Residency: Detroit Osteopathic Hospital
The Detroit Osteopathic Hospital was an imposing structure situated on the corner of Third and Highland Avenue in Highland Park, Michigan. The main building was four stories tall with a tower in the center that rose to eight levels. It had a couple of hundred beds and an emergency room that was never empty. The DOH complex included several old mansions that were converted into intern’s quarters, resident’s quarters and a beautiful old house for the nurses. It was the most wonderful Osteopathic hospital that I had ever seen and was the crown jewel among Osteopathic teaching institutions. On the top floor of the tower was an auditorium, a well stocked medical library and an intern’s and resident’s lounge. It was a very busy emergency room. The seventh floor of the tower housed the administrative offices and the fifth and sixth floors were surgical suites. The emergency room had eight separate rooms and on weekends the ambulances would arrive in tandem.
When I arrived, the first thing I was told to do was to go across the street to the hospital laundry and pick up a dozen pair of white cotton trousers, a dozen white shirts and several white lab coats. A black tie was required to complete the uniform (I wore out several sets of clothing in the three years I was a resident). The new residents were told to contact the chief resident and he would assign us our duties. At DOH, the chief resident is always picked from the senior group of medical residents. I was assigned to double on his service for my first month. My introduction to the residency at DOH was by virtue of holding onto the coattails of the chief resident. He was a wonderful guy, Bill Toy by name, and he guided me through the various duties I was expected to perform for the next three years. It soon became evident that I was in over my head. The level of medicine at DOH was light-years ahead of the level of medicine that I had become accustomed to in Delaware Valley.
East Coast medicine is known for its conservative approach; DOH was aggressive. Let me give you an example: throughout med school, and my service time as extern and intern at DVH, I was taught to be very cautious when doing a thorascentisis (removing fluid that accumulates in the chest, usually on very sick patients.) The first week on service we had a patient with a chest full of fluid and I was told to order a setup and remove the fluid. I proceeded to prep the area on the patient’s chest, inserted a needle and began to draw 50 cc every five minutes. About 30 minutes into the procedure Dr. Toy walked in the room, took one look and said “No, No, Charlie, get a 1000 CC vacuum bottle and pull the fluid out.” I looked at him incredulously and whispered “But the patient may go into shock.” He smiled and said “That’s the nonsense they preach in Philadelphia but we look at things differently here.” Well, I attached the vacuum bottle, extracted about 700 cc in a matter of minutes, removed the needle and not only did the patient not go into shock but he said he felt better than he had in two weeks!! The three years that I spent at DOH were filled with similar experiences and with each passing month I was sure that I was in the right place.
The medical department had five senior internists with a medical resident assigned to each. There was one more service that included coverage of pediatrics, emergency room, and other internists who had staff privileges. In this way we rotated through each service twice a year. Not that the following names mean anything to you, the reader, but they are men in whom I have the highest regard. I rotated one-month service with each of the following internists: Stanley J. Turner, Joseph Amalfitano, E. Dean Elsea, Daniel Siegel and the kingpin of the medical staff, Neil R. Kitchen. In the next few pages I will tell you stories about each one of them.
Medical resident’s duties were formidable. The morning started by sitting with a radiologist reading the x-rays taken the day before. The radiology department was bigger than anything I had ever seen in Philadelphia and included a cobalt therapy room lined with lead dug deep into the sub basement. Then morning rounds on each patient on service, examining them and writing progress notes; at 11 AM, it was time to pick up the morning prothrombin times, adjust the anticoagulant schedule for each patient and head to the dining room for lunch (if you weren’t interrupted by a stat call somewhere else in the hospital).
A happy spot, and one frequented often, was the dining room. The hospital provided a very large cafeteria for visitors and family open every day from 7 a.m. to 7 p.m. The doctor’s dining room was a private affair but most of us had breakfast and lunch in the cafeteria. There were two staff internists who made rounds late in the afternoon. They would usually begin by congregating in the doctor’s dining room and the resident on service would brief them on the patients. The schedule was light or rigid depending upon whose service you were on. With Dean Elsea, everything was easy going. With Dr. Kitchen or Dr. Siegel, the day started promptly at 8 a.m. and ended only when they left the building which was usually 1 p.m. On Dr. Turner and Amalfatino’s service, rounds typically started at two or three in the afternoon and could go on until late evening. The screwy schedule made for difficult times on the home front.
My first several months on medical service were a real education. The system tries to start all new medical residents on service with Dr. Kitchen and that is where I began. He was a very severe taskmaster with little sense of humor, as a matter of fact, he was little all-around. He didn’t stand more than 5 foot three, had small hands, small feet but a huge intellect. I learned a lot from him, mostly his dedication to his patients. He would start out each morning at 8 a.m. and after I briefed him on what happened during the night he would look at me and say “Charlie, let’s go and take care of the sick people.” Rounds were usually finished by 1 p.m., he would go to his office and would not return to the hospital until the next day. In the three years I was a resident the only time he came back to the hospital in the evening was one night when I admitted one of his best referring physicians. Otherwise, I would admit his patients, make a preliminary diagnosis, call him and write the admitting orders. As he got to know me, his comment on the telephone was “Charlie, set the patient up and I will be there in the morning.”
The difference between Dr. Elsea’s service and service with Dr. Kitchen is the difference between a pleasant stroll in the park on a cool summer evening and a category five hurricane in the Gulf of Mexico. Dr. Elsea was a grand old man in every way. He was a physician of the old school, possessed of much more charm and engaging personality than medical acumen. His patients adored him and he had a huge practice. Dr. Elsea’s medical service provided a range of patients not unlike a typical doctor’s office in a remote northern county where he was the only physician for miles around. In the doctor’s dining room, he would regale the resident staff with tall tales about what it was like in Detroit before WW2.
Service with Doctors Turner and Amalfatino was difficult and demanding. The two of them had the largest practice in the area and consequently the patient load required two residents, one for each of them. During my time with them I saw a great variety of medical cases; my experience and competence grew with each day.
Service with Dr. Sigel was interesting in that he had a very small practice, which left me a lot of time in the afternoon to spend in the library or the pathology lab. I soaked up every bit of information that I could from journals, textbooks, periodicals and medical literature in all forms. The 60s were during the time of M.D. /D. O. estrangement and we were not welcome visitors to other medical institutions. The school of medicine at Ann Arbor held weekly clinical pathologic conferences and lectures on various medical topics. I took every opportunity to cut out of DOH and sneak into Ann Arbor for lectures.
I learned a tremendous amount of medicine at DOH and the doctor that I am today is because of the knowledge that was imparted to me and the experience that I got during the three years of my residency. The sheer volume of the hospital was impressive. There was never an empty bed and the variety of medical cases that I got to attend put me far above the average doctor. In a three-year period of time, I saw cases that the average general practitioner doesn’t see in a lifetime. It was a privilege and frequently a pleasure to be in that hospital at that time.