The Doctors' Dining Room

 

Old school hospitals offered lots of special treatment to their esteemed  medical staff. Free front row parking with valet service on demand and an ornate dining oasis which was far removed from drab, utilitarian hospital environs were the more obvious perks. Physicians were the alpha predators in the hospital food chain, far removed from nurses and ancillary staff. There were no "mid level providers" in days gone by. It was just the doctors and everyone else.

Doctors' dining rooms were entered through a solid wood door conspicuously marked PRIVATE. Inside the door was a room paneled in dark mahogany with fancy brass grills covering the radiators. Maroon Karastan carpeting covered the floor. Pictures of the institutions hallowed great healers from the ages adorned the walls with an occasional pretentious bronze  bust tossed in for good measure.  Genuine white table cloths with a fresh floral arrangement salvaged from one of the many bouquets  left behind by departing patients added to the ambience. Fancy light fixtures illuminated these deluxe digs and sculpted plaster potentiated the high brow ambience of these over stated  eateries. A two year old with a plate of spaghetti could do more damage to an over adorned room like this  than a hurricane 

General practitioners and internists served the role of personal physicians and  asserted complete control over the care of their patients spending  many long hours in the hospital.  A readily available source of nourishment was essential.  These dining areas were a feeding lot open 24/7, serving snacks like Good Humor ice cream bars, bagels, donuts, and crackers laden with cold cuts or liver pate' during off hours. Normal operating hours featured  food from the hospital cafeteria embellished with little sprigs of parsley, ripe olives or whatever else the colorful characters known as hospital cooks could whip up. A distinctive touch to our hospital dining room were  bottles of hot sauce smack dab in the middle of every table.

Doctors'  dining rooms were the consummate private place for the boys to raise questions about care and explore  solutions to ethical dilemmas. Operating rooms were fertile ground for  mishaps and screw ups when  minimally trained general practitioners were  granted surgical privileges. Thankfully, they were prudent in restricting their services to simple procedures like vein strippings, tonsillectomies, and D&Cs. 

A ham fisted G.P. might ask an ENT specialist if it was OK to with hold information about a patent's uvula  that had the nerve to get tangled up in an errant tonsil snare. The ENT doc usually advised it was best to be truthful since the first time a patient looked in the mirror he would notice that little thingee hanging down in the back of his pharynx was AWOL. It's best to be honest when your mistakes are obvious.

Wrong site surgery was an egregious error but could be easily explained away by claiming that the errant surgery was necessary and not a simple minded mistake. Circulating and scrub nurses would likely be fired for wrong site surgery or  foreign body oversights, but the surgeons remained unscathed except, perhaps, for an admonishment to be more careful next time.

Doctor's private dining rooms were doomed by hierarchy busting youngsters and the welcome influx of women to the medical field. Most women did not take kindly to putting their own needs ahead of patient welfare when covering up mistakes, an issue frequently addressed in all male forums like doctor's dining rooms.. Corporate healthcare had a significant role in shuttering doctors' dining rooms because of their negative cash flow. Any use of space that failed to contribute to cash flow was history.

Fine Dining Hospital Nursing School Style

Oh..The tales that were told during mandatory dinner hour.

Vintage  hospital diploma schools were hybrid affairs: one part workhouse, one part charm school, and one part plantation. The charm school component made attendance mandatory  for the evening meal in the hospital cafeteria if you happened to be fortunate enough to work  on a clinical unit during the 3-11:30 shift. Sharing a meal together was probably  thought to have a positive  social impact on  hospital confined and culturally deprived nursing students

The nursing school had commandeered a long table in the very back of the chow hall. A sense of decorum was added to the ho hum environment by the use of genuine china dinner plates emblazoned with "IMMC School of Nursing  Dedicated to the Service of Mankind."  Another unique touch was the  disbursement of several bottles of Red Hot Sauce prominently displayed as a centerpiece.

