Chapter 7
Women
A large part of a general practitioner’s work is done with women as patients. There is a marvelous variety of women and no two are alike. There are those who are genuinely ill, those who wish sympathy and someone to talk to, those who try to seduce the doctor, and those who come for many other reasons.
One day when I first started practice, I was called to a home nearby to see a very acutely ill patient. Since patients were scarce, I hurried down to see her. I rang the bell, waited a few minutes, and then the door was opened by a lovely young lady in a flimsy, sheer negligee. I stepped inside, and she collapsed in my arms without saying anything. She had one arm around my neck, holding on for dear life. I set my bag on the floor, took her over to the sofa, and laid her down. She released her hold on me and spread her negligee while I hurriedly rescued my bag and left her house as quickly as possible. Never did I hear from her again, and I don’t know to this day just what she had in mind, but I didn’t intend to play a part in it.
Then there was the young woman talking about a frustrated love affair who said, “He doesn’t know what he is missing not having access to me. I am always available. I have the attributes of a female besides being lonesome and anxious to please.”
One of the amusing incidents to break the monotony of everyday complaints was when a woman said to me, very seriously, “Yes, I have a hole in my head. Feel right here and see for yourself.” And where she indicated there was a spot where she had had a craniotomy which left a distinct depression. Yes, she definitely had a hole in her head.
Patients have great differences in their ways of expressing themselves. Take the woman who, in answer to my query as to how she actually felt, replied, “I feel better today, Doctor. Even my painful spots have a happy tingling that makes them bearable and makes life almost enjoyable.”
I was amused at Mr. Andrews, when I met him on the boulevard and inquired as to the condition of his wife, whom I was treating. “Oh, she’s about normal, I guess. She was complaining this morning that she felt better.”
One dear soul, who was a regular visitor, talked so incessantly that she forgot what point she wanted to make in her story and couldn’t remember just how she wanted to bring it out. She had to be reminded of what she had said before and led around to the subject of her illness. At one time, she said, “Doctor, I want to skitter over my subject like a lizard over a hot rock, and when I give you enough history for you to make a diagnosis, then stop me.”
Miss Clark was an attractive and popular woman who, unfortunately, has psoriasis from head to foot. It was so bad across her abdomen that when she scratched, white flakes by the thousands fell to the floor, leaving a fiery red abdomen. It was very bad on her elbows, below her knees, and on her thighs. She dared not wear a bathing suit and always wore long sleeved dresses or blouses. Fortunately, it was not on her face or anywhere it showed, so she stoically accepted the fact that she had to live with it and accepted the fact also that it was seasonal, being worse in fall and winter. One day she said, “Isn’t it a lucky thing that people wear clothes?” I fully agreed, as the majority of us do indeed look better that way. She finally got married, and I have often wondered how her husband responded to her psoriasis.
She was a patient one, but the prize for patience goes to Ruth Kennamer. Ruth and Fred grew up together, went together all through school, and were actually engaged for nineteen years. Ruth lived with her mother and was her sole support. Fred was the sole support of his mother (this was before the age of welfare), so he kept putting off his marriage to Ruth. Ruth told me that she was prepared every day for Fred to set the date. Finally his mother died, and still he said nothing, and still she waited. But people do what they want to do, usually, so Fred went year after year without setting a definite date. When, after nineteen years, I lost track of them, they were still waiting.
A daughter is more a captive of the mother than is a son. Many a lovely young woman has given up marriage because of this mother-captive influence, while a son, if he wills, can usually escape such captivity through the help of a sweetheart, whose drawing power is much more intense. If a man marries a captive daughter, he finds himself corralled by two women. On the other hand, many young women are unknown heroines (or fools) for staying with their mothers and passing up early chances to marry until it is too late.
In the early days and in modern times of “unliberated” women, marriages were arranged by the parents of the bride. Now, at least in our country, they constitute the climax of violent emotional experiences, and we blame heaven for them. We frequently hear that his or that marriage is made in heaven. However, frequently the party of the first part does not remain so excited about the party of the second part, and there intervenes a complicated feeling of being rejected, unloved, or misunderstood. The individuals cease to be angels to each other and find it difficult to come down to earth and be human.
Perhaps many divorces in earlier years were prevented by the death of the wife. Only a few years ago a large percentage of young women succumbed to tuberculosis. The longevity now enjoyed has no doubt kept alive many people to the divorce age. We frequently hear of couples who have been married thirty, forty, or fifty years who have finally decided they can’t stand each other. Then, too, there are fewer social pressures holding couples together now that the wife can work and frequently earns more than the husband, so she can easily go out on her own. Earlier, there was disgrace about divorce, which inhibited some couples from going through the procedure.
Now, many teenagers seem to be joining the wedding ranks. This brings an increase in problems since some young couples consider it a temporary state. Frequently the wife works, giving her a feeling of independence, so there is not the economic necessity to remain married. It is not unusual now to find nineteen and twenty-year-old girls with their third or fourth husbands.
Perhaps there is now more tension and difficulty in adjustment. All young couples are in a hurry these days. A few years ago, the young folks got married, rented an apartment, and were satisfied with a bed, a range, and a few tables and chairs. Now, they want to buy a home outright, complete with furniture for all the rooms. That is the way the Joneses do it, so why shouldn’t they? Payments on house, furniture, refrigerator, car, and then a color television can account for some built-in problems to begin with.
Remembering that man lives for his work, while the woman lives for her love, is very helpful to young couples to get along better. Adjustments should be made accordingly.
One of the greatest causes of tension, besides financial, is the sexual adjustment. With many there is still a state of anxiety and a feeling of guilt and shame. However, this is diminished as people become better informed. With understanding on the part of each partner, this usually is adjusted satisfactorily. The contraceptive pill has been a great tension reliever.
There is a great difference in the way that children are brought up, and in their attitude towards life in general. This can result in such different outlooks that personality clashes can come from many everyday incidents. This, when accompanied by a definite lack of maturity in one or both individuals, can cause grievous misunderstandings over almost insignificant things. It is said that the worst difficulties arise over the smallest things, while the really big troubles bring us together, and we can work them out. Anyway, immaturity can cause an individual to act impulsively, without due consideration to others. Those who have their way as children may continue to be selfish and unsure of themselves after marriage.
