…Beer and the Doctor

Alcoholic beverages have been a part of our human lives since the beginning of civilization, when we first learned to cultivate grains.  Shortly thereafter we learned how to ferment grain into alcohol. The art of medicine probably began at the same time, when we learned how to care for the sick, providing comfort and relief of pain. Alcohol was undoubtedly one of the first medicines. Since that time, the medical arts and alcohol have been linked, if only because they are an integral part of human existence. Fast forward to the present time.

This is a semi-autobiographical collection of notes about my life as a doctor. Beer or other spirits are a common thread in the stories, sometimes causative, mostly coincidental.  The stories are mostly true, though the names have been changed.

Beer, anyone?

I grew up in ethnic, Polish Chicago, where beer drinking is a way of life.  Except in our house.  We drank champagne. Not just for special occasions, but any time where a beer would be called for.  It started with my Uncle Rory.  I remember Saturday evenings as a child, when Rory would show up to the house with a couple of six-packs, and he and my folks would drink into the night, talking and laughing. Everyone loved Uncle Rory, but it was common knowledge that he drank too much. One evening he brought a few bottles of cheap champagne. From then on, the Saturday evening parties continued with champagne instead of beer.  Years later I asked my father why the switch from beer to champagne. “That’s because Rory’s doctor said he drank too much beer, and if he didn’t stop it would kill him.  So he switched to champagne.”

A tough place to study

I studied medicine in one of the toughest hospitals in Chicago–Billings Hospital, at the University of Chicago.  Now an elite “Center for Advanced Medicine,” in the 70’s it served as a community hospital for one of the poorest neighborhoods in the city, and one of the toughest.  This was Hyde Park-Kenwood, long before it gentrified and became a suitable home for president Obama and his family.  Crime, drugs, alcoholism, and gunshot wounds were common, even among the hospital employees. One week we had more fatal gunshot wounds among the hospital cafeteria workers than in the emergency department. One was a drug-related shooting in the cafeteria, and in the other instance, a jealous husband shot his wife’s lover in a drunken rage; both worked in the hospital cafeteria.  After that I brought my lunch from home.

Drinking with my cadaver-mates

I didn’t really drink until medical school. Drinking with the other med students is a big part of the bonding experience. Four of us had all been partners on the same cadaver—two on the right side and two on the left—and we would do everything together. In fact, I married my other half on the right side. Typically, we would join the other  med students at Jimmy’s bar to unwind after an exam.  But once we went out for a drink before an exam.   It was the night before Part I of the National Board exams, in our second year of medical school. This was an important test, a “make-or-break” for doctors. “Where shall we study for The Boards?” I asked.  Jeffrey, my left-cadaver partner, said, “Carol, if we don’t know the material by now we’ll never learn it tonight.  Let’s go for a drink instead.”  Who could argue with the logic?  We had a drink at the bar — we were the only med students there.  Then we went to see “The Exorcist,” which had just opened.  We all passed our Boards.

Two guys walk into a bar and end up in the emergency room

Medical students who were on their surgical rotations were encouraged to hang around the emergency room to help out, and possibly get a chance to practice surgery. Weekends were the best time. One Saturday night the cops brought in two men with facial cuts that they got during a bar fight. They both needed to get stitches, and they were very intoxicated. They were put onto adjacent beds in the emergency ward, separated by privacy curtains–we didn’t have individual emergency room beds in those days. I helped the surgeon start the stitching, and then he let me take over on my own. Since they were on adjacent beds I was allowed to do both.   I did a careful job and was very proud of my work, and I threw the curtains back to show it off to the attending surgeon.  At that point, the two patients recognized each other—it turns out they had been fighting each other! They tried to jump out of bed to continue their fight, and I was caught in the middle.  I learned another lesson that night–it’s very easy to subdue a belligerent drunk, since they aren’t coordinated enough to do any harm.  I just used my loudest “mom” voice, scolded them for fighting, and put them back to bed to sleep it off.

