Lost and Found in the Call Room

Medicine Mensch 5 is here, so you can continue your vicarious medical-school education. (Study hard, there'll be a test later.)

Update: 4, not 5. You haven't missed one.

At long last: I'm posting the whole thing below (I had to ask my Forward folks if it was okay first), and I'll post my other Medicine Mensch articles on my blog over the next couple of days.

MEDICINE MENSCH: Has Anyone Seen a Wedding Ring?
By Zackary Sholem Berger
April 1, 2005

In between patients, each room in the hospital has a life of its own: The operating theater is prepped for another run; the delivery room is ready for another baby to come down the pike. Everything's sterilized and rearranged. While the attendants and residents wolf down their cheeseburgers, a medical student (that's me) retreats to the residents' call room to make quick work of his dependable cheese sandwiches and raisins. ("Oh!" a resident says admiringly. "You're so healthy!" "No," I respond. "I'm kosher.")

The call room is a place that many patients wouldn't want to see, since its workaday normality might disappoint those who expect their doctors to be something other than run of the mill. Imagine your break room at work, but without the stern hand and refrigerator-clearing punctiliousness of an office manager. This room is furnished with chairs that also have served as footstools and as impromptu beds; a refrigerator higgledy-piggledy with old lunches, and a TV talking to itself. Off the main call room is the back room, with a bunk bed; piles of white medical jackets, coats and other clothing, and a box of shoes that hasn't been touched since the Ford administration. Project onto this backdrop the rhythms of any workday: petty frustrations and jealousies, hot- and cold-running gossip, and unavoidable tedium, and you can understand why "ER" never could be called "Call Room."

Last week I lost my wedding ring in the back room. It's probably still there.

It happened like this. I had a week of observing surgical procedures. Surgery, like a symphony orchestra, is fascinating in the abstract but puts me to sleep after the first 30 minutes. I strain to keep my eyes open; I think of chapters from the textbooks I'm studying; I say Psalms under my breath; I eat a good lunch and sleep right; all to no avail. Luckily, my head jerked up with a start just as I was about to fall, face first, into the instrument tray.

Observing procedures is a lot less boring when your hands are allowed into the surgical field. "This is the aorta," a surgeon said during one procedure, and I said to myself, "Put it away before something happens to it!" Nothing untoward happened, even though I was only 18 inches away — partially because I wasn't allowed near any of the knives. My job was to retract, to pull apart the edges of the incision to allow the surgeons to see as much as possible.

Even for this minimal participation I had to get ready like the high priest entering the Holy of Holies. Before I donned the surgical gown and the surgical nurse held open the gloves so that I could stick my hands down into them, I scrubbed up just so. First fingernails, then sides of fingers, then fingers, palms, backs of hands and arms. I was cleaner than I'd ever been in my life. This reminds me of washing hands before breaking bread, which is similarly governed by precise detail but for a very different purpose: not cleanliness, but sanctification through the remembrance of Temple purity. In both sorts of washing, extraneous objects must be removed from the hands (although, relying on some fairly obscure leniencies, I don't take off my ring before washing for bread). I took off my watch and stuck it in the pocket of my scrubs. The first time I ever scrubbed in to a surgery (a long three weeks ago), I forgot to take off my wedding ring. As I stuck my left hand through the sleeve of the surgery gown, ready to meet the glove midair, the nurse raised her eyebrows as she glimpsed the band on my finger. "Uh-unh," she said. I retreated to the sink and started over.

Before long, I had come up with a place to store my wedding ring before scrubbing up — my Palm Pilot case — and had congratulated myself on my cleverness. Last week I was getting my things together after a long and frustrating day. I had gotten up at 3:15 a.m., arrived at the hospital at 4:30 a.m. to write notes on patients' progress after their surgery, and stood at drowsy inattention during a six-hour procedure at which I did not fall over onto the patient. I was standing in the back call room — the one with the bunk bed, piles of clothing, a box of neglected shoes and a general air of summer-camp disorder — ready to restore myself to everyday life, complete with wedding band, and go home. I opened up the Palm Pilot case, and, with a happy clink, the ring sprang free to find a new home. I haven't seen it since then.

