In teaching hospitals all over the United States, July 1 is the day new interns and residents arrive on station. It can be a little intimidating because suddenly, you are expected to perform as a physician. In most cases, for the first month, the new interns are awkward and a bit unsure. (If you are a patient, try not to be admitted to a teaching hospital in July) My intern partners at Delaware Valley Hospital were Tom Halpin and Dave Miller and we were ready to begin. It was no problem for me; I worked there for the past two years and I felt at home. Our schedule was tough and typical of the times. The working day during the week began at 8 a.m. and ended at 6 p.m., all three of us on service during the day. At night, one was the night intern, one went home and the other was on call if needed. During the week it was one day on, one day off and one day on call and we rotated accordingly. The weekends were much the same; one intern on duty Saturday and Sunday, one free to go home for the weekend, and the other on call if needed. We were pretty strict about our nights and weekends on call. Something had to be really devastating in the hospital for the on call intern to come in. When you analyze it, it’s a heavy work week. Your turn to cover the hospital on the weekend started 8 a.m. on Saturday morning and ended 6 p.m. Monday. Then you got the entire night off but had to be back on duty Tuesday morning. We had our own intern’s quarters, a small room with a desk, bookcase, double-decker bunk bed and a bathroom with shower. With only three interns to cover the hospital the rotations were simple, one on medicine, one on surgery and obstetrics and one on the rest of the hospital.
Delaware Valley Hospital was a small community hospital with 75 beds that were constantly full. There was one operating suite and one obstetrical unit. The emergency room was active day and night and weekends could be a zoo. During our intern year, we had one medical and one surgical resident. Medical service was the most active, with several physicians doing internal medicine. We had one certified internist and several general practitioners who practiced internal medicine. There was one general surgeon on staff and a variety of surgeons from Philadelphia available for orthopedics, urology, gynecology and other special surgical services. It was not much of a teaching hospital and I elected to do my internship there because it was convenient, close to home and relatively speaking, I had a free hand. It was my plan to open a general practice office in the area and I gave no thought to a residency. My first love was obstetrics and I knew that if I opened a general practice in the area I would be allowed to do my own deliveries at the hospital. In the three years that I spent at Delaware Valley Hospital, as extern and intern, I did a lot of deliveries on my own. Several general practitioners, if they were too busy to come into the hospital, (a frequent occurrence) would let me do the delivery on my own . I got to be pretty slick at delivering babies and looked forward to a lifetime doing it. I didn’t care much for the surgical service, it consisted mostly of standing at the table and holding retractors. The surgeries scheduled were routine, an appendectomy, a cholecystectomy, the occasional gastrectomy and sometime a diagnostic laparotomy. Orthopedic surgery and the other surgical specialties were on a “when needed” basis. Surgery per se did not light my fire but medicine and obstetrics did. As much as I enjoyed deliveries, I began to be more and more enamored of diagnostic medicine. Examining patients and making a correct diagnosis is challenging and I began to think of doing Internal Medicine. I became a fanatic on signs and symptoms of disease and I would post the “syndrome of the day” on the wall of the intern’s room. I made morning and evening rounds on the medical patients in the house as well as performing my other duties. I became very friendly with the chief of internal medicine as well as the other practitioners on staff.
Working long weekends was physically taxing and I was usually wiped out by Monday evening. After one very hard weekend I went home Monday evening and slept long into Tuesday morning. When I finally woke up I realized I would be at least two hours late getting to the hospital. I was changing into my scrubs when the call came over the PA system for me to “report to the administrator’s office, stat.” I knew I was for it because it wasn’t the first time I was late for work. Joe Dummin was a regular guy and he had a well-developed lecherous side to his personality. He told me he was tired of my frequent tardy arrivals and if I had an excuse it better be a good one. I said that if I told him the truth he would have to promise to keep a secret. His eyes lit up and I related the following: "Joe, I was having a fling with a lady whose husband worked the night shift. It was 1 a.m. and we were in bed enjoying a roll in the hay when the front door opened and her husband walked in. I had nowhere to go except under the bed. The husband complained he wasn’t feeling well and left work early. He went to bed, she went to bed and I remained under the bed. He was restless, I was afraid to move so I just stayed where I was. He didn’t fall into a sound sleep until after eight in the morning and only then did I dare crawl out from under the bed and run like hell out of there."