Death by aerosol

As a medical student I did a 2-week rotation on the inpatient psychiatric ward at Billings hospital. It was a locked ward. Our job was to look after the physical health of our patients, while learning as much as we could about their psychiatric illness. I was assigned to Frank, a pleasant, 50-something man who seemed perfectly normal. Many people with psychiatric illness drink excessively, and Frank was no exception, though he had no trouble stopping when he checked himself into the ward. He was just a regular guy from an ethnic neighborhood in Chicago, a retired factory worker who spent his days at his local bar.  Frank told me there was absolutely nothing wrong with him.  He claimed he had no psychiatric problems, he was just hiding out at the hospital so his brother-in-law couldn’t find him and kill him.  Frank claimed that the brother-in-law had an aerosol can filled with a deadly poison and was following him in close pursuit, trying to spray him to death.  To avoid this, he took 3 different buses, in several different directions, running miles on foot between bus stops, until he reached the hospital and voluntarily signed himself into the locked ward for protection.  Frank had what is called “a fixed paranoid schizophrenic delusion.” Except for this one obsession, everything else about his mental state was normal and coherent.  He was convinced, and convincing.  I was afraid for him to be discharged from the ward — because what if he was correct?

Euphemistically speaking

As interns, it was our job to admit patients to the hospital and manage them during their stay.  We were on call to take new admissions every third day; most of our admissions came in from the emergency room, which was used by most local residents in place of a primary care physician.  Most came in at night.  On those days we’d be up all night, to take new patients, evaluate their medical problems, and start their treatment.  In the morning, bright and early, we would go around with the attending physician and the rest of the doctors to see the patients, who would then assist in their diagnosis and management. The challenge was to discuss the case at the bedside, in front of the patient.  We became adept at using Greek and Latin phrases, and euphemisms to discuss sensitive medical details in front of a patient.  A typical presentation:

“This 60-year old man, a known habitual user of two-carbon fragments, presented to the emergency room with hallucinosis and odor spiritus fermentum. His BAC was .16.  He was started on prophylactic diazepam and IV thiamine, to prevent delerium tremens and Korsakoff’s.  We are monitoring his BAC pending discharge.”

The old drunk would lie in bed smiling, enjoying the attention, impressed and pleased that his doctors were discussing him in Latin, totally oblivious to the true meaning of the discussion.

Translation: “This patient, a known alcoholic, showed up in the emergency room seeing pink elephants, and smelling of alcohol.  He was drunk at twice the legal limit.  We gave him Valium to stop the DT’s, and vitamins to prevent further brain damage. We are letting him sleep it off until his alcohol level drops low enough for discharge. “

The Animal

I was called to the Emergency Room late one night for my next admission, a big brute of a guy with head trauma who had to be admitted for observation.  We interns usually ended up transporting our own patients from the ER to the ward, since the patient transport service was slow and lazy, and patients could die waiting for them (literally).  They handed Tyrone off to me on a gurney, told me his nickname was “The Animal” and that he was ready to go except for a small detail–he had to have head X-rays to make sure he didn’t have a skull fracture. It appears that he fell off a second story balcony, but was so drunk that he didn’t feel a thing.  Apparently this was not the first time it happened.  The Emergency Room staff was unable to get this burly, muscular, 250-lb man to cooperate for his X-rays, as he tried to hit anyone who came near and he was too heavy to lift. So now it was my problem.  Fortunately, his wife showed up, all 300 lbs of her.  She barged into his room, scolded him for giving the doctors trouble, grabbed him by the ear and led him to the X-ray machine.  Cowered, he followed meekly.  Fortunately, his X-rays were normal and we brought him to his room to sleep it off.

Addicts, needles and antibiotics

There were many heroin addicts in our neighborhood.  They had no regular medical care, and used the Emergency Room as their primary care physician.  Addicts frequently developed serious medical problems as a result of sharing needles. A blood infection which settles on the heart, bacterial endocarditis, was one of the most dreaded This was in the days before AIDS (which later killed many of them). We had a rule: if an IV drug user showed up with a fever that lasted more than a couple of days, we’d admit them for observation with the presumption that they had bacterial endocarditis. If the diagnosis proved to be correct, then they had to stay the hospital for 4 to 6 weeks to get antibiotics given intravenously, 2 to 3 times each day.  Without this treatment, they would die.

