7. Stranger in The Mind-Chapter 7

Chapter 7.  March.

March 2.

I’m on-call for the infant floors tonight, and I’m on Seven, orienting Lou Sharp, who’s the Night Float coming on duty.  Dave is his SR.

“There were two admissions this afternoon.  Otherwise I don’t think that you’ll have that much to do on Seven, Lou.  Harley Park is an eleven-month old with sickle cell anemia who came from the ER with high fever, pneumonia, and a hemoglobin of five.  Got transfused, and he’s on IV penicillin and chloro.  Seems comfortable now in O2.  But you’ll need to check on him.  Cherie Shaw is a six-month old with failure to thrive, who was admitted from the OPC well-baby clinic for work up.  The thinking is that it’s probably deprivation.”

We briefly discuss the others on Seven.  I wish Lou good luck, and pick up my jacket to head over to the cafeteria for a snack, before going to the HOB.

The phone wakes me at two.  It’s Lou with an admission.  The ER is too busy tonight for him to do the work up, so it’s mine.  I pull on my whites and head over through the empty tunnels.

The Pediatric Emergency Room is really bustling tonight, with all cubicles occupied.  In the first, a mother is sponging her febrile, crying infant with cold water to lower his temperature.  Susan Lewis, the RN, is on the run.   “Your admission is in the sixth crib,” she says as she hurries past with an LP set.  I can hear Lou behind a curtain telling a parent, “Now if the spinal tap is okay, we can probably let Jamey go home.  Why don’t you have a seat outside till I finish?” 

If not you’ll be calling me with another admission.  “Hi Lou,” I say through the curtain.  “I’m here for the admit.”

Lou sticks his head out.  “Pretty straight forward.  A four-month old girl with a high fever.  I cathed her and her urine was loaded with pus, so she needs to come in for treatment and work up.  Thanks.”  He disappears again behind the curtain. 

In the sixth cubicle, a heavyset teenager waits standing with her daughter asleep on her shoulder.  Grandma is sitting and looks tired.  Mother’s about fifteen, sixteen.  A child herself.  I smile at them, “Hi, I’m Dr. Morton.” 

I take the chart off the holder on the cubicle wall, and glance at the ER registration sheet for identifying information.  “I’m here to admit Darlene and talk with you.  You’re Darlene’s mother and grandmother?”

“Yeah, I’m Darlene’s mom, and this is my mom.”

“Let’s see,” I look at the registration sheet again.  “You’re Celeste, and you’re Mrs. Williams.”

“Yeah.  But tell me what you gonna do with Darlene?” Asks Mrs. Williams

“Did Dr. Sharp talk with you about needing to admit her because she’s got a urine infection?”

“That’s what he told us,” she says.  “But I’ve had lots of urine and bladder infections and never was admitted.  Why’s she gotta be admitted to the hospital?  You doctors wanna practice on her?” 

Little hostile?  “Darlene has to be admitted because she’s only four months old.  There’s a lot more to worry about when young babies have an infection.  We need to be sure that it isn’t in her kidneys.”  Damn, going to take time to explain.

I convince them at last that Darlene really needs to be admitted for treatment and work up.  I call the floor to let Belle, the floor RN, know there’ll be an admission, and what the problem is.  Then I take the history, do the exam, and talk with the family about what will probably happen next.  Seem okay now.  Maybe all they needed was to feel someone listened to them, took them seriously.  I walk beside Celeste and Mrs. Williams, who carries Darlene, to the Seventh floor.  “You gonna be taking care of her, doc?” she asks.

“Yes.  I’ll be following her till she goes home.”

“That’s good, we don’t wanna be talking to a new doctor every day.”

On the floor, Belle and Anna have a crib and the IV tray ready.  They introduce themselves to Celeste and Mrs. Williams and weigh and measure Darlene, who cries through it all.

“Okay Celeste and Mrs. Williams.  I’m going to start an IV on Darlene.  Please wait in the office until I’m done.  Then I’ll come to get you.”

“Can we stay here while you does it?”

