crop for the present. The nurse and I returned to the chart desk, where I signed new orders for the patients. At the moment, everything seemed to be under control, and I decided I'd better get out while the getting out was good. I left quietly by a side door and started for the office-one hour late for appointments.
A doctor's office is like no other place on earth. To it come the sick from all the cultural and economic layers of life. Some come willingly, others reluctantly; but most come resentfully, for sickness is an inconvenience, and people resent being inconvenienced. So these displeasured humans come and sit and wait. And while they wait they talk. It is amazing how they talk. To a total stranger they will divulge secrets they never told mamma. They compare symptoms, diseases and treatments. Others talk politics, sports or local gossip.
The office nurse is usually listening too-at least with half an ear-as she stands guard between the waiting room and the inner sanctum. These gals have one of the most difficult, many-sided jobs to be found anywhere in the field of female employment. A good one is hard to come by; and if sometimes a doctor seems to idolize his office nurse, you can understand. She makes his life bearable-and not in the way that some novelists have suggested.
A third of the office suite contains the examining and consultation rooms wherein sits the physician. Here, enthroned and protected, he dispenses a conglomeration of science and philosophy. No two offices, no two doctors are alike, but they all serve to one end- the relief or cure of human misery.
Jan-my girl Monday-through-Saturday-had things all lined up by the time that I got settled behind the desk. The morning mail contained nothing unusual. Our town was in the midst of a minor "flu" epidemic, so Jan had a list of phone calls from patients who had come down with that disease. As I thumbed through these she recited the list of the morning's appointments. At the very bottom of the phone numbers I noticed that of "the Gasser."
In the rush of the emergency room I had forgotten her. "Tell her I'll be by at lunchtime," I told Jan. "And I don't notice Marv's name here. Didn't he call?"
"He didn't, but his wife did." Jan said. "It stopped raining, so Marv decided to string some fence. He'll come by on the next bad day."
"Yeah, and she'll phone at five A.M. again," I said. "I ought to call him late tonight and ask how his fencing job went. "
The day's first patient was a middle-aged, rather obese female who had developed hypertension. Drugs had lowered her blood pressure, but her weight kept going up. Six weeks-ago I had placed her on a diet. Now she had gained six pounds. She was cheerful about it and insisted that she had counted her calories faithfully.
"You know how it is, Doc, I think it's my glands," she said. "Everything I eat- even water-turns to fat."
I swallowed hard to keep from exploding, gently chewed her out, reviewed the diet list once again and gave her a pat of encouragement. As she waddled out, I wondered whether everyone should be made to conform to our weight charts. Seems like some people "just gotta" eat- it's part of their personality.
She was followed by one of our regular repeaters, a man complaining of chest pain. I'd been expecting him for several days-ever since one of his close friends had had a heart attack. He was a "heart conscious" patient, and each time he heard of someone having a thrombosis, his own symptoms returned. I listened to his story, rechecked his chest and blood pressure and found nothing to suspect that this "attack" was any different from his others. As we had been through this cycle many times before and had gathered a whole file of electrocardiograms, I told him I didn't believe a new one was necessary. I reassured him, prescribed a mild sedative and asked him to come back in several days if he wasn't better. I was sincerely glad that he had come that day. I wish that more people were like him- overly cautious. The mortality of many diseases would decline sharply if folks would see their doctors and would stop trying to diagnose and treat symptoms they don't understand.
The next patient was real fun. She was a five-year-old who had caught a sore throat. Her temperature was elevated, but that didn't slow her down. As I entered the examining room, she was laughing, giggling and generally carrying on. She stopped long enough to look up- at me with her baby eyes- she had already discovered contained magic-and say, "Hi, I brung you a new drawling."
With that she handed me a sheet from a child's coloring book-all filled in with a most unlikely combination of hues. For some years now we have kept the walls in the examining room papered with similar "drawlings" of the young patients. So, with great solemnity, we played the game of finding a clear spot and then, with equal seriousness, we stuck it on the wall.
Checking her over was fun. We found television pictures in her ears, the Milky Way in her eyes, nasty old Mr. Staphylococcus in her throat, winter winds in her chest and hungry little growling dwarfs in, her tummy. She thought that it was a big deal and seemed to enjoy every minute of it-especially after I told her that we wouldn't give her a "shot." I helped her to get dressed, fumbling with the wrong buttonholes, gave her a kiss and sent her home to what I hoped would be bed rest.
After she had left, I returned to the consultation room to see a very stubborn young housewife. She had developed tension headaches either as a result of overwork or an unhappy family situation. At least, I knew they were tension headaches-she was convinced that she had a brain tumor. Despite doing all I could, I couldn't shake her beliefs. She had a low I.Q., but a high degree of prejudice-I just couldn't get through to her. So, with reluctance, I picked up the phone and made her an appointment with a neurologist. Perhaps he could convince her.
Next came another acute infection- this one a pneumonia. He had the usual story of a cold, cough and fever for a week or more. He had taken everything that anyone suggested, but failed to improve. Finally he gave up and decided that a shot of penicillin would cure him. He didn't get the shot from me, but he did get some other medication. As he left he asked, "Doc, is it O.K. if I get some of that blood builder that I saw on TV last night? They say that it's good after the flu. "
Some people just never learn.