To an addict, 6 weeks in the hospital was like 6 weeks in jail.  You couldn’t leave, couldn’t do what you wanted, and worse yet couldn’t smoke, shoot heroin, or drink. Most of our addicts were put on methadone, and could sneak out to the yard to catch a smoke, but getting a drink was almost impossible. For us interns, getting assigned to an IV drug addict for 6 weeks of antibiotics was no picnic either.   First of all, many of them were in the hospital against their will, and at times we had to forcibly restrain them (yes, you could get away with it in those days, since we were saving their lives, after all). Worse yet, we had to start IV’s in order to treat them.

Back then, all IV’s were started by the interns.  Typically, most addicts have used up all the “easy” veins for his drug habit, so it could easily take an hour for an intern to find a vein and get in an intravenous line.  I recall one frustrating situation with a 30-year-old addict, Leroy, who had no veins left, and didn’t particularly want to be in the hospital. I don’t know how many times I stuck him with a needle without any success. Finally, Leroy got sick of being a pincushion.  He grabbed the needle from me without a word, put a tourniquet around his leg, and proceeded to put the IV into a small vein between his toes.  “There you go, doc. There’s your IV in my favorite vein. Now would you please let me get back to sleep?” I thanked him profusely.

Ed. Part 2 of this fascinating narrative will be coming tomorrow and posted below to avoid symptoms of dizziness and nausea due to disorientation. 

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The blood of a brave soldier

After I finished my MD, PhD, and Oncology training, I joined the faculty at the University of Chicago.  I continued my cancer research with a group of scientists who specialized in cancer genetics. We had found a new, rare form of leukemia among the samples that were sent to the lab for analysis. We tracked it down to a patient in the VA hospital. We needed to get more of his blood cells, hoping to make a breakthrough, and we needed to do it fast, before he died of leukemia.  Since I was the most junior member of the lab, they sent me.   Back in those days we didn’t have to go through extensive review panels or get signed consent forms.  We just had to ask the patient for a blood sample.  So I drove out to the VA hospital, got permission from the ward attending doctor, and approached the patient.  He was pleased to have a visitor, since he clearly loved to talk and had a great sense of humor. He told me he was a veteran of Korea and ‘Nam, and had been in the hospital for a few weeks already. He didn’t mind, though he did miss having his beer on the weekends.  When I asked him for a blood sample for research, he said, “Anything to help leukemia research. But you better get it now before I croak.” He said he wasn’t afraid of dying; he’d seen action in two fronts.  He figured he was going to die soon.  In fact, he said, his doctor told him not to buy any long-playing records! And his insurance agent sent him a 3-month calendar instead of the usual year! So he let me draw his blood, and gave up 6 tubes. I thanked him, he laughed.  I never saw him again.  He died within the week.

This veteran’s blood did, in fact, help leukemia research, as it helped us to find the mutations that caused his disease.  And it launched my own career in medical research, which continued for almost twenty years.

New York, New York

During my research years I took a weekend trip to New York to visit a colleague, a scientist who was on sabbatical leave from London.  By then I was single again, and I enjoyed being on my own in New York. I was on the subway on my way to Grand Central Station when the car stopped.  An announcement was made, “This car is out of service because of a medical emergency.  Passengers are requested to leave the train and board the express train on the next track.”  I ran out and followed two patrolmen to the front car of the subway train to see if I could be of assistance.  In the car was a businessman in suit and briefcase, the conductor, and the two policemen, standing over an unkempt old lady who was slumped over in her seat, looking to be fast asleep.  Her hand grasped a dollar bill that someone had probably put in, out of charity.  The passenger spoke. “I think she’s dead but I’m not sure.”  “I can tell, I’m a doctor,” I volunteered.  I reached for her neck to check the carotid pulse, thought twice about reaching for the neck of a possibly armed street person, and checked first for a pulse at her wrist.

