The View from the Vue (6 page)

Every three weeks a new batch of medical students came to the labor room, and they were assigned to patients in rotation. The residents helped them as much as they could, but there were too many laboring women and too few residents. Therefore, before they could learn the ropes, many students were forced to stand by in hysterical horror as their patients unceremoniously pushed out their newborns into their excrement-laden beds.
Inter urinam et faeces nascimur
.

One evening, as I was in the process of doing a forceps delivery, a first-night student flew into the room, his eyes wild with fear. “Come quick, Dr. Karp,” he croaked, “The head’s gonna come out.”

“I can’t stop in the middle of this one,” I told him. “Go back and do the best you can from what you’ve read in the textbook, and I’ll be there as soon as possible.”

The poor guy shot out of the delivery room and into the hallway, where he ran directly into Myra. She had finished setting up one of the other delivery rooms, and was coming back to watch the forceps operation. The student had no idea who she was, but she must have looked as though she knew her way around the suite, because he grabbed her desperately and pleaded, “Do you know how to deliver a baby?”

Myra had seen enough frantic new students to be able to figure out what was happening. “Let’s get back to your lady,” she said coolly. “I’ll help you out.” And as they walked away I heard her say, “Now, the only thing you’ve really got to remember is just to keep it slow and smooth.”

As they got to the labor room, they could see that the baby’s head was very much in the process of coming out. “Put on your gloves,” said Myra. “Now, put your right hand here, and your left hand there. That’s it.” She guided the student through the entire delivery, and when I checked the patient afterward I could find nary a tear.

“You didn’t expect one, did you?” demanded my wife.

“Hell, no,” I answered. “I figured you guys were at least as good as a couple of cab drivers.”

“That’s really fun,” Myra said.
“I’d
like to be able to do it. Almost makes me want to apply to medical school.”

I shuddered.

Before long the routine deliveries began to lose their challenge, and Myra moved on to bigger and better ones. She stood by as twins were being born, and watched fascinated as we delivered breech babies. The more unusual the procedure, the more my wife enjoyed it. She failed to get in on a caesarean section only because these patients had to be wheeled across a rooftop to get to the operating room halfway across the hospital, and in the general fuss and confusion Myra was concerned that she might really be in the way. But she saw every other manner of delivering a baby.

Well, almost every other manner. Sometimes a baby’s head will be facing the wrong way in the birth canal, and the delivery can’t be accomplished until it turns or is turned. In cases where spontaneous rotation fails to take place, a special forceps, designed by the Swedish obstetrician Kielland, can be used. But for some reason Kielland rotations were never performed while Myra was around. One night she even waited until three in the morning while a likely candidate labored, but at the very last minute the head rotated spontaneously. Myra muttered her way back to our apartment, convinced that the ghost of Dr. Kielland did not believe that wives of residents should be on delivery suites.

When the last week in June arrived, Myra knew that her days as obstetricians’ helper had just about ended. Not only would I be leaving The Vue on July 1 to spend two years defending my country by delivering Navy wives, but she herself was nine months’ pregnant. Very soon there would be valid reason for her to sit home at night. But while she could, she waddled around labor and delivery at The Vue, savoring every last minute of it.

The next-to-last night was a horror. No medical students were on call, there being a weekend’s hiatus between groups. So, naturally, we were bombed with patients. I ran from one delivery room to the next just as quickly as the nurse and Myra could set them up and wheel the patients in. For every woman I delivered, another one was admitted. By midnight the hallway was lined on both sides with laboring and delivered patients, all mixed together. There wasn’t even enough time to sort them out, let alone put them into labor rooms and post-partum ward beds.

I was as alone as I could possibly be; the senior resident and the chief resident had gone across the roof with a bleeding woman who needed an emergency caesarean section. There were no other doctors to give a hand. At that point, the tuberculosis ward called to tell me that one of their inmates had gone into labor.

I felt dizzy. It seemed that in one night I was fated to deliver every woman in New York City between the ages of fifteen and forty-four. I told the chest people to put a mask on their patient and send her over. She arrived a few minutes later, very much in labor. We found a spot for her against the wall.