Life is always more complex after marriage. It becomes necessary to make decisions that were previously made by the parents. Emotional adjustments must be made, there are daily problems that must be confronted, the budget must be balanced, and always there is the marvelous state of being married. In other words, no matter what small differences may arise, they must be always kept small and the mate must be kept happy.
As luck would have it, I had occasion to deal with very few severe mental cases, but there are two I must enumerate. One was a middle-aged woman who had a “heaviness” in her stomach. X-ray examination revealed a very opaque mass of some sort in the stomach and other small opaque objects scattered throughout the bowel. We opened her up and found 328 small metallic objects in her stomach, and some had passed on through the bowel. They were small bolts, nuts, coins, small closed safety pins, and things that amazed us. She really had an appetite for metal. There was no indication as to how long this had been going on.
Another patient complained for two months about a frog in her stomach. She could feel it move and could hear it croak. We tried psychotherapy on her, but she could still hear and feel the frog. X-ray examination did not reveal a thing, but she insisted the frog was there. Finally, we decided to operate, take out the frog and show it to her. She entered the hospital, we made an incision in the skin, then clipped it up and had a frog from the laboratory in a pan to show her when she came to. By golly, it worked! The symptoms cleared up and she no longer heard or felt the frog and she was cured. We rejoiced. But in about six months, she got another frog. Then the problem was really ours.
Which reminds me of a contraceptive method that is used in Communist China. In 1956 there was a birth control campaign in which the Chinese Minister of Health called for the sacred contraceptive formula of herbalist Yeh Hsi Chun. It is as follows.
“Fresh tadpoles coming out in the spring should be washed clean in cold well water and swallowed whole three or four days after menstruation. If a woman swallows fourteen live tadpoles on the first day and ten more on the following day she will not conceive for five years. If contraception is still required after that, she can repeat the formula twice and be forever sterile.” Yeh Hsi Chun says the formula is good in that it is effective, safe, and inexpensive. The defect is that it can only be used in the spring. (Understand, please, that I do not recommend it, as my experience with this method is lacking.)
It is a known fact that people who are infertile for years can become highly fertile after adopting a baby. I had two experiences proving that. Mr. and Mrs. Caldwell had been married fifteen years and were very desirous of raising a family. Finally, after a wait of almost two years, they were called by the Children’s Home Society. Mr. Caldwell was a principal of one of the schools, but he took the day off and joyously went over to pick up the lovely boy they had for them. Within three months his wife was pregnant. She had another boy. And one year after it was born, she gave birth to a girl.
Another case was that of a banker and his wife who had tried for years to have a family. They had all the fertility tests, which turned out positive. They received a child from a private source, and within a year were blessed with a child of their own.
In the delivering of babies, there are some very interesting things arise. Obstetrical patients love their doctor more than any other patients. Even a grandstand surgical case or a drawn-out medical case fails to impress a woman like her obstetrician and his care. Somehow he is closer to her, in a more personal way, than any other doctor. A woman can have an acute appendicitis and be successfully operated on, then go on almost to forget her surgeon, but let a man see her through childbirth and she doesn’t forget him.
I really enjoyed obstetrics, in spite of the fact it always was a bother at night or during busy office hours. The doctors have a way of inducing labor now to correspond with their social events, but I always left nature to take its course.
There was one time that I was frightened during a forceps delivery. The patient was a young girl with her first baby. She had been in labor for an unusually long time, it seemed, and I saw that she would require a forceps delivery. So, I very carefully applied the forceps to the head and eased the baby out. I was surprised at the ease with which the baby was delivered after her laboring for so long. Just as the child came through the birth canal, there was a very loud pop. I wondered what I had done to the head or neck. The position was normal, and I had exerted little pull while the delivery was relatively easy. Sometimes a patient can have ineffectual labor pains which do not accomplish much, as in this patient’s case. However, there was something which popped so loudly that all the nurses heard it, and one of the nurses looked as me as if to say, “Now you have done it.”
That baby had one of the best examinations that any newborn ever had. There were faint forceps marks on the head, and we could find nothing else. It was indeed a perfect baby. Later when I mentioned to the mother about the occurrence, she said, “Oh, that was my left knee. It always pops when I least expect it.” Boy, was I relieved to hear that. I had to rush out and tell the nurse who had given me such a dirty look at the time of delivery.
One day during the war, a very lovely girl came in almost ready to deliver. She was from Texas, her husband was in the army, overseas, and so forth. I made arrangements with the hospital, gave her the preliminary examination, and waited. She delivered in the daytime about two weeks later. She had one of the most beautiful little girls I ever saw. It was really a honey. I even envied her a little bit. I was telling her how lovely the baby was, not a bit of moulding, pink-cheeked, and perfect.
“Take that damned baby and give it away,” she said. “I don’t even want to see it.”
We were amazed at her reaction. She was like a Dr. Jekyll and Mr. Hyde. She insisted she didn’t want even to see it, so since she signed a consent to give it away, we had the Children’s Home Society pick it up. How fortunate some family was to get that child. That night, she disappeared from the hospital, owing both the hospital bill and my bill. We never heard of her again. That was a case of lack of appreciation all around.
One day a mother and daughter came in together, both pregnant. The daughter was nineteen and the mother was thirty nine. The daughter was a bride of a few months and was very happy about her condition, while the mother was very unhappy.
“Why, you are not too old to have a baby,” I told her, trying to cheer her up and put an optimistic face on the occasion.
“It’s not that I mind so much. It is just the thought of ten more years of PTA,” she wailed.
There was a young woman who had had polio, which left her crippled in a wheel chair. Her husband came in with the news that she was pregnant. She had not menstruated for four months, and he brought a sample of urine. He maintained that she was unable to come in but wanted me to take care of her. Each two to three weeks he brought in a specimen, told me her weight, that she was feeling okay, etc. My insistence that she come into the office was in vain until she was almost at term. Then, one day, he wheeled her in. I put her on the table and gave her a good examination. In the first place, she was not pregnant at all. He could not believe me, even though she had gained very little weight. I could easily feel the uterus between my fingers, and it was of a normal size. I told them the painful truth.