Finally the last patient left, and it was time for lunch. In the course of the morning, I had seen eight patients-and not one of those ravishing beauties who frequent the doctor's office in the movies. I grabbed my coat before the phone could ring again, shouted that I'd stop by to see "the Gasser" on my way back, and left.
The ten-minute drive to the restaurant on the outskirts of town was refreshing and relaxing. I eat there almost every day with a group of people who believe that the lunch table is the last place where business should be discussed. This day we were putting the finishing touches to a new, strictly nonprofessional, nonbusiness organization we were forming. It is called the "Man Will Never Fly" Memorial Society and is dedicated to thinking people everywhere who sensibly refuse to believe that heavier-than-air flight is feasible. We had put out the advance publicity. a week before; today we were going over some of the clippings from our surprising nationwide response. But my lunch was cut short when a waitress touched my shoulder and told me that I had a phone call. It was Jan with new troubles. One of the elderly patients in a nursing home had "gone bad" and needed immediate attention. I told her to cancel what she could of the afternoon's appointments, get another doctor to cover the emergency room until I returned- "and call 'the Gasser' and tell her that I'll be by at suppertime."
At the nursing home it was evident that the lady was in heart failure. She was having marked difficulty in breathing. After examining her, I gave her several injections and sat down to watch their effects. Obviously she would have to be moved to the hospital, but I wanted her in better condition before transferring her.
While I waited, I looked around the nursing home and, as usual, didn't like what I saw. Many of the patients were invalids who needed constant care, but many others were there as a matter of family convenience. I have never been able to get used to the present-day practice of shoving the old folks out of the door when they become too much of a problem at home. It seems to me that grandma should still have rocking-chair rights and grandpa should still be able to beguile the young'uns with his tales, real or imaginary.
The patient who sat huffing and puffing for her life was an example of what I was thinking. A fine old widow, with enough money to meet her needs, she had been shunted from child to child until she was no longer strong enough to travel. The children then held a conclave and decided a nursing home was just the place for her.
"You'll like it mother," they told her. "It's a fine, new place, with people your own age, good food and regular hours."
And mother hadn't argued. She didn't try to tell them that old people don't particularly like new things. She didn't mention that all she wanted was her family and the feeling of being needed. So she had come to the home. Now she sat gasping for breath -all alone except for paid professional help.
Soon I would have to phone long distance to one of her daughters and tell her that her mother was acutely ill. Before lifting the receiver, I knew how the conversation would go-and it did.
"Now, nothing is too good for mother," the daughter said. "Put her in the hospital-in the best private room. Get her the best nurses and the best specialists. And call me back if there is any change in her condition. Remember, we want mother to have the best of everything."
I thought, "Sure-the best that someone else can give her."
But I said, "Yes, ma'am, we'll do all that we can." I used to read the riot act to people like this daughter. I learned that you can't give a conscience to those who haven't any.
When I returned from phoning, the medicine had begun to take effect, and the patient was breathing more easily. The ambulance that I had requested had arrived, so we sent her to the hospital. True to my instructions, I ordered the best of everything.
Fifteen minutes later I was back in the office, where Jan had rescheduled all appointments except those of four men who, for one reason or another, thought they had to be seen that day.
The first was a good friend who didn't realize that the party had been over for days. It had been meant to last one day; but with the help of John Barleycorn, he had managed to stretch it into five. Now he was fearful of seeing the little creatures and wanted me to give him something that would keep them away. I gave him that, plus some unsolicited advice delivered in seaman-type language.
Then came a young man with the mumps. He was wondering the same question that all young men with the mumps wonder about. I told him not to worry, prescribed an ice pack and sent him home.
He was followed by a typical business- man with a typical ulcer which reacted inversely to the size of his bank account. That is, the smaller the account the bigger the ulcer. Sales had been on the downgrade lately, and his stomach was confirming the fact. I let him vent his troubles on my ears, tried to throw in a few basic facts of life and changed his medicines around a little. Then he reurned to his temple and his own private wailing wall. He was guilty of worshiping false gods, and they were betraying him.
Finally there was an elderly man who was typical of an ever-increasing number of patients. He had terminal cancer. He knew it, I knew it, and we both knew that the other knew it. Yet the dreaded word had never been spoken between us. That was the way he wanted it, and that was the way it was going to be. I had checked to make sure his house was in order; there was no good reason for me to squelch whatever hope he had left. So, we played the game of what he would do when he was well again, and I prescribed some medicine to make him more comfortable during the time he had left.
He closed the door as he left, but Jan opened it immediately with word that the hospital had called about the lady in heart failure. She wasn't doing so well, and they thought I had better come take a look. That meant the end of office hours for the day, and I couldn't say I was sorry. I threw Jan a figurative kiss and left for the hospital.
For once the floor nurse had overstated the symptoms, and the old lady was in fair condition when I arrived. I rechecked her, ordered one new medicine, then made evening rounds on the other patients. All were satisfactory, so I beat a hasty retreat for the door.
