Chapter Five: Medical School, University of Illinois, Chicago

Chapter 5 Sub-sections

As he began his presentation for our entering class of 160, our orienting professor said that a

Figure 4
Fig. 4. Chicago's west side medical center, 1940s
#10       Cook County's Main Building, with 4 south-directed wings
#16       Contagious Diseases
#15       Medicine, 8 floors of 110 bed wards
#11       Pediatrics
Center of Photo: Power Plant – with smoke
#14       Tuberculosis
#13       Cook County Morgue
#12       Psychiatry
#1, 4-6  University of Illinois Medical School

physiologist needed two students to work in her laboratory. Gerald Hammond and I agreed, and worked 20 hours per week in her laboratory the entire four years of medical school. Our work in the laboratory of the endocrinologist Neena B. Schwartz, Ph.D. in part involved anesthetizing rats with ether. In performing an experiment, we would place a rat in a closed beaker containing ether, transfer it to the laboratory table when asleep, and perform a tracheostomy. We would excise either the thyroid gland or the adrenals. Our research team reported responses with various drugs and with changes in temperature (Schwartz et al, 1957, 1960).

Dr. Schwartz's research laboratory was on the second floor of the medical school building facing Polk Street, directly south of the city's Cook County Hospital grounds. The medical school teaching hospital, R&E (Research and Education), had some 300 beds (below and out of the picture in Fig. 4. (See Fig. 2 for permission; this figure is from page 16 of the source). Cook County, or County, was the charity and emergency hospital for the city of Chicago. It had 3600 beds in separated buildings: the Main Hospital building (Obstetrics, operating rooms, Emergency Room), Internal Medicine, Pediatrics, Contagious Diseases, the Psychiatric unit, and the County Morgue. From our laboratory, we looked directly across at the morgue, and the Psychiatric Unit was to our right. The Psychiatric Unit was for temporary stays, while the patients were being evaluated regarding their more permanent disposition, e.g., returned home or committed to a psychiatric hospital.

Cook County Hospital is closed and the Harrison Street entrance boarded up. Its replacement, the Stroger Hospital for Cook County, is located just west of the old hospital building (to the left in the upper left corner of Fig 4). Wolcott Street, going up Fig 4 on the left, is gone, replaced by newer buildings. The buildings on the south portion of the old Cook County Hospital grounds have been replaced with newer buildings - these older buildings were # 16 - Contagious Diseases, 14 - Tuberculosis, 13 - the County Morgue, 12 - Psychiatry.

County had underground tunnels connecting all the buildings. The tunnel going south from the main hospital building ended at the morgue, so, in bad weather, to leave County, we'd take the tunnels and exit through the morgue instead of walking outside. There was a Catholic chapel on an offshoot of one of the tunnels. It had all the required incense and mystery – incongruous in the setting of dirty poorly lit rough concrete walls. County at that time had no security guards, and people were all over it all the time, day and night. The pediatric building was restricted as to visiting hours, but no other wards. Elevator operators were there as political jobs --- the elevators were automatic. More on Cook County later, now back to the medical school.

In addition to my job as a laboratory technician, I supplemented my income by being a guinea pig. One experiment, for which I was paid $50, involved an examination of the efficacy of the common cold virus in a cold atmosphere. Ten of us sat on metal chairs for an hour in a room at 35-40o F, wearing a light sweater. Half were inoculated intranasally with the virus and half with saline. I eventually found out that I received saline. I don't know if the study was valuable but the money was.

I did this one other time, for $75, in an evaluation of the effectiveness of artificial ventilation in an anesthetized paralyzed human, using the then prevalent arm lift, back pressure technique. This discarded technique involved placing the victim in the prone position; the resuscitator knelt at the head and pulled both arms from the sides toward the head, then pushed both palms on the back of the lower chest, the former to aid in inspiration and the latter to aid expiration. Dr. Archer S. Gordon was the senior researcher. I received intravenous thiopental, had my trachea intubated, and had a steel needle placed into my femoral artery. They used an ear oximeter to evaluate the adequacy of oxygenation, as well as measured oxygen and carbon dioxide levels in my arterial blood.

When I emerged from the thiopental, I discovered firsthand the long tail of depression that results from large doses of thiopental. Despite being awake and intelligently responsive, I couldn't prevent myself from falling back into intermittent deep sleep for 16-18 hours following emergence. My groin and trachea were quite sore.

