...from “I’ve Got To Write a Book!”
by Ira Wiggins
Doctor’s Days and Nights
When I left the army I had paid off only a small amount of my debt to my father. Betty suggested that we take time off for the honeymoon which we had never had but I was not convinced. I was eager to start working in private practice, pay off my debts, buy a home and raise a family. We had decided that six or eight children would be about right, a number we were to reduce to four after the first baby and to further reduce to two after the second one.
Declining to work as an employee or an associate, I preferred to be on my own and, through medical journals, had lined up several possibilities. One was a practice in the suburbs of Chicago, Betty and I looked at it and agreed that it was in an area that was too crowded, dirty, bustling and big-cityish. We both preferred life in a small town.
The second place on our list was a small town, population 1,600, in southern Michigan, only about 35 miles north of the Indiana-Ohio border. It was on the highway between Chicago and Detroit., formerly the old indian Sauk trail. As we drove in from the north in my father’s car we were impressed by the well-kept appearance of the farm homes and by the prosperous appearance of the fields and orchards. We were already half sold. The practice for sale was that of a recently deceased, older and well-loved physician. Office space was on the second floor over the bank building on main street. It consisted of a waiting room, a consultation-examining room and a drug room which did double duty as a dressing room for patients. On hot days I was to use a large block of ice in a pan with a fan behind it as a crude form of air-conditioning. The few hot days we had in southern Michigan did not warrant the expense of a regular air-conditioner, - at least not with my state of financial affairs.
The town looked to us like our idea of a good place to raise a family and to start our life’s work.
The widow, Mrs. Fisk, let us know that she felt some responsibility for the type of physician she chose to bring to Jonesville. She intimated that the other physician in town, Dr. Luther Day, might not be entirely happy to see us come. When we met him we found the exact opposite to be true. He was overworked and was most eager to have another physician to share the responsibilities. He was cooperative to the extent that he even gave me the names of some of the most notorious “deadbeats” on his list. To me that was entirely “above and beyond the call of duty”. His many acts of helpfulness and generosity to “the new doc in town” I will always remember.
Mrs. Fisk was agreeable and on July 18, 1946 I gave her a check for $1,500.00 ($300.00 for drugs in stock and $1200.00 for equipment and medical records). The office space was owned and maintained by the bank. Rent was $25.00 per month (1946). Now there are certain disadvantages to having a doctor’s office on the second floor with no elevator. For one thing, some disabled persons are unable to navigate the stairs. On the other hand I found the location not without its advantages.
“How many times did you have to stop today coming up my stairs, Mr. Gillis?”
“Y’know, doc, when I first came here I had to stop at least four times to rest coming up the stairs, but since I’ve been taking that heart medicine I only have to stop once, and I’m not breathing as hard when I get to the top.”
“That’s good, Mr. Gillis. We’ll continue the same dosage.”
Due to painting, cleaning and rearranging, the office was not scheduled to be opened until Aug, 12. Betty had agreed to be my nurse-receptionist for the initial months of my practice. Fortunately her memory for names was as phenomenal as mine was atrocious. On innumerable occasions she softly let me know a patient’s name to save me embarrassment.
Eleven days before the office was open a local widow lady called and asked me to see her in her home. I gladly complied. The diagnosis was arthritis and the charge was $3.00. Three days later, as I was leaving town for a few days just prior to opening the office, I dropped by her home to see if she was improving. No charge, of course. She was most impressed by this act of concern and told all the neighbors what a caring doctor I was. Well, she was my first patient in private practice and I wasn’t about to let anything happen to her.
On Monday Aug. 12, 1946, the first day the office was open, ten patients came in. The charges ranged from $1.00 (advice only) to $3.00, including medications. At 7:00 p.m. I was called to see a lady in her home 7 miles away ($6.00). Every patient paid cash and the total income for the day was $30.00. In the next few days there were Pre-marital blood tests ($1.00 each), suturing of an avulsion of the scalp ($10.00) and daily home calls ($3.00 plus mileage).
The second Monday the office was open I saw only four patients, with a cash income of $8.00 and one $3.00 charge for a dressing. My busiest day of that month was Sat. Aug. 31 on which I saw nine patients in the office, made seven home calls and an emergency call to the local asphalt plant where a man had been run over by a coal car. He was being pronounced dead by Dr. Day as I arrived. Frantic by-standers had called both of us to the scene. Total income for the day was $51.00 cash and $7.00 in charges.
