The View from the Vue Read Free

the length of the hospital to Central Supply when the electrocardiograph machine ran out of paper in the middle of working up a patient.
    The scut jobs at The Vue were endless, and medical students spent an inordinate amount of their time wondering how it came to pass that their tuition fee involved them in more hours of doing scut than making ward rounds with attending physicians. When they protested, they were patronizingly told that scut was, after all, also an L.E. (Bellevuese for “Learning Experience”), to which the students would usually react with an expletive that meant scut.
    After four years of medical school, and having mastered the fundamentals of basic medical science and patient care, the student was permitted to put M.D. after his name, and was graduated into internship. Now the learning process began in earnest.
    Although the intern was technically an employee of Bellevue Hospital (being paid a munificent $3,200 per year), he was part of the affiliated medical school teaching staff together with his more senior house officers—the residents and the staff of attending physicians. He learned from his superiors and he helped to teach the students beneath him.
    Working on the wards and in the clinics all day, and taking calls through many of the nights, the intern was first on the firing line in the care of his patients. By doing what he could by himself, and by helping his seniors with more difficult tasks, his fund of knowledge and reservoir of confidence gradually increased. It is generally true that most doctors have learned more during their internship than during any other single year of their lives.
    Upon completion of internship, the doctor became a resident physician. Residency consisted of a set number of years of training, during the course of which there was progressive assumption of more complex duties and greater responsibilities, all of which ultimately led to the doctor’s capacity to function independently as a specialist in a particular field. The length of time spent in residency varied with the specialty, ranging from two years in pediatrics to seven or more years for some of the surgical sub-specialties. Residents supervised the work of interns and medical students, and they, in turn, were supervised by more senior residents and by attending physicians.
    For all practical purposes, the chief residents on the various specialties were the kingpins of The Vue. In consultation with their attending physicians, they made the ultimate decisions regarding patient care, performed the most difficult operations, and generally kept watch over their entire services. When an intern or a junior resident blundered, the chief resident was held accountable. When all was going well on a service, that was merely to be expected. The buck definitely stopped on the chief’s desk. After surviving that sort of a year, the graduating chiefs were ready for anything that practice had to offer.
    The senior members of the teaching team were the attendings, of which there were two types. Part-time attendings were men and women in practice who wished to maintain a strong association with a medical school. Therefore they donated their time to help with the on-the-job training for the medical students and the house staff. The full-time attendings, on the other hand, were paid a salary by the school in return for which they taught at Bellevue, gave lectures to the pre-clinical students, and did research. Even at the attending physician level, the Bellevue fondness for hierarchism exerted itself: the attendings were placed at either the junior or the senior level.
    At Bellevue, no service had anything good to say about any other service. According to the surgeons, the internists were a bunch of pusillanimous dudes, many of whom wore glasses, and were given to interminable arguments over picky, unimportant details of diagnosis or therapy, usually carried out while the patient was dying before their eyes. In return, the