Addison Wolfe never wanted to be a physician. He wants to be an astronaut. NASA turned down his application, forcing him to seek employment as a doctor. The problem with obtaining a physician's license is that it is necessary to complete an internship to acquire one. Wolfe finds himself in an undesirable rotating internship in a very busy public hospital. The Director of Medical Education seems to have taken an instant dislike to him and the remainder of the internship class. "The absolute worst time to go to a teaching hospital as a patient is the month of July. Recent medical school graduates, known as doctors, start their real training on July first. They don't know anything. They don't get any sleep. They are underpaid and overworked. Their stress is at catastrophic levels. Is it any wonder they make mistakes?" - Anonymous "In local news today," the reporter said, "state and federal authorities are in the process of taking into custody the entire intern class at University Hospital in Jacksonville. Officials cited the number of deaths attributed to this class as the reason. It seems that wrong doses of medications, inappropriate surgeries, failure to diagnose lethal conditions, and other mistakes have led to hundreds of deaths...." "The overdose?" Wolfe asked. "Yes," Dr. Rubel replied, "that will be her legal cause of death, of course. The real cause of death was the autopsy. Barbiturate overdose, followed by refrigeration outside and then here in pathology, slowed her metabolism down. She was actually alive when they started the autopsy. The flexing of her limbs when the saw touched her brain happened because of nerve conduction, brain to extremities. But it was too late; we can not put her back together. A hard lesson for those poor boys to learn. You, too, gentlemen. It is also true for those who are clinically dead from exposure or drowning. Remember this: a patient is never dead until he is warm and dead. Don't forget that!" The senior resident started his description, "EMS responded to a report of a cardiac arrest at 1:07 a.m. in Junior's Topless Bar, on East Bay Street...." Figueroa again jumped to his feet. "What is this, a bad joke?" he asked. "Two EMTs walk into a bar.... Let's be reasonable, guys. The most likely reason for needing a paramedic in a bar at 1 a.m. is a knifing or a gun shot wound, not a heart attack." The autopsy and x-rays were condemning. The thirty-nine year old, black male had no history of heart disease. No medical history of any kind. He did have a bullet entrance wound to the back of his head, with no exit, bullet still in his brain. The patient was a massively obese woman who complained of a headache. The intern knew only that she was complaining of a headache and had requested aspirin. Extremely busy, and assuming the nurse would let him know if it were not a good idea to give the patient aspirin, he quickly flipped to the order page and signed the order that had been written by the nurse. Figueroa asked the intern if he had talked with the patient. No. Had he examined the patient? No. Had he even skimmed the chart? He had not. He asked if he knew what allergies the patient had. The intern did not know. At the time he approved the order for aspirin, did he realize the patient was on warfarin, another clotting inhibitor? No. Did he know that aspirin also inhibited platelets and clot formation? Yes. Did he know the patient had a history of blood clots? No. Did he suppose that a blood clot in someone's brain, or a ruptured berry aneurysm in the same area might cause headaches? Yes, he knew that. The autopsy pictures revealed stenosed carotid arteries, two small clots in the patient's brain, and massive bleeding from a ruptured berry aneurysm.
About the Author: Bill Yancey had the privilege of being the son of an air force officer and the grandson of an army officer. As a result, he lived all over the world, but never really grew up. He attended four high schools, a prep school, and five colleges. After bouncing out of an engineering curriculum, and spending time in Vietnam as a result, he finally obtained an undergraduate degree in general science from Virginia Tech in 1971. The Medical College of Virginia still regrets giving him an M.D. degree in 1976. He writes for his own entertainment, and hopes you see the humor in it, too.