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A MONTAGE OF RESIDENCY MEMORIES
By
Jay
Lieberman, DPM
by Jay Lieberman, DPM
Editor, PRESENT
drjayl@prodigy.net
In 1981, a good surgical residency was hard to come by.
Only 30% of the podiatry school graduates got into a credible surgical
program. Another 40% accepted programs simply to obtain a certificate.
The remainder of the class took preceptorships or went directly
into private practice.
I recall standing in front of the Joint
Disease Hospital with the envelope from CASPER in my hand, too afraid to look at
the contents. Eventually, I mustered the courage and saw the match
with Osteopathic General Hospital in North Miami Beach, FL. Not bad, a
good surgical program in a clean, well run hospital and nice weather
to boot. I had spent a month at the hospital earlier in the year and
got to know most of the attendings. While staying in the
resident quarters across the street, I also became familiar with the
Palmetto Bug. A half cockroach, half rat, that flies. I usually
slept with one eye opened, fully clothed.
Dr. Steven Spinner had just taken over as the director
of the Program. It seemed to me that most directors had one or two traits that
made them extraordinary. They were either great educators and
modest surgeons or great surgeons and modest educators. Steve
was unique in that he possessed three strong traits. He had (and still
does have) a great pair of hands; he possesses a wealth of knowledge and is
a great educator. He is also an eloquent
speaker. As hard as we tried, we could
never bluff our way through anything. Steve had our number. His weekly lectures were
phenomenal. For an hour, he would go into what appeared to be a ZEN
trance and relay to us all he knew about a particular subject. A great
guy!!
The food at OGH was outstanding. Once a week, the
ladies in the cafeteria would put together a dish called Mambi. A Latin
dish that usually contained most of the week’s leftovers and a fair
amount of low-density lipoproteins. We could always count on a visit
from a semi permanent inpatient
octogenarian named Mrs. Mingelbaum who would shuffle her way to the
cafeteria, with the back of her gown flying open to pilfer some of the
offerings each day. It was particularly memorable if she dropped her
food and had to bend down to pick it up.
Minimal incision surgery (MIS) was the rage at the time.
Classmates of mine were making fortunes while I was collecting
less than $200.00/week. Radiographically, it looked horrible, but
people were lining up for the simple approach to foot surgery.
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Closed Mitchell, Akin and Other
Assorted Horendaplasties |
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Pre op |
Post op |
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I spent a lot of my free time in the emergency room.
Some of the memories from that time are burned very deeply into my
memory. Here are some events that have remained with me for all
these years.
The local recreational drug retailer came in one night
with a large knife buried to the handle into his clavicle. His neck was
engorged with hematoma, but he managed to survive and continue with
his profitable business.
An immigrant family arrived one afternoon with the body
of a small boy who had wandered off and had been found in the bottom of a
neighbors pool. The ER staff worked for over an hour with tears in
their eyes as they tried unsuccessfully to revive the lifeless
boy.
A lady arrived one evening with severe abdominal pain.
She was unknowingly pregnant and in labor. I followed her to L and D to
watch the delivery; a moving experience.
Neurology Grand Rounds was always fascinating. Pressure on the “Main Brain Nerve” applied by the attending
brought
forth a myriad of interesting responses. For example a motionless hand
was suddenly able to move. The pain associated with a migraine
headache immediately resolved. The power of suggestion can be amazing
when utilized by an imposing neurologist.
My first correct
diagnosis
The patient complained of intense pruritis one
week after showering at the local YMCA (the classic causative factor). My
clinical examination revealed exfoliating skin, web space fissuring and mild
erythema in the webspace. The KOH was positive for dermatophytes.
Although it was early in my residency program, I knew enough to get this man
some Loprox post haste.
My second correct
diagnosis
There is no escaping my keen
diagnostic skills. The history revealed the gentleman to be a non
compliant insulin dependent diabetic, with a 610 blood sugar and a 420
cholesterol. He smoked two packs of cigarettes a day and hadn't seen his
physician in over a year. I pulled out my Merck Manual, reviewed risk
factors and came up with the diagnosis of gangrene secondary to peripheral
vascular disease. Wow!! I nailed this one!!!
No diagnosis, but one heck of a differential
(Little practical joke on me)
One of my attendings sent me to work up this "airline stewardess" for
an Austin Bunionectomy and 5th toe arthroplasty. I had to check with Steve
on this one.
Iatrogenically induced
elevatus
Nothing was sweeter than to crank
down that IM angle to almost zero. What was the best approach? Loop
circlage wire or cross K wires? The AP views were always impressive, but
invariably the patient ended up with an elevatus status post closing abductory
wedge osteotomy. That's why they call it practicing medicine.
ORIF !!!!
Although we never wanted to see
anyone hurt, we relished the opportunity to take one of these to the
OR.
Earth Shoe……. The end to our
profession as we know it?
Curiously, we saw an increased
amount of patients with injuries to the Achilles Tendon. Correlation, or
not?
My best result
I brought this one home for my wife
to look at. We started looking for homes in the better
neighborhoods. Little did we know that managed care lurked in the
shadows.
PRE
OP POST OP
Misfortune
This horrendous injury was caused
when the rear tire of a cement truck rolled over this poor fellow's foot.
The reduction of the rearfoot dislocation was fairly simple.
Unfortunately, the circulatory status could not be re established and the
patient went on to a below knee amputation.
Surprise!! Send the specimen in
alcohol, not formalin!!
Beware, Residency Applicants.
Gout crystals will dissolve in formalin. This is a commonly asked
question.
The cheater
Akin!!
Many in our profession did not
believe in subjecting the patient to a metatarsal osteotomy. A McBride
Bunionectomy with aggressive Akin was the answer. These patients
invariably returned to surgery years later.
The responsible way of
evaluating an x ray
We scrutinized each pre op x
ray to death, and then the attending did whatever he was most comfortable with
anyway.
Me at my
best!!!!
The lady I am treating here is my
grandmother. In her time, she welcomed, fed and oriented more immigrants
into the United States than the processors at Ellis Island.
Please
share with me and the rest of the podiatry community, memorable moments
from your residency.
Send in YOUR Stories
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