Weekend by the Bay

Anyone remember this post? (To save you the trouble, it was about a friendship I made online, with a man who trained where I did about ten years earlier, and who eventually sent me a key to the fabled and loved Chief Resident room in the fabled and loved San Francisco General Hospital, of which I was the last occupier before it was torn down.) We've corresponded for over a year, but until Saturday, we'd never met.

This weekend in San Francisco a "distinguished professorship" in honor of one of the early Chiefs of Surgery at UCSF was celebrated. The professor died many years ago, while I was in training; in fact, I was a pall-bearer at his funeral. The professorship was financed by his daughter and her husband, the former being Dianne Feinstein, US Senator. Hosted by the two of them was a fancy dinner at a fancy hotel, with the attendees mostly surgeons who'd been trained by him, many years before me. There, I was the young guy.

Ordinarily I'd not be attracted to such a gathering; I feel out of place amongst strangers, especially those more glamorous than I (which includes pretty much everyone) and having connections to one another that don't include me. (We trained at the same place, but not at the same time.) But at the urging of JB -- the keymaster -- and with the knowledge that a couple of my old professors, now frail and failing and not likely to reappear, would be there, I took a one day trip to SF. Mostly, I'm glad I did, even though it began with a flight made stressful by that fearsome announcement midway to SFO: "If there is any medical person on board, please turn on your call light."

It wasn't the first time I've responded to such a plea. Stalling for a few seconds to see if any other lights went on, I chimed in with the reluctance that comes from fear of the unknown. A steward came and leaned to me (I'd noted his unusually cool and amusing delivery of the safety speech, and his friendly handling of the delay in takeoff occasioned by the usual SF morning weather.) "We have a lady who looks pretty gray. What sort of medical person are you," he asked. "I'm a physician," I replied. "A surgeon, actually. I could take out her appendix if needed." He smiled and led the way to the back of the plane.

In a seat leaning back as far as they go (meaning pretty much vertical) was a thirty-something woman looking indeed quite peaked, already with flimsy and ineffective-looking oxygen mask on her face but with an adequate albeit quite slow pulse, felt under the skin of a clammy wrist. I asked a few questions, determined that she was in prior fine health, no meds or allergies, no clots, had flown in the past with no problems. Ever notice how in the movies -- or even in televised fights of some kinds -- when a person goes down they sit him up, or even try to get him up walking? Pretty basic: when fainting or otherwise woozy, lie the hell down and stay there! Conveniently, the woman's seat was right across from the galley area. After the stewardess spent a couple minutes trying to remove the arm of the seat before discovering it wasn't designed to come off, I helped the lady (she was cognating marginally but able to supply a little leg work) over the armrest and onto the floor and kneeled down beside her, readjusted her silly mask and took the offered sphygmomanometer and stethoscope. There was, of course, no way to hear a damn thing in that rackety galley, but I checked her pressure by palpation and it was good enough. She'd picked up her pulse rate a little, too, complained that her fingers were tingling. About this time her friend came down the aisle and said they'd been out drinking a lot last night.

I was handed a headset. The crew had been in contact with the ground, connecting with some sort of emergency physician, with whom they wished me to speak. As I had when doing my required flying in Vietnam, sitting in the copilot seat and given control of stick and rudder, mic pressed against my lips properly near as confirmed by the frequent kissing of it (pilots did it, so I did, too, singing out "roger one-five-niner" and "rollout" while taking directions from the spies in the back of the plane), I donned the set and knowingly tucked the phone close to mouth. There was a button to push when talking. It was all so familiar... I gave my assessment, thumbing the button like a veteran, and the doc on earth said "sounds like a vagal thing." I agreed, but added that I thought there was a measure of dehydration, hung-overness, and hyperventilation.

"Think she can just check in with her own doc when she's on the ground?"

"Doubt it. She's better lying there, but I don't think she'll be getting up and out on her own power."

"OK, so you want EMTs there?"

"I think it's best."

After reassuring her that I was sure it wasn't serious, she was in no danger, there wasn't more I could do. Thought about getting her to drink some juice, but figured better to let her lie. I returned to my seat after filling out some forms; came back a couple of times to check on her. Interestingly, and rightly I'd say even though it probably broke some rules, they kept her lying there for the landing. We were held in our seats until the EMTs came aboard, checked her, exited and returned with a gurney/wheelchair hybrid (I felt vindicated at that point) and rolled her out. The stewardess thanked me earnestly, offered me a Starbuck's gift card as a reward. For five bucks.
A few hours later I met JB at my hotel. He was more compact and wiry than I'd have guessed. In his seventies, he bristled with contained energy, had a perfect voice: just grainy enough and quietly powerful, confident, in charge. He'd sat himself down with a couple of ladies in the lobby, unknown to him, and was chatting away when I came down, missing him at first, expecting him to be alone. His baldness was semi-encircled in the grandfatherly way. Obviously fit, wearing cowboy boots to the ball, and a Panama sort of hat sporting service medals and insigniae from his time in Vietnam (where, unlike me, he'd served as a fully trained surgeon, well in the thick of it, the real deal), he'd brought a copy of my book for signing. It was heavily annotated and curled from re-reading, underlined, with lists of questions at the back. I'd planned to tell him of my airborne adventure, but his stories were much better, and I lost mine in the moment. After the night's ceremonies and a detour into the bar for one more round, we parted company in a fully exchanged hug. Worth the trip. I want to spend more time with JB.