The story is a complete fabrication but I swore on a stack of Bibles that it was the truth. He roared with laughter, slapped his good hand on the desk a few times and told me to get out of the office. When I got back to the interns room my partner Tommy Halpin asked what happened and I said “Tom, you’ll never believe it, let it go at that.” I thought that was the end of it but Joe Dummin was not the type to keep a secret. By the end of the day every doctor on the staff heard about it and pestered me for details. I had to go along with the story so I made up a few spicy bits. I got away with it but the story followed me like a shadow for a long time.
The week before Christmas the area was blanketed by a heavy snowfall. I was working the weekend and was called to the emergency room on Saturday afternoon. The patient caught his thumb in a band saw and almost amputated it. I took one look at it, stopped the bleeding, put a tight dressing on it and called Philadelphia for the orthopedic surgeon. He called me back and said there was no way he was able to get to Delaware Valley Hospital. He had other cases scheduled and would not be able to get to DVH until the next day. I described the thumb to him, that it was cut to the bone but still somewhat intact. He told me to do what I could and he would see the patient in the morning. To complicate matters, the patient was Mr. Horace Schmidt, Chairman of the Hospital Board of Directors. He owned Schmidt’s nurseries and flower gardens and was preparing hundreds of poinsettias for the Christmas season when he cut his thumb. He knew I was an intern and was not trained to treat his wound. He said it was foolish to wait until morning and that I should do whatever I could. I went to the library, took an anatomy book, brought it to the emergency room and opened to the anatomy of the thumb. I stopped the bleeding and sutured the tissues together; I probably put three times as many sutures as necessary. By this time the first digit had a dusky blue color to it and I was concerned about the blood supply to the area. I told him that I wasn’t sure what it would look like in the morning, that there was a 50-50 chance it would have to be amputated. I straightened it out, put it on a tongue depressor, covered it with antibiotic ointment and put a dressing on it. I sent him home and told him we would call in the morning when the orthopedic surgeon arrived.
I called him back to the emergency room at 10 a.m. Sunday morning with the orthopedic surgeon in attendance. I think we both held our breath while the dressing was removed. It was rather amazing; the thumb was pink, no sign of infection and other than a cobweb of sutures, looked pretty good. It healed but he was never able to flex the digit. He made a big thing of it and told the story all over town about how an intern saved his thumb. He brought it up at a Board of Directors meeting and showered me with accolades. I was at home on Christmas day when the doorbell rang. A Schmidt’s flower truck was outside and the delivery man brought in two dozen potted plants, compliments Horace Schmidt.
Internship
My internship was prior to the time of Intensive Care Units so when we had a cardiac patient we would convert the room to accommodate all the equipment we needed, ie., ECG machines, oxygen tents and a cart with cardiac drugs. When we had a particularly difficult medical case we would call Philadelphia for consultation. I became well acquainted with Dr.’s Segal and Licoff from Hahnemann. To watch them examine and diagnose was a thing of beauty and I knew then that internal medicine was for me. I talked about it with Dr. Ralph Tomei, a certified internist and our chief. He told me to apply to Detroit Osteopathic Hospital for a residency in medicine under the tutelage of Dr. Neil Kitchen. There were many obstacles in the way; primary among them was the fact that DOH only accepted medical residents from their intern class. Neil Kitchen was a legend among medical residents in Detroit. He was a brilliant but harsh taskmaster and honed his residents to a sharp medical edge.