The arm lift back pressure method of artificial resuscitation was discontinued in time for the improved mouth to mouth technique, but I'd seen its effectiveness prior to my being a guinea pig. In summer 1955, between my freshman and sophomore medical school years, I had taken my 5-year-old niece Phyllis to Lake Michigan near South 57th Street, walking along the large flat rocks at the water's edge. A passerby noticed that there was someone out in the lake, some 100 feet or so, flailing his arms. No lifeguard was near, so a teen and I swam out there after I'd stripped to my shorts. We pulled this man in his 50s to the rocks and discovered how difficult it was to lift a limp, soaked, dressed adult up out of the water to the rocks some 2 feet above water level.

With help from others, we finally lifted him onto the rocks, and I began arm lift back pressure resuscitation, realizing immediately that, for some reason, I wasn't moving any air at all. At that point a lifeguard dashed up and took over. First, he swept his hand inside the man's mouth and removed his false teeth. After that, ventilation was effective, the man awakened, and I was ashamed at my ignorance about airways. All my education toward care of people, and not yet any practical knowledge. Phyllis, meanwhile, was tugging at me, really wanting away from there, so we left.

I phoned the local hospital the next day to see how he was doing, and was told that he was quite upset because he'd been trying to commit suicide.

Research Chicanery – Polio Vaccine

The chair of Internal Medicine, Dr. Harry Dowling, solemnly addressed our entire class during our freshmen year. He began his presentation with the comment that there was developing a significant and major medical news item, for which we needed background information to provide balance to our opinions regarding this breakthrough.

He began with history: the National Institutes of Health had been funding a number of laboratories in the quest for a polio vaccine. He described an NIH coordinated effort planned by the virus scientist John Enders to perfect a polio vaccine. Preliminary studies had demonstrated a series of parallel avenues to pursue. These avenues, for efficiency, were cooperatively apportioned for NIH and the National Foundation for Infantile Paralysis by the internationally known epidemiologist Thomas Francis (Taber, 2005) as a mass search among ten capable laboratories, each qualified to identify an effective vaccine.

As Dr. Dowling told us, it would have been a waste of time and effort for each laboratory to follow each individual potential avenue. Therefore, the various laboratories were divided as to purpose and each was assigned a certain path, without knowing which lead was most likely to be successful. All were delighted that one laboratory was now successful in investigating its lead, and a news conference was planned for the next morning to announce this major advance and to delineate the results of a cooperative and unselfish effort among a number of laboratories. However, as Dr. Dowling solemnly told us, this news conference was now cancelled, as the single successful laboratory had scheduled its own news conference for this very afternoon, without consideration of the cooperative directed efforts among laboratories.

Thus Jonas Salk announced his discovery of the polio vaccine and how his laboratory had successfully achieved this. Dr. Dowling told us that we should form our own opinions in evaluating Salk's decision and that Salk's scientific honors would be somewhat limited. However he expected that Salk would be otherwise strongly rewarded (Oates, 1995). Salk's project was basic routine virus research, described by Salk's competitor, Sabin, as ‘kitchen chemistry' (Obituary, Jonas Salk, 1995). Salk received neither a Nobel Prize nor election to the National Academy of Sciences, but did receive generous private funding for a well-regarded laboratory.

The Unforgettable Patient, Who Teaches You

Some patients you don't forget: “The career of every clinician is punctuated by a few formative cases” (Goldberg, 2001). I spent three months in a pediatric clerkship at R&E hospital during the spring of my junior year, 1957. During the first six weeks, while on the pediatric ward, a 20-month-old white boy was admitted for failure of mental and emotional development. This boy had an indelible effect on me as well as others.

Initially during his two week stay, he was quiet, virtually mute, and a loner. As nursing and medical personnel played with him, held him, and stimulated him, he began to blossom. By the end of the two week period, he was running around the ward, talking very well, laughing, and interacting. He was the star of the pediatric ward and obviously intelligent. We sent him home with great feelings of satisfaction.

Several weeks later, while I was in the outpatient clinic, his mother brought him back for his followup visit. He was a disaster, as he was now exactly as he had been when first admitted to the hospital. His home environment had prevailed. What was his later life like, and how did he eventually use his intelligence? Had we wasted our time, or would the brief awakening of our ward life in time influence him beyond his home environment?

A Woman Dies

This 28-year-old woman entered the hospital with an infection that had turned into a raging sepsis. We could not find a cause and she swore that she knew of nothing that might be causing it. She died after several days of intensive treatment. Her autopsy disclosed a uterine infection related to a ‘back room' abortion. Her husband related that they had three children and could not hope to afford another child. She apparently was psychologically unable to disclose what had happened, regardless of circumstances or outcome.

Cook County Hospital

Cook County Hospital was a parallel to Charity Hospital in New Orleans, the latter nicknamed the “Big Free”. County was over-crowded and under-staffed and maintained through the efforts of dedicated nurses, residents, interns, medical students, teaching staff, and recovering patients.

