The soldier on the front line sees only his small part of the larger picture, and I saw only a small part on my "front line" as a house officer during medical training. But, still, there is something undeniably true about the instance, even if it does not allow for generalization.
Watching, "Band of Brothers" there is a story line about a disaster of an officer, Lieutenant Dike, who is described by the truest hero of the series, Richard Winters, as "another one of those jerks from Yale, who think they can be leaders."
Dike came to mind as I was talking with a colleague about the Harvard medical students he had dealt with, who were told to go home at 10 PM so they could study, because, after all, they were at medical school to learn, not to be sleep deprived and abused.
House officers I had met who had gone to Harvard Medical School and who wound up on the wards of Cornell-New York Hospital, shared one curious characteristic, which may have been one of those things which was possessed by all or most Harvard medical students, but it was certainly characteristic of these two: they fled the scene when things got frightening.
In the case of Lt. Dike, of "Band of Brothers" the narrator tells us he was a bad officer not because he made bad decisions; he was a bad officer because he made no decisions. But, what we see in the story goes beyond that--he disappears, or he freezes into inaction.
The writers take great pains to show how it was helpful, even necessary, to get soldiers briefly off the front line, even just 50 yards to the rear, sometimes just for one hot meal to get them to return to full efficacy. But Dike was more often than not, simply absent. He was the classic empty suit--simply not there, physically or mentally.
In the case of my two fellow house officers, one was my intern when I was a junior resident, who I'll call Don, and the other was my own year, or rank, I'll call Jack.
Don was eager to begin research projects with the faculty members who drifted through our wards, which was fine, but the internship year was not about research. It was about learning how to keep the patients in front of you out of trouble and alive. But, oh, well, whatever floats your boat. If you want to dream about publishing papers from experience with patients on the ward, fine, as long as you do your job. And Don seemed to take that job seriously--he brought a portable typewriter to the wards, which he locked with a chain to the radiator, and you could actually read his notes, which given the handwriting of the average intern, was something better than usual.
"The Tower," the 15th floor of the hospital, was where private patients enjoyed large, single rooms, furnished with better furniture than you saw on the wards and there was an occasional actual objet d'art on the walls, and the windows offered spectacular views of Manhattan, but the patients were just as sick. The thing about the Tower was the halls were vast, and empty, and it was a long elevator ride away from the rest of the hospital, from cardiac code teams, from any kind of help; there were simply not the same number of nurses and interns and residents and other staff around. It felt more like a hotel than a hospital, which was pleasant but when things went wrong, help took a long time for help to show up.
One day, a patient's daughter ran up to me in the hall and pulled my arm, and dragged me down to her father's room, where the wife and another sister surrounded his bed, and he was clearly in extremis.
I can't remember now exactly what was wrong, but I think I opened up his IV line and used his bedside phone to call for help, and took his blood pressure a few times and lowered the head of his bed and raised the feet and slapped on an oxygen mask, and he began to pink up a little.
And then I turned to the wife and said something to the effect that while he looked better now, we would likely transfer him down to the ICU for a day or so.
And I'll never forget what she said:
"Just as long as you do not leave this room!"
And, confused, I said, "I have no intention of leaving your husband's side. Why would you say that?"
"Because that other doctor who was in here just before you, he just stood a the door, and then ran out of here and left us."
Later, I learned it was Don who had taken two steps into the room, seen the patient looking some morbid shade of blue gray and fled.
When I confronted Don about this he said, "Yes, I realize I could have done better," sounding like a schoolboy who had flunked his spelling quiz. "But I learn from those mistakes."
"You can't learn," I remarked. "If you're not there."
I said nothing more because I had learned, even at that tender age, to my chagrin, that the things I found to criticize in others, I often have done myself, or would later do myself, so I try not to cast stones too often.
But, actually, now, with the perspective of years, I do not think I ever simply fled the field. I was clearly not the smartest doctor in that hospital, nor the most skilled, but the one thing I could do was be present, to stand fast, to help in whatever what I could.
One thing you could say for Cornell, for all its faults, the faculty wanted you present, and if you were there, in the fray, they generally forgave a lot. They were pretty clear being at the bedside was also educational, even if it did not show up in exam scores.
At Harvard, students passed all their standardized exams. And it could be argued simply spending long hours on the ward, where often nothing much is happening, could be seen as a waste of time and energy.
At Cornell, at least in those bygone days, it was always, "You learn the most medicine at the bedside. The wards are often hours of boredom, punctuated by instants of berserk action. Get the patient through his crisis. Be there."
My other Harvard Medical School friend and I were walking back to our apartment building through the tunnel from the hospital one day, when two young men barreled past us, bent at the waist, running like a running back and his blocker, right by us.
As we approached the underground Citibank branch--yes, amazingly, they had a branch in the tunnel--we could see through the glass wall, everyone was on the floor, and when I stepped through the glass door, they all ducked back down. Those two kids had just robbed the bank, pulled out big guns, and one had bludgeoned the sixty something bank guard over the head, and he was unconscious on the floor.
So, I went over to him, tried to feel a pulse in his neck and do some poor excuse of an exam, and looked up to tell Jack to get on the phone to the ER to send over a team for the guard. But Jack was frozen at the door, looking, to my eye at least, terrified.
Some bank clerk called the ER, after I shouted out the telephone number, and they arrived about 10 minutes later.
Jack was nowhere to be seen.
When I asked him about that later, he snorted and smirked, and he said, "Well, you were playing the calvary riding to the rescue; I thought there were enough heroes for one small bank."
So remaining with an unconscious patient was just me showing off.
I never could see Jack the same way again. He was, as a girlfriend told me, "Your most interesting friend. The only one who is really classy." He had a wry sense of humor, a sort of aristocratic manner of speaking--he was Mainline, Philadelphia, everyone of his brothers were Yale College/Harvard Medical School--but after that, for me, he was just another Harvard jerk who did not stand fast when things got rocky.
At least, that was my take then.
