Give Me Sugar

An airport security guard in a yellow Volkswagen beetle dropped me off outside the emergency room at about 3 a.m. He had seen me wandering around the airport with a suitcase, and I was grateful for his offer to take me to the hospital after his shift ended.

The next morning, the chief nurse oriented me to the patient floors, call room, and operating room. A secretary handed me a badge, several white coats, and household essentials such as bedsheets, towels, and pillow cases for the rental apartment in a hospital-owned building across the street.

Surgical rounds with residents the next day, January 28, 1972, turned out to be an eye-opener. Stethoscopes mostly stayed in their coat pockets. A workup consisted of “panels” of a sizeable number of tests, routine x-rays, and first-generation cephalosporins I had never heard of for postoperative pneumonia.

Beeping noises came from unrecognizable monitors and ventilators in an ICU. I was reminded of special permission needed for x-rays, labs, and the single ventilator in the surgical ward of the hospital.

That first night on call started with routine phone calls, and except for the need to ask about the generic names of the new drugs, I felt less anxious — until the ICU nurse called. “Doctor, I need you in the ICU to see Mrs. S, please.”

Upon arriving, I saw a somnolent elderly lady with an oxygen mask on her face. The nurse said, “Doctor, Mrs. S needs an A-line and a cutdown.” I observed an IV pole to the patient’s right with an intravenous solution bag hanging and a sterile kit on a stand. On the patient’s left was a similar IV pole and a wire connected to a monitor and a smaller-sized kit.

I had performed cutdowns at the bedside in my six-month surgical internship, so I understood the cutdown part, but an “A-line.”? Not wanting to appear clueless, I asked about the patient’s medical condition and indications for the procedures. The nurse then added, “We have had problems starting an IV. Her physician has also requested an arterial line to monitor her blood gases and blood pressure.”

I had seen blood gases drawn from the femoral artery but was unsure where the catheter was needed. Another nurse started uncovering and prepping both arms. Several scars from previous cutdowns at the elbow regions and needle sticks over both wrists were visible. Confident now that the arms needed to be worked on, I proceeded to check both her radial pulses.

After injecting enough local anesthetic, the percutaneous left radial artery catheter and the cutdown over the median antecubital vein at the right elbow went well. I quickly stitched the cutdown, took off my gloves and mask, and thanked the nurse as I started to walk away. Mrs. S had not opened her eyes or responded in any way, even when I warned her about feeling needle sticks. As I turned away, I heard her whisper loud enough for us to hear, “Give me sugar, honey.”

This phrase was not in my vocabulary. I looked around and failed to see a cup of tea, coffee, or drink. I then glanced at the nurse, who was smiling. In response to my puzzled look, she said,” Doc, she wants you to give her a kiss!” I replied, “Why?” The nurse, still smiling, remarked,” The previous procedures have been very painful, especially the cutdowns. I assume she is appreciative of the generous local anesthetic.” As I bent down and gave her a peck on the cheek, she opened her eyes and smiled.

My family’s acculturation proceeded with highs and lows as we discovered the nature of Americans.

I learned to write my first “thank you” note to the security guard who had deposited me at the hospital. A senior nurse took my wife and me under her wing and became “Granny” to our newborn daughter.

My father, while visiting four years later from Southeast Asia, required a coronary artery bypass at the same community hospital. I took the large hospital bill to the physician owner of the hospital, a retired surgeon, so I could arrange payments. He asked me to sit, put his reading glasses on, and looked at the hospital bill I handed him. He proceeded to tear up the bill, saying, “You are one of us.”

The generosity of ordinary Americans continued to overwhelm us.

REALITY CHECK

To my surprise, there were many professional hurdles at all levels of training. Reality was different from the Lone Ranger comics, Perry Mason shows, and Rock Hudson movies. The color barrier became apparent one evening in my first full year at the county hospital as a resident in charge of one of the busiest surgical/trauma ERs in the country. I happened to walk across the hall to the medical side and saw a nearly rubbed-off but visible “white’s only” sign over the water cooler. It would soon begin to make sense.

Our pyramid general surgery residency program went from 13 categorical spots to eight third, fourth, and chief residents. I did not make the cut until three of the selected residents dropped out for various reasons.

My rotation to the elite, almost all-white university hospital rotation as a chief resident was changed to another location. My grumbling reached the chair who threatened to end my career if I spoke again. My application to the vascular fellowship was rejected when every previous intramural candidate had been accepted.

CHANGE OF HEART

Hearts changed over the next five years. After not finding a fellowship spot, our well-known chief of trauma surgery moved up his trauma fellowship one year early to end my joblessness. I was accepted into a vascular surgery fellowship elsewhere the following year. My previous chair, who had changed my university hospital rotation, pulled some strings to get me in. Apparently, he offered to pay my annual salary if they were not satisfied.

At no time over a 40-year career did I perceive any racial- or ethnicity-related reaction from my thousands of patients. Within a few minutes of a consultation, their only focus was on their well-being and the resolution of their medical problems. Some were even blind to color or ethnicity.

Our group of three surgeons consisted of one pale Caucasian, another brown, and the third very dark brown in color. As I exited a semi-private room with my rounding team of residents, students, and nurses one day, we heard one elderly Caucasian lady telling the other, “These three Italian doctors are really nice!” I felt like going back and giving them “sugar.”