Country Doctor A Memoir

by Dlin, Ben

• ISBN13: 9780920576854
• ISBN10: 0920576850
• Format: Paperback
• Copyright: 2000-11-01
• Publisher: Caitlin Press Inc.

Summary

Starting with his first patient, a horse, Ben Dlin discovered that rural doctors are called upon to do things that he never dreamed of when he was an intern. "I learned that I had to be prepared to do anything, any time and any place, without regard for the hour, the inconvenience, the exhaustion and the absence of assistance." Set in the post-war period of the 1940s and early 50s, Dlin recounts the responsibility of being the one person who is called upon in emergencies to make split-second decisions that can impact patients and their families for life. "I believed then and I still believe now that every student of medicine should spend time in rural practice. It is the place to discover what you're made of. But more importantly, it is the best place to learn the profession. Within the novice it creates a lifelong humanistic approach to medicine that remains no matter what specialty is pursued."

Author Biography

Born of European Jewish refugees, Ben Dlin has led an unusual life. He grew up in the only Jewish family in Bruderheim, northern Alberta. An indifferent student with an attitude problem in high school, he became a leading psychiatrist in Philadelphia, Pennsylvania. He now splits his time between Pender Harbour, BC, and Philadelphia. 'Country Doctor' is his first book.

Excerpts

The hospital also had its "bedlam" wards, much like that portrayed in the classic movie One Flew over the Cuckoo's Nest. Most of the staff members were somewhat weird themselves; many of them could, in fact, be easily mistaken for patients, and since the patients could sense illness, it affected their trust in their caregivers. One of the younger staff doctors, an overtly effeminate homosexual, was severely beaten one day for no obvious reason when he went to his assigned job in the closed, disturbed female ward.

Although the most violent and uncontrolled patients, some with and some without clothes, remained locked in padded cells, this one ward housed more than a hundred psychotic women ranging from manic depressives to catatonic schizophrenics. Many were dangerous. They wandered barefoot in drab, shapeless cotton dresses; mumbling, screaming, begging, pleading, masturbating, rocking, or just standing or sitting like statues in one fixed position. When it was time for bed they would be herded to their locked sleeping quarters down the hall.

It was this unit of suicidal, homicidal patients and other psychotics that I was assigned to take over. Naively, I unlocked the door and stepped into a world of bedlam. Almost immediately a huge woman about six inches taller than I and weighing at least 280 pounds walked up to me and said in a heavy, authoritative German accent, "I take care of you!" Whereupon she reached over and picked me up with one arm and began carrying me around the unit. I was safe. I had the protection of the toughest woman I'd ever met in my life. "Vee go here or "Vee go dare," she would say.

When I felt comfortable enough with her, I'd say, "Take me over dare," or "Vud you please pud me down und vate for me here," and she would comply. For the whole time I was in charge of the unit, she was my companion. I never read her chart because I was afraid that I might discover that she had killed her husband and her children. It seemed best just to carry on with the illusion that she was my protector. There was just not enough time to read all the charts, anyway. The focus instead was on handling each crisis as it arose and in dispensing medication.

Most of my chores were directed to dispensing medication for the epileptics, sedatives for the agitated, and electroshock for the depressed.

During these rounds I would also be on the lookout for physical illness or injury. Many women refused to eat, and without daily tube feedings most of them would have certainly died of starvation.

It was interesting to note that open, compulsive masturbation was far more common in the female than in the male units. I wondered if that had to do with the taboo at that time against masturbation. It came to me that the authors of those old textbooks on descriptive psychiatry must have assumed that since crazy people masturbated excessively, it was therefore a part of the reason for their being sick.

From time to time I noticed a thin older woman, with a greatly distended abdomen as she slunk around the ward. She looked nine months pregnant. I thought that she might have a gigantic tumor, but when I finally examined her, I discovered that the cause of the swelling was a massive faecal impaction. The nurse on duty had no idea that she had stopped having bowel movements. There was nothing to be done but to begin removing the faeces manually.