For example, the eight floor building for internal medicine patients had a 110-bed ward on each floor. The beds were lined up side by side, 55 on each side of the ward, with two semi-private rooms near the nurses' station for sicker patients. By day, there was one nurse per ward; at night, there was one for the entire building. She did not have time for direct patient care, but could provide medications to those who needed them. We as medical students were impressed with the dedication of the nurses, as they stayed well past the end of their shift to finish giving meds or helping specific patients. Patients who were improving and ambulant routinely helped with nursing care. This is quite unusual now, but non-paying ward patients were grateful, friendly in general, and helpful. We medical students learned from the huge population and helped where we could.

One unique event involved an elderly Chinese patient, who spoke minimal English. He was recovering from an internal medicine disorder, and ambulatory, when his behavior changed. He continued to be his good-natured self, but now tried to give what little money he had, mainly change, to anyone who would accept it. We told him that he'd need it once he was again outside the hospital, but that didn't deter him. After he'd disposed of it, he lay down on his bed. Fifteen minutes later, he was dead, without evident cause.

Another example of Cook County's amazing health care was normal uncomplicated obstetrics, another 110-bed ward. Fifty women delivered every day, and, in two days, the ward was full. Those doing well went home, and the others were transferred to a ‘complications' ward. My 1957 summer job was as a 3-11 p.m. nurse technician in the fourth floor obstetrical delivery suite at Cook County Hospital. My function, not that of a nurse, was to facilitate where needed in the 50 deliveries per day, yes, 1500 per month, 18,000 per year.

There were four delivery tables in three delivery rooms, a totally inadequate number for that volume. With this incredible volume in a tiny facility, there were many urgent deliveries: in the hallway, coming off the elevator, and in the ‘labor line' -- the 15-bed-room where the mothers waited until ready for delivery. We had occasional relief from obstetric stresses with our north-facing windows that overlooked the newly opened Eisenhower Expressway. After a severe June rainstorm, the freeway flooded, because leftover straw floated into and plugged the sewer system. We could see the tops of the stranded cars.

In these obstetric patients, pre-eclampsia was a frequent problem, with high blood pressure and various side effects. County treatment for pre-eclampsia was the Stroganoff method: morphine plus magnesium sulfate, given until the mother was groggily stuporous. This was effective because it kept blood pressure closer to normal limits, controlled muscle responses, and didn't require sophisticated equipment for administration. In that area, things moved quickly and nursing and physician staff had to make rapid decisions, as well as not be encumbered with equipment requiring close supervision. Their activities were directly focused on their patients.

The newborn infant of a Stroganoff-treated mother was opiate-obtunded, with markedly depressed respiration, and the obstetric resident would call for reversal with levallorphan (Lorfan®), then the popular reversing agent, to stimulate respiration. While awaiting the effects of Lorfan®, the resident used a slightly stiff brown woven tube to intubate the trachea tactilely (finger guidance – they did it impressively well), and gently breathed mouth to tube for the baby until the intra-muscular injection of levallorphan took effect. We flowed oxygen into the resident's mouth for expired gas enrichment.

A final Cook County example was a patient room in the eight floor pediatric building for babies with hydrocephalus. There were about 15-20 babies there, in individual cribs, with pumpkin-sized large heads, small faces, and tiny eyes. At that time, mid-1950s, this could not be treated, as shunt procedures were not yet developed. Without treatment, the babies' heads slowly enlarged. With their huge heads and tiny eyes, they could only lie on their backs, unable to lift their heads. They were given good care and feeding but in time could not survive. The skin on the back of the head developed bed sores, and became infected. They were so inactive due to the weight of their heads that they were in poor condition to ward off any health stresses -- a tough ward to be on as a medical student.

During my summer as a nurse technician on the obstetrics labor line, I met Pat Sparlin, a student nurse on her evening teaching rotation. We were engaged within three weeks and married five months later, December 26, 1957. I first noticed her caring for patients in the labor line, attentive to patients, but also watchful of everything that went on. As was routine in the delivery area, she wore a full cap that hid her hair. Her face had a fabulous tan, which I later learned was due to a recent one week vacation in Salt Lake City with her widowed mother. Seeing her tan, I had decided that she was another of those young women with bleached blonde hair to go with the habit of soaking up sun on every possible day. To my surprise, when she took off her cap at the end of her shift, she had dark hair generously sprinkled with gray. I realized that this 5'3” 161 cm 21 y/o woman was remarkably attractive. At the first opportunity when our shift ended, I asked her to the Greek's, the hangout across Harrison Street from the hospital, for a hamburger. I learned that she was from Lewistown, Montana, and interested in everything about Chicago. Our first date was to the Indiana Dunes State Park at the southern tip of Lake Michigan, with its great beaches. We became serious rather soon.