Half an hour later, I was working with a patient in Delivery Room Two when Myra stuck her head in to announce that our tuberculous transfer was ready to have her baby. “Take her into Room One,” I yelled, gesturing with my head. “I’ll get there as soon as I can.”

I delivered and sutured at double time, ripped off my gown and gloves, and ran toward Delivery Room One. As I got to the door, I heard the unmistakable howl of a newborn infant. “God damn!” I muttered. “Too late.”

I walked into the room and froze in disbelief. The woman was up in the delivery position, and the baby was wrapped in a blanket and lying in the bassinet near the window. Between the patient’s legs was my rotund wife in the process of catching the placenta in a basin as the woman pushed it out of her vagina.

“What are you doing?” I whispered.

Myra jumped as though goosed. “Oh, it’s you,” she said, her voice just a bit shakier than usual. I noticed that her hands were shaking too. “What the hell does it look like I’m doing?”

“But why you? Why didn’t you get help?”

“Who from?” Myra snapped. “The other guys are still doing that section, and you were in the middle of your delivery. After I told you she was ready, I put her up in the stirrups and washed her so you’d be able to just run in and deliver her. But she didn’t wait. She started to push the kid out; all I did was keep it slow and smooth. Thank God, the baby was in good shape. I put it in the bassinet, head down, and then I came back and caught the placenta when it fell out of her. I figured that was better than just standing there and letting her deliver with no help at all.”

It all struck me as logical, but not quite kosher. “Why didn’t you call Mrs. White?” I asked, simultaneously wondering where the nurse was.

As if for answer, Myra pointed toward Delivery Room Three. “Are you kidding?” she said with a little laugh. “She can’t do two at a time either.”

The dialogue was brought to an abrupt conclusion by a piercing shriek from the hallway. I ran out to find the inhabitant of one of the stretchers with her knees pulled up to her chest, alternately screaming hysterically and grunting like an eighty-year-old who hasn’t had a bowel movement for a month. As I charged over, she grabbed me by the arm and shook me so that my teeth rattled. “Helpa me, helpa me,” she implored wildly.

Simultaneously trying to free myself from her grasp and pull back the twisted sheet from her abdomen, I finally managed to get the baby, which was lying between her legs, almost totally immersed in a puddle of amniotic fluid. As I pulled the infant out by his feet, he gurgled, choked, and turned even bluer than he had been to start with. Since he was still attached by the umbilical cord, my mobility was severely limited. “Get me an emergency tray!” I howled at the top of my lungs. “Quick!”

Almost before the echoes had died down in the hallway, both Myra and Mrs. White were standing there, each holding an emergency delivery kit. I took one—I’m still not sure which—cut the baby free from his mother, and I sucked out what looked like a gallon of amniotic fluid from his nose, throat, and chest. To my immense relief, the kid turned pink, and let out a properly enraged howl.

After all the babies had been wrapped and sent to the nursery and their mothers had been taken down from the delivery stirrups, I slumped into the nearest chair. “Gawd,” I mumbled. “What next?”

Another shriek from the hallway cut through the air. Simultaneously, I heard Mrs. White’s always-calm voice: “Dr. Karp, come quick.”

I got up running.

A deficiency of ancillary personnel is, of course, a relative matter, and since the early 1960’s the situation at The Vue has been ameliorated to some extent by medical insurance plans. Because so many people are now covered by insurance, enabling them to seek care from private doctors who practice at private hospitals, smaller numbers of patients come to The Vue (and other city- and county-supported institutions), and it is, therefore, easier to keep up with them.

But now with New York City’s desperate financial problems, it can be predicted that the other part of the equation will also diminish, and that there will be fewer nurses, aides, and messengers employed at The Vue in the years to come. My humble suggestion to meet this crisis is straightforward: when internship and residency candidates are interviewed for positions, talk to their wives and girlfriends (or husbands and boyfriends) as well. A newly created volunteer position of house-staff helper would improve both the efficiency and the morale of the doctors at The Vue, to say nothing of patient care. I’ll testify to that at firsthand.

