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...from “I’ve Got To Write a Book!”
by Ira Wiggins

Doctor’s Days and Nights (part 4)




Patients not infrequently came to our home after office-hours. On one occasion the parents brought a toddler with a metal crochet hook protruding from the infant’s temple. It was not easy to hide an expression of disbelief but I did my best.

“He was on the floor, doctor, when my crochet hook fell off the shelf and stuck into his head. We can’t get it out.”

I knew a crochet hook had a course barb on the end, but how long was the instrument? How far had it penetrated? Which way was the barb pointing? The latter was the most important for ease of removal. While the father and I took the baby to my office the mother went home and returned with an identical crochet hook. The flattened mid-portion had printing on one side; it was toward this side that the hook pointed. My task was simplified immensely.

A little novocaine. A one-eighth inch slit in the skin at the site of penetration. Gentle manipulation to free the barb and the crochet hook came free to be returned to the relieved mother for more prosaic use.

*****

Late one Saturday afternoon in summer we were visiting on the screened porch of some friends when a car drove up to the curb. The plainly dressed woman strode purposefully toward us.

“They told me you were here, Dr. Wiggins. My son was fishing and got a fish-hook stuck in his eye. He’s in the car.”

With visions of a punctured eye ball I strode rapidly to the car were the 12 year old son was holding his hand cupped carefully over his left eye. As he slowly removed his hand I could see the treble hook of a casting lure, one hook stuck in the skin of the upper eye-lid, another in the lower lid. The third hook was free. The eye ball was uninjured.

“My husband cut the rest of the lure off.”

“That’s good. We’ll go to my office. How did it happen?”

The boy, silent up to then, answered, “My lure got stuck on a limb. When I tried to pull it off it flipped back and hit me in the eye. Can you get it out?”

“Sure, Billy. It won’t be any great job.”

And, using a little novocaine and the same crochet-hook technique, it wasn’t.

A tetanus booster and two tiny band-aids completed the task.

“Can I ask you something, doctor?”

“Sure, Billy What is it?”

“Would it be okay to go back fishing? The fish were just starting to bite.”

*****

Boredom never was a factor in general practice. What you read here are only the unusual and interesting incidents. 99% of my practice was run-of-the-mill: colds, flu, minor and major injuries, family problems, routine baby care, shots, deliveries at all hours of the day and night, psycho-neurotics, elderly, heart problems, infections of all kinds, etc. I did minor surgery (some people say that’s any surgery done on someone else) and assisted with major surgery. We all took turns being “on call” for the local emergency room at Hillsdale Hospital. For me that was five miles away and could be an aggravation in the middle of office hours or during the night, especially if I was called back for another case just 10 minutes after climbing back between the sheets, or if Betty and I wee in the midst of a warm embrace. “Come right away, doctor, it’s an emergency” cannot be put off. Betty could never be sure when I’d be back or even if I’d be back that night. No wonder she later developed spastic “colitis”. In a small town she found it impossible to answer the phone with, “Sorry, the doctor isn’t at home.”

There were stark tragedies too, one so emotional that I avoided discussing it to this day. A doctor may have to learn to live with the unexpected post-operative death of a child; a young housewife with four children and incurable cancer; sudden deaths from heart attack or stroke; lingering death from brain disease of an intelligent, vivacious wife; leukemia; untreatable, wasting muscle disease; tragic auto accidents; suicide; broken homes.

“Being involved with all those things, didn’t you have trouble relaxing and sleeping at night?”

Sometimes, yes. But, if at the end of the day, one can stop to reflect and say, “Today I have done the best that I know how,” then relaxation is more apt to follow. Then, too, the physician in general practice has the advantage of being able to refer the most difficult cases to a specialist.

