Almost-a-doctor

I walked through the autumn leaves in the fall of 1950, toward my first day as a real medical student with a feeling of exultant expectation. Up till then, I had found that being a “pre-med” didn’t make as much impression as I would have liked. With girls, especially, the attitude seemed to be “Forget this one; he’ll be buried in the books for four more years.” But now my embryo medical career was finally on track. I had at least made it in through the door.
     Classes for first year medical students were all held in one building, across campus from my home. I joined seventy would-be doctors in the lecture auditorium that first day, all of us waiting with apprehension for the professor of anatomy to appear, who would rule our lives for the next five months. First semester in medical school covered only two subjects: Human Anatomy and Histology, which is anatomy viewed through a microscope.
     Dr. Phillip Armstrong was a deceptively bland man in his fifties, who made no effort to put us at ease. His aphorisms were memorable:
     “We will address you here as ‘Doctor’. For some of you, this will be the only time you will ever hear it applied to you.”
“Up until now, you have worked to achieve a well-rounded education. Here, we intend to flatten you out.”
     We spent that first day getting organized into working groups of four, and learning detailed instructions for the care and study of our cadavers. We took notes on everything; one nervous student even jotted down the professor’s “Good morning.” We entered the dissecting room that first afternoon, wondering what our reaction would be to studying the dead. We four, Onas Morgan, Tony Rivera, Tony Slivinski, and I, grouped ourselves around our dissecting table, and surveyed the motionless shape swathed in pungent, formaldehyde-soaked layers of sheeting beneath the yellow oil-cloth.
     Following the instructor’s directions, working one pair on each side, we laid bare the groin area and made a first incision along the inguinal ligament, surprised at the toughness of human skin, careful to go slowly and meticulously, exposing and identifying each nerve branch and blood vessel. We would spend most of the first week on the abdominal wall, laying open each muscle layer under the critical eyes of the instructors and Dr. Armstrong himself.
     Dissecting a dead person brought a feeling of awe, different from working with dead animals in my pre-med courses. All of us had a healthy fear of making a mistake in the work and earning Dr. Armstrong’s displeasure. Perhaps he kept us off-balance on purpose during these first uneasy encounters with death.
     “The name of the muscle is not pronounced ‘ili-op-soas’ as it is spelled,” he said. “Say ‘ilio-soas.’ The ‘p’ is silent. As in swimming.”
     Three students dropped out that first week. One fainted dead away. Another threw down his scalpel, cursing, and stalked out. We never saw him again. Rumor had it that the third decided to take his girl-friend’s advice to study pharmacy instead.
We compensated for our insecurity with a certain amount of dark humor. Medical students learn a large number of limericks and memory devices, ranging from the fate of nymphomaniacal Alice or the efficient young man from Bel-Air, to the names of the eight bones in the wrist or the sequence of the twelve cranial nerves.
     We four lab partners learned that our cadaver’s name had been Peter B_____, who had died in a state hospital of “old age.” Weeks later, deep in the abdomen, we found that undiagnosed urinary obstruction had destroyed his kidneys.
     A month after entering medical school, I had acute appendicitis. The operation went well, but spinal headaches from the anesthetic kept me on my back for a week. I still recall trying to study, holding the six-pound Gray’s Anatomy textbook on my sore abdomen. I also remember, when I was exhausted by the four-hour work sessions in the anatomy lab the following week, that even Dr. Armstrong had a compassionate streak. He stopped at my table to ask quietly how was I, and to tell me it was all right to take a rest break occasionally.
     We four, and most of the rest, survived that five months and the examination at the end. One of my tense friends panicked when the examiner thrust a skull at him, jabbed a finger at the large opening at the base and barked, “What goes through there!”
“Food!” the student blurted, then winced as he realized the answer should have been spinal cord. Our universal wish, we all agreed, was that we could repeat the whole course, now that we knew what we were supposed to be learning.
     We celebrated the end of anatomy the last weekend in January, a double milestone for me. That night I first met the girl I would marry.