The following day (Sunday) I made four home calls and sutured a lacerated arm in the office. Medical practice in a small town, I found, was to be a 24-hour-a-day, seven days a week job. A few years later, during a flu epidemic, I made 15 home calls one Sunday before instructing Betty to refuse further calls. The reason? I had the flu myself and was running a fever higher than most of the patients I was seeing.
*****
One of the patients I had inherited from Dr. Fisk was a pleasant elderly lady who informed me she just wanted to come in once a month “to talk like I always did with Dr. Fisk.” She was happy to pay for an office call each time. The blood pressure check and examination of the heart and lungs were incidental and unimportant to her.
*****
During this post-war period there was a long waiting period for new cars. I was driving a car borrowed from dad and paying him $70.00 a month for its use but was anxious to return it to him. When I approached a local auto dealer in Jonesville he offered to put me in a priority position on the list if I would make it worth his while with an extra $500.00. The hospital was located in Hillsdale, five miles away. When I went to the Chevrolet dealer there and explained my situation he graciously put me in a priority position and I was soon driving a new car. The price was $1,249.00. During my subsequent 20 years in Jonesville the only cars I bought were Chevrolets.
*****
I had been in Jonesville a couple of weeks and had never met Mrs. Fisk’s elderly mother who lived alone across the street from her. I rang the door bell, black bag in hand and, I assume, with a bright, eager countenance. After the sound of shuffling steps the door was half opened by a rather tall, thin, slightly stooped lady with the furrowed face of age but with a clear, unfaltering voice.
“Yes, what do you want?” No wasted words for her.
“I’m Doctor Wiggins. You asked for me to come.”
“Oh, my goodness, I wasn’t expecting a boy. Come right in.”
She meant no offense and I tried to take it in my stride but that wasn’t the greatest confidence-builder I had ever encountered. After that we got along fine and she seemed to treat me with at least a little bit of respect. However, she usually did manage to let me know what she thought the diagnosis was and I had a tendency to listen to her suggestions as to what she felt the appropriate treatment might be. After all it might be some time before I became as familiar with her condition as she already was. It was about then that I entertained serious thoughts of growing a beard or mustache but got no encouragement from Betty. I endured the frequent “My, you look young for a doctor,” and, as years passed, it became less and less frequent until one day I realized no one was saying that to me anymore.
*****
In my first year of practice it was not unusual for me to take a blood specimen from a patient in his home and return to the office to do the blood count myself - as in a case of abdominal pain where I suspected appendicitis. On one occasion I even did a diagnostic spinal tap on a farmer in his home. Having found him with fever, headache and stiff neck, it was necessary to consider the dreaded meningitis. So I returned to the office, got the sterile spinal tap set, returned, did the spinal tap, then back to the office to examine the specimen under the microscope. There were an abnormal number of lymphocytes but no “polys”, so the serious type of meningitis was pretty well ruled out. I phoned him to give him the good news and then learned by questioning that his daughter had recently recovered from mumps. That was the diagnosis: mumps meningitis. It often occurs without any swelling of the mumps glands and usually runs a quite benign course. He completely recovered in a few days, the only medication being aspirin.
After the first year in practice I became too busy to do my own laboratory work and subsequently referred such cases to the hospital lab. Too bad, in a way, for I had saved the patients considerable bother and money. Presently, doing a spinal tap in the home without elaborate sterile precautions and proper assistance would, no doubt, be severely frowned upon - or even the basis for a malpractice suit.
*****
The advent of multiple, effective, broad-spectrum antibiotics had not yet arrived during my first few years of practice. We had penicillin and the sulfas but tetracycline was only on the horizon; the -mycin drugs and their multiple, subsequent, highly effective derivatives were yet to be - with their initial introductory price of $1.00 per capsule. At such a price some of my patients declined the medication. Chronic pelvic inflammatory disease (P.I.D. for short) was thus difficult to treat. One treatment used was weekly injections into the hip (intramuscular) of two to five cc. of sterile milk. The milk used was the regular, household, pasteurized and homogenized cows milk which was delivered to homes in glass bottles with round cardboard stoppers. (Remember how in sub-zero weather the milk would freeze, pushing up the top to sit at an angle on a cylinder of frozen milk?) It was boiled, allowed to cool and the appropriate amount drawn into a syringe with a long needle. This foreign protein caused the patient to have a foreign reaction lasting two - four days. It was often reasonably successful in accomplishing relief of chronic pelvic discomfort due to P.I.D.
