ACADEMIA: The Law of the Jungle: Surgeon in training, Garven Wilsonhulme, fang-and-claw competition for glory
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Carl Douglass
Author Carl Douglass desires to live to the century mark and to be still writing; his wife not so much. No matter whose desire wins out, they plan an entire life together and not go quietly into the night. Other than writing, their careers are in the past. Their lives focus on their children, grandchildren, and great-grandchildren.
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ACADEMIA - Carl Douglass
Sixteen
CHAPTER
One
The first day, specifically, the first evening, of his neurosurgery residency started more formally than Garven’s previous educational positions and involved his wife. The residents—one each year—were invited to an elegant and formal party at David Stark’s home in Beverly Hills. Elizabeth had rented a tux for her husband, and had a new formal dress made for her. She wore a single strand of pearls, rather than the diamonds her mother had given her, to avoid any hint of ostentation that might have embarrassed Garven. The couple was ushered into the imposing Tudor home on the corner of Elevado Avenue and Elm Street by an elderly butler.
Dr. and Mrs. Stark were both busily entertaining neurosurgeons and their wives from the city. Garven and Elizabeth were led to Frank Trentham, the chief resident, who then introduced them to the other neurosurgery staff men and their wives and to the other residents and their wives. The division of neurosurgery consisted of Dr. Stark and Steven Chou, the professors, Don White and Alfred Grossner, the junior staff men, both assistant professors, a chief resident, a senior resident, Richard Vondell, a middle resident, Carter Nesbitt, and Garven, the junior resident. Garven already knew most of the members of the neurosurgery division, at least as acquaintances. The rotating residents, from general surgery, and the interns were not counted in the official roster.
Elizabeth put her education to work and proved herself to be a major asset to Garven in the formal party environment. For his part, Garven was timid and felt awkward. He was well aware of his position back down at the bottom of the totem pole, and recognized that every surgeon present was his better. He felt that he did not have much to contribute to the conversation. He had the same feeling that he had every time he rose to the pinnacle of being a senior,
only to have to start over again as a freshman.
He looked forward to that mystical day some time in the future when he would not have to drop back to the junior
status again.
Each conversational group Garven approached tried to talk about something besides medicine, and they all failed. For the most part, the residents regaled the women with war zone stories from the EOR at U.C. Osterlund. They all had anecdotes that illustrated the poverty, ignorance, and brutality of the customers
and an irreverent attitude about the education, the customers,
the professors, and each other. It did not take long for Garven to be able to add his own unique experiences, to show that he was one of the boys. He told about the pianist, Van Gildersleeve, and they told about lover’s triangles and GSWs to the head. Elizabeth looked on with a poorly concealed look of consternation while Garven and his fellow residents laughed about the crudities and horrors of the world of the knife fighters
—the homo lupus homini [man is a wolf to man]. Garven had not spoken to her much about such things, and Elizabeth had maintained a picture of dignity and sympathy as the principle characteristics of the doctors in training and of medicine in general. She did not particularly like this insight into the underbelly of the Profession—the stories they only shared with one another.
Garven gained insight into the residents and the two junior staff men. The latter were unpopular with the residents, and they stood apart from the others. Neither of them was married, and all of the house staff men were. Frank Trentham, the chief resident, was a crude and foul-mouthed man from the high desert area of Los Angeles County, a minuscule little town named Mojave. He spoke of the place with unfeigned affection and let it be known that he planned to return there to become its first neurosurgeon. He was not well liked by the other residents, especially by the middle resident, Carter Nesbitt.
Carter took Garven aside and whispered, Frank’s a drug addict, pervert alcoholic, and half crazy. I feel sorry for you having to start out with him. If it gets too bad, look me up. I’m out to the VA with Richard.
Carter’s wife took Elizabeth aside and told her about Frank’s deplorable performance at last year’s party. He was unmarried then and showed up with a floozy who was wearing a low-necked dress with a skirt cut well above her knees. She had been loud and preferred the company of the men to that of the women. Frank himself had showed up in a tee shirt emblazoned with a Budweiser logo, a pair of shorts, and sandals with no stockings.
He’s just a show-off. Carter thinks he’s dangerous. We can’t, for the life of us, figure out why Dr. Stark seems to favor him over the rest of the residents, always has. Go figure.
Without being told, Garven concluded that Richard Vondell, the senior resident, was not one of the favorites of either the attending staff or the house staff. He seemed stiff and somewhat distant to Garven, although pleasant and engaging whenever anyone included him into the ongoing conversation. He was conspicuous because he was not drinking alcohol like the rest. Garven asked Carter about Richard when the two men were sitting down to eat Mrs. Stark’s seven-course dinner.
What’s with Richard? He seems to be a little outside the regular group. Am I right?
asked Garven quietly.
He’s okay. You’re right, though. He’s not really one of the guys. Doesn’t drink, or smoke, or go out with us. He’s a Mormon, you know. I thought you knew. They’re pretty strict, like the Amish, I guess.
David Stark proposed a toast and hoisted his wineglass. Everyone followed suit except Richard. Garven glanced at Carter.
Won’t even pretend that he has a glass of alcohol for appearance’s sake. Kind of a pain in the butt. He needs to do a little just to fit in better, if you ask me,
Carter said. He’s in a kind of cult.
Is he always like that?
Garven asked.