Of course I got upset, like any normal person. But it's hard to stay annoyed about things you've lost when among the patients you see the next morning is Dolores, a woman who had a hysterectomy as a treatment for uterine cancer and (as a bonus) some of her very large stomach removed to make the operation easier. At 6 in the morning, awakened by a medical student's awkward questions, she was hardly even put out, and very happy with the belly button reconstructed for her by the surgeon. Here's to her new navel, and here's to whoever finds my wedding ring. May you use it on happy occasions.

Zackary Sholem Berger is a medical student, but someday (he hopes) he'll be a doctor. This series of columns traces his metamorphosis from one into the other. Send comments, complaints and lost-and-found notices to doctor at forward dot com. No medical advice given.

Empire of the Bland

Certain restaurants are the bedrock of existence (Chennai Garden, Mendy's). Some restaurants are like old friends who you know won't write or call more than once a year -- and that's okay. Whenever you meet, you immediately pick up again where you left off as if no time had intervened; phone calls or e-mails would just get in the way. Such a restaurant was Gan Eden Glatt, an Uzbekistani place (I think; I'm not knowledgable in Central Asian cuisine, but I know what I like) on 74 W 47th St. Whenever I found myself nearby, either for reasons of jewelry or buying Chasidic newspapers, I would drop by for a plate of plov, some spicy soup, or a skewer of grilled meat. All ridiculously cheap, and served up with a Soviet-style, um, nonchalance: "You don't like it, find another restaurant.' Usually there was a group of guys in the corner dressed in sweatsuits, talking tough and looking nasty. I'm sure they were perfectly lawful gentlemen whose dress was only an ironic tip of the hat to the prevailing stereotype. Once I (accidentally) stepped on the foot of one of them, and had to quickly apologize because I wasn't packing any heat that day.

I was in the Diamond District the other day to replace some jewelry I had lost (more on that in my next column), and I decided to satisfy my need for non-humanely slaughtered, kosher meat. I walked up the two flights of stairs and I stopped stock still at what I saw on the door:

Dougie's Express.

Now, you might know Dougie's on the Upper West Side. I'm probably one of about six or seven people on the planet who find it a somewhat unappetizing -- okay, gross -- testament to Orthopop* conspicuous consumption. But it serves a purpose. Then Dougie's opened a dairy place next door. Two is maybe one too many, but stil not out of the ordinary. This Dougie's Express, this extra slice of white bread added to a tasteless table of kosher alternatives in the city, is just too much. I (should have) immediately ripped a hole in my lapel and sat down on the floor, wailing and lamenting.

*Orthopop: Orthodox pop culture. I'm trying to find a good term for it. I know "Orthopop" sounds like it means pop music, though, so if anyone can figure out another good word -- or if there's one already I'm ignorant of -- speak up!

If you haven't heard enough about metzitzah b'peh
Please read on.

My instincts, both scientifically and halachically, tell me that those advocating metzitzah b'peh by suction tube (rather than direct oral suction) are in the right. But if the haredi community considers it important enough, another option might be to institute a stringent screening program for mohalim such that herpes would disqualify. Technical details of testing aside (which would be difficult to various reasons), ethical problems would still remain in this case. Even if a community were to accept upon itself some risk for deleterious outcomes (i.e. genital herpes) in circumcised children, such acceptance would not be legitimate, for the simple reason that the consent of these infants is impossible to obtain!

What comes to mind, however, is that such consent is exactly what we are not obtaining in (non-herpetic!) circumcision. There is an obvious difference, however. Normal circumcision (i.e. with a non-diseased moyel, or non-oral suction) is a medically safe procedure. Circumcision with oral suction, as demonstrated in this paper, is not. Of course, the case for circumcision still needs to be made, but it is prima facie defensible in a way that oral suction isn't.

בחורים וגם בתולות . . .
Young men and young women . . . (Psalm 149)

I don't have time to generate original thoughts, but I can share my stored-up thoughts that others have certainly had. For example: where are all the children's books which feature (or at least show) girls studying Torah? I've asked around at my egalitarian shul, I've Googled, I have "searched but not found." Help me?

Newborn medical students
And other miraculous beginnings.

My new Medicine Mensch article, written between deliveries.