Nursing students were undernourished in social experiences and overfed on shame and degradation  dished out by mean old coots masquerading as instructors. The fine china and special sauce adornment was a lame attempt to mitigate the harsh realities of life as a nursing student and spice things up a bit.

Working with the most challenging patients was difficult enough, but our tough minded, anal retentive instructors demanded strict self-regulation of our behavior. There was no crying, complaining, or lamentations of any sort permitted. We always answered to our hard core instructors in plantation speak, "Yes'um, No madame, and Right away," were stock replies.

So when we all sat down together for dinner, it felt as though a weight had been lifted off our shoulders. Typical dinner table conversation revolved around difficult nursing procedures and technical tips for their  successful completion. Occasionally the various foodstuffs were used as props. I will never forget the time my friend, Janess, demonstrated her prowess at removing fecal impactions by using a stale donut leftover from breakfast and an overcooked chunk of bratwurst. The key was to bury your finger well into the brat and the flex the distal phalanx into a hook like device before pulling it  through the donut.

Being the sole male at the dinner table had it's awkward moments when I was called to mediate arguments about boyfriends or menstrual cycles. Although I may have been a disinterested party my knowledge base was not up to snuff and led to lots of round about jibber jabber.

Our final dinner together as student nurses was held outside the hospital at a really nice nearby restaurant, The Ivanhoe, which was just down the street between Clark and Halsted.  The senior dinner held right before we were crowned GNs was memorable because or instructors were finally nice to us because we survived and were on our way to becoming peers. I made up my mind then and there that I was never going to treat anyone as we were treated as students.

Drinking Bile

No, that's not bile in a T-tube drainage bag. It's a bilious beverage 

just waiting to wet your whistle. Bottoms up!

Waste not / want not was the mantra in epoch hospitals. This philosophy led to events like performing sterile procedures with 2 fingercots and overly judicious rationing of utilities. There were almost no lights on after dark so night nurses always had a flashlight on hand. Recycling and reuse were common with "disposable"  equipment having an almost infinite life span.

Recycling was not limited to medical equipment. Gall bladder surgery was a brutal and miserable experience  with a huge subcostal incision in close proximity to the diaphragm so every breath exacerbated post-op pain. A T-tube was usually placed in the common bile duct during surgery and drained the greenish yellow unsavory goo in a nearby bag.

Bile is a vital component in the digestive process and works to emulsify and break down fat. A deficit of this greenish gooey fluid results in an unpleasant condition known as steatorrhea whereby fat passes through the intestines undigested. An unusually putrid scented diarrhea is the end result.

To avert steatorrhea old school surgeons had a very direct and straightforward solution.  They ordered the night nurse to save the contents of the biliary drainage bag and serve a glass of this gruesome green goop to the patient prior to breakfast. Hospital breakfasts were notorious for their high fat content. Just about every meal was a permutation of that All American staple, bacon and eggs which was a steatorrhea stimulator of the highest order.

The disgusting bile beverage was best served in an opaque vessel such as a coffee cup so as to obscure that yucky green visual stimulation. Minimal explanation was also important. The nurse never drained the bile into the serving container in view of the patient. Optimal bile bag emptying was done with the patient sound asleep and unaware of the impending tortuous tipple. Old school nurses were masters of deception and were even known to ask patients to turn over for a temperature check. While they were prone a painful and totally unexpected intramuscular injection was hastily administered.

The bile drinking gambit  was not much different than the stealthily plunge of the 18 gauge needle during the temperature diversion injection. Either experience was misery of the highest order no matter how it was presented. Bile had a unique earthy/nasty scent to it that could not be masked and the bitter salty taste was cringe worthy. Oh..And be sure to offer mouth care after bile consumption. It promoted dental decay.

Did bile recycling help patients? That's a tough question. Perhaps the diversion of consuming the vile liquid distracted them from their symptoms. It's always prudent to maintain a high level of suspicion when offered just about any beverage from an old nurse. Better safe than sorry.

