There is a quote paraphrased from Mother Teresa that goes something like:
“We the willing, led by the unknowing, are doing the impossible for the ungrateful. We have done so much, with so little, for so long, we are now qualified to do anything, with nothing.”
Everyone who worked or trained at Charity had their “making do” moments. We were not Mother Teresa, but after a few years there, you did feel like you could do anything with nothing. The budget at Charity was very limited, and what was budgeted was sometimes rumored to be misused or embezzled – this was the way with Louisiana State Politics. With a limited budget, the hospital was short staffed on ancillary help and the hospital physical state and equipment were always in the need of repair or replacement. This led the interns and residents to be very creative in some areas of health care. As they say, necessity is the mother of invention.
My first “making do” moment, came in the first days of internship. When showing up for work the first day as an intern, there were certain necessities to have in your white lab coat. The list included a stethoscope, a prescription pad, and usually a paperback book that was a reference to look up basics about the service you were on. Like “Neurosurgery for the House Officer”, or fill in the title with the service that month. This was before smart phones, the internet, and Google; so you had some “ectopic brain” to carry with you for some sense of security. You quickly learned that the elevators at Charity were too slow. The elevators at the time had the two doors that required the elevator driver to open and close each door. Plus these elevator operators were never in a hurry and would stop on a floor and just talk with another employee about the weather, or the Saints football team, or anything; and you would be just stuck there in the elevator. Most interns and residents were in a hurry and could not lollygag around with the elevator operators. There were stairs at Charity, but they were designed to be for emergency evacuation only and the doors to the stairwells would lock behind you. These stairs were to take you to the street level to exit the hospital. Some brilliant resident had figured out that an IV piggy back hanger was also a Charity stairwell “key”. A piggy back hanger was used for hanging IV fluids and was readily available. It was basically a heavy gauge wire with an open loop on each end. If you bent one end slightly, you could use it to quickly open a stairwell door. One of my first lessons as a new intern was how to make and use the stairwell “key.” So every resident and intern had a stairwell “key” in their white lab coat, it was as important as your stethoscope. Most of us had patients on several different floors of the hospital and this let you move up and down in the stairwells without needed the very slow elevators.
There was very limited ancillary staff at Charity. As interns and residents, we would transport patients to the CT scanner at all hours of the night, clean the ORs between cases, and run the fluoroscopy unit in surgery. If you waited for the hospital staff to do these things, it would make your already long day into a nightmare. X-ray films were kept under the mattress of the patient’s bed. Films that made it to the x-ray file room, were usually lost forever. In the ICUs, the nurses were great about drawing blood and starting IVs, but on the wards these jobs would often be for the medical students or interns. There was no respiratory therapy, so interns were frequently using red rubber catheters as NG tubes to “snog” the patients into coughing and taking deep breaths to treat atelectasis and preventing pneumonia. There were times when there were no physical therapists, so orthopedic residents would put together crutches and teach patients how to use them before discharge. All of this “extra work” was just a normal part of the day and standard “making do” activity.
The physical plant of Charity was also crumbling in places. At one time during my residency, the electric breaker panel to the orthopedic wards burned up. The orthopedic wards were without electricity for about two weeks. The breaker panel was so old, a new one had to be custom made, it could not just be replaced. We would usually make rounds before sunrise and afternoon rounds after sundown. So there was a couple of weeks where I made rounds with the pen light from my white coat. There was electricity in the Accident Room and Operating Rooms, but on the floor I only saw my patients with a flash light. It was dark on the wards, and the nurses and doctors worked by flashlight until the electricity was restored. Again just “making do.”
During another episode, the plumbing draining the orthopedic wards was broken and took a couple of weeks to repair. The Charity solution was to have a port-o-can in the hall outside the orthopedic wards. A port-o-can in a hospital – only at Charity. So patients recovering from orthopedic injuries were forced to use a port-o-can during their stay. That is not easy to do on crutches. Sometimes, it was the patients that had to “make do.”
My most memorable “making do “moment involved the fracture table at Charity. A fracture table is a specialized table used in surgery that can position patients and apply traction. It is absolutely a critical piece of equipment for orthopedic trauma. The fracture table at Charity was really, really old. Many parts were missing, and could not be replaced without replacing the whole table, which was expensive. As Chief Resident in Orthopedics, I had talked with hospital administrators about the conditions of the fracture table. I was told a new fracture table was too expensive and to use what we had. For each case, we had to rig it with kerlex rolls and duct tape to position the patient. It was “making do” at its finest. The fracture table height was controlled by a foot pump and hydraulics that would raise and lower the table and patient. Traction was applied to the lower extremities by a worm gear on each foot. Some of the foot pieces and straps were missing so that is where the kerlex rolls and duct tape were used. We had positioned a patient for fixing a subtrochanteric hip fracture. After positioning the patient, a sterile plastic sheet drape was applied to only expose the incision area of the patient’s thigh. We were just getting started with the procedure, and I was helping a younger orthopedic resident do the case. Without warning, the table started to lower the patient towards the floor and black hydraulic fluid came pouring down the plastic drape. The old fracture table had finally kicked the bucket. I took over doing the case since time was of the essence and the patient was slowly sinking. I finished the case laying on the floor putting in the last screws and stapling the skin closed. The CRNA doing the anesthesia was on the floor bagging the patient as we finished the case. Luckily, the patient did fine. We had a new fracture table two weeks later.