And here it is in full:

MEDICINE MENSCH: Bringing Up Baby — and Doctor
March 4, 2005

Even God needs help when making miracles. He sent a wind to split the Red Sea rather than doing it directly; Moses took intensive elocution lessons before he could shout the Ten Commandments down to the Israelites, and the walls of Jericho could well have been jerry-built by history's first unscrupulous contractors. Add to this list the Miracle of Birth, which requires a number of gadgets that whir, beep and gargle to help doctors coax new life into the world. As I begin my rotation in obstetrics and gynecology (OB/GYN), I know to treat these machines with wary respect, stepping aside as the all-powerful nurses set them up, then copying down their flickering readings with equal parts diligence and ignorance. One new mother attached to a monitor wanted to know whether her blood pressure readings were good or bad. "They went up, and now they're coming down," I answered lamely, to her silent dissatisfaction.

A few days ago, for instance, I participated in the delivery of an ultra-Orthodox woman's baby. Most such women, though young, already have a number of kids, and respond to my questions either in blasé fashion or with outright impatience, aware that they know their own physiology better than I ever will — after all, it's served them for the past four or five children. Their next birth will be fine, God willing, and, in any case, they've got an experienced obstetrician waiting in the wings to help make sure the miracle proceeds as planned.

When I say "participated in the delivery," I mean that at first I stood in the corner, paralyzed with fear, hoping that if I were asked to catch the baby, it wouldn't slip out of my hands like a wet trout. (Newborn babies should come with grippable surfaces, as do basketballs or pistols.) As it turned out, I did leave the corner, when invited by the attending physician to help support the mother's body and the baby's emerging head in a way that made me think I was helping. (This is an essential part of teaching: making the student think he or she can be of service even when it's not the case.) I put three fingers on that warm, black-haired dome and, together with the doctor, gave a gentle pull. The newborn flopped out purply with a healthy cry, caught by the doctor, or — more important to my terrified self — someone other than me. I didn't drop anything! The baby was transferred carefully, but with great speed, to a couple of waiting pediatricians.

This is the point when the father swung into action with his own piece of equipment. As the pediatricians hovered around and above the child (I thought doctors and father were going to butt heads, but, by another miracle, they did not), Dad held his cell phone up to the squalling bundle, broadcasting its cries to a grandmother in Brooklyn. The father returned the phone to his ear, said "Mazel tov" and burst into tears. (He had been in the room the whole time, learning Torah, carefully training his eyes on the monitor or out the window when the mother-to-be, his wife, was convulsed in another epic round of pushing.) His wife asked him, in Yiddish, "Host yeder gekolt?" ("Did you call everyone?")

Off in the corner where I stood, another birth was taking place, helped by nature and by medical school, if not quite by God. A new medical student — me — was coming into the world. Sure, this is my second rotation, but the first, though fascinating, was the decidedly nonstrenuous 9-to-5 Psychiatry rotation. The first couple weeks of OB/GYN has you working from 4 in the morning till 7 in the evening. The unit in which I'm stationed delivers around a hundred babies a week. Here, what's miraculous is the transformation of the act of birth from the breathtaking to the manageable. "This is not normal," one new mother said, smiling through tears, trying to describe her feelings as she watched her baby being cleaned and monitored by the pediatricians. "Every delivery is different," the doctor responded, friendly but underwhelmed, as he sewed up an incision.

A miracle becomes everyday through systematization. The people were stunned by their first exposure to the divine voice, and refused to listen to God after his first words, but Moses had done it a thousand times; for him, it was already routine. When I see a pregnant woman, as ripe as a watermelon, warily approaching the secretary to say that she's here to give birth, I realize that this might be the first time she's ever said those words, while it's maybe the millionth time they've been uttered on this floor. Miraculous acts are not available to the medical student, but a short interview and physical exam, performed in the service of routine medical evaluation, can make sure that the abnormal and the wonderful give rise only to results that can be treated and managed. At least in the medical realm. As for raising the children themselves, that's an even more slippery fish to catch.

Zackary Sholem Berger received his doctorate in epidemiology in January from New York University. Now he's becoming that mythical figure, the Jewish Doctor. His OB/GYN rotation lasts until Purim, when he will not deliver any babies while drunk — or sober, for that matter. Questions and comments can be sent to doctor@forward.com; no medical advice given.