“Your wife is not pregnant. She has a condition called pseudo-cyesis, or false pregnancy.” I did not want to make them feel too bad or embarrassed. After all, she had had showers, they had outfitted a room for the baby, and all preparation had been made to receive a child at home.
“Doctor, are you really sure?” the husband asked.
“Yes, I’ll swear to it,” I said.
“Well, you know, her pregnancy is different. You see, she is pregnant by the Holy Ghost.” He was serious as could be. He insisted that she was pregnant, and if we’d just wait and see, she would have a baby. But she didn’t deliver as much as two years later, when I lost track of her. I still wonder what explanation they gave their friends.
Mrs. Beatty was the mother of a minister and was a dear old soul. She was extremely hard of hearing and always rolled up a newspaper into a cone shape, giving me the big end to speak into. She was never very ill but used the excuse for me to come to see her. She must have been very lonely as she always had many questions for me and tried to keep me as long as she could. This was when hearing aids were first coming on the market and were so high priced that she could not afford one.
“This newspaper makes an excellent hearing aid,” she said. “Besides, I can use it to hear only what I want. If I had an electric aid, I might hear a lot of rubbish I am not interested in.” She could in that way keep isolated from the world when she wanted. The more I think of it, the more I think she has something there.
One patient I shall never forget was a surgical patient. We removed her appendix and then inspected the pelvis to see if there might be any further offending organ. The pelvis was clean, but she was one in many to have a bi-cornuate, or double-horned uterus, just like some of the animals. This condition arises from the arrest in the fusion of the two separate tubes, the Müllerian ducts, which normally unite to form the uterus. This woman was in her forties, had never had a pregnancy, and had made no effort to prevent it.
The cornua (or horn) on the left side was slightly smaller than the one on the right. She was the only patient with that condition, but I understand it occurs in a number of individuals.
One day when I had just begun to practice, one of my doctor acquaintances sent Mrs. Norton in for me to do an abortion. It seems that many of the older doctors try out the newer ones to see if they do abortions. (This was in the days when abortions were very illegal.) Mrs. Norton was young, healthy, just married a year or so, and I figured she needed a child. Her husband did not want any children, in spite of what he had told her before marriage. Well, I refused to do it, telling her it was not in my line of work, and I finally talked her into having the baby. It was a lovely girl, and both she and her husband were so pleased that they had two more, both girls also. They made one of my happiest families, and the girls have brought me great joy.
Another obstetrical patient I’ll never forget was Mrs. Hays. She was a big, jolly girl, 5 feet, eleven inches, well built and the wife of a fireman. She was pregnant for the first time. After my evaluation of her, I decided she would be no problem. We had the usual prenatal visits, and finally she went into labor. She went into the hospital, had her preps, and was having labor pains moderately and regularly. At last the time came as it always does. The nurse called me to come down and be ready. When the nurse returned to the patient, there was the baby, delivered and crying. Everything was fine when I arrived. My work was done and the mother and child were in fine condition.
Mrs. Hays got pregnant again in a year or so and went to the same hospital. The girls all remembered her, so they decided she would not fool us the second time. They called me early so I could be there in plenty of time. When the nurse returned to the bed, there was the baby, crying lustily, in perfect shape. She had done it again. She was really quick on the draw.
I mentioned her husband being a fireman. He worked nights, so he decided that everyone else was awake at two o’clock in the morning. He, instead of his wife, called me at that ungodly hour to report on the baby’s progress and to get feeding advice. In those days I was getting a minimum of sleep anyway, so I soon put a stop to that.
Mrs. Hopkins was being honored as a mother at a Mother’s Day ceremony. It was a lovely affair, and a large, beautiful potted plant was bestowed upon her, and everyone was happy.
“Why in the world should I be honored as a mother? It was not by my choice that I became one,” she secretly told me.
Then there was the woman who came in to make arrangements to have her husband “clipped.” I didn’t realize just what she meant, but found out that she wanted him to have a vasectomy. It seems that some neighbor’s husband had been “clipped.”
One older woman said she had dandruff on her special wig. Another came in complaining of “gall stones in my kidney.”
Still another, when I asked her what her complaints were, replied, “My achromic clavicular hurts, and I have calcific densities in my pelvis.” She had made the rounds of doctors and repeated what she thought she remembered hearing them say.
A patient in the menopause age was to get a shot of estrogen for her hot flashes. She had no panties on and called my attention, needlessly, to the fact. Then she said, “You see, I am prepared to take advantage of any opportunity that presents itself.”
Mrs. Hastings had a small ranch and hired a helper. She had had an auto accident in which she had her nose scraped off, so in order to avoid having people look into her nasal cavity, she had an artificial nose constructed to fit. It was apparently made of poor quality clay and served the cosmetic purpose, although it was far from being a good match for her face. Then, later, she had another nose made of plastic material which matched her face much better. It was of finer texture, was better finished, and was finished in a much neater fashion. She used the first nose every day, just in case she might have an accident, and saved the second one for Sundays and special occasions.
One day her hired man quit and the employment office sent another. He was younger, better looking, and proved to be a very good worker. In fact, she liked him so much that she wore her Sunday nose every day while he was there.
There is an exasperating situation which does occur more frequently than we think. When a patient comes in, the doctor likes to get the history from the patient in his or her own words. It is customary for a wife to accompany her husband, for frequently it is through her efforts that he is coerced into coming to the doctor in the first place. So, when a patient is asked a question, the doctor expects an answer from him, and not from his wife, unless he should be paralyzed or otherwise unable to answer. Some women take it upon themselves to answer every question for the poor husband, making it impossible to get any information from him. Then, too, a few husbands attempt to speak for their wives.
Another situation that always impressed me as being peculiar was to have the father of a newborn baby ask all the questions regarding the child. Many mothers waited until evening to bring in a child, because the husband had the car in the daytime. When they arrive it is usually the mother that gives the report, asks the questions, takes the formula, and shows the most interest. An occasional father does all the questioning and leavles his wife speechless. Then, later the following day, the poor mother calls up on the phone to get the advice straight.
Sometimes a wife can give a clue which helps to make the diagnosis. I think particularly of Fred Bean, who came in having some very weird symptoms, including a rash which we could not get to clear up. He made two trips to a dermatologist, to no avail. He kept coming in, almost every week, with a new symptom, all a little psychiatrically oriented. I was at a complete loss to know what it was because the symptoms were so vague and bizarre.