By the way, there’s an epilogue to the story of Myra’s Bellevue career. Eight days after she left the hospital for the last time, she entered University Hospital, right next door, to give birth to our son. When the moment arrived, it was discovered that the mirror which allowed women to watch their own deliveries was out of whack; the screw holding the adjustment mechanism was loose so the mirror couldn’t be properly positioned. All obstetrics ceased while a screwdriver was located, the offending screw tightened, and the mirror adjusted to give Myra an unimpaired view of her nether regions. Only then did the obstetrician apply the forceps, turn the baby, and extract him.

“Was it really worth it, having everyone running after screwdrivers like that?” I whispered to Myra as the obstetrician was removing the placenta.

“Darn right it was,” she said emphatically. “I finally got to see a Kielland rotation.”

The Bowery is the section of New York City which centers on Third Avenue below Fourteenth Street. During the late nineteenth century, it was the fashionable dining and theater area of the city, but that didn’t last long. Before 1900, the place had already acquired a reputation as a locality where a citizen stood a pretty good chance of having his phrenology redesigned with a blunt instrument, and his wallet liberated. From that point, it was no time at all until the Bowery became New York’s Skid Row, a collection of sleazy flophouses and greasy lunchstands where the sidewalks were littered with newspaper pages, broken bottles, nasopharyngeal oysters, and puddles of vomit. Thus it has remained to the present, inhabited by men (and occasionally women) who wander through the streets in alcoholic fogs, usually alert only to the likelihood that the next guy to nudge them in the ribs and say hello will be the skinny fellow in the black cape with the grinning face.

Such were the Bowery Bums, perhaps the principal customers of The Vue in the early 1960’s. Their needs were many and varied, which was not terribly surprising. Basically, they were a bunch of guys who spent most of their time in the great outdoors, all year long.

In the summer, they had relatively few problems. The wards at The Vue were quiet, and the new house staff had time to learn their way around the hospital. Occasionally, one of the bums would be brought in with assorted fractures after having been hit by a car, but generally, things were peaceful.

By October, the leaves and the bums began to fall. An open doorway for a bed, and a newspaper for a cover, did not offer much protection from the New York winter winds and the cold, and the Bellevue ward population began to increase. By December, the natural elements and a diet of occasional bottles of Thunderbird wine combined to produce a full house at The Vue. In January, when even the healthy ones couldn’t take it anymore, we were filled to capacity and we put ’em in the hallways, on the rafters, two to a bed, or anything else we could think of. This continued till March, when it began to let up a bit. By late May, Bellevue was quiet again, permitting the old hands among the house staff to finish up in peace. Then the new doctors reported in July, and the whole thing came full cycle.

I never could figure out why the bums stayed in New York for the winter. Birds went south. Golf caddies I knew when I was a boy in New Jersey would migrate to Florida in late September, spend the winter on the Sunshine State links, and then would appear back in New Jersey the next March all suntanned and hearty-looking, ready for another season.
So why in
God’s name did the Bowery Bums have such an attachment to Third Avenue below Fourteenth Street? Why weren’t the autumn streets filled with vast flocks of them crossing the Hudson to catch the freights as they rolled across the Jersey meadows?

Once I got curious enough to ask one of my patients this question. He considered the situation, and then shrugged and said, “Dunno. Never thought about it much.”

I figured that pretty much answered the question. When you hit the Bowery, you’ve hit bottom; there’s just nowhere else to go. You have no future and no hope; you’re just marking time and waiting. When you hurt enough, you try, somehow, to make it stop. Total numbness is the
ultima thule
.

And so, the annual parade of infected lungs and rotten livers went on making their way to The Vue. The individual faces were familiar for a time, but for most of them it was a pretty short career. Attrition was high among the old-timers, and their places were rapidly assumed by the new arrivals. Youth must be served. The Bowery is a tough world.

One day during my internship, they wheeled in a guy for me to take care of. He was about forty, with wiry, gray hair and beautiful yellow skin. He wasn’t Oriental though; it was his liver. He was out cold with hepatic failure. I figured that his liver must have been about the size of my pinky and have had both the appearance and the functional capacity of a piece of shoe leather. I really thought he had had it.