Spilling the Beans on Vintage Hospital Cafeterias

Lots of folks have bitter complaints about hospital cafeteria food.  Not me!  I actually enjoyed eating in the ultimate of institutional dining settings. Student  nurses had unlimited access to this crude, but very satisfying  sustenance  via  monthly issued meal ticket books. One day my clinical work was interrupted by that dreaded summons. "Report immediately to the nursing  director's office."  I was soon ushered into her inner sanctum by her assistant who was an authentic nurse with cap and pin; there were no nattily dressed executive assistants with perfectly coiffured  hairdos  for old school nurse executives.  I was somewhat  relieved by her cheerful demeanor, "Fool, the girls  (her generic term for all student nurses except for me. Male students threw her for a loop) have told me how much you enjoy the cafeteria meals and I wanted to give you extra meal ticket books." I stammered and stuttered a timid "thank-you," and slithered out dreaming of those perfectly round machine stamped salisbury steakette  patties. I was fascinated by the way grease gravy squirted out of them and glistened in the overhead florescent lights  when pressure was applied with a fork. Fine dining in all it's stomach gurgling  glory.

The Sisyphean task of tendering expeditious food service to intermittent parades of time pressured hospital personnel gave way to many unique innovations.  Fiberglass trays were easily propelled along shiny chrome runners that minimized friction as hungry diners made their selections. Just as ceramic tile was the defining element to the operating rooms, chrome was the underlying theme to old school hospital cafeterias. The shiny stuff was just about everywhere from the food displays to borders on any horizontal surface. Even the Sweeda cash register was chrome.

 A small army of colorful characters on the supply side of the chow line could cut a gigantic sheet cake into perfect 3 inch square pieces or whip up a massive vat of our favorite desert , Whip N' Chill in the blink of an eye. I don't recall the flavor of my favorite whipped desert but it was  red in color. That  food dye would leave a permanent stain so be careful with that white uniform.

Just about any standing kettle of soup or chili would acquire a 1 inch thick layer of gooey grease that rose to the top. These underpaid but well meaning food service workers had bulging forearms from the near constant stirring motion necessary to keep the grease in suspension.

In the OR all of our cases ended in an ectomy and in the cafeteria all the meat product entrees ended in the suffix ette. There was my favorite pork chopette, steakette,  hamcheesette, and last. but not least chicken croquette. None of today's  pretentious  light and fit, locally sourced artisanal food here. Artificial flavors and texture enhancers were embraced as a great space age wonder. Those clever scientists were hard at work making our food taste better. Great work and don't spare the MSG and nitrates.

The three horsemen of addictive, pathogenic food additives were proudly displayed as the centerpiece of each table. A gigantic cylindrical dispenser of good old fashioned sugar was always front and center, tempting nurses to drown their fatigue in a hyperglycemic rush. Pepper and salt were readily available. There was nothing like dousing highly processed foodstuffs in salt for a hypertensive boost. The artery clogging fat of a pork chopette could be supplemented by that insulated mini carafe of whole cream for your coffee. Some folks liked to add a spot of whole cream to their Whip 'N Chill to give it "extra body," but I preferred mine unadulterated.

Perhaps it's time to resurrect old school hospital cafeteria food. In the mindset of today's greedy hospital corporate types foods like this are an integral component of a dynamic profit circle. Consume these  high fat, high sugar, processed food and business is booming in the diabetic clinic and cardiovascular services. Besides, I have a decades long hankering for just  one more pork choppette

The Metrecal For Lunch Bunch

Old time surgeries could last for a very long time as a result of their complexity, a lackadaisical attitude about anesthesia time, or unforeseen pathology. After 6 hours of standing on your feet (never, ever lock those knees) a sense of fatigue would settle in and it was tough to be at your hypervigilant  best. I always knew I was in trouble when my head started to feel heavy or my hands began to shake. I devised some strategies to deal with hand tremors and they are O.R.  tested. You can find these tips at this link. It's a common problem with some straightforward  solutions that worked well for me.
http://oldfoolrn.blogspot.com/2015/03/fools-foils-for-fasciculating-fingers.html