One day, after being concerned about his condition, I called his wife, thinking I might get a lead that he failed to give me. I learned that she was even more exasperated with him than I. After all, she had to put up with him more hours than I did. He had told me he didn’t take any home remedies, but I asked her, in order to get the picture from her angle.
“Did he ever tell you that he takes some stuff for his headache, and on general principles, almost every day?” she asked.
“No, he never did. He said he didn’t take anything.”
“Just a minute. Let me look and see what it is.” A pause, and then she returned and said, “Bromo-Seltzer. He takes some almost every day.”
That was the answer to our problem, and it made the diagnosis. Fred had bromide poisoning, which was causing his rash and his bizarre symptoms. When confronted with the fact, he sheepishly said, “Oh, that was hardly worth mentioning. It didn’t amount to anything.”
But when he eliminated it from his routine, his symptoms cleared up and he felt his former self.
While I was early in my practice, there was a middle-aged woman in town from Australia. She had a very painful type of arthritis and being a wealthy sheep owner’s wife, he had taken her to European medical centers for relief from her arthritis. They had been to Vienna, Paris, and Glasgow, with no results. Then they tried Johns Hopkins, Mayo Clinic, and a medical center in Boston where they were given the admonishment, “You’ll just have to live with it.” They were in Los Angeles, on the way home, and she developed a very acute appendicitis. We took out her appendix, she had an uneventful recovery, and remained in the hospital fourteen days, as the patients did then. She had her own nurse traveling with her, so after another week or so she was able to take a boat home. (There were no flights then.) Two months or so after they left I had a letter from her nurse, telling me that the patient’s arthritis had cleared up and that her pain was absolutely gone. Apparently the arthritis had stemmed from her infected appendix, which had not bothered enough to call attention to itself. This helped with our “focus of infection” theory. It was a new slant, but we were very happy to know we had helped cure her arthritis when the big medical centers could not.
Most plastic surgery in adults is not to improve the imperfections left by various disease processes, but to erase the changes that come with age. Most of these patients are women because they are the most vain. The men just do not care enough to go through surgery if it is not necessary. A great deal of plastic surgery is for sagging breasts, or for breasts that are too big and full. In the early thirties, some breast surgery involved the injection of breasts with liquid paraffin. I have never seen any directly after the operation, but after awhile the paraffin becomes lumpy and pliable, and can be molded in almost any shape. The breasts are moderately painful, and are certainly no beauties to behold. Since then other materials have been designed to inflate sagging breasts, but none are very satisfactory. The best way is to take fat from the thighs and build up the breasts to size.
Sometimes the breasts are large and the woman wishes them smaller. It is a tedious trick to remove some fat, cut new openings for the nipples in the right place, and insert them successfully.
One young woman had such large breasts at eighteen years of age, she had them completely removed. I don’t know who would completely remove an eighteen year old girl’s breasts, but at twenty-three she became romantically inclined and wanted some breasts built up for her. I put her in contact with a good plastic surgeon who was willing to try, and we went to work on the project. We took fatty tissue from the thighs, and materials for the nipples from the vulva and in several stages built up a pair of breasts that at least gave her shape. Hospital prices were much lower then than now, and a woman could afford to be vain.
Another type of plastic surgery that is even more necessary is to repair burn scars on a neck. It is surprising how many children pull pans of scalding water or coffee over on them, resulting in third degree burns on the neck, with intense scarring. Those big, ugly scars can’t he covered up, but they can be helped. Sometimes they pull the head over so the child can’t look straight ahead. After several operations, the child can look straight ahead and live a normal life.
Nasal surgery is frequently done, too. In fact some noses are very greatly improved in appearance and nasal surgery seems so easy. It does give a fellow a very peculiar feeling when the chisel is in place, and he is told “hit firmly, but gently,” and he always wonders if he has struck the type of blow he should.
One day one of my long time patients came in after an absence of over a year. “Doctor, I just can’t hear as I should, even with my new hearing aid.” This woman was a very lively, older lady who worked as a helper in the blood bank. She was always available to help out, never complaining that it was too hard, or that she was too tired and didn’t feel well, or the myriads of other excuses that one usually hears. Now, she didn’t have a hearing aid when I last saw her, so I questioned her about it. It seems as though, about six months before, she suddenly developed a hearing difficulty, so her friends advised her to go to be tested for her hearing. The result was a hearing aid which was “unsatisfactory.”
I had her take it out, and I examined her ears, only to find them filled with large amounts of inspissated wax. After washing out the wax, so the tympanic membrane shone in the light of my otoscope, she was astounded.
“Why, I can hear perfectly, even without the hearing aid,” she happily announced. Some very high-powered salesman had made a sale when no sale was necessary. She was one of the happiest people I have ever seen, to know that her hearing was good.
During the war, when so many of our commodities were rationed, we doctors had our share of problems. One woman told me, “Doctor, I have an arthritis condition which simply will not be controlled without thirty- two cups of strong coffee a day.”
Now I had never heard of such a thing, nor was there any indication that coffee would help arthritis. However, she talked incessantly and very convincingly, but she could not convince me. I told her that there was nothing in medical science to back her up, and that if I should send in a request for her to have that much coffee, she and I would be the laughing stock of the town. That was obviously one of the many tricks to get more of a rationed commodity.
Since there were so many people working for manufacturing companies where insurance was part of their pay, I was always having to evaluate carefully the cases to guard against malingering. There were some really funny things, sometimes, like the woman who blamed the concrete floor where she worked, for causing her hemorrhoids. Further questioning revealed the fact that she had a slab floor in her home (as many homes had that were built in those days) and she did not blame it at all!
Another woman with very painful hemorrhoids felt she had to be helped out to the car after her treatment. She had a little Pomeranian dog in the car, which caught the eye of my nurse. There was some talk about it before the patient went her way. About a week later, the nurse saw the patient, walking briskly along in the shopping center, so the usual greeting ensued, with the nurse finally asking, “How is your little poochie?” referring to the dog.
“Oh,” she said, “it is a greet deal better. It hasn’t bled a bit, and it doesn’t hurt any more.”