We got her onto a table and I proceeded to remove stool that was mixed with glass, stones and other foreign objects which she had either swallowed or inserted up her bum. I must have torn a dozen pairs of rubber gloves as I dug and dug, filling buckets with her bowel products. I would have preferred using a shovel. All the while this was being done the patient screamed. When I was finished and she was cleaned up, she leaped from the table and disappeared into the crowd like a wild animal running for shelter into the forest.

Three times a week I administered electroshock treatments. Though rather primitive at that time, it was still one of best tools available to help those who suffered from depression, agitation and mania. Unfortunately, it was useless for most other conditions.

Food was not allowed prior to the shock treatment in order to avoid aspirating stomach contents and to decrease bladder incontinence. The patient would lie on a table with two attendants on either side, two holding arms and shoulders while the other two held onto shins and thighs. A fifth attendant would place a roll of gauze into the mouth for the patient to clamp down on, then support the chin and head. This way the body was given some protection when the patient went into the post-electroshock grand-mal seizure, but they were given nothing to alleviate the terrible physical trauma that the body had to endure.

My job was to administer the shock. I felt like some mad scientist from a Frankenstein movie as I set the voltage on the control box so that when the button was depressed an electric impulse would travel through wires that connected to the ice-tong-like instrument that I held. The ends of the tong were wrapped in gauze pads that had been soaked saline solution to improve conductivity. I would apply these wet ends to the patient's right and left temple, and we were all set for "blast off." I'd say "Ready," and all five people would bear down with all their strength. Instantly the entire body went into severe, continuous protracted spasm, which was followed by a series of powerful convulsions that lasted about a full minute. The force was so great that the convulsions often caused compression fractures of the patient's spine.

On one occasion the nurse forgot to wring out the excess solution from the gauze ends, and some of the brine leaked onto my hands and onto the hands of the nurse supporting the patient's head and chin. When I depressed the button the patient had a seizure and both the nurse and I followed along with seizures of our arms. It was a crazy morning. I told the nurse that it might well result in our having subsequent personality changes!

Most patients came willingly and without fuss for their shock treatments, waiting in line as if it were a dental appointment. After the treatment they would go into a recovery area, sleep for a while and then be taken back to their wards. Amnesia was both a complication and a blessing of shock therapy. On the one hand, it helped to erase the frightening memory of the event, but it often led to a profound confusion that could last weeks and even months.

There were two other forms of treatment for severely disturbed patients. One was very tricky to manage: insulin shock therapy. Patients were given a dose of insulin to produce severe hypoglycemia or a fall in blood sugar, resulting in profound sweating and stupor. Occasionally, they would have a seizure. Then we would administer intravenous glucose, thereby satisfying the excess insulin circulating through the body. The patient would wake up drenched in sweat, sleep for a while, eat, and then be returned to his or her unit. Other than sedating the patient and providing a lot of attention, I saw little if any benefit from this treatment.

The final form of treatment for the severely disturbed, a very ancient one, was to wrap the patient in woolen blankets soaked in ice-cold water. Within a short time, the body heat of the patient would rise and be kept constant by the wool swaddling. The patient would become calm, perspire profusely and usually fall into a restful sleep. Later he or she would be toweled off, and then indulged with food and fluids. This treatment provided the same temporary effect In tension reduction that one might get by sitting in a hot tub or a Turkish steam bath.

Years later, when I attended a meeting of the American Psychosomatic Society, I heard a very interesting paper dealing with the therapeutic effects of regressive psychotherapy. As I listened, it occurred to me that this is what had been taking place with our swaddled psychotic patients in Ponoka. The technique apparently took the patient back to feeling like a completely dependent child, his entire needs anticipated in such a manner that he was, for all practical purposes, reduced to the emotional age of one or two.