“You know, it always makes me nervous when the family watches, and I don’t work as well.  So please wait in the office till I finish.”

“Some of the doctors don’t mind letting the parents watch,” says Belle, after they leave the ward.

“Well, they probably have better hands than I do, and are more self-confident.”

I mix up the IV fluids in the elongated glass burette and cover the open top with a gauze pad, then fill the rubber IV tubing and clamp it.  With Belle holding and Anna looking on, I tape Darlene’s left arm to an IV board, apply a tourniquet, and start looking for veins in the back of her hand.  I stick her a couple of times unsuccessfully, then re-tape her arm to look at her antecubital space.  Darlene’s loud cries can probably be heard up the hall.  Another miss.  Finally I get a vein in the back of her right hand.  I connect the IV, finish restraining her arms and legs, and add the antibiotic, chloro, to her IV.  Tricky.  Got to be careful using sulfa at her age.  Same with chloro because of ‘gray baby syndrome.’  Now to get the family.

“Look at how she’s tied down, and all those Band-Aids on her,” says Celeste, tears running down her face.  “Oh poor Darlene.”  She gives me an accusing look.

“Guess that’s why doc didn’t want us watching,” says Mrs. Williams.  “But like he told us, she got to have all this stuff done to her to make her better.  So it hurts her now, but it’ll kill the germs.”

Glad grandma’s on my side.

“Will you be staying?”  Belle asks.

“If she’s all settled now, we’ll go home.  Celeste has got school in the morning.  What time can we come visit tomorrow?”

“Immediate family can visit any time after ten.”

They leave, and I also prepare to go.

“Have some coffee and cake with us first,” says Belle.  “Anna and I are going to take a break now.” 

“Thanks, that sounds good.”

The small prep room next to the service elevator has stainless steel counter tops.  A hot plate sits on one, with a pot of coffee.  Anna gets out a frozen Sara Lee brand pound cake from the refrigerator, removes the cardboard cover from the metal foil pan, and cuts the cake, while Belle pours out three mugs of coffee.  We perch on metal stools.  Belle is half a head shorter than I am, trim-figured in her white uniform, neat brown curls under her square RN’s cap, while Anna, her aide, is short and stout, steel-framed glasses on her round face, about 45 or 50, with graying hair and no cap.  The cold cake is rich with butter; the hospital-supplied coffee tastes slightly metallic as usual.

“Don’t you ever get tired of working nights?  Starting your shift at eleven PM,” I ask.  “How long’s it been?”

“Five years for me,” says Belle, “Since I got out of nursing school.  But Anna’s been doing it for much longer.  Actually, I like nights.  It leaves my days free.”

“Yeah, me too,” says Anna.

“But it must be hard on your social life,” I say.

“What social life?  It’s tough to find time for one, when I’m off Sunday and Monday.  Also, being named ‘Belle’ doesn’t help.  I think it raises expectations for certain guys, whenever someone tries to fix me up.  My parents sure made it hard for me to live up to.”

“Belle fits you fine.”

“I don’t know.  Look at my nose—it could be smaller, and my chin’s too strong.”

Why do good-looking women always worry how they look?  “You know, with your hair in those tight curls, and your nose and chin; you look just like one of those Roman marble busts.  Classic.”

“Do you think so?  Well thanks,” says Belle with a smile, leaning forward a little.  “It’s easy to work with you, Dr. Morton.  I remember that night we tapped Toby White.  Things really moved along smoothly.  It’s not that easy to work with some of the other residents, though I won’t mention any names.”

The phone rings at the desk, and Anna goes to answer it, then returns.  “The operator wants you to call her.  Said she’s been trying your room.”

“Thanks.”  I walk out to the desk and dial zero.  “This is Dr. Morton.”

“I’ll connect you to the ER.  Dr. Sharp wants you,” says the operator.

Lou Sharp tells me that the baby he tapped earlier does have increased numbers of white cells in its spinal fluid, so it is meningitis.  Although the senior resident and he think that it’s most likely viral, they feel that admission for antibiotics till the culture comes back is the prudent course.