There was an attractive young woman, about twenty-two years of age who came in one day for a check-up. In the course of the history, I asked her occupation. “I am a sporting girl, down here from Canada to try to break into the Los Angeles trade.” I was rather taken aback by her frankness. But I asked her a few questions further.
“Are you having any luck? Do you find business as good as you expected it?”
“Business is not worth a damn. There are entirely too many eager amateurs here.”
I pondered that a moment. “Yes,” I replied. “I guess even sporting girls have their competition.”
Some people enjoy poor health to such an extent that they seem to welcome it. Such was the case of Petty Anderson. Petty was fifty-five years old, a well-to-do widow with a new car and nothing to do but take care of her seventy-five-year-old mother. But the poor mother had to take care of Petty. She was very demanding! There was nothing wrong with her except overweight and over-indulgence. I checked her very carefully, having all the X-Rays and laboratory tests even remotely indicated and I could find nothing but boredom. I asked her, “Why don’t you go to church, or join some of the clubs like the women’s club, or do Red Cross work? You would be a great deal happier if you kept busy.”
“Oh I have been through all that. It doesn’t mean anything to me. I’d rather have someone do something for me.” And she was always expecting someone to wait on her.
On the other hand there was a dear little soul who was alone in the world, who had a mild coronary attack. She lived on a meager pension, but her wants were few. She could hardly wait until she was well enough to resume her work. “There is a great deal of satisfaction in knowing I can be of help,” she stated. In addition to her church work she knitted for the Red Cross, and was always busy helping someone.
Many women are extremely gullible, and will believe almost anything, especially if it sounds to their liking. I am thinking of those who are so sold on chiropractors that they actually risk their lives sometimes, going to them. Chiropractors are excellent salesmen, and it is too bad more M.D.’s don’t use some of their ability. Chiropractors’ sales ability far supersedes their scientific ability, when they can convince a patient that an adjustment of the spine can cure diabetes, allergies, heart disease, cancer. and tonsillitis.
One day I sat at a counter having lunch, when a young man next to me spoke and introduced himself as a chiropractor. I didn’t tell him I was an M.D., but let him talk. He had recently finished studying the Palmer Method, and had opened his office. He gave me his card, assured me he could cure almost anything by adjusting the spine, and hastened to inform me that he had recently finished a six-weeks course in obstetrics. My curiosity was aroused, so I ask him where he had his course.
“There is a school downtown here where they have a good course for six weeks, working with the mannequin. We explored it very thoroughly, from every angle.”
Too bad it isn’t that easy. A mannequin can be so different from a real live mother, and so many problems can present themselves in a live patient. We had studied a mannequin for about one hour, but our experience had to be far more extensive than that.
The danger in trusting a chiropractor is that while depending on him with a chronic disease or a malignancy, one is losing a great deal of valuable time while the disease could be investigated and treated.
I think of a very well-known patent attorney who was chronically ill. He had been attending a chiropractor for over a year, and he had a variety of pills to take. Since chiropractors are not allowed to prescribe or give any medicine, he had told the attorney to take every day over-the-counter preparations and the fellow had taken them regularly. He became weaker, and weaker, until finally he called on me just to consult with him. He had cancer of the bowel, which proved to be inoperable, and he died just a few weeks later.
There was a case of diabetes in a middle-aged woman. She had been attending a chiropractor for over a year and having some “wonderful” adjustments. One day she went into a coma and was rushed into a hospital where she was found to have severe diabetes. She was controlled with diet plus one of the oral diabetes agents which have proven so wonderful.
I could cite many similar cases. Fortunately, the common cold always improves after a week or so, no matter what one does, and sore muscles, strains and sprains do respond to massage, but when I hear of a poor, unsuspecting woman who turns herself over to a chiropractor, it makes my blood boil. The fact that they are not licensed to practice in Massachusetts, Mississippi, and Louisiana, makes me think that they are far smarter in those states than we are in California.
I’ll have to tell you about Cheryl who presented a case of a really spoiled kid. She was an eleven year old who had such trouble breathing, and so much trouble with tonsillitis I decided to take out the tonsils. This is something I tried to avoid if possible. There are too many unnecessary tonsillectomies done, so kids were always given a good chance to outgrow their tendency to have tonsillitis. However, this girl had trouble repeatedly, so we scheduled her, operated and I was ready to leave her in the hospital overnight, as was my wont. The mother said, “Can’t Cheryl come home tonight?”
“I like to leave the kiddies in the hospital overnight, in case they have any trouble,” I said.
“Oh, but she is different. She can’t possibly stay in overnight.”
“Why not? You can take her home in the morning, the cost is the same, and I’ll feel better about it.”
“I’ll tell you, doctor. She still drinks from a baby bottle, and I’d be embarrassed to have to ask the nurses to fix milk, or water in a bottle.”
I was astounded. “Why don’t you break her from that habit? She is eleven years old, and will soon be old enough to think about boys.”
“She is our baby, Doctor. She is only young once, and she seems to enjoy it so much.”
I let her go home, and the next day when I went to the house to check on her, sure enough, there on her bedside table, was an Evenflo baby bottle, nippled, and full of water. She had had this service ever since her babyhood.
A young fellow, obviously a working man, came in one afternoon with his girlfriend. He was one of those possessive gents, who did all the talking for the patient. He very promptly sailed into the subject.
“I was loving Mabel up the other night, and found this lump in her breast. I felt it two or three times since then and told her she ought to see a doctor; and here she is.” Then he proceeded to start to undress her, so I had my nurse prepare her for an examination.
“Do you want him to remain in the room?” my nurse asked.
“Sure, he has seen my breasts before,” was her candid reply.
Mabel had indeed a suspicious lump, we took it out, found it malignant, and had to remove the breast. In this particular instance, it was lucky he found it when he did, for Mabel had not noticed the lump at all. She is still alive and healthy. And every woman should be taught to examine her breasts.
“Doctor, I have a tumor,” excitedly said Mrs. Farrow. “I have just discovered it a few minutes ago, when I took my bath.”