Her wrist was stone cold.  And it was stiff–literally stiff–with rigor mortis.  I could have lifted her up by the arm.  Likewise, the dollar was wedged tightly in her hand and could not be dislodged, though I’ll bet several passengers had tried.

“She’s definitely dead,” I pronounced.

“Should we call an ambulance?”  the cops asked.

“No need to hurry,” I said.  “She’s been dead at least 3 hours, because that’s how long it takes for rigor mortis to set in.”

The cops knew her to be an alcoholic, a homeless street lady who panhandled on the subway trains.  They took her body to the morgue.

I felt very sad then.  Sad to realize that a homeless person could die on the subway, riding it up and back between Queens and Manhattan, for 3 hours before anyone noticed.

South African wines

I went to South Africa while I was on sabbatical leave from my university position.  This was in 1991, shortly after apartheid was ended, and the academic boycott of South African universities was lifted. My visit to Capetown was hosted by Professor Patel (not his real name).  Patel was a South African of Indian background.  As a non-white he was fortunate to have a faculty position at Capetown University, one of the few South African universities which remained integrated through apartheid.  He took us on a day tour of the Stellenbosch wineries, which are conveniently close to Capetown.  This is South Africa’s Napa Valley, producing work-class wines which had been overlooked for years due to trade embargoes.  Patel took us around and had us sample some premier wines.  I complimented him on his taste and knowledge of South African wines, stating “You know these wines so well!  You must have been visiting these wineries for years!”  He looked at me with surprise. “Not at all,” he said. “Until recently I would never have been allowed to set foot into a South African winery.”

Bantu Beer

During the sabbatical trip I was treated to a weekend “safari” in Botswana, with a few of the scientists and students from Witswatersrand medical school. To get to Botswana, our group drove north across the Transveld in a couple of VW minibuses.  We stopped along the way in a small town for supplies: anti-malaria pills, soft drinks, ice, and beer.   The town liquor store obliged by providing a few tables and chairs where customers could sit, relax and drink a cold beer. One of our group suggested I might be interested in a taste of millet beer, a local specialty, so we bought some for me to try. Freshly made, and with a short shelf life, it was sold in cartons, like milk. “You can’t drink that in here,” the proprietor told us, so we left the store and took our purchases along to drink in the vans.

I wondered about the law forbidding drinking millet beer in the store.  I learned that, under apartheid, there was a prohibition on the sale of European liquors to Africans. Millet beer, also known as Bantu Beer, was a uniquely African drink, brewed by the natives from millet (sorghum). Africans were allowed to buy the alcoholic beverage, but they were not allowed to sit in the store and drink.  After apartheid was lifted Africans could purchase anything they liked, but millet beer was preferred because it was familiar and cheaper than anything else.  Banning its consumption in the store imposed a de facto apartheid.

I tried the beer.  It was cloudy, like a home brew, and very mild, pleasantly carbonated, bland-tasting with no hop flavor. We continued north, crossing the Limpopo River to Botswana.  We had a fun time on our weekend safari, camping out in tents, with a big barbecue around a campfire.  The next morning we took a trip by Land Rover to see the elephants.  We were not disappointed.  We saw dozens of all sizes and colors.  But no pink elephants.

The Gypsy King 

At the start of the month as attending physician on the cancer ward at the University hospital, I would be given charts for all of the patients by the previous month’s attending. (We had paper charts then.) Jim Morgan had been a patient on and off for several months, but he had a very small chart.  As it happened, though, most of his medical records were in a much larger chart labeled “Jack Martin.” “Don’t worry,” I was told, “it’s the same man. He had to change his social security number and his name because he owed the hospital a lot of money.  Not your problem, just take care of his cancer.” Hmm.  Seemed like a good trick that I had not seen before, and have not seen since.