*****

Bilateral vasectomy was, and still is, an effective, economical and generally satisfactory means of birth control. I did the operation when indicated and requested, with no adverse side-effects. There was only interesting exception. The young man returned to my office about two months after the operation stating that every time he drank alcoholic beverages a tender swelling appeared for a few days under the site of the incision on the left side of the scrotum. At that time there was no swelling and I had to confess to him that I had never heard of such a thing and “if you can come back when the swelling is present perhaps I can tell you more.” He returned in a few days to show me the swelling (having had some whiskey the evening before). It was as he had said, out I was still at a loss to explain it. There were no signs of infection. I felt a bit inadequate as I gave him the only advise I could think of.

“I guess you’ll have to avoid alcoholic beverages for a while.”
“For how long, doc?” Obviously the advise was not exactly what he had hoped for.

“Well, I really don’t know. Just play it by ear and see how things come along.” Neither he nor I were very satisfied.

I thought of him occasionally in the next few months. He had not been a regular patient of mine. Finally, about a year later, I saw him while shopping on one of the main streets of Hillsdale. I could not resist speaking to him and ended by inquiring if his problem had resolved.

“Oh, yes, doc. That got gradually better after I saw you and in the past six months doesn’t bother at all.”

I lost track of him after that. Never did learn whether he developed a problem with alcoholism.

*****

Ever hear of a female circumcision? Neither had some of the nurses who read the surgical schedule. It is a legitimate operation consisting of the removal of the foreskin which usually partially develops the clitoris. I am dubious about whether it is really ever truly indicated. In any event the young lady and her husband of some four years came to my office and requested the surgical removal of this tissue. It seemed that her sexual responsiveness had waned to the point of non-existence and they were both convinced that the thickness of this bit of foreskin prevented a normal response. After an appropriate history and doing a physical exam I explained to them that I was very dubious that the thickened foreskin was the source of the problem. They denied any other marital difficulties or maladjustments and were adamant in their request.

“Do you mean that it is impossible that this could be the source of her trouble, doctor?”

“No, not impossible, but, in my opinion, highly unlikely. I seriously doubt that removal of the foreskin would solve the problem.”
“Then what do you suggest?”

“I know that you are not aware of any marital tensions, but I’d give marriage counseling a try.”

The suggestion seemed to offend both of them. At their insistence I scheduled the surgery and it was carried out uneventfully, other than for a few snickers that I thought I detected from the surgical staff.

To everyone’s disappointment (I had hoped that I was wrong) no benefit resulted. Several months later I read in the newspaper that the couple had been divorced. “Too bad,” I thought. “What could I have done to have been of more help?”

A few months later still I read where the young lady had remarried. When she showed up with a minor complaint in my office a short time later and I had finished prescribing for her, I asked, “By the way, are you still troubled with lack of sexual response?”

“Oh, heavens, no, doctor. From the moment I married _________ things have been wonderful. I didn’t know it could be so good,” and she stepped gaily out of my office with a broad grin on her glowing face.

It wasn’t the foreskin that had been the problem. It was the husband.

*****

Most children are adequately immunized against tetanus. In my years of practice I saw but one case, thank God! At that time the fatality rate, I believe, was 80 - 90%..

I was called to see the six year old son of a farm family. They were not patients of mine but the boy was obviously very ill with fever, headache, irritability, stiff neck and tendency to muscle spasms. Frankly I did not know if he had polio, meningitis, encephalitis or tetanus, but, on questioning the father stated that tee boy had never had any “baby shots”. Further questioning revealed that two weeks previously he had stepped on a thorn and “it got infected a little, - but, hell, doc, he goes barefoot and is always doing that.”

Whatever the diagnosis, he was too sick for me and I persuaded the parents to rush him to the nearby university hospital for admission while I phoned ahead to make the arrangements and to provide the tentative diagnosis.

The boy did have tetanus. By the time he arrived at the hospital he had started to convulse. If uncontrolled the convulsions would cause death and could be controlled only by deep general anesthesia. When the anesthesia was lightened he would convulse again, so he was repeatedly put under anesthesia so deep that artificial respiration had to be maintained. It was two full days before the anesthesia could be discontinued. During that time he was given massive amounts of tetanus antitoxin and was maintained with tubes in the veins, nose and bladder. The boy lived and eventually came home, but not without damage to his nervous system.