We examined her and found that she had just what everyone else has. Her “tumor” was the Xiphoid process, the little soft cartilaginous formation at the lower end of the sternum, about eight to ten inches above the navel. I finally calmed her down, by explaining what it was and allowing her to feel my Xiphoid process, and that of my nurse. When she realized we all had the same kind of affair, she was satisfied. What surprised me was that she had never discovered it before.
Mrs. Allen was in an institution for the moderately mentally ill. She had been there for years, but all this time she was so docile, and so sweet, that when the institution had a change of doctors, the one in charge decided she might go home. He had talked to her several times and, decided there was nothing wrong with her, or if there had been, she was cured. One morning when he had made up his mind, he when in for a last interview.
“Why were you sent here in the first place, Mrs. Allen?” he asked.
“Simply because I like buckwheat cakes.”
“There is nothing wrong with that. I like buckwheat cakes too,” was his reply.
“Oh, you do? Well when I get home, you come to see me. I have thirteen trunks and two suitcases full.”
Mrs. Blair was an occasional insomniac. She told me she had always been a very poor sleeper and that sometimes she wakened at two o’clock in the morning and couldn’t go beck to sleep.
“Have you tried counting sheep?” I asked.
“I have counted so many sheep that I can’t even eat lamb chops any more.”
“Have you tried a cup of warm milk and crackers?”
“That only starts my stomach growling and makes me want more food. And as you can see, I’m too fat already.”
“How about Sleep-Eze or aspirin, or some of these over-the-counter preparations?”
“I have tried them all. But I do have a remedy, that is, something to do. I just waken my husband, and have him play cards with me. He has to get up at 5:30 to go to work anyway, so he can keep me company and make the time pass more quickly.”
“Doesn’t he object to being aroused so early?”
“No, he’s a dear, and he likes to play cards as well as I do.”
Mrs. Anderson came in feeling rather acute pain one day. She was a charming young lady, and had been married only a short while. Her pain was in the chest and was aggravated by breathing. I examined her and heard a slight clicking sound, similar to the sound we hear when a rib is broken. I questioned her about the possibility of an injury, since she had not told me all I wanted to know. She became very embarrassed, turned red in the face and acted very coy about it.
“You’ll never believe me if I tell you,” she admitted.
“Almost anything can happen in medicine, and it frequently does,” I informed her.
“My husband was so delighted with the dinner I fixed him last night, he hugged me very tightly. It was after that, that I had the pain.”
X-ray examination revealed a fractured sixth rib. He had really shown his affection in a manly way. The chest cage was strapped, and, she healed promptly, ready for more love.
Some women are great ones to worry unnecessarily. Mrs. Belch was one such woman. She came in to see me with an article she had cut out of the paper, reading, “Ageing begins before birth, perhaps before conception.” She was pregnant and was worried that her child was already growing old. There have been infants born with some hardening of the arteries, but it is very rare. It certainly does not occur often enough to cause worry.
On the other hand Mrs. Chapman had a different story. She informed me that her children had all grown up and married. There would be no more P.T.A. She was past her menopause and need not worry about pregnancy. Her hot flashes never bothered her, her husband had a good job, and their house was paid for, so there were no financial worries. She couldn’t think of a thing to worry about and she just wanted to visit with me for a few minutes to tell me how contented she was.
There is considerable infidelity encountered in a doctor’s office. Some women are so brazen they even proposition the doctor, yet some are so ashamed of what they have done, they hate to admit it, but come in for an examination for venereal disease. If they are found to have gonorrhea, they wonder how they can either explain it to their husbands or how they can keep the husband from finding out. These are sometimes difficult problems to solve to and keep everybody happy.
We doctors hear a lot in the doctors’ dressing rooms before surgery, about some of the patients and their problems, with no names mentioned. And occasionally a doctor tells one on himself, in a braggadocio way. I recall one of the doctors who was separated from his wife, and in the process of getting a divorce. He was a surgeon, and a very good one. Several of the men, who did no surgery, referred their cases to him. He told of a fairly young woman who had had a hysterectomy for fibroids. Six weeks after her surgery she came in for her final examination, on a Saturday morning when his nurse was gone. He had short hours on Saturday because he almost always played golf, if there were no sick post-operative cases in the hospital.
The examination over, she got down from the table and opened her gown, standing before him in a very revealing condition. She offered, and he accepted. As she was getting ready to leave she said, very sweetly, “Well, I guess that takes care of my bill.” The doctor was dumbfounded, but there was not a thing he could do. His four hundred dollar fee disappeared like that.
Mrs. Crabtree had very recently come out from western Arkansas, and she presented a problem we saw frequently in our practice in Oklahoma. She had had fifteen children, all of them at home, and usually was treated by a neighborhood woman who “knew something about childbirth.” She had had a tear somewhere along the line, and each succeeding child made it worse. Her uterus was hanging out between her thighs, and had been outside so long that there were calluses on the sides where it rubbed against her thighs when she walked. It was a very uncomfortable looking condition and she hated to go anywhere because her walk was necessarily a waddle, and she tired very quickly. Her urine was difficult to control especially when she coughed or sneezed.
It was a real pleasure to operate on her and to see how she was so pleased, nay, happy with the ease with which she could get around afterwards. As is the custom of such a patient, she did very little complaining when she had her condition at its worst. She had had it so long, probably she was “all complained out,” and took it for granted she would always be stuck with her condition. But when she got over her surgery she was so enthused about life in general she was jolly to be around. Her husband told me she was like her old self when they were first married.
In the thirties and forties, even early in the fifties, the patients who were very ill but could not afford hospitalization remained at home. They required frequent visits, sometimes daily, if they were terminal patients. They seemed to get a great deal of satisfaction out of those visits by the doctor, but later when nursing and convalescent homes were built, and people became more affluent, these patients went into homes where the nurses could care for them, thus taking the burden off the family. After all, it is extremely difficult for members of the family to care for their own, especially when they are all working and have had no training in patient care. It is far easier emotionally, too, to have one in a nursing home during this very upsetting period.
I must say a bit about women smoking. Fewer women quit than men, and they have some very good reasons for continuing. Years ago mother and grandmother loved to knit, crochet, tat, and piece quilts. It was something to do with their hands, and they kept busy that way, making wedding gifts or just making heirlooms. Women now-a-days have a tendency to get away from that, although at a meeting one occasionally encounters a woman knitting away while listening to a speech.