Jim was a pleasant fellow, in his 40’s, much too young to be dying of metastatic prostate cancer.  He was surrounded by a crowd or relatives, many of whom moved into his room with him and never left.  The family was swarthy, Mediterranean, and spoke a foreign language in addition to English.  I asked him what language, and he said, “Romanian.”  Hmm.

After reviewing his case, it was clear that he was dying.  His cancer had spread everywhere, and the treatment was not working.  There was nothing we could do except give him pain medicine. I suggested to him that he stop all the treatment and be discharged, to spend his last few weeks at home, in hospice care. He refused to make a decision until he spoke with his uncle, who was flying in and would be there Saturday.  So we waited.

On Saturday morning the uncle arrived.  Or should I say The Godfather? He came by wheelchair, with his entourage.  He was an imposing presence, and was treated with deference and respect.  He listened politely to my evaluation and recommendation and thanked me.  After I left the room they conversed for a long time and the uncle left.  Jim called me in to talk.  “What did you decide?” I asked.  He gave me his permission to stop treatment, and he’d be ready to leave in the morning.

“What are you going to do?” I asked.

“First, I’m going to get myself a bottle of red wine and drink it down. Then, I’m going to Vegas,” he said.  “I’m feeling lucky.”

At that moment I realized a few things.  (1) Mr. Morgan was anything but lucky.  He was dying of prostate cancer at age 43. (2) A number of credit cards, in different aliases, would probably make their way to Las Vegas that week.  (3) The Gypsy King was not a legend.  He lives, and I met him.

It’s time to stop my cancer treatment

After twenty years it was time to leave the university. By then I was remarried and I wanted to do something different.  I gave up cancer research to become a full-time doctor, taking a position as a Medical Oncologist in a small practice in rural Indiana. No interns, medical students, or research labs.  Just doctors, nurses, and patients. And the patients were the salt of the earth–for the most part, conservative, deeply religious, living life in moderation.

One of my patients had early stage breast cancer, and was scheduled to come in for chemotherapy every 3 weeks for 8 treatments.  Her prognosis was excellent.  I saw her in the office just before her second treatment.  “I’m going to stop treatment,” she pronounced.  I asked her why.  Was it the hair loss?  Was she vomiting?  Was it that bad?  “No, it wasn’t bad at all.  But it’s ruining my marriage.”

I finally got her to explain.  It seems that she and her husband were in the habit of having a glass of wine together every evening. One glass. It was their one vice.  But the nurses told her she was not allowed to drink while on chemotherapy, so she hadn’t had a drink since before the last treatment, 3 weeks ago.  Her husband was getting irritable, and they were beginning to grow apart.

“Just one glass of wine?  Of course you can drink a glass of wine daily!  It certainly won’t hurt you.”

“What do I tell the nurses?”

“Don’t tell them if they don’t ask.  If they do, just say it’s the doctor’s orders.”

She agreed to continue her chemotherapy, and the next time I saw her for chemo, she was beaming.  I didn’t ask why.

Three strikes, you’re out

Aunty Debby was one of my favorite aunts. Although she was mother to seven of my first cousins, she was not your typical 1950’s housewife. Her father, she claimed, was a bootlegger for Al Capone. During prohibition she would ride along with Daddy as a decoy, a little girl covered demurely with a blanket–sitting on a case of whisky!  Aunty D loved beer, cigarettes, and the Chicago White Sox.  In the end it was the cigarettes that did her in.  She had survived two previous early-stage cancers, but when she was diagnosed with cancer for the third time we knew she would not make it this time.  She had advanced lung cancer.

By then I was an established physician working in another state, but I helped out when I could, answering her questions and providing what support I could.

Aunty D struggled with treatment, and said it was the White Sox that kept her going–they had their winning-est season ever.  She was sure they’d make it this year, after 88 years without a World Series win.  Ironically, the Sox did win the 2005 World Series that year, But Aunty Debby died a month before their victory.   A few days after the Series my cousin picked me up with some White Sox gear to decorate her grave, and let her know that her beloved Sox won.  When we arrived we were surprised to see that every grave in that small cemetery was decorated with White Sox hats and pennants. This was a graveyard filled with loyal Sox fans, who voted Democratic every year!

