House Calls with John
This experience was devastating to me. Realizing that I needed more training in tuberculosis, I left my practice for two weeks to work with the country's foremost expert in childhood tuberculosis, Dr. Edith Lincoln at Bellevue Hospital in New York City. I returned a better trained pediatrician and later encountered a number of young patients with tuberculosis.
I continued to make many house calls, including at night. These were very tiring, but I never refused such calls. Sometimes, however, after answering the phone, I'd fall right back asleep—only to be awakened again by a second call a little later when I didn't show up. And occasionally in the middle of the next day, while I was taking a history in the office, a surprised parent would say, "Why, Doctor, I believe you've fallen asleep."
I also began to carry a harmonica wherever I made house calls, finding that a few tunes were an ideal way to distract a frightened child. And I always remembered birthdays, whether in the office or on home visits, playing "Happy Birthday" for the unsuspecting child. I had been in Maine for three years when I started receiving queries from practices elsewhere. I determined that one of my mentors at Mass General had been passing my name along. At first I turned down these approaches. I didn't want to abandon the families in Bangor that had come to depend on me. But one call from a three-physician private practice in Rochester, N.Y., was appealing. Not only would I have a clinical appointment at the University of Rochester Medical School, enhancing my opportunities for continuing medical education, but I would have associates to share call with and could give up responsibility for managing an office.
So in 1958, Dotty and I moved the family to Rochester. One reason I even considered the move was the practice's emphasis on making house calls. Parents were told they could expect a house call the morning after a child with a high fever was seen in the office; they were asked to call by 7:00 a.m. and cancel the visit if the child was progressing well. Often we made eight to ten house calls a morning, in addition to our hospital visits.
Occasionally house calls could be life-saving. One morning, my list included a child with croup. Upon arrival at the home, I realized that the child was in extreme distress—struggling to breathe and in much more difficulty than the usual child with croup. I suspected epiglottitis, an infection of the small flap of tissue that separates the esophagus from the trachea, or windpipe. A swollen epiglottis can completely block the airway. There was no time to wait for an ambulance, so I phoned the emergency room, bundled the mother and child into my car, and drove—horn blaring all the way—to the University Hospital. An ear, nose, and throat specialist and an anesthesiologist met us at the door and took the child right up to the operating room. The anesthesiologist inserted an endotracheal tube to provide a temporary airway, and the child immediately went into a deep sleep, relieved of his tortured efforts at breathing. The ENT doctor performed a tracheotomy, cutting a small opening in the child's neck, which allowed the insertion of a special airway tube. The tube was removed in four days, after the swelling of the epiglottis had subsided.
In the early 1960s, I started volunteering on evenings and weekends at an inner-city clinic run by a faculty member at the University of Rochester Medical School. It served impoverished, mostly minority families that had little access to the kind of care I was able to provide the families that were patients of my daytime practice. So I was receptive to making another change when, in 1964, I received an offer to join the Rochester faculty. I announced my decision to my colleagues with regret, for they had taught me many of the finer points of pediatrics.
As a junior faculty member, I was fully involved with hospital responsibilities but soon had my eyes opened to a totally neglected population. Unbeknownst to me, Rochester was surrounded by many migrant farmworker camps. Naomi Chamberlain, a perceptive African- American member of the medical school's faculty, introduced a few of us to conditions in the camps. At one, I saw workers housed in a chicken coop with whitewashed walls covered with chicken excreta. In addition to primitive living conditions, contaminated water supplies, and inadequate toilet facilities, they had no medical care at all. I was shocked that such conditions existed in the Rochester environs.
In 1965, under Naomi Chamberlain's leadership, we began to hold a weekly evening clinic at one of the farms. Soon, we had enough volunteers—nurses, medical students, and several other faculty members—that we could open the clinic twice a week and also make some house calls.
One evening, I received a call that a woman in one of the camps was in labor. Another physician, two nursing students, and I soon arrived at her home. She looked pregnant, complained of crampy pain, and seemed to be in active labor. Since the University Hospital was 25 miles away, we didn't take the time to examine her but just bundled her into my car and drove hurriedly to the emergency room. While I was assisting her into a wheelchair, her membranes ruptured and I was completely soaked. We left her in the hands of the obstetric personnel and headed home.
The next morning I called to check on her progress. "Oh, she isn't here," I was told. "She was discharged last night."
"How could you do that?" I asked.
"She wasn't in labor. She just had a full bladder and pseudocyesis."
Never having heard of this diagnosis—but not wanting to appear ignorant—I hung up the phone and pulled out my medical dictionary. I learned that pseudocyesis is a "false pregnancy." It usually occurs in women under emotional stress or with a very strong desire to become pregnant