I talked the situation over with Agnes because taking a residency anywhere was a difficult decision. It would mean another three years of hospital living and hospitals were not known for their lavish pay scale. Leaving the comfort of home was another major problem. We had three children and to go to Detroit would be our first experience living away from our parents. We both knew that Detroit was a long shot because they never accepted a medical resident from outside their intern class. We talked about taking a medical residency somewhere in the city but I was firmly against it. East Coast medicine is ultraconservative and I was looking for something aggressive. Detroit had a reputation for quality and volume. One of the most important things in a teaching institution besides quality is patient volume. It’s no good spending three years of your life in an institution that doesn’t have a volume of varied patients. I made several calls to the administration at Detroit requesting an application and information as to salary and housing. From everything I was told, I didn’t think I had a chance of being accepted. Hospitals don’t choose the new resident staff until May. I had nothing to lose so I filled out the application, sent it in and waited. I didn’t give it much thought; as a matter of fact, I started to look for an office to open a practice.
Levittown was a suburban community close to the hospital, a booming city planned and built by Levitt & Sons. What set Levittown apart from other developments is that it was built as a complete community; it was a perfect practice location. The homes were moderately priced and required only a low down payment. I found a home on a corner lot that was ideal. It was the ‘Country Clubber’ model and could be adapted to office space and living quarters. I talked it over at home and Agnes was all for it. I contacted a real estate agent, put $100 down and planed to open in July. Agnes and I were excited and we started to make plans for a new life.
At the hospital, we continued working rotating services. I had good relations with the staff and most of the nurses. I had particularly good relations with Willie Mae, the head cook. She was a religious black lady and when I was working Sunday mornings I would go into the dining room early and conduct a sing-along with Willie Mae and everyone else in the room. We sang Rock of Ages, Bringing in the Sheaves and many others; we sang them long and loud. Willie Mae’s face would light up and when the singing was over she would cook a plate of steak and eggs with home fries. It was only on the menu for me.
There was a nurse on staff who did not like me. I have no idea what I did to make her dislike me but ‘dislike’ was a mild way to put it; she thoroughly despised me. She became pregnant and as her time drew near, she made it clear to everyone on staff that I was to have nothing to do with her delivery. She was admitted to the obstetrical service and started labor. It was her first baby and labor was difficult and prolonged. Her attending physician was a general practitioner and did not want to induce her. She put a sign on the labor room door that read “Dr. Del Marco is NOT allowed in this room.” It was a Saturday afternoon and as luck would have it, I had the weekend duty. Her doctor was known to enjoy a drink now and then and for whatever reason, he was nowhere to be found and no one was covering him. With each passing hour, her pains got worse and soon the child was ready to enter this world. Throughout the afternoon, the nurses came to me with reports but there was nothing I could do. It finally got so bad that the head OB nurse pleaded with me to go into the labor room and talk to her. I put on my best bedside manner, explained that her doctor could not be found and I was the only one in the house. I told her that with her permission, I would take care of her to the best of my ability.
She was weak, tired and in pain; she had no alternative so she told me to go ahead. I left the room and hustled the nursing team to get ready for delivery. I silently vowed to do a first class job of it. I scrubbed in and gave her a block to relieve the pain. I put her up in stirrups, did a right lateral episiotomy, slipped in a pair of outlet forceps and delivered a healthy baby. I remember thinking to myself as I repaired the episiotomy, “I’ll put you back together better than you were when you walked in.” The rest of the evening was uneventful and when I saw her in the morning she was comfortable and resting. I told her that all went well, her baby was doing fine and her doctor would be in shortly. She looked at me, mumbled something, but not thank you. As a matter of fact she hardly ever spoke to me again. She and her husband left the hospital, mother and baby in good condition. I never got a handshake or a thank you, but that’s the way it was…….and that’s the way it is.
There was a small room at the end of a hallway that did double duty as a library and an examining room. There were shelves with books along one wall and a treatment table in the center. One evening I walked in looking for a book and found one of the doctors standing by the treatment table with his pants down around his ankles. One of the nurses was lying on her back on the treatment table. I guess you could say he was giving her an internal examination but it would be a bit of a stretch. They were startled; I was startled and I left as quickly as I could.
Oh, did I mention that he was the Chairman of the Executive Committee? From that moment on, my internship was secure.
