Polite Dissent

Last Thursday, the local health department held a flu shot clinic at the Moose Lodge down the street. They had 750 vaccinations, which they figured would be enough. People started lining up by 2:30 AM, and by the time I was trying to drive to the hospital at 7:30 it was a full traffic jam, with cars bumper to bumper. People were parking two-wide along the sides of the street and had even parked in the Lodge’s prized softball field. It took me twenty minutes to drive the two blocks past the lodge. I felt like I was back in big city traffic.

There’s a real shortage of flu vaccine this year in Illinois and it looks like I won’t have a chance to get vaccinated. This will be the first time that I haven’t received a flu shot in six years. They were offered to us for free during medical school, but in my first-, second-, and third-year I never got one because I knew that “I never got sick.”

That all changed quickly my third year, when I was serving my time doing a month of general surgery at the St. Louis Veterans Administration (VA) Hospital. St. Louis has 2 VA hospitals. One in way out on the edge of south county, but that hospital is used mostly for psychiatric care and long term rehab. The main VA hospital, John Cochrane, is located in the older part of downtown St. Louis. It’s not in the nicer near-the-Arch downtown, but instead the older downtown, full of dark streets, tenements and abandoned buildings.

Every morning in February, I would wake up at 3 in the morning, shower and shave. I would put on a pair of threadbare VA surgical scrubs, pull on my coat and gloves and trudge downstairs to scrape the ice off my car and coax it into starting. The road would be nearly devoid of other cars as I drove downtown. Being a lowly student, I wasn’t allowed to park in the VA lot, but instead had to park in a public lot three blocks away. That meant walking three blocks in the dark St. Louis morning, a freezing wind cutting through my paper-thin scrubs, skirting around vacant lots to reach the VA emergency entrance.

Entering the VA didn’t offer much relief. I’ve noticed that each hospital has a unique atmosphere — more like an aura. It’s hard to put into words, but different hospitals give off different feelings. For instance, most children’s hospitals give off a sense of hope and promise when you enter them. VA hospitals are the opposite. You could feel a palpable miasma of depression and despair when you entered the hospital.

I would trudge up three flights of stairs to the surgery residents’ room and drop off my coat and gloves. Wandering out to the ward, I would pick up may patients’ charts and begin “pre-rounding”. As a medical student, you are expected to know every single thing that has happened to your patients in the previous 24-hours; therefore you have to pore over their charts page by page and examine every inch of the patient before official rounding starts at 6AM. This pre-rounding process usually took just shy of two-hours. We would then round with the residents on our patients, pause for about 5 minutes, and then round on them again, this time with the attending physicians. After that, we would write notes on each patient and take care of whatever scut-work the residents or senior physicians needed us to do. In the meantime, we were also responsible for attending (and sometimes assisting) in surgeries.

The VA rotation was designed for five students. Unfortunately in February there were only three of us. That meant that we had to cover every third patient, attend every third surgery, and take call every third night. Then Amy, one of the other medical students, came down with a severe case of pneumonia. Now there were only two of us. Tom and I had to cover every other patient and attend every other surgery. Thankfully, we talked them out of making us take call every other night, but it was a close thing.

About the end of third week I started to feel very run down. I figured it was just the long hours and unpleasant residents taking their toll and tried to telling myself, “Just one more week.” Then I developed a hacking cough. It was mostly at night, and just enough to keep me from getting what little sleep I was able to scrounge. By Friday, I had developed a high temperature and felt totally miserable. I had muscle aches all over and uncontrollable chills. Now, as a medical student I knew that fevers were “bad”, but had not yet reached the point where I actually knew what to do about them. It never occurred to me that reducing the fever would make me feel better.

I also knew better than to miss work. Amy only got out of it because she was hospitalized. So dutifully I trudged into the VA like always. I pre-rounded, rounded, and rounded. Most of the rest of that day was a blur. I remember scrubbing into surgery and feeling absolutely horrible. Wearing a surgical gown, gloves, and hat is always hot; with a fever, it was absolutely unbearable. I was pouring sweat like a fountain. At one point, we were doing a bowel surgery and I was holding the retractor keeping the rest of the abdominal organs from spilling over into the work area.

“Hold that retractor steady!” bellowed the surgeon.

“I am,” I replied meekly. I was trying as hard as I could to hold it steady, but was simply shivering too much.

Finally, he glanced at me and noticed that I was clearly quite sick. Never let it be said that surgeons lack empathy. He eyed me up and down and then told me: “Then use both hands, idiot!” Is it any wonder I never wanted to be a surgeon?

I went home, wrapped myself in a blanket and slept for the next thirty-six hours. I haven’t missed a flu shot since.