But I didn't make it. I was stopped by the emergency-room nurse, who was having difficulty with a new patient-a young gal who had taken an overdose of sleeping pills the night before. Her family had spent all night and that day trying to bring her back to consciousness. They had succeeded, but she didn't like it and wanted some pills so she could go back to sleep. I told the nurse to give her some green aspirin and I ran for the car. Then finally-home. I opened the door, yelled to Doris and was greeted with, "There's a phone number in the living room. It's from _"
"I know. It's from 'the Gasser.'"
"Haven't you been to see that woman yet?"
"No, I'll go after dinner. We've got a hospital meeting, but I'll go before that." "I'd get another doctor if you treated me that way."
"Now, why don't you just call her up and suggest that? Then everyone will be happy."
But Doris didn't. She just put dinner on the table and mentioned that it was time to eat. So we ate and talked over the events of the day, interrupted by one or two phone calls from people who "didn't want to disturb you while you were busy at the office." These are my very favorite people. When someday comes the revolution they're going to be the first to go.
Right about then I had to go too. "No time to help with the dishes tonight," I told Doris. "I'm off to see 'the Gasser,' that wonderful gasser of ours."
Actually, though I kid her a lot, I'm right fond of "the Gasser." She's just a lonely woman with lots of nonmedical problems that she never solves. That night was no different from the other times; I drank her coffee, and she talked. After some forty-five minutes she was beginning to lose breath, and I was running short of time. As she inhaled for her second wind, I interjected that I was late for a meeting and really had to go. She followed me to the car, talking all the time. Rude or not, I had to start up and head for the hospital, leaving her still talking.
The staff meeting was rather routine and, for a change, it was short. We didn't have a single good argument and in an hour we were ready to adjourn. As I left, I spotted the emergency-room nurse hanging around the edge of the crowd. I walked over and asked her what new problem she had managed to dig up.
"I've got a woman who was cut by her lover," she said. "It's not bad-just a slash across her neck."
While the nurse was scrubbing the wound, I made a quick trip upstairs to check on the heart-failure case, then returned to try to put the woman's neck back together. Luckily her lover was an amateur with the razor; he had missed all of the vital areas. Just as I was putting in the last stitches, the police came in to investigate the crime. They questioned her backward and forward but, true to her rules, she suddenly "disremembered" what had happened. She couldn't even recall where she had been. After a few minutes the police gave up in disgust and left.
I wasn't long in following them. I had been on the merry-go-round for some seventeen hours and I was ready to get off. All I could think of was taking off those damned shoes and lying down. Doris must have read my thoughts, for without a word she pulled back my bedspread and opened the window. Wonderful creatures, these doctors' wives, the best people in the whole wide world. Gee, but it felt good to get between good sheets! I was asleep before I turned over once.
And asleep I stayed until a little after three, when the phone had a shaking chill. I grabbed for the monster and said something that must have been interpreted as "Hello."
"Ed." It was the voice of a close friend. "Jim's sick-real sick," she said. "He's got indigestion and he can't stop vomiting. And his chest hurts. What shall I do?" "Nothing. Don't do anything. I'll be right there."
Jim's wife met me at the door and walked with me to the bedroom where Jim was resting between trips to the bathroom. One look at his ashen face and his perspiration-soaked body was enough to increase my suspicion that he had had a heart attack. After a quick check, I gave him an injection and asked him to try to relax. While I sat there waiting for the shot to take effect, his wife updated on his recent history. It was the old, old story.
For the past week or so Jim had been tired; no matter how much he rested, he couldn't regain his old pep. He knew that he needed a vacation and promised that he'd take one just as soon as a current big deal was concluded.
Last night he had gone to bed early and had slept soundly until about two o'clock, when he was awakened with a tight, pressure-type pain in his chest. He became nauseated and vomited profusely, but his misery didn't leave. Then he went to the medicine chest and sampled almost everything in it. This didn't help, either. At that point his wife awakened, realized that this was no common bellyache and called me.
By the time that his wife had finished talking, Jim was resting comfortably. His condition had improved enough that I thought it best to transfer him to the hospital. I told them of my suspicions, and they agreed that he should be where he could be treated properly. So I called an ambulance and sat there drinking coffee while he dozed off.
In another hour Jim had been bedded down under an oxygen tent and was sleeping soundly. The relatives had assembled, and I had spent some time briefing them on what they could expect. After their last question had been answered, I returned to his room to check on him once more before I left the hospital. His blood pressure, pulse and color had improved. I patted him on the leg as I passed by and walked down the hall to the exit.
As I crossed the parking lot, I glanced at my watch. It was five A.M.- twenty- four hours since Marv's wife had called me. I was thinking only of sleep as I started home, but along the river road the rising sun was beginning its business of drying out the drippy haze. It was a magnificent sunrise-full of reds and pinks and grays-a scene of intense peace and tranquillity. Fatigue seemed to melt away. There remained a feeling, a good feeling, that it had all been worth while-that the world might be a little bit better this morning because of the combined efforts of all of us yesterday. THE END
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