*****
Our town was served by two telephone systems: Bell and the Independent System. There was no “cross-over” service, so we had two telephones on the receptionist’s desk, in the examining room, in our bedroom and in the living room. When the phone rang in the middle of the night I, often as rot, grabbed the wrong one. I learned to sleepily ask Betty, “Which phone was that?” The Independent system was on its way out but had its advantages. “Mert” knew everyone and everything. If I would ask her to ring a certain number she might say, “Oh, they’re over at McGriff’s this afternoon. I’ll ring there for you.” Or, “There is no one home there. I just saw them walk by the office here, but it looked like they were headed toward home, so you might try them in a few minutes.” Small town charm? You bet!
*****
Betty laughingly told me of the call she had from a young man wanting to know if the doctor was an “army doctor”.
“He used to be, but is now in private civilian practice,” was her answer.
That was all he wanted to know. He had no use for anyone who had ever been a doctor in the army. He made no appointment.
*****
One evening I received a phoned request to make a home call on a farmer’s wife near Jonesville. The name rang a bell. Dr. Day had told me this man was in the habit of non-payment of medical bills but would often offer a $100.00 bill to be changed when a doctor made a home-call. I went prepared. After examining and prescribing for his wife I said, “That will be $5.00, Mr. Simpson (not his real name)”.
He went to the other room and returned. “This seems to be the smallest bill I have. I don’t suppose you can change it.”
“Sure I can. No problem. Here is your $95.00 change.”
I don’t remember ever being called again to care for the man or his family.
*****
Dr. Fisk’s medical records were hand-written, brief and often in code, I rapidly became expert in deciphering his writing. 0ne item, however, stumped me for several weeks, A commonly used medication noted in his records was “c.c. tabs. - ii q.i.d.” This translated to “2 c.c. tablets four times daily.” But what on earth were “c.c.” tablets. They were given, I noted, to patients with fever, colds, flu and respiratory illnesses. In the drug room was a large bottle labeled “acetylsalicylic acid tabs., brown” and another labeled “acetylsalicylic acid tabs., pink” - brown aspirin and pink aspirin. I knew his code for the latter was “asa. p.” It dawned on me that c.c. might stand for “chocolate colored”. Showing the pills to a patient who had been taking “c.c.” confirmed it. The pink ones were used for arthritis and rheumatism: the brown ones were used for fever and flu and colds. Many of his patients swore by them and would accept no substitute. I had frequent requests for “those brown cold tablets” or “the pink arthritis tablets”. At the end of 20 years of Practice in Jonesville I still carried both types in stock and they continued to give relief. At one point I was employing a practical nurse as nurse-receptionist and was amazed one day when she came to me with a cold and asked, “Dr. Wiggins, which is it I should take for my cold, the pink or the brown aspirin?” I solemnly answered, “0h, the brown ones.” No patient ever asked what they contained and I never volunteered. The closest anyone ever came was a lady who came in for the brown tablets any time she had a cold. On one such visit she said, “I don’t know what those tablets are, maybe only aspirin, but just taking plain aspirin at home never does near as much good.” Faith, perhaps.
*****
During October of my first year the electric bill for my office was $2.88. I bought a small electric heater to supplement the forced air heat provided by the bank and in November the electric bill rose to a dizzying $8.14. Filling my car with gas cost $2.00 - $3.00, depending on how empty the tank was.
During the four and a half months of my practice in 1946 I delivered only two babies. Expectant mothers prefer an older doctor.
In 1950 the number rose to 32 deliveries and increased each year until it exceeded 100 per year. I found delivering babies to be an uplifting and joyous experience. The new parents are immensely relieved to have an end to the long period of waiting and equally relieved to have a normal baby. All in all it was a very satisfying part of the practice of medicine, despite the disruption of office hours and the middle-of-the-night calls to the hospital labor and delivery rooms. The fact of being up all night supporting a woman in labor and delivering the baby did not excuse me from arising at the usual time the next morning for office hours and hospital ward-rounds.
*****
I was the family physician for an industrious and pleasant farm family near Jonesville. They had two children when I moved to Jonesville and I delivered the next three. The wife was a bucolic, easy-going but hard-working woman of very stocky build. She invariably came for her first Pre-natal visit to me sometime during the 8th month of her pregnancy. When I asked her the usual, “And what can I do for you, Mrs. ———?”, she would chuckle with satisfaction and say, “You mean you can’t tell, doctor?” She always corseted herself so severely during her pregnancies that her condition was in no way apparent. She was overweight and usually gained no weight at all during her pregnancies. Her neighbors and friends never had an inkling she was expecting until the husband announced that she was in the hospital having a baby. I never saw any ill effects on mother or baby resulting from this ill-advised, severe constriction of the abdomen.
*****