An entirely new process, the prefrontal lobotomy, was done on patients with severe obsessive-compulsive disease and on patients whose violence could not be controlled. Our chief of neurosurgery at the university, Dr. H. H. Hepburn, would drive down from Edmonton to do the surgery, and I was pleased whenever he requested that I assist him. One of the approaches he used was to burr holes through both temples; the other was to approach the brain through the thin bony orbit of the eyes. In both procedures a thin stainless steel probe was inserted into the brain and then the surgeon would sweep the probe in such a manner as to sever each frontal lobe from the rest of the brain.

After surgery it was necessary to re-educate these patients in almost everything. They had become docile little children. However, after all this tedious retraining, they would revert to the way they were before surgery, the crippling mental illness returning with no hope of ever getting better. All was for naught. This "ice pick" operation was a brutal one that illustrates the extent to which frustrated neuropsychiatrists would go to find the 'cure' for mental illness. Today, we use simple medications to deal with the same sorts of illnesses.

It always amazed me when some woman approached me in the midst of this bedlam and said in the most rational tone of voice, 'Doctor, I am okay now." After spending time with her, I would move her gradually through the various gates to healthier and healthier units until she was discharged. I had no idea why, or how, these patients got better.

There were also a few young women in their late teens or earlv twenties who had been admitted to the bedlam wards because of the sudden onset of insanity. I spent hours with these young inmates looking for some way to reach them. I recall taking one young woman for long walks in the garden and around the grounds. A university student, she chatted at first about the things around us, then finally began talking about her family. I felt this was important progress in someone who was diagnosed as having "simple schizophrenia" because schizophrenics are characteristically void of emotion and so withdrawn they have nothing to say. But when I reported my observations at the next staff conference, I was told by the senior staff, "Don't waste your time. She is a hopeless simple schizophrenic!"

Many years later, when I was on the faculty of medicine at Temple University Health Science Center, one of my post-graduate students observed that most young girls with a first time admission to a mental hospital had their psychotic break because of an incestuous relationship with their fathers. I thought back to that young university student and wondered if she had been such a victim.

Our regular staff meetings were held in a large conference chamber that looked like a courtroom, with the jury of doctors and nurses sitting in a semi-circle. Patients were brought in one at a time and seated on a straight-backed chair in the center of this courtroom to be questioned like prisoners. The interrogation was brief, and after the patient was excused, decisions would be made as to diagnosis and disposition. It was medieval, and I realized that Ponoka was simply a cleaner version of insane asylums that had existed a hundred years earlier.

One evening while on general hospital duty I was making rounds in the chronically ill male unit when I noticed a young man leaping up and down on his bed and making noises like a one-year-old. He looked familiar. I went over to get a closer look, and to my horror I recognized Kasa, a Japanese boy who had been my high school classmate. A bright and studious kid, he had sat in front of me in algebra class. When I read his record, I learned that he and his sister had contracted congenital syphilis in utero because both parents were silent carriers of the disease. Kasa would not live long because he was suffering from general paresis of the insane, a late stage of syphilis that destroys the brain.

My time at the hospital was not all work. Dances and other social events were held for the open unit patients, who had the freedom to do as they wished, and the younger staff members were encouraged to attend. I found it really fun dancing and chatting sensibly with women whom I knew and cared for, who had been psychotic only a week or two before.

I also became very good friends with Gladys, a terrific girl who had come from Edmonton with another nurse to earn a few extra bucks and get away from home. We had a great time together and, as was usual for me, I had a major problem controlling my passions. She did too, so we "suffered" the joys of passionate love-making without guilt or regret.

All in all, Ponoka was a fascinating experience. I had seen a slice of medicine that I hoped I'd never witness again. For many of us that spring, our brief jobs marked the end of having to grub for money. I had completed and paid in full for an intensive, accelerated, six-year pre-medical and medical program. Soon we would all be entering a twelve-month hospital training program. As interns each of us would have our own small room with maid service, meals and a salary of twenty-five dollars month. White uniforms were included. Now that's what I call living!

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Excerpted from Country Doctor: A Memoir by Ben Dlin
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