Many have taken to smoking to keep busy with their hands. I once asked a woman why she didn’t quit her cigarettes.
“Did you ever try to push a watermelon through a keyhole?” was her enigmatic answer. Another woman quit and took up cigars, but her husband couldn’t stand those, so she went back to the cigarettes. I have pointed out that those who smoke two and one-half to three packs a day have cancer deaths at five times the rate of non-smokers, but few have ever quit under my urging. With men, I have had wonderful luck, but the women still defy and baffle me.
Modesty can be carried to the extreme. I recall a very pleasant woman in her early sixties, whom I had occasion to see for a moderate condition. The necessary examination was very difficult, for she kept pulling the gown to cover her various parts of the body. Apparently her mother had taught her that she should not reveal anything. I hate to think what her reaction to a bikini would be.
In the course of her examination, I discovered a large black tumor in the belt-line of her back. It measured about three and one-half inches by two inches, was rather flat but irregular. She really fought me off and didn’t want me to discover it, but it was there, and I couldn’t miss it. I said nothing about it, however, which seemed to disappoint her somewhat. Finally she brought up the subject herself.
“I guess you noticed my lump on the back?”
“Yes. I expect you have had it all your life.”
“That ugly thing is the reason for me being single. I once had a sweetheart, doctor, and was very much in love. It was really the most beautiful time of my life. He was so romantic when he proposed, but I just couldn’t marry him and let him know I had that awful thing on my back. So I refused him. I cried for a long time over that.”
“Don’t you know that can be removed? It will be no big job at all.”
“You don’t say! Even at my age?”
“Sure. Age is no barrier. If it would make you any happier, we can remove it, it will heal and the scar will hardly show. Especially as you keep it covered all the time.
“I’m too late to have any vanity, or another sweetheart, but let’s get rid of it. It has been the cause of years of unhappiness.”
So under local anesthetic it was removed, and she was very much more contented. She may have even dreamed of another romance, for there is no age limit on romance, or dreaming.
Betty Hainsworth was an obstetrical patient, expecting her third baby. She lived in Bell Gardens, which is a small town east of Los Angeles. She came in faithfully for her check-ups, followed directions very carefully, and was a good patient. I didn’t expect her to be any trouble, and arrangements were made at the local hospital.
I was eating my dinner about 8:30 one evening when her husband called, to tell me she was in hard labor, and they were just leaving for the hospital. I told them I’d meet them there, wolfed my dinner and rushed over to be ready, for sometime the multiparas (women with more than one) can hurry along. Betty arrived in such hard labor she was taken directly to the delivery room, where she promptly delivered a seven-pound boy.
“Betty, when did the pains begin?” I asked her.
“About three hours ago.”
“Why did you wait so long to come in?”
“Well, doctor,” she replied, “I had company, and I just couldn’t leave them any sooner!”
I was lucky with her, however. She delivered in the daytime, which was something. Getting up at 2:00 a.m. for a delivery is not nearly as bad, as getting up at 6:30 for surgery the following morning. However, I was so short on sleep for twenty-five years, that I was always able to go to sleep quickly.
Still, that is not as bad as the young pediatrician who had been on a pheasant hunt, and came home so completely exhausted that he fell right into bed. About 3:00 a.m. his phone rang, and he went through the motions of answering it. Then he promptly went back to sleep. His wife wakened him, and said, “Who was that that called?”
“I don’t know.”
“Do you know what you told her?”
“No, I don’t remember.”
“You said, ‘You run them down the hedge-rows, and I’ll shoot them when they take off.’”
It is amazing how vulgar some women can be. I had one very lovely young lady (in appearance) who could not talk without the most vulgar expressions. It didn’t seem possible that such a pretty young lady could harbor the thoughts behind her intense oral obscenity. It fairly made me cringe to hear her speak. I finally had to tell her, “Listen, Betty, I want to treat you as a lady, but you’ll have to talk like one first.” She had difficulty in speaking good English without messing it up with profanity.
Then there was a young lady who had just gotten married recently and came in to discuss some details with me. While in the reception room, with a woman who was a complete stranger to her, she went into the most intense details about her wedding night. She related everything, step by step to this complete stranger, who told me about it later. She would have made a writer of pornography blush with shame. We don’t think so much about what the patients relate to the doctor, but some of that is even unnecessary to make the point, and get to the diagnosis.
Mrs. Crenshaw was a lonely woman in her sixties, who came in occasionally. One day she called very apologetically and said she just couldn’t come in, Would I make a house call? As that was a part of my service to my patients, I told her I would come by at noon.
She lived in the neighborhood, close by, so at noon I dropped over to see what her trouble was. When she admitted me, cats jumped and ran in every direction. There must have been at least thirty of them, all colors and sizes and shapes. There were cat hairs all over the furniture, scratches in all the windows, and the sofas and chairs were shredded, where the cats had sharpened their claws. There were bowls of water and of food on the dining table, and as I could hear them yowling in other rooms, I knew there were cats all over the house. In fact, as far as I could see, the house was a shambles, for the poor old soul couldn’t keep cleaned up after that many animals. I very quickly took care of her health problem and was so relieved to extract myself from that malodorous house.
One day an elderly woman came in for a check-up, and as a matter of form the nurse always makes a record, including age, address, etc. This particular woman finally was admitted to the examination room in a huff.
“Imagine that young whippersnapper wanting to know how old I am! Why, it is none of her business, and I’m not going to tell her. Boy, is she nosey.”
I tried to tell her that we always put down the age of any patient, for it was helpful for us to know.
“Oh, doctor, I’ll tell you, but it is nobody else’s business.”
One of the most interesting cases I knew of was the woman who was in the General Hospital with a chronic illness. In fact, the medical students were studying her condition, and she really seemed to be enjoying her stay, which lasted some four months. The very interesting part is that she was in one of the big twenty bed wards, and when she was discharged, she was two and a half months pregnant.
Of all the patients who are acutely ill, we worry about them until they reach the cranky stage, complaining about the various things about them, instead of how they feel. When a patient complains that the water isn’t cold enough, there are lumps in the bed, the food is under par, nurses are slow, the bed pan is cold, and all sorts of little things like that, we know they are getting better. In fact, one man in giving a report on his wife’s condition said, “Oh she is reaching the cranky stage now.”