*****

The young professional man came to my office out of exasperation. He had had bouts of stomach pains for several years and had visited many different doctors without benefit. He had had many negative x-rays and had visited a good gastro-enterologist. No medication had been of the slightest help to him - antiacids, antiulcer, antispasmodics, tranquilizers, etc. No special type of food or drink ever caused an attack. There was no associated nausea, vomiting, excess gas, diarrhea or constipation. In short, nothing but pain that came and went without apparent reason. He was otherwise in perfect health and seemed emotionally and mentally quite normal.

“If you wait long enough the patient will often tell you the diagnosis” is an old medical school dictum.

“One thing I’ve noticed, doc; I can usually tell when a bout of pain is about to occur because my vision seems to get slightly blurry, like faint wave lines in it. But I don’t suppose that has anything to do with it.”

Bingo! The little, figurative light-bulb above my head started to faintly glow. I had read about abdominal migraine (pain comes in the belly instead of the head) and about abdominal epilepsy (pain in the belly replaces the convulsion) but had never seen a case of either.

“Do you have any relatives that are subject to migraine or recurrent headaches?”

“Not that I know of, doc.”

“Anybody with epilepsy or anyone that takes regular medicine to prevent seizures of any kind?”

He was hesitant. “Well, as a matter of fact, one of dad’s brothers used to have some kind of convulsions but he doesn’t anymore as far as I know. He still takes medicine every day though. Says he is sure he could get along without it but his doctor says he must keep taking it. What does that have to do with me?”

I explained my suspicions to him. He was wary of the stigma but was anxious to try an anti-epilepsy medication if I could assure him that it would not become general knowledge. This, of course, I did. On a regimen of daily bedtime doses of dilantin the bouts of abdominal pain disappeared completely. He was a a most happy and grateful patient but requested my reassurance that his case would be kept confidential.

*****

I was always fairly strict about confidentiality, even to my wife. At a social gathering of local doctors I was asked by a radiologist, “I hear Mrs. ______ has been coming to you. What’s her trouble?” I do rot remember how I phrased my refusal and would not have even remembered the incident except that a few days later a doctor who had been at the party told me he had overheard the-conversation and wanted to say that he admired my lack of willingness to give out such information on a purely social basis.

*****

“You castrated my husband!” the elderly lady in my office angrily blurted out in response to my usual question, “What can I do for you?”

She was obviously very, very serious and very, very upset. I rapidly became very, very serious and very, very apprehensive. Lawsuit? Physical mayhem? What? The only indication for castration that I know of is cancer of the prostate and those cases I always referred to a specialist. I had never castrated anyone in my life. I did recall the husband being under my care in the hospital for pneumonia about a month previously.

“When did this happen, Mrs. ________?”

“When he was in the hospital. I was visiting and you asked me to go outside because you were going to castrate him. He hasn’t been the same since.”

Slowly, as the light began to dawn, a feeling of great relief flooded over me. The husband was quite senile and often did not entirely comprehend what was going on around him. On this day he had developed urinary retention and I had had to catheterize him - draw the urine off with a small rubber tube. I had catheterized him, not castrated him! It took a good bit of talking and explaining but she finally appeared to be somewhat convinced that I was telling the truth. It was his post-pneumonia weakness that was causing him to be “not the same”. I reassured her that he should gain strength slowly if she would be patient. Fortunate1y, she was - and he did.

*****

“He was doing his family duty when he died, doctor.”

Thus the wife answered me when I made a midnight home call far from Jonesville and asked the circumstances of her husband’s sudden death, for which I had been called.

“His family duty?” I queried vaguely.

“Yes, we were—-well, —-You know.”
Now I had heard of “the family jewels” and being “in a family way”, but darned if I had ever heard of “family duty” as expressing sexual activity. Obviously one’s education does not end after medical school. Of course the thought crossed my mind that the man had died happy. Neither the circumstances nor the time of night were suited to jocularity, so I maintained my usual serious demeanor as I sympathetically told her that the coroner would have to be notified (her husband had not been under medical care) and would determine if an autopsy was indicated.