The following incident occurred after a particularly difficult night in the emergency room. I was on call and awake most of the night. My two partners arrived around 8 a.m. and I got out of my scrubs and into the shower. The water was hot and I was lathering up for a 'fare thee well' when my partner Tom popped his head in and said “Joe Dummin called and wants in his office right away,” I said “tell him I’m in the shower and I’ll be there when I finish. Tom came back a few minutes later and said “Charlie, Joe said he wants you right now.” “Tom, tell him I’m soaking wet, for Christ’s sake.” After a few more minutes, “Charlie, he wants you now and he means right now.” My hair was full of shampoo and I was soaking wet but I put on a lab coat and walked out of the intern’s quarters, straight down the hallway to Joe Dummin’s, office dripping all the way. I burst into his office saying “Joe what the hell is so important that it can’t wait another 10 minutes." Then I purposely sat on the edge of his desk and dripped water all over the papers that were on it.
He screamed "You're crazy, Charlie, Crazy; get the hell out of here."
Now that’s the way it happened but the story that filtered through the hospital was that I walked naked down the hallway dripping wet into Joe’s office. Once stories get started its hard to defuse them. Truth is the first thing that suffers when people are spinning yarns. Maybe my lab coat was open a bit but I was far from being naked….well maybe not that far.
A lot of interesting things happened during my intern year but the memory of the incident I’m about to relate remained with me ever since. One night when I was on duty, the house was reasonably quiet and I went to sleep in the interns room. It was 1 a.m. when the night nurse got me up me and said that a patient was unable to sleep and wanted to see the doctor. I ordered a sleeping pill but the nurse returned a few minutes later and said the patient refused the sleeping pill and wanted to see the doctor. I got up, put my lab coat on, and went to see the patient. I turned on the soft night light, pulled the drapes around the bed and asked what the problem was.
The patient was an attractive middle-aged woman sitting up in bed, rocking to and fro. She said she couldn’t sleep. I told her that she should take the medicine I ordered, it would help her sleep. She looked at me for a long moment and said “I think I would be able to sleep if you would kiss me goodnight.” I told her it was an unusual request and that such an order is not in the medical pharmacopeia. She reached over, took my hand and said gently, “Please kiss me goodnight.” I remember looking at her, thinking, "why not?" I leaned over, gave her a warm smooch on the lips and said “now please go to sleep.” I left the room and she went to sleep. She was discharged the next day and I never saw her again.
The intern year was coming to an end and I was busy making preparations to open a practice. It was sometime in
May when I got a letter from Detroit informing me that I was accepted for a three-year medical residency. It was a time of mixed emotions; I wanted the residency but with three growing children at home, economics suggested that I open a practice. Agnes and I talked it over for several days and Agnes said that if I wanted to go to Detroit to study for another three years she would be with me 100%. I have always admired her for what she did because it meant another three years of struggling, scratching and stretching to make ends meet on a resident’s meager salary. I called DOH and told them that I would be ready to start on July 1. Several weekends in June, I went to Detroit looking for a place for us to live. I signed a lease on a two bedroom apartment in an a complex several miles from the hospital. In the meantime Tom Halpin, my intern partner, was thinking of opening a practice in Levittown. I had an office location ready to open so I turned it over to him. Of interesting note, Tom practiced in that same location for the next 30 years.
One of the last things that I did before leaving Philadelphia was to satisfy the vendetta. I went to La Salle looking for Bro. David Cassian. I had difficulty finding him because he was no longer associated with the High School. I found him in an obscure office, barged in and said, words something like “Remember me? I’m the little dago whose days in school you said were numbered. Guess what, you bastard, I finished my internship, am a licensed physician and I am on my way to take a three year residency in Internal Medicine. If you are still here three years hence, I will look for you.” I left the office before he could say a word.
The internship was over in June. My intern partners and I shook hands, wished each other good luck and I headed for Detroit. I remember driving 12 hours nonstop from Philadelphia to DOH to start the residency. A week or so later, Agnes and my mother stuffed three children in the car and, along with all our worldly goods, drove to Detroit. We didn’t have much in the way of material goods so we bought what we needed at a secondhand furniture outlet. We settled in and spent the next three years in a cozy little apartment.
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