Belle comes out to the desk and looks inquiringly at me.  “Another admission?”

“Yeah, but it’ll be going to Eight.  They haven’t had any since morning.  Goodnight, Belle and Anna.  And thanks.”

“Anytime,” says Belle, with a lilt and a smile.


March 3.

Driving home after chief’s rounds, I turn left off Bay State, drive on three blocks and stop again at the intersection with Massachusetts Ave.  “So you think you still got it, eh?” asks Sal, after I tell him about the happenings of last night as the light changes.

“Yeah.  Two admissions, and today was busy as well.  Yet all the work went smoothly, and I still feel energized and wide-awake tonight.  At times like this, I feel like a good juggler, able to keep all the balls in the air.  Unfortunately, it doesn’t always feel so in synch.”

“I was referring to that business with Belle.”

“Oh that.  She seemed down on herself, so I boosted her self-confidence a little.”

“Right.  By telling her she looked like a Roman goddess.  And weren’t you also feeling just a little pleased and smug that she would come on to you?  I’ll bet that you were thinking, ‘I may be married but the girls still look me over.’”

“I don’t think there was any come on.”

“Come on, Bob.  When you were leaving Seven.  You were wondering if she was encouraging you.  You felt pleased with yourself.  That you still had it.”

“Well, maybe a little like that.  But let’s find out for sure.  Why don’t you just peek in her mind and tell me.”

“Bob, you know that I can’t do that.  It wouldn’t be ethical.”

“Just a quick look.  What harm would it do?”

“Because if I looked, then told you, you might act on the information, and that might hurt her, or someone else like Karen.  Knowing you, I don’t think that you’d do it, but as long as there’s any possibility, I can’t.”

“Okay, okay.  But I think you sometimes go overboard with your ethical stuff.”

“Bob, listen.  Belle’s quite a woman and would be a temptation for any man.  First you flatter her; then she responds.  Be real clear in your mind about where all of this can lead.  Remember, if you aren’t going to like the destination, don’t even start the trip.”

“Sal, why don’t you lighten up.  Sometimes your preaching’s a real pain in the ass.  Do you really think that I’d cheat on Karen?”

“I don’t think that you’d ever plan to cheat on Karen.  But things have a way of happening unplanned, when the opportunity presents and there’s encouragement.”

“Well, stop worrying.  I’m not going to.”

“I’m glad you’re clear about that.  You’re almost home.  I’ll talk with you tomorrow, Robert.  Cooling off now?”

“I wasn’t upset.  Well.  Maybe just a little annoyed.  Oh hell, you can tell how I feel.  Yeah, kind of pissed off.  But I’m okay now.  Hey, no hard feelings, Sal.”

“No hard feelings.  Good night, Bob.”

After parking, I cross Beacon, still feeling annoyed with Sal, but mostly with myself for being so transparent.  Sal can see right through me even when he says he isn’t looking beyond my surface thoughts.  Hope not everyone can read me so easily. 

I enter the apartment and hear Karen in the kitchen.  The warm smell of dinner fills the air.  I walk through the living room and stand by the kitchen door.  She’s bending over, taking what looks like meatloaf from the oven, and looks up smiling as she closes the oven door.

“Hi Bob.  How do you feel?  Did you get much sleep last night?” 

Man, just look at her.  So fine.  With a cook like her, home cooking sure beats eating out.

She straightens up, puts the aluminum pan on the top of the stove, comes to me, we exchange a long kiss, then hold each other close, her head against my shoulder, while I rub her lower back.  “It was pretty busy,” I say, “but I’m not sleepy.”

“I’m glad,” she says, as she leans back in my arms and smiles at me.

“So what’s for dinner tonight, besides you?  You look just delicious.”

“You know, I think having a busy night at the County boosts your libido.  All those stress hormones must be still floating around inside of you.”

“We were taught in physiology that stress causes ‘Flight’ or ‘Fight’ responses.  Are you saying that there’s another ‘F’ response possible?”

“Shame on you,” she says, her smile turning impish.

But she’s not pushing away from me.

March 8.