Nottingham High

from "Bridge Ahead, A Medical Memoir" copyright 2008 Keith Dahlberg

High school is a time of many changes for any teenager. Still more so, if the teenager is a dissident. And I was a pacifist, in the middle of World War II.
I felt strongly about this. I took my cues from my Dad, whose sermons from the pulpit were pro-people, but against all war. To him, peace did not mean merely absence of war. He believed war went against the word of God and solved very few issues. It did not mean that a Christian should be a weakling or a doormat. On the contrary, Christians are expected to be strong in order to help the oppressed, enslaved, or lost to find a personal relationship with God, and so far as possible help them find a way out of suffering and injustice.
As a young man at the time of the first World War, Dad at first had refused even to register for the draft. He finally registered as a conscientious objector, although the draft board would have allowed him a clergy exemption. He continued to preach against war during World War II, even while he ministered to the needs of two hundred service men and women among his congregation in Syracuse. The FBI had him on their list for a while; they listened to him preach, and questioned the church members, but never found anything to even suggest that he was seditious or unpatriotic. (Years later, I read their conclusion in the FBI's dossier on Dad, released under the Freedom of Information Act.) His congregation, in fact, highly respected him, even though many members had questions about his message.
During World War II, a pacifist teenager was hard for most of my classmates and teachers to figure out. Following Pearl Harbor, the whole nation had mobilized to the war effort. Buy war bonds. If you can't afford a bond, buy war stamps each week until you have enough for a bond. Turn in your aluminum cooking pots to build airplanes. Plant victory gardens. Save gas. Knit sweaters. Write the boys overseas. The time I spent at Boy Scout farm camp, in 1942, weeding cabbage fields and picking beans, was to help the national effort to raise more food, and I had no problem with that.
But I had a decision to make on my own in wood-shop class in junior high school. The whole class was assigned the project of making scale-model wooden airplanes, about five inches long, used for training aircraft spotters and gunners in instant recognition. To me, that was supporting war and I told the shop teacher, Mr. Pepper, that I couldn't do it. "I understand,was his gruff reply, but I don't think he ever really did.
It got worse in high school, during home-room period each day. Students were expected to buy at least one war savings stamp (twenty-five cents) each Friday. If even one student in the whole school did not do so, the school could not display the 100% banner on the flag pole that week. Nottingham High never got to fly the banner when I was a student. Some of my classmates resented this, although most adopted a neutral attitude. Things improved after about a year when the school held a Red Cross fund drive one day. I figured up what I had not invested in war stamps over the past months, and gave it to the Red Cross, possibly more than the rest of my home room combined. A hostile classmate accosted me one morning, "How come you can give to the Red Cross but not to the war effort?"
I told him the Red Cross healed people. I added that I wouldn’t get any savings
investment returned after the war, like he would from his war bonds. He didn't like that at all; I thought he might hit me, but I stood my ground. The class president and his girlfriend were standing nearby; both took my side and told the guy to back off. After their endorsement, things got better.
During 1945, the Baptist Youth Fellowship at church became active in drama. I had a bit-part in Elmer and the Love-Bug, found that I liked acting, and when a drama club at school presented Why I Am a Bachelor, I got the lead role, playing a misanthropic lecturer. It was a corny play, but the student body liked it. In looking back, perhaps part of its popularity was their opinion that the role fit me exactly.
In my senior year, I happened to have Miss Frederica Smith as my English teacher. "Sister Smith was a middle-aged, self-possessed soul in horn-rimmed glasses who believed in getting the whole class involved. After we had studied poetry and verse-making for two weeks, Miss Smith announced that, tomorrow being Valentine’s Day, each student would choose some character from literature and write an appropriate valentine to him or her. After making sure that the Bible was considered literature, I submitted my valentine, from Samson to Delilah, with a straight face:
All the while I’ve been making your people feel blue,
Though I’m fighting with thousands, yet think I of you.
I’ve torn city gates from their place in the wall,
But your icy cold heart I cannot move at all.
In times of distress I’ve relied on my brawn,
But that’s no help at all when to you I am drawn.
Of all the Philistines I think you’re most fair
But Baby, I can’t keep you out of my hair.

