An English Doctor at Hopkins: 1953|
The story of a 29-year-old medical school graduate, who at mid-century left behind his new wife and his country to work with two great figures in obstetrics and gynecology at Johns Hopkins.
In 40 years I never encountered another surgical chief of an academic department with a practice approaching TeLinde’s in numbers of patients or procedures. He was reputed to earn in excess of $2 million annually.
he spring of 1953 was a bittersweet moment for Richard Morton, a 29-year-old medical student in his final year at the Middlesex Hospital in London. In May, as England celebrated the coronation of its new, 25-year-old queen, Morton married Kate Macnamara, 16 months behind him at Middlesex, and headed for an internship in the United States. Kate would follow the next year. Here, from his recently published memoir, An English Doctor in America (Fraser Publishing Co.: Phone: 800-253-0900), is an excerpt about his time at Hopkins.
procrastinated until April 1953, one month before my graduation from medical school, before acting on my plan to emigrate to the United States. Only then did I visit the U.S. embassy and receive an interview with the chief medical officer. Which hospital, I asked him modestly, was the finest in America? The honors, the doctor replied, were evenly divided between Massachusetts General Hospital in Boston, and Johns Hopkins Hospital in Baltimore, depending on the specialty. When I informed him I was planning to train in ob/gyn, he said Hopkins was the choice, for Dr. Eastman, author of the standard textbook, was chief of obstetrics and Dr. TeLinde, author of another standard work, was chief of gynecology. He then consulted a directory, which revealed that each chief offered only six places for which more than 100 well-qualified Americans would apply, and a foreign medical graduate (FMG)—the first time I heard this unpleasant term—stood no chance of acceptance).
Even so, I decided to write to Dr. Eastman to ask for an internship on the principle of nothing ventured, nothing gained, but I steeled myself for the probability of a rejection. Two weeks later in the middle of breakfast, Mother handed me a small envelope with the Hopkins Dome insignia embossed on heavy white bond paper. Eggs and bacon turned to ashes in my mouth. I went up to my room, slit open the envelope and read:
Dear Mr. Morton:
I have long wished to employ an Englishman but hitherto none has applied....
Please report to my office on June 30, 1953, prepared to serve as an intern for six months in obstetrics followed by six in gynecology.
Goodbye to Kate
My heart was in turmoil as I waved goodbye to Kate, my parents and England from the deck of the Ile de France six weeks later. Upon docking in New York, I boarded a bus headed south, crossed the Susquehanna River as it terminated in Chesapeake Bay, and arrived in Baltimore on the afternoon of June 30. The city was hot and humid and my thick English woolen clothes unsuitable. Carrying two suitcases, I walked through the city and up the long hill to the hospital, arriving soaked in sweat.
The Johns Hopkins Hospital stands on a 55-acre island site east of and above the city, looking downtown to the west and over the harbor to the south. On entering the building from Broadway, you are confronted by a heroic 12-foot marble statue of Christ dominating a small rotunda of six stories, above which stands the Dome, reached by a broad staircase.
My room, shared with two other interns, was at the top immediately under the Dome. No elevators sullied this, the oldest part of the hospital. Walking further revealed a courtyard similar to the one in the Middlesex Hospital. Turning left brought me to a dining room marked “Doctors.”
Too weak to carry my suitcases any further, I retreated back through the dingy exit I had just left and was directed to a room where about 20 people were assembled. I sat at the back while my new chief, Dr. Eastman, presided. A resident was describing a pregnancy, labor and delivery of a dead baby. When the session was over, Dr. Eastman greeted me and inquired if I had found the discussion interesting. I confessed that it was my first experience of a fetal mortality conference, as in England only a maternal death merited such inquiry. Dr. Eastman, who commanded a vivid phraseology, replied, “Maternal mortality can be prevented. Today the spotlight is on the fetus. The obstetrician shall become pediatrician to the fetus.” In this, as in many obstetric topics, he was accurate and 20 years ahead of his time.
Success Too Early
My first assignment was the emergency room. As I wondered where to start and what to do, I noticed one patient lying with her knees drawn up, occasionally turning them from side to side. This posture is adopted by patients with pelvic pain, frequently due to peritonitis and/or intra-pelvic bleeding. Reaching her side, I heard her moaning quietly. I pulled over a blood pressure machine and while fitting the cuff inquired when her last menstrual period had been. She replied softly that it had started, stopped, started again. Then the pains had begun low down and suddenly gotten worse.
