As an intern at Cook County Hospital in the late 1960s you were assigned to either the male or the female Emergency Room (ER). I was assigned to the male ER – and disliked it intensely. Heavily populated by the homeless who were involved in trauma and/or who were drun,, I ached for “the other side,” the female ER. And when the opportunity presented itself, I happily took it. Sure, there were the homeless, the prostitutes, the drug and alcohol abusers amongst the women. But there was ever so much more. The women who came to the ER tended to have predominantly long-neglected medical or obstetric problems – or both. Some, I will never forget.
One night a big, strapping middle-aged woman presented with complaints of “terrible arthritis.” I examined her and noted that she had “clubbed fingernails.” (This is ‘medicalese’ for abnormally shaped, extremely convex mails, often a sign of heart or lung disease.) I sent her for a chest x-ray and was horribly saddened to see obvious lung cancer, a diagnosis one detests making, especially in a busy ER.
Another day a lovely, pregnant woman came in complaining of the worst shortness of breath she’d had with “any” pregnancy. My stethoscope revealed the cause – severe rheumatic heart disease. She and her husband had recently “immigrated to Chicago” from the Deep South (like so many of our Cook County patients) and had been told that she should really not get pregnant again. Oh, for free contraceptive advice and “the pill.” She was enrolled in our cardiology clinic.
But there were happy surprises as will. One afternoon a young woman came in to the ER in active labor. I told the very capable head ER nurse to rapidly transport our patient to the obstetric ward. She looked at this green intern in obvious disbelief and said, “Honey, she’s not going anywhere. It’s your baby.” I countered by saying that I had never really delivered a baby on my own. She replied, “Well you are now.” And so we delivered a very healthy newborn in the Cook County Emergency Department (not the first, nor would it be the last in this setting).