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Tales from "The Pit"

    We were all terrified, of course.  It was a usual Saturday morning in the winter of 1975.  The LSU medical students sat nervously in "The Pit," the stepped amphitheater on the twelfth floor of Charity Hospital where the Department of General Surgery discussed cases from the week before.  Two or three students were assigned to present a case, after which the head of the department--the Chairman-- would quickly decide whether to decimate the presenter or challenge, point blank, the attentive med students who were the audience.  If he liked the presentation--if it was a logical reporting of symptoms, signs, findings, diagnosis, and treatment--his finger would swing around and zero in with a question to a random casualty in the seats above that surrounded him.  If he didn't like the presentation, if the student hadn't prepared that well or was sleepy, The Pit became the teaching experience from Hell.  The other students could then relax because all the barbs and verbal entrapments would be going elsewhere.

     The presenting student got only one sentence out before he was stopped.

     "You all heard him," the Chairman said with a smile on his face that fooled no one.  "He stated that this is a case about right lower quadrant pain."  He paused.  "Ahhh," he said, slowly extending the index finger of his right hand.  "Dr., um, DiLeo," he snapped (even though I wasn't a doctor yet), his hand and finger locked and loaded.

     "Yes, sir?"

     "Dr. DiLeo, what would you do?"

     "I would get a careful history from the patient," I answered.  Somehow I knew this wasn't going to satisfy my debt to The Pit.

     "You were going to get a history, were you not?" he swung around to ask the presenter.

     "Yes, sir, and after that I was--"

     He was stopped dead by the finger waving negatively.  This finger was running the show now on this Saturday morning.

     "We'll let Dr. DiLeo tell us what's next, right, Dr. DiLeo?"

     Well this wasn't fair at all.  True, I hadn't had my turn to present at one of these Saturday kangaroo courts, but that was no reason to make me present the case I was hearing about for the very first time.  Now no one relaxed, because others realized that finger could jump track to any one of them instead of me.

     "I would do a careful physical exam," I explained.

     "Oh, I expect it would be a careful one, Dr. DiLeo," he assured me.  Of course I chuckled along with him which seemed the respectful response to his wit.  "But first, before the physical exam, what about the history?  What do you want to know about the history?"

     "Well," I stammered, "I didn't hear it yet."

     "Of course," he agreed, turning to the presenter.  "Let's hear a bit of the history, shall we?"

     "Mr. Temple was a 21 year old black gentleman--" the presenter got out before silenced again.

     "Dr. DiLeo," the Chairman asked, "what can you tell me now?"

     "Uh," the stammering continued, "that he was 21..."

     "And?"

     "And he was black..."

     "And?"

     "And...uh...I didn't hear anymore," I responded.

     "And?" he asked again, raising his voice.

     "And...uh...um...that he was a gentleman?"

     "No! No, Dr. DiLeo!"

     "You mean he wasn't a gentleman?" I asked, flustered in the brain.  The department head thrived on flustering.  The rest of the students laughed.  I was a dead man.  Mercifully, he turned back to the presenter.

     "Dr. DiLeo has made a value judgement about Mr. Temple.  So what can you tell me so far based on what you've said?" he asked him.

     The presenter, like me, had simply run out of gas.  His mouth opened as if to begin to answer.  The department head raised his eyebrows in excited anticipation, but no words issued forth from the presenting student.  He snapped around.  I braced myself, but he fired his finger at the student to my left.

     "I don't think we can say anything else about Mr. Temple until we do a physical exam," the student answered, suspecting a trick question, because there were always trick questions.

     "You!" he shouted to the next student in line, but she wasn't fast enough, and his finger skipped on down the line, student by student.  "And you?  And you?  How about you?  Surely you know?"  He troubled himself to put on obvious expressions of disbelief.  This went on and on until--and I don't know why--I slowly raised my hand.

 "Doctorrrrr DiLeo," he said with glee.  "Dr. DiLeo--unless he has to go to the bathroom, has had an epiphany.  Please, Dr. DiLeo, share it with us."

     "Well..." I began.

     "Yes," he blurted, smiling at how he knew he was sucking me in.

     "Well...Mr. Temple is a 21 year old black gentleman."

     "Yes, Dr. DiLeo--your insight, please."

     "Mr. Temple is not a 21 year old black lady," I continued.

     "No, Dr. DiLeo, that would make him ‘Miss" Temple, wouldn't it?  And your point is?"

     "I know that Mr. Temple has right lower quadrant pain and he's a man, so I know his pain isn't from a right ovarian cyst.  Right?"

     The head of the Department of Surgery stood silent for a long moment, then finally rewarded my insight.

     "Dr. DiLeo," he said with a most sympathetic tone, "you need to be a gynecologist, not a general surgeon.

     He was so right.

Epilogue:

     Twenty-three years later, I was touched to see this man at the funeral of my father, a retired general surgeon who died at the age of 84.  He knew I was a gynecologist, but this irony was lost on him, because although I remembered him so well, he probably didn't remember me or this episode.

     But then again, maybe he did.

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