She was thin, and I put my hand gently on her lower belly. She guarded, tensing her muscles and trying to push my big hand away with her small one. Her pelvis was tender, and I felt there was distension. I tried to take her blood pressure, but not hearing anything, thought the machine was broken or that my stethoscope had not survived the journey. After exhorting myself to calm down and pull myself together, I heard a soft systolic, low, about 60. Her eye mucosa was pale, her pulse rapid and weak.
I said to the nurse, “This patient has a ruptured ectopic and is in shock. Get some saline and an 18 needle. And what’s the number of labor and delivery!” Despite not recognizing my name, the resident responded quickly, and the patient was taken to the operating room. Later, Dr. Eastman complimented me. This was the only time I distinguished myself during my time at Hopkins, and I had to waste it on the first day.
As the months passed, I learned that Dr. Eastman’s teaching emphasized “Keep it simple.” The senior residents who were up to date with the most recent reports and newer procedures asked him why he had not included one of the latter in the latest edition of his textbook. He replied that in small rural hospitals, the babies were delivered by general practitioners. He called on us to obey the first rule of medicine—“do no harm”—and warned us about “meddlesome obstetrics,” which he detested.
I was soon indoctrinated into the Hopkins method of taking and recording an obstetric history: methodical, systematic, complete, but with style. Our records enabled Dr. Eastman to gather many details concerning pregnancy, labor, and delivery for each patient we served. He invited me to his office one day and showed me his sorting machine, which stood in an adjacent corridor—the tool he used to analyze this data. Each patient’s chart was abstracted and 80 facts were punched into the numbered slots on a rectangular card. Watching his demonstration, I understood how he obtained the numbers for his book and lectures.
The senior resident in every department at Hopkins was omnipotent, and a clash between him and the chairman would have provoked a constitutional crisis. However, this was unlikely, for the senior was the survivor of extensive culling of his peers by the chairman. The senior residents had all worked five years at Hopkins and many in the subspecialties for seven or eight. The residency system was superior to the English model, for it provided graduated responsibility.
The Great TeLinde
After Christmas, I changed to gynecology. One month was to be on the private service where the majority of cases were those of the chief, Dr. Richard TeLinde. Dr. TeLinde, in addition to being an excellent surgeon and a succinct and prolific author, was a gynecologic pathologist. He also conducted a busy private practice, seeing patients every afternoon. In 40 years I never encountered another surgical chief of an academic department with a practice approaching his in numbers of patients or procedures. He was reputed to earn in excess of $2 million annually.
It was the duty of the intern to meet Dr. TeLinde at 6:30 a.m. daily. He was laconic, wasting no time in small talk, asking terse questions concerning the condition of the post-op patients he was to visit. Accompanied by the staff nurse and intern, he made quick rounds, issued clear orders and missed nothing. Then our steps were retraced down the corridor, and he questioned me about the surgical list for that day—the procedures, the pathology, the patients and any complications.
Before 7:30 a.m., the first incision was made, and like many surgeons, he relaxed and began to talk. Sometimes he described the history of the procedure, who had pioneered this approach, what refinements had been added and how the results had improved over time. I enjoyed this, for I had not met a surgeon before with such a sense of history of the craft. Surgery, except for emergencies, was over by 2:00 p.m., when he started seeing private patients in his office downstairs. A time/motion expert should have studied him.
Time to Move On
Hopkins was organized according to a “pyramid system”—which was responsible for some of the competitive atmosphere. My letter of invitation had stated “to serve an internship.” No mention had been made of a residency, but it was nonetheless June before I realized that only one person could remain, and I knew it would not be me, as I was not the best qualified. I did not have the best intellect.
My intuition was confirmed. Dr. Eastman summoned me and explained that he regretted there was not room to keep all those who merited it. He would arrange for me to go to any hospital I chose for the remaining three years. He recommended either Los Angeles County Hospital or Kings County Hospital in Brooklyn. I then told him, for the first time, that I had no money and a wife who would graduate in October who hoped to be a pediatrician. He responded that he had more influence in New York, where the chief was a former member of his faculty. He promised to call and see what could be arranged.
The next day he informed me that if I went to Brooklyn, Kate could join the pediatric program in October and that residential accommodation would be available for us in the hospital at no charge. Our salaries would be $75 and $50 per month, and neither program was pyramidal. I thanked him and accepted. He gave me a large signed portrait and wished me well. That was the last time I saw Dr. Eastman.
POSTSCRIPT: Richard and Kate Morton returned to Baltimore in 1971. He joined the University of Maryland faculty. She practiced pediatrics at Hopkins, became the first woman in the School of Medicine's dean's office and appeared on a popular weekly TV program called "Prognosis". In 1978, she was named president of New York Medical College. Now retired, the Mortons split each year between their residences in San Marco Island, Fla., and England.