Wil and I are in the cafeteria for a snack at 10:30, after signing out to Lou, who’s Night Float.  A few of the staff and workers are sitting scattered about at other tables. There’s a sound of clanging in the back as the pots and pans are washed, but otherwise it’s less bustling than usual.    

“Hey, what’s with Mark the last few days?” I ask.  “He seems kind of quiet.  Moody.”

Wil looks around, then lowers his voice and brings his head closer to mine across the table before speaking, “Didn’t you hear?”

“Hear?  No, what?”

“You cannot repeat this to anyone else.  Okay?”

“Wilson, you know me,” I reply,  “I don’t gossip.”

“Okay.  Well, Mark’s steady in the sack is pregnant.”

“Juliet?  No lie!  Are you positive?”

“Of course I am.  I wouldn’t be telling you this if I wasn’t.”

“How’d you find out?”

“From Frieda.  They’re in the same dorm.  She and I were getting hot and heavy last weekend, and she stopped me and wanted to know if I had a rubber just in case.  Said she didn’t want to have any complications like Juliet.”

“You were working on Frieda, the German girl?  You practicing just in case you get stationed over there, Wil?  How sure is she about Juliet?”

“Real sure,” says Wil.  “Their rooms are across the hall from each other.”

“So what are Mark and Juliet going to do?”

“Well, when Mark found out, of course he wasn’t happy, but he did offer to marry her.”

“Mark’s a real old-fashioned gentleman.”

  “Yeah.  But then Juliet told him that she only had next year to go for her RN, and didn’t feel she was ready to be tied down just yet.”

“So is she going to have the baby, but not get married?  Is she thinking of giving the baby up, or keeping the baby, or what?”

“No.  Neither.  She decided to get an abortion.  Without talking to Mark, she decided what she was going to do, and went ahead and arranged for it.  Then she asked Mark for the money.  That’s why he’s bummed out.”

“An abortion?  Is Mark upset because she decided to get an abortion on her own, or because of the money?”

“Mostly the first, but also, I think, because of religion,” says Wil.  “Even though he doesn’t go to Mass that much now, he was brought up in the Church really strictly.  Altar boy and all.”

“Juliet must be a Catholic too.”

“Well, maybe she is, but regardless, that’s what she decided to do, and if Mark doesn’t like it, well, T.S.  Juliet’s a gal with a mind of her own.” 

“So what’s he going to do?”  I ask.

“Well, he couldn’t talk her out of it, so he’s going along with her and come up with the money.  I mean he does really care about Juliet, and doesn’t want her to go to some cheap, clothes-hanger pushing sleaze-ball and run into really bad trouble.  As I heard, at least the guy she’s going to is an MD, and he’s been doing abortions for some time.”

“Mark got the bread?”

“Yeah,” says Wil.  “And some of us offered to float him a loan if he needed it.”

“Wow, Church’s teaching and Hippocratic oath and all.”

“But what would you do?” asks Wil.  “Mark cares about Juliet, maybe even loves her.  And she’s determined to do it with or without his help.  He’s got no choice.  He can’t turn his back on her.”

“Yeah, I guess.”

We leave for our rooms in the HOB.  I reach Sal while I’m showering * * * *

“So Sal, with your ethical bent, what do you think?  What about Mark breaking with his religion and the oath he took at graduation?”

“Bob, you took the same oath.  What would you do?

“Well, first of all, I would have worn a rubber.”

“That’s not what I asked, Bob.”

“If I were in Mark’s predicament, I wouldn’t have the same strong religious qualms that he has.  So I guess the main things would be the illegality of doing abortions and, as corny as it may sound, the oath we all took at graduation.

“And those would be the main determining factors as far as you’re concerned?  What about the woman’s desires and her point of view?”

“No.  You’ve a good point.  Of course she should have the final say.  But I would hope that she would tell me as soon as she was sure, and we could talk freely about different alternatives.  But ultimately, I guess that I’d support her decision.  Like Mark’s doing.”