This relates to the young woman who was out here on honeymoon from New York. A year previous she had had an appendectomy in New York, and here she developed a terrific pain in the same area. It was excruciating, and the blood-count was indicative of something like an appendicitis, there was extreme tenderness and rebound tenderness, so we took a chance and opened her abdomen to explore. Believe it or not, the New York surgeon had removed the appendix, but left about three fourths of an inch at the stump. The three fourths inch stump was very highly inflamed, so she required a second appendectomy. Thus a quandary was solved. She was one of those young women who recovered quickly and began to complain early about the many inconsequential things.
One day I was called to the home of one of my deaf women. I walked up, pushed the button to ring the bell, then happened to think, “Gee, they can’t hear that,” but very promptly the husband came to the door, and admitted me. Upon inquiry, the husband had wired the house so that when the bell was pushed, it made a light flash in every room in the house. I thought that was pretty clever.
There was a very worried young man who came in one day to report that his wife of two years had gone absolutely frigid. He wondered if there were some shots, or some type of medication that would restore her to her normal self. Well, yes there was, so I advised him to get her to come in for a check-up and we would see just what she needed. A week or so later, she came in. He had told her why she was to come in, and she was prepared.
“Doctor, I don’t need any medicine for my sex life, or for anything else. My husband simply does not turn me on anymore. In fact I am getting satisfaction from my boyfriend, who really turns me on.”
Bernice was a lovely young woman with many attributes in her favor. She was lucky enough to be going with a fine young fellow that I knew, Ralph, and he told me he was becoming a bit serious about her. After about three months of mild courtship, the fellows in the group had a party for him, and it turned out to be a party to celebrate his engagement to Bernice. Now this was a surprise to him, because he had never mentioned to her the plans that were formulating in his mind, to ask her to marry him.
When apprised of the news, he asked, “What is this all about?”
“Bernice told Margie the good, news, that you were going to be married.”
Ralph was in a quandary. After all, he was very fond of Bernice, and didn’t want to do anything to put her in a bad light, nor did he approve of her jumping the gun on him and telling something that was not so. If she would tell such a thing without reason, what would she tell after marriage, and could she be depended upon to keep family secrets at all? This required a lot of thought as he tried to figure out just what to do. The more he thought about it, the more upset he became, and as he talked to me about it, I could see he was emotionally upset, and in a real quandary. Any girl, he figured, no matter how much he loved her, who would tell such a thing before it happened, was not to be trusted. So to solve his problem, he had his company transfer him to the Portland office, and he quietly slipped away without saying anything. He wrote Bernice from Portland, let her know he had been transferred, and then wrote no more.
One of the mistakes a doctor can make is to ask a woman patient how she is when he meets her in a shopping district. Not all are so verbose, of course, but some respond with an organ recital that occupies entirely too much time. One woman I recall, went into such minute detail about almost every part of the body and its malfunction. I was hurrying from an errand when I encountered Mrs. Spaulding moseying along window-shopping. With my greeting I asked how she was, and she almost made me late at the hospital. But perhaps she was greatly relieved by getting a big burden off her chest, in enumerating the long list of symptoms.
Mr. Walden surprised me one day when I inquired about his wife. He told me in no uncertain terms, “With my wife, any day that starts with getting up is a bum day to begin with.” It seems that she was one who stayed in bed until noon almost every day.
Little Nick was a beautiful, baby, about four years old. I well remember the day he was born, for he had aunts, uncles, and grandparents all over the place, and they were so happy and excited that they had a real celebration the Saturday after he was born. I was invited, and as I had an hour, I went to see one of the post-birth festivities. It reminded me of an Italian wedding. The poor boy was loaded with relatives and they were in a festive mood. The celebration started out as if it were going to last quite a while. Wine flowed freely, and there was a smorgasbord designed by an expert. No one can say Nick wasn’t ushered into a family where he was quite welcome.
Nick’s mother worked in a medical laboratory and seemed to be very popular there. Her husband was a very nice chap, and drove a truck. They were quite appreciative of the small part I had played, and in general were devoted parents. But they belonged to some religious group that didn’t believe in any immunizations. As they said, “We don’t believe in putting all those poisons into our system.”
When Nick was four years old, some relatives came out from Arkansas for a visit. Someone must have been a diphtheria carrier, for the little fellow came down with the disease. It was certainly unusual among my patients, because I always insisted on all the immunizations for children under my care. It is so much easier to protect children against “childhood” diseases, than to treat them for them.
A word about being a carrier of diphtheria. When we studied biology, each student had to make a smear of another student’s throat, and culture it. That way each student was given a test. To our surprise, our student-body president, one of the most popular chaps in the class, was the possessor of the most virulent diphtheria germs, so he was very definitely a carrier. Likewise, it is possible that this relative from Arkansas was a carrier, and since this family mentioned was a kissing family, little Nick may have gotten the disease from her. That is only a conjecture. Anyhow, the boy was sick, with a sore throat and a high fever. Apparently it was the first time, outside of having a cold, that he had been ill.
I was called to see him. The chest was clear, the temperature 102 degrees. There was a grayish-white membrane in his throat, very indicative of the presence of diphtheria. I immediately sent for 20,000 units of diphtheria antitoxin, which I gave promptly. Another 20,000 units were ordered for tomorrow, for it is always better to give too much than not enough. Also was the order to keep him quiet, because the toxin, or poison elaborated by the diphtheria germs, is very powerful and affects the heart muscle especially. The diphtheria can be controlled with the antitoxin, but the only way to control the effect of the toxin on the heart muscle is to keep the patient as nearly immobile as possible. The parents are instructed to keep the patient absolutely quiet.
This boy overcame his diphtheria very well, but on the fourth day someone allowed him to get up and go into the kitchen. His heart muscle gave out and he died on the kitchen floor from his toxemia. It was a real tragedy, and it especially hit me, for I was very fond of the boy, plus the fact that if orders had been followed, he probably would have been saved. He is the only child patient that I lost during my entire career. He certainly spread an abundance of happiness during his mundane existence, so perhaps his short life was not in vain.