For that generalized malaise and heavy headedness feeling there was only one remedy and that was intraoperative nourishment. You can't eat a Big Mac in the midst of surgery although I did witness an attempt to ingest a hot dog which  was accompanied by an assortment of gastronomic complications. Those tube steaks are hard to slip under a surgical mask and difficult to properly masticate with mask ties impeding jaw movement.

Philadelphia Eagles quarterback, Mark Sanchez knows all too well the down side of eating hot dogs on the job because of the trouble he got into eating a tube steak  on the sidelines. It did not work well in the OR either. The consistency of a traditional hot dog makes it an aspiration hazard if eaten quickly. The diameter of the hot dog is the perfect size  to occlude a trachea or if further down the line, a main stem bronchus. At least in the OR, a Magill forceps is close at hand to extricate that wiener plug from an airway. For hot dogs to work in a surgical setting, the contents of the meat in the casing would have to be similar to toothpaste. Just have the circulator inset an end of the hot dog under the mask and once the scrub nurse chews the end off, squeeze the meat paste into her mouth. The Surgi Dog is born.

This illustration of Hawkeye of MASH eminence shows some of the challenges with intraoperative nutrition. The circulator, Hotlips, just contaminated the front of the surgeons gown with her nutririve ministrations. Solid food which requires sacrificing the surgical mask coverage is not prudent. The ideal mid surgical procedure meal is a liquid, nutrient dense, and shelf stable. The name of that miracle surgical sustenance was an old time product that was one of the very first diet products, Metracal.

The longing for a svelte body is not a new phenomenon. Mead Johnson came up with the diet drink, Metracal, which soon became a pop culture icon in the 1960's. Each can which required the use of a genuine can opener, delivered 225 calories derived primarily from soy protein. The consistency was a miserable watery, pasty slurry that often contained tiny lumpy glops of congealed soy protein. To disguise the unpleasant taste, novel flavors like Danish coffee and egg nog delight were offered.

Ad copy from the mid 1960s touted, "Join the Metracal for lunch bunch on a new kind of treasure hunt. Discover Metracal which tastes just like a milk shake." The ad suggested that 4 cans per day of this diet drink would trim off the pounds in nothing flat. It was a popular product and sold for 12 cents a can at your local grocery store even though it tasted nothing like a milkshake.

We discovered that Metracl was a near perfect nourishment for intraoperative sustenance. In the OR can openers were readily available for popping the tops off multi-dose vials and also  worked great to open the Metracal cans. The next step was to obtain a straight catheter (18 Fr. worked just perfect) and insert the business end into a can of Metracal. The flared distal end of the catheter was carefully threaded through the side of the anxiously awaiting scrub nurse's mask  and it was lunch time while the surgeon searched for that last persistent bleeder.

There is nothing quite like savoring the gastronomic delight of a Danish coffee Metracal while inhaling putrid Bovie smoke. That combination of gustatory delights is bound to induce an anorexia syndrome that practically guarantees weight loss. Maybe Mead Johnson should have figured out how to can and sell Bovie smoke.

Since Metracal was mainly protein, we would add a 20ml ampule of D50 ( concentrated Dextrose)after about half the can of Metracal was consumed. I just loved the loud snap-crack noise those big ampules made when they were cracked open with bare hands. The scrub nurse knew that a pick me up was close at hand when that crack thundered throughout the room. Metracal and  D50 really did enhance vigilance when lassitude settled in during a lengthy case. My all time favorite flavor was called Thahitian treat - a taste of coconut delight from the islands while sweating it out in a Chicago operating room. Life  was good.