“Oh, so now you are willing to go along with the woman.  She’s the one responsible for making the decision; you’re just agreeing with it.  That’s a punt.  Now put yourself in Juliet’s situation,” says Sal.  “Say you’re the woman, within a year of finishing your residency, and you’re not married, and you become pregnant.  Now what?”

“Abortions are illegal in Massachusetts first of all–”

“For the sake of argument, suppose they were legal, and available,” says Sal.  “But you’ve still taken the same oath.  What would you do?”

“Well—I’ve got to think about that a little.  I mean there’s a lot of things that enter into a decision like that.”  I towel off.

“Not so easy, is it?  When does an absolute become conditional?  Thou shalt not kill—except during wartime?  Thou shalt not commit adultery—except when feeling horny?”

“Now that wasn’t necessary.”

“No specific reference intended,” replies Sal.  “It was just to illustrate my question.”

I start brushing my teeth.  “Oh right!  But since we’re on that non-subject, what do you think I should do about Belle?  I really like her as a person, yet I don’t want her to get the wrong idea about my intentions.  I’d like to stay friendly and platonic.  Is that possible with a good-looking woman?”

“If you can make sure that you just stay friends.  Why don’t you run through some possibilities about what you might do?  I’m sure you’ve been thinking about it.”

“Okay.  First, I could do nothing, which would leave things as they are, up in the air.  Or, I could try avoiding her, but that’s impossible as long as I pull call and have patients on Seven.  I could become very formal and proper and begin addressing her as Miss Basilio.  Or I could tell her that I don’t want to have any misunderstandings, but I want to still stay friends.”  I rinse off my toothbrush and head up the hall to my room.

“I agree with you about the first two,” says Sal.  “They’re not very good choices.  What do you think about becoming very formal with her?”

“I don’t think that’s good either because Belle might begin to wonder if she did something to upset me, and that wouldn’t be fair to her.  What do you think?”

“Yes, I’d agree.  Suddenly doing that to her without an explanation might cause her needless worry.”

“So that leaves talking to her openly.   Not so easy to do.  What’ll I say? Something like, ‘Jeez, I didn’t mean to say anything to make you come on to me the other night,’ sounds kind of crass.”

“Speaking plainly doesn’t mean blunt like a sledge hammer,” says Sal.  “Saying something like that would sound presumptive, egotistical, and it would also be insulting to Belle.”

“How about if I say, ‘Belle, it’s nice having you as a friend,’ or ‘You’re like the sister I never had.’”

“Talk about clichés,” laughs Sal.  “But yes, something like that might be better.  And because they’re clichés, she should clearly recognize what you’re trying to tell her without you spelling it out and embarrassing her.  See, you figured it out on your own.  And while you’re at it, think some more about Mark and Juliet’s situation.  What would you do?”

March 11.

I’m admitting a toddler with croup from the ER to Seven after midnight.

“Guess you were lucky the last couple of times you were on call,” says Belle.  “I haven’t seen you and I didn’t hear you get paged.” 

She sets up the steam generator beside the croup tent, fills the glass reservoir with water, and plugs it in, carefully positioning the nozzle so that the infant can’t reach it and get burned.

“Yeah,” I say.  “It was so unusually quiet that I couldn’t sleep well either night since I kept waiting for the phone to ring.”

“Well, you’re back in the routine tonight,” she says with a smile. 

“Okay, Mrs. Osgood,” I say to the baby’s mother, “Kelly is all set up now.  As I mentioned earlier, I don’t think she’s in any real danger.  Perhaps she could even have gone home from the ER.  But this way we can watch her and if she should get worse tonight, she’ll be right here where we can help her, and you won’t have to dash back to the ER.  Better to not take a chance.”  I bend the goose-necked lamp towards the floor so that it isn’t too bright.  “Try to get some rest in that chair.”

“The main thing is for Kelly to do well,” says Mrs. Osgood.  “I hope that I don’t have to see you before morning.”

“Do you have somewhere else to go,” asks Belle as we walk away, “or can you take a break to have some coffee?”

“Coffee sounds great.  Thanks.”

“I brought some muffins,” says Anna as we go to the prep room.