Yeah. He’s strict about it and won’t bend at all. The first time he came here, you know, at the dinner like this one, when he was a first year, he made kind of a scene,
Carter told Garven.
What kind of a scene?
Mrs. Stark offered him wine before dinner. He wouldn’t take any. She quietly told him that her husband was a stickler for tradition, and the wine toast at the opening dinner was an important custom in the division. He still wouldn’t take any or even pretend. Dr. Stark walked right up to Richard and looked him in the eyes. I remember what he said: ‘Not too good to drink with us, are you, Richard?’ Man, I would have withered on the spot. Not Richard. He was polite and really quiet. He said, ‘No thanks, Dr. Stark, I don’t drink. Ever.’ Dr. Stark looked at him like he’d just spit in the punch. He’s been on Richard’s back ever since. I’ll tell you something, Garven. It doesn’t pay to make waves around here. Trentham’s the only one who can get away with it.
Dr. Stark offered his toast. To neurosurgery and neurosurgeons, life’s most important activity practiced by the best men there are!
Everyone except Richard Vondell swallowed the excellent wine.
Dr. Stark looked at Richard in a side glance and smiled.
And to Richard, that he may keep himself pure.
Everyone laughed, Richard louder than the rest.
Frank Trentham stood up and proposed his own toast.
To the chief, who’s the best neurosurgical educator in the country, and to his wife, who puts on the best seven-course meals in the world.
He paused and took a drink from his refilled wineglass but did not sit back down. Her dinners are even better than the Osterlund habitués prepare. They have seven-course dinners as well, you know.
He looked mischievously at Mrs. Stark, who obviously liked him as well as her husband did. A six pack of Budweiser and a possum,
he concluded and sat down.
The chief laughed. His wife did, too, but she pretended to be shocked.
Elizabeth was a little shocked, in truth.
Is that the man you are going to have to work with most of the year, Garven? He doesn’t seem like the proper kind of brain surgeon. I don’t care for him; how about you, Garven?
She looked perplexed and doubtful, as if she had been personally affronted.
I’ll wait and see, Elizabeth. I’ll hold my judgment until I see what he’s really like,
said Garven.
The following day was Garven’s first on the service. It started with rounds at the unholy hour of five o’clock—O dark thirty
—as Frank put it when he called Garven late the night before to tell him about the starting hour. Frank, Garven, a rotating general surgery resident, Tom Matthews, and a straight surgery intern, Hank Withers, were all on the floor. The back one-fifth of the large neurosurgery ward had been modified to serve as a formal and well-equipped neuro ICU, and rounds started there. There were five beds in the ICU. Three of them were occupied by victims of GSWs to the head who were beyond help. The residents examined each victim—two men and a woman, two homicides and a suicide. Frank looked at Garven for a diagnosis after each examination.
Brain dead; no pupil function, no reaction to pain, no reflexes, no respirations off the respirator,
he said about each of the three.
What do we do?
Frank asked Tom Matthews, the general surgery resident.
Unplug ’em.
Agree, Garven?
Yes. We’d better let the family know, then we can do it,
Garven replied.
Don’t have time,
Frank said and took the respirator off each victim in his or her turn, clamped the IVs, and turned off the EKG monitors.
Garven looked quizzically at Frank.
The floor resident can tell the families after rounds. Let’s look at the rest of them,
Frank said.
The chief resident’s word was law, and the house staff men moved on. Five minutes of examination, decision making, and action had elapsed since they entered the ICU.
In twenty minutes, they had seen fifty-one patients, treated one convulsion that occurred from the stimulation of his examination, made decisions about what work was to be done and who would do it, and were ready to separate for the day’s work. It was a swift decisions making, no nonsense service. The decisions were sure and final—not always right, but always sure,
Garven remembered from somewhere.
Garven drew the short straw and had to stay on the floor with Hank Withers to do the day’s scut on the patients with cerebral aneurysms, brain tumors, ruptured discs, gunshot wounds and stabbings, and those who had medical problems to be attended to before they could be considered ready for the OR, or for discharge home or to the rehab center. Hank, who was starting his first day as an intern, looked like a piece of the sky had fallen on him when he was handed the entire floor scut list. Garven had to go to radiology to do the day’s myelograms, PEGs, ventrics, and angios. He was grateful that he had had the resident experience on neuro a year previously, even if it had been deemed to be premature. At least, he had a pretty good idea on how to do the work, which was considerably more than could be said for Hank.
Garven was on call that night. The entire service, including Dr. Stark and the attendings, White and Grossner, made hurry-arounds at seven o’clock, then everyone, except Garven, headed for home. The indigent patients’ H&Ps and scut work were all done. The only thing left for Garven before the EOR started its nightly telephone barrage was to tend to one new patient for White and one for Grossner. The two junior staff men were cut from the same bolt of cloth. White had done his residency in the WFMC in Rochester, Minnesota, and made sure that everyone he ever encountered knew that he was trained at the World Famous Mayo Clinic. Grossner was a mousy academic researcher type who had trained at Johns Hopkins.
They were both picayune-detail obsessed men who knew a prodigious lot about the neurological and neurosurgical literature and were able to quote chapter and verse from the latest Journal of Neurosurgery or from The Archives of Neurology. Garven had heard that neither of them could cut their way out of a wet paper bag and had come to Osterlund Memorial to get some hands-on surgical experience. They were both unhappy with the program because it was a resident’s service; the residents did the surgery and