The class, Miss Smith included, burst into laughter. To my surprise, I was later elected senior-class poet based on this offering, and was invited to join the staff of the school newspaper, but I never wrote any more poems worth remembering.
The year went by quickly after that, and on June 24, 1946 graduation night came for 256 of us. Our principal, Harold Coon, was graduating too, moving up to a post in the school district headquarters downtown. There was the usual procession to Pomp and Circumstance, speeches, awards etc. My mind was chiefly on summer vacation; I would go directly from school to the railroad station and catch the night train west for my second summer of work at Green Lake, Wisconsin, along with one of my classmates.
I was startled out of my reverie by hearing my name called at the tail end of the athletic and citizenship award presentations. Mr. Coon announced that the class had voted me the one they would most like to represent them in life. I hadn’t known there was such an award, but it’s the one I would most like to have.

Front Halves of Horses Sent to Washington DC for Assembly

That was one of the guesses about what was being manufactured at the super-secret city of Oak Ridge, Tennessee back in the 1940s. The closely guarded production turned out to be purified Uranium-235 for the first atomic bombs, but in a back-handed way the earlier guess has been quoted as a paradigm for thought processes in the nation's capital.
This was reinforced in my hometown of Kellogg, Idaho back around 1984, when the Cold War and atomic bomb threats were often in the news. Someone in the national bureaucracy, pondering how to save citizens' lives in case of atomic attack thought "Mine tunnels!" The Silver Valley in northern Idaho has more than 200 miles of tunnels underground, thought to be enough to accommodate most of the population of the city of Spokane (seventy miles away, it's true, but they had a super-highway.) Accordingly, 200 cots and a few initial supplies of food and medicine arrived for storage in our local hospital against the day of holocaust.
The bureaucrat's thinking was not entirely off the wall. An atomic bomb hitting Fairchild Air Force Base (ten miles the other side of Spokane) might conceivably give citizens an hour or two to take shelter from the radioactive dust that would be borne on our usual westerly winds. And after three weeks underground, people might (we were told) be able to survive in the diminishing radioactivity. When Mount St. Helens had blown up, four years earlier, the volcanic dust did indeed reach Kellogg and beyond. The local miners noticed that it only penetrated the mine tunnels about 300 feet before adhering to the moist tunnel walls, and it was reasonable to suppose that radioactive dust from a bomb might behave in the same way. Anyway, some of us had enough interest in the topic to spend some of our days off evaluating the suitability of mines as fall-out shelters.
After getting permission from the mine companies, four of us - a fireman, a public health worker, an instructor from the mine rescue training school, and myself (a doctor) - formed the core of a crew to map the mines, We pre-supposed that in any atomic attack electric power would be gone, and the mine hoists and ventilation fans would not be operating. So only entry level, horizontal tunnels would be accessible. (Try climbing twenty flights of stairs, the distance between one mine level and the next, and see how your legs feel.) There would be no light or food except for what could be brought in or stored ahead of time.
There is natural air circulation in many mines, and a warm enough temperature. Our public health man tested various underground water sources and found some of them drinkable. Some had drainage ditches that would provide sanitation. The tunnel floors are rocky and wet, and many of the mines had nothing but a vertical shaft access. We checked out ten or fifteen mines. It wasn't until we saw our mine rescue expert casting worried glances at some of the rotting mine timbers in a long-abandoned tunnel that we decided we had explored enough.
The mines of Shoshone County, Idaho, those with horizontal access, drinkable water and breathable air, had enough room to accommodate perhaps 1,200 people, if food, medicines, and electric batteries were stored ahead of time and people did not mind the dark, damp, sometimes dangerous surroundings.
But as is often the case, bureaucrats in the nation's far-away capital city had no clue about conditions in mines. Nor did they realize how much preplanning, and checking the facts of the local situation, was needed to provide genuine safety for the people on site. Our bureaucrats took no further action.
When I told some of my patients about our study, showing room in the mine tunnels for only about one-tenth the local population, let let alone 250,000 Spokanites, they were philosophic. One told me:
"Well, that's okay, Doc. If the bomb ever drops and we can't dynamite the river bridge in time to keep the city folks out, I'll just sit on my front steps with a six-pack of beer, and watch the fireworks."