“It’s nice that you had an easier time on call for a change, Dr. Morton,” says Belle.  “Even if you couldn’t sleep.  How are things going outside the hospital?”  She pours coffee as Anna puts two muffins on a plate and cuts them in half. 

I help myself to a half a muffin and take a mug. “Pretty well, thanks.”

“Isn’t your wife a teacher?”

“Yes, first grade.  Over in Cambridge.”

“How’s she coping with all your night call?”

“Okay.  Why?”

“It must be hard for anyone not connected to medicine to really appreciate all the stress that a resident gets hit with.”

“For someone who isn’t, Karen does pretty well.  It’s true that she doesn’t know the terminology, but she’s very aware of the demands on me.”

“Well that’s good.  I’ve heard of some non-medical wives who don’t understand what their husbands go through in training, and who just aren’t that sympathetic or supportive.”

“I have too.  I feel very lucky.  She supports me at home, and here at work I have friends like Drs. Wee and McKay and you.  You’re very easy to talk to, Belle.  Almost like the sister that I never had.”  Hope that was clear enough. 

“Oh.  Well, I’m glad that you feel that way, Dr. Morton.  About me I mean.”

“It’s silly for you to keep calling me Dr. Morton if we’re friends, Belle.  Please call me Bob.”

“I will, Dr. Morton.”

“Remember, it’s Bob.”

“Yes, Bob,” Belle says with a little laugh.

March 15.

It’s drizzling as I make my way past the statues in front of the administration building after Chief’s Rounds.  The evening sky shows lingering traces of light towards the west.  Spring’s coming.  At last.  Be nice to get out to the shore with Karen when it gets a little warmer.  Had good times there in the past. 

“Hello Robert,” says Sal, breaking into my thoughts.  “Had a good day?  So did you see Belle again last night?  Did she seem friendly or more distant, after your comments about friendship your last time on call?” 

“Evening, Sal.  Yeah, a decent day.  Belle and I worked together on an asthmatic last night.  She seemed okay to me.  We’re friendly, but nothing more.  I’m glad that what you and I talked about worked out.  I like her as a person and wouldn’t want to hurt her.”

“You had coffee with her and Anna?”

“Yeah.  I thought that if we’re to be friends, I should continue to act like one and not be afraid of socializing.”

“What did you talk about this time?”

“I asked her about her family and what it was like, growing up in Brockton.  She told me about her older brothers and their problems.”

“Safe stuff.”

“Yeah.  Look, I don’t know if you’d be willing to or not, with all your ethical concerns, but could you check out Belle and let me know in general terms if what I did was okay or if I need to say something more.”

“No, I’ll take a look.”

“How come you’re willing to look now and you weren’t willing to the other night?”

“Because you’re asking me to do this out of concern for Belle, not for possible personal advantage.  And I can see that any action you take will be to help her.  I’ll let you know tomorrow.”

March 17.

I have on my clip-on green bow tie for St. Patrick’s Day.  The wearing of the green is serious stuff in Boston, and no one is more serious about it than Peg O’Hare, the diminutive elevator operator in pediatrics.  She is decked out in green from the ribbons in her dyed red hair, to her socks and green leather shoes.  Even her brogue seems thicker this morning.  “Ah doctor, it’s good to see that you’re wearing a bit of the green today.”

“Top of the morning to you, Peg.  Think you’ve got enough green on?”

“Ireland’s not known as the Emerald Isle for nothing,” she says.

“Guess you’ll be celebrating after work.”

“It’s sure that I will be.  I’ll be off at three today; then it’s over to Southy, where the beer flows green.”

“Both in and out, eh Peg?”  I get off on Seven.

In the afternoon a patient’s blood needs to be checked for sickling.  I offer to show Terry, one of our medical students, how to do a sickle cell prep.  We head down to the pediatric building’s basement laboratory with a tube of the patient’s blood and hear a rapid rhythmic tapping as we round the corner.  There, up on one of the lab benches is Peg, kicking up her heels, doing a vigorous jig on the black granite counter top, for her audience of Judy Russo, the lab tech, and a couple of maintenance men.  She pauses when she sees us.