“What do you think he died of, doc?” asked the coroner on the telephone.

“I don’t know.”

‘Well, what do YOU think it could have been?”

“I really don’t know.”

“Could it have been a heart attack?”

“It’s possible.”

At that time the coroners were elected officials. I had long since learned that they didn’t want to “rock the boat” or to do anything to make themselves disliked. What politician does? The easiest way out for them was to get the doctor to make a probable diagnosis, they would quickly agree, fill in the diagnosis and sign the death certificate without the need to order an autopsy and thus possibly offend or antagonize the relatives.

On the other hand, I strongly suspected that some of the sudden deaths that occurred and were allowed to pass without an autopsy were not always exactly what they seemed to be. I had never seen this family before. For all I knew the man could have been poisoned or suffocated.

“Why don’t you just put down ‘heart attack’ and I’ll sign the certificate,” he persisted.

“I really can’t do that in good conscience.”
After a pause, I heard a long sigh, “Oh, all right, I’ll take care of it.”

I truly did regret spoiling his night’s sleep, a right which I viewed with considerable respect, if not actual reverence.

*****

After being in private practice for several years I finally accumulated enough money that I felt I could accede to my wife’s increasingly persistent suggestions that I build a small office building of my own - on the ground floor and with real air-conditioning to replace the fan blowing over a cake of ice in a large pan. It could have a ramp for wheel-chair cases, two examining rooms and a recovery room where someone could lie down and be attended without “tying up” an examining room. The toilet could be located between the two examining rooms. Oh, I had lots of ideas and had been drawing up tentative plans for at least two years. It would be all brick with a minimum of maintenance, even if the initial cost was a little higher.

The American Legion had extra property adjacent to their building just one block off Main street. They had no apparent use for it, so I inquired if it might be purchased. They would bring it up at the next meeting. They couldn’t agree. Next meeting perhaps. Still couldn’t agree. Idea. I made them an offer in writing of $1,000.00 for a specific area of land. This forced the issue to a vote and the majority ruled. I got the land.

By that time I had completed my own drawings of exactly what I wanted and felt no need to hire an architect. A local contractor-builder, Wendell Maine, was a patient of mine and was happy to contract for the work. Jonesville had a healthy local population of termites but I was sure that if I put a brick building on a cement slab, air ducts, water and drain pipes to be included in the poured cement, there would be no problem. It was a fact that the termites had to have daily contact with the soil or they could not survive.

Some two years after the building had been completed I was still smug and happy with the results. Then one day in the bathroom I noticed a “wrinkle” on the surface of one of the large plastic tile squares on the wall. I probed it curiously with my finger-tip and was amazed when my finger slipped readily through the tile and exposed typical termite workings. The backing of the tiles, I found, consisted of a glue-woodchip mixture, a delicious termite snack.

I quickly called the “Terminex” company. They came to examine the building and were glad to explain to me where I had gone wrong.

“Subterranean termites like nothing better than a cement slab to live under. The cement always gets hair-line or larger cracks in it, giving the little rascals ready access to the material above. They can also follow the spaces adjacent to pipes and heating ducts in the cement. If you had called us before you poured the cement slab, for $100.00 we would have poured chemicals beneath the slab that would protect the building for as long as it existed.”

“Oh, ————and what can we do now?”

“Now it’s not so easy. We still have to get the chemicals beneath the cement. To do that we have to drill holes through the cement floor - about every 24 inches. I’ll figure the cost for you.”

“It will be quite a bit more expensive.”

“Well, yes.”

It was.

Leaving a floor-plan to show where aIl the pipes were located, I took an unplanned three-day vacation while the work was being done. When I returned I found that a worker had drilled right through a water pipe with the resultant geyser spraying the room until the water could be turned off. I wonder whether originally hiring an architect would have saved me all of this. Maybe.

*****



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