The Key

The best thing about having written a book is hearing from people who read it. At the top of that list is the friendship I've established with JB, who trained at the same place I did, UCSF, about ten years ahead of me. I'd never met him (still haven't, other than via many emails), but I'd heard stories: like Hawkeye Pierce, he got away with some memorable stuff there because he was a really good surgeon. He was also a surgeon in Vietnam, where he ran an Army trauma unit; and he's done a little writing. He's lived an extraordinary life; in the words of a mutual friend, he's "the real deal." I'm honored that he contacted me. And his feelings about the place where we became surgeons are a lot like mine.

Readers of my book will know that a central character is that classic county hospital, San Francisco General Hospital, and the trauma center within it, Mission Emergency Hospital. Maybe the source of the phrase "brick shithouse," the place was memorable in countless ways. First and foremost was the building itself. Decades old, made of brick adorned incongruously with a sort of Gothic roofline and containing unexpected marble floors and carved wood banisters, "The County" -- as we called it -- served most of the destitute of the City-by-the-Bay, and provided trauma care to everyone of all walks of life, housing them in open wards, providing the most modern of care in the most ancient of settings. Containing surgical amphitheaters from the days of surgeons operating in suits in front of an open audience, in more recent times, just preceding my arrival, it had also been the living set of famous movies. Becoming Chief Resident on the Trauma Service was the pinnacle of years of training: the top of a steep and tall pyramid, the most demanding, the most exciting, the most responsible job there was. Having looked with awe at those chiefs as a lowly intern, working slowly and exhaustingly toward the goal over many years, finally finding oneself in that role was magical. Unbelievable. Both daunting and exhilarating. And you lived in a cool place. Deservedly, since being Chief Trauma Resident meant staying in the hospital, instantly available round the clock for sixty days straight.

It wasn't much, really, by most standards. Off a dark hallway on the second floor of the hospital was a small bedroom just large enough for a single cot and a bedside table, outside of which was a larger room where the senior residents slept (the trauma service consisted of two teams which alternated twenty-four hour shifts -- plus time required for joint rounds and finishing of work; more like thirty-plus hours on and twelve-plus off -- each headed by a senior resident, with a single chief of both teams, who stayed put.) Big enough to house the occasional liver rounds, that outer room also contained a chair or two, a bookcase, and a display of various items that had been extracted, over the years, from the recti of many clients... Despite being sparse and bare-walled, it was a cool place, if for no other reasons than throughout the hospital only the Chief Resident of the Trauma Service had access to such a room; and that so many generations of surgeons had occupied it, including some pretty big names in American surgery. When I moved in, I was very aware of the river of history that flowed through that suite and was deeply humbled by it. A storied nook in a fabled place. And I was the last ever to occupy it.

For much of the time I was there, a new hospital was being built -- modern, sterile, with private rooms, narrow corridors with none of those great and gloried ghosts walking them. It was while I was Chief Resident that the work was finished, and the move to the new facility made. (I did the first operation in the new operating room, it having been very important to the Chief of Surgery that the trauma team do so.) All we had for sleeping in the new place was an unused patient room, devoid of all that history. And having vacated, they took the wrecking ball to the old brick house. It put up a good fight; took much longer than had been planned, so sturdily constructed it was. (As opposed to the new place, wherein holes were punched into walls by door-handles within days of opening.)

I wrote about the mysteries of the old County in my book, and of the sense of loss as I moved out. JB read it and, because he'd felt the same way about that place, he wrote to me. He told me stories of many of the characters in my book, and said how much he'd loved reading mine. And he said he had a gift for me, something he'd had for many years and with which he'd always felt there'd come a time when he'd know what to do. Unaware of its impending ignoble end a decade later, he occupied that Chief Resident room with a sense of devotion and awe like mine, and when he left, he'd kept a little piece of it, which lay for forty years in a dresser drawer. He read my book, he retrieved the memento, made for it a proper repository, and gave it to me. A most wonderful thing. It is this:





Thanks, JB.

[Update, 2012: turns out the key isn't what I thought. In fact, I have no idea what it's for. I remembered the chief resident room was room 320, lovingly called "The 320 Club." It's all poetically appropriate, since it's turned out JB wasn't who I thought he was, either; namely, a true friend. But that's a long and sorry story, not worth repeating yet another time.]