Terry laughs delightedly.

“More, Peg,” I say.  “Don’t let us stop you.”

Peg curtsies.

“I need to save something for after work,” she says, puffing, but obliges us by continuing for a bit till she stops, out of breath, as we applaud and whistle.

“It couldn’t be done any better in Dublin, Peg.  And do we get to see you do the tarantella on Columbus Day, Judy?”

“Peg’s the dancer, Dr. Morton.  I get my exercise walking the stairs.”

“Well, it’s almost three,” says Peg.  “I’m off to Southy.”  She climbs down from the counter with the help of the maintenance men, and sashays out the door.

“Goodbye, Peg,” I say. “Hope you’re sober by morning.”

“Wow,” says Terry, “I was told that it’d be more lively at ‘The SuC’ than at the other hospitals where I could have taken my peds rotation.”

“Yeah.  But remember, you’re at ‘The County,’ Terry, not ‘The Suc’ and you do get to do more things here as a student.  While Peg’s off to celebrate along with all of Southy it’s back to business for us.  There’re a couple of simple ways you can screen for sickle cell disease or trait.  Why don’t you grab a couple of clean slides and I’ll show you how to set them up.”

March 22.       

Sam Shapard, the other JR on Seven, and I are sitting in the second row in the basement conference room while the discussion goes on and on about the treatment of middle ear infections.  Irv Corwin, from Mass General, and Saul Norman have been invited by the Chief to come and give us their opinions, since they both consult on infectious diseases in adults and children at their respective institutions.  There’s a recognized rivalry between the men, since both are on the Harvard faculty and both are well published.

“Now, Irv,” says Dr. Wasserman with a smile, “do you mean to say that you actually prefer daily injections of procaine penicillin and streptomycin for the outpatient treatment of uncomplicated otitis media to oral antibiotics?”

“Only in the clinic population.  Not in the private office,” says Dr. Corwin, a tall, lean, serious man with a gray crew cut.  “I must emphasis that, because of the documented unreliability of clinic patients in completing prescribed courses of oral antibiotics.  I’m saying that even five days of intra-muscular antibiotics, reliably given, are more effective than seven to ten days of oral anything.”

“And what would you advise our residents to do, Saul?” asks Dr. Wasserman, puffing on his briar pipe, and turning to Dr. Norman.

“While I’m sure that Irv’s approach works,” says Dr. Norman, “I would be concerned that after the first few visits, not that many parents would bring their babies back to be stuck like pin cushions for even five days.  For the uncomplicated case of otitis, there are many oral antibiotics that can be used.”

“I’m talking about effectiveness of treatment,” snorts Irv Corwin, “not placebo effect.”

“Streptomycin’s pretty ototoxic, Irv,” interjects Dr. Scott.  “Aren’t you worried about causing deafness while you’re treating a relatively minor condition?”

“After just five days?  Come on Virgil,” replies Dr. Corwin.

“Lots of thunder, and no light,” Sam whispers to me.

“Keeps everyone awake though.”

The discussion goes on, with firmly stated beliefs, but no agreement on a single approach. 

“To sum up, if a tossed salad can be summed up,” says Dr. Wasserman finally, “we’ve heard a number of different approaches espoused this afternoon.  But don’t forget, successful treatment begins with accurate diagnosis.  Learn to use your otoscopes and know what you are looking at.  Then pick a study or an expert to support your choice of treatment.  But also remember, as you’ve seen today, even acknowledged experts can differ in their opinions.  So keep an open mind. 

Thank you both for being our guests today–Dr. Corwin for coming across town to visit, and our own Dr. Norman. 

Now before we break up, I’d like to make an announcement that I think many of you have been waiting for.  It is with pleasure that I can introduce Dr. Dave Siegal as our new chief resident next year.  David, stand up and take a bow.”

All right, Dave!  We applaud, then cluster around Dave to congratulate him.

Drs. Norman and Corwin leave the conference room followed by their fellows, still engaged in earnest discussion.