Nelson Mandella’s legacy

I went back to South Africa years later with my husband Rick.  One of our best memories of the trip was sitting in a sports bar in Capetown, drinking Tusker beer, watching the crowd as they watched a rugby game on the television.  The crowd was rowdy, and really into the game. Years later, when we saw the movie “Invictus,” we understood the deep-seated rivalry between the South African and New Zealand rugby teams and understood the passion that we saw in the bar.

During that trip I was invited to visit the hospital in Baragwaneth, I was excited by the chance to visit the cancer ward in this massive hospital of over 3,000 beds. It is one of the biggest hospitals in the world, and the only one which served Soweto, the large black township (ghetto) in the suburbs of Johannesberg. Rick was asked what he wanted to do while I was on rounds, and he asked for a tour of Soweto. A few heads were scratched–this was not a typical tour–but they obliged and brought a driver and a tour guide in a mini bus.

Apparently Rick saw every sight in the “little town” of Soweto (population 1.3 million).  The visit to Baragwaneth Hospital was a memorable experience for me, beyond description. At the end of the day we compared notes.  I asked him what was his most memorable experience of the day, and he said, “I visited Nelson Mandella’s house, and I peed in his toilet.”

Run for cancer

After many years I took up running again.  It was enjoyable to run along the country roads near home, and a good way to let off steam.  I ran an occasional 5K race, and I helped to organize our cancer center’s annual “Run for Research.” When my Chicago friend Gary learned that I was running again, he invited me to go on the “I Beat Cancer” Hash in Chicago.

As Gary put it, “I’ve done hashes for plantar fasciitis, mad cow disease, and swine flu.  For what it’s worth, it’s been 5 years since my cancer surgery.  I’ve also had plantar fasciitis, but to the best of my knowledge I’ve never had mad cow disease or swine flu.  The other hashes weren’t fund raisers, and neither is this one.  We are not using the words, ‘for the cure’ so Susan Komen’s people can spend their money on cancer research instead of suing us.”

I was intrigued, so I asked, “What’s a hash?”  He explained it’s a kind of race that starts in a bar and ends in a bar.  “Hashers are drinkers with a running problem.”  Sadly, I couldn’t join the has because I had to do work that day; I was doing my own part to beat cancer. Maybe next year.

Guinness Pot Roast 

Noreen was a pretty and spirited young woman in her early 40’s.  She was a very Irish lass, from South Bend, with dark hair and sparkling eyes.  Unfortunately, she was dying of metastatic cancer.  We worked hard through the winter, she and I, to get her cancer under control with chemotherapy.  We made some progress, but it was a losing fight, and she knew it.  She had one request — she wanted to put her treatment on hold for St. Patrick’s Day.

“We usually have a big party for St. Pat’s.  I invite all our friends and acquaintances, and I make my famous ‘Guinness pot roast’ for all.”  Her husband raved about the pot roast, so I agreed to wait with treatment for a few weeks, under one condition — that she give me her recipe for ‘Guinness pot roast.’  We had a deal.

I saw her later in March, and we started treatment again.  But eventually she succumbed. I tried the pot roast recipe after I heard about her death.  She was right; it was excellent.  I still think of her every St. Patrick’s Day, and I still make the pot roast.

Spring peepers

It was Friday, the end of an especially difficult week; we lost a few cancer patients, and everyone in the clinic was a bit down.  It was cold and dark, at the end of February. It seemed like winter would never end.  In the evening, Rick picked me up to drive us to our house in the Dunes.  As we drove through the wetlands he stopped and opened the windows. I could hear them, the spring peepers.  In the early spring these frogs are the first to awaken, and they start their plaintive calls when the rest of the world is still silent.  You could hear each individual frog’s call, and they sound like lost souls. To me, they are the first sign of a coming spring, that things were starting to get better.  Rick rolled up the windows.  “Come on.  Let’s go. You need a beer.”

 

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