As portrayed in the TV show MASH, Hawkeye and Trapper John were meatball surgeons in a Mobile Army Surgical Hospital during the Korean Conflict, some of the same years I was resident physician at City of Detroit Receiving Hospital.
The two hospitals were so similar I never had any trouble identifying with their efforts to deal with injuries and death resulting from human mayhem, or with the irreverent humor they mustered to relieve tensions inherent in their jobs.
Receiving was never directly under fire (although a resident was killed by gunfire during the 1942 Detroit riots) and had a more steady flow of emergencies--although we peaked on weekends, and Christmas and New Years Eve, when families got together. And, any potential for intramural violence was dampened by two armed City of Detroit policemen in a cage right in the center of the admitting area.
Perhaps the greatest difference was the MASH unit did not have to deal with women whose lives were in jeopardy because of induced abortions.
Receiving was a 400 bed hospital that received nearly all emergencies from a metropolitan area of two million people. As I recall--and all figures will not be exact after 55 years--we had 13 emergency rooms with two to six gurneys in each, a capacity for treating about 50 patients at any one time.
To care for several hundred emergencies each day, we had a large, skilled nursing crew and four to eight interns. And four resident physicians--one surgical resident, one internal medicine resident, one psychiatric resident and one obstetrics and gynecology resident in or near the ER at all times.
Why psychiatric? Heroin was big then, and many people were irrational, comatose or dead on arrival from overdoses. And, as always, alcohol, and delirium tremens (DTs). These conditions sometimes made it darn near impossible to evaluate associated medical and surgical conditions.
The full-time OB-Gyn resident’s numerically biggest job was caring for women who had had the infamous back-alley abortions. We saw scores of them.
Their ambulance ticket to Receiving Hospital was usually heavy bleeding from an incomplete abortion, or from injuries ranging from potassium permanganate burns to perforated vaginas to torn cervices and uteruses.
Most “incompletes” were cared for on the gurney by removing retained, often infected tissue with a ring or ovum forceps. That and oxytocins usually stopped the heavy bleeding.
Blood and antibiotics were often necessary. If the uterus was intact, the tissue removed and the patient stabilized, they were transferred to one of several area hospitals for further observation and treatment, or sent home with instructions. Only the very sickest and nearly bled out were admitted.
Some women, not many, but some each year, were dead on arrival or expired shortly after arriving, almost always of hemorrhage. To this day, I can see a plump, blonde girl of 15 who lay marble-white on a gurney after an would-be abortionist had inserted a coat hanger that perforated her uterus and uterine vessels. Her parents cried at her side.
The adhesions that followed abortion and venereal disease resulted in many ectopic (extra-uterine, often tubal) pregnancies. On two occasions, we had four cases on the way to the ER. In all, we had more ectopics at Receiving than reported for the entire city of Baltimore. They were great first surgical cases for us, just as gun shot wounds were for first-year general surgical residents.
After Receiving, we had seen it all, from unattended obstructed labors with dying or dead babies to advanced, untreated cancer. Most of us moved on to gentle practices in nice places like Topeka where our previous experience served us well.
But, just as I suspect of Hawkeye and Trapper, we didn’t forget the needless human trauma we could only treat after the fact. For the most part, we put it out of mind. It made for better mental health.
And, while we would have liked to modify or eliminate the causes of injuries we treated, we hardly expected an opportunity. But, if opportunity knocked, we were experientially more motivated to act. In my way, I did.
Dr. Roy may be reached at firstname.lastname@example.org