Cedric C. Jimerson was born in August 1919 in Hornby, NY. His father was a farmer who had graduated from Alfred College. In addition to working his 110-acre farm, he was head of the vocational shop at a high school in nearby Corning and was a home-builder. When Cedric was 13, his father died of tetanus, leaving his mother with four children under the age of 14. She began teaching for a dollar a day in one-room schools in the county and told the children they would have to work their way through college. Cedric proceeded to do just that, at Cornell University, and was one of seven students admitted to Cornell Medical College after his junior year. After graduating in 1943, he began his surgical training at The New York Hospital in New York City. His training was interrupted after his first year by military service, and he spent the next 2 ½ years as Captain and surgeon with the U.S. Army Medical Corps. He resumed formal training in 1946, first back at The New York Hospital in general surgery, then in thoracic surgery at the Bronx VA Hospital and at a VA hospital in upstate N.Y. Finally, he completed a senior resident year at New Britain General Hospital in New Britain, CT, followed by a 6-month pathology residency at the same institution.
Dr. Jimerson’s search for a position in general surgery, upon completion of his training, led him to Reading, where he joined the staff at Community General Hospital as the only board-eligible surgeon who had completed a formal surgical residency at an approved university hospital. He maintained a grueling pace of practice there for the next 35 years and became a beloved figure in the community. Despite the demands of practice, Dr. Jimerson made time to advocate for physicians and patients as a member of the Berks County Medical Society and the American College of Surgeons. His life and career have spanned changes in medicine, surgery, and society that would likely amaze any young person beginning a career as a physician in the 21st century. Dr. Jimerson has written in great and fascinating detail about his experiences, in part to preserve some important Berks County history, and he recently contacted the Medical Record to offer selections of his memoirs for publication. The following selection is a description of his internship year in general surgery at The New York Hospital. Additional selections will appear in future edition of the Medical Record.
Cedric C. Jimerson, MD Surgical Internship
– The New York Hospital
I graduated in April, 1943, and I started my internship the very next week. Arthur Chenowitz was the senior resident on the seventh floor. Gardiner Childs, who later became Chairman of the Department of Surgery at the University of Michigan Medical College and who became renowned in biliary tract and pancreatic surgery, was the senior resident on the sixth floor, Eugene Clifton was senior resident on the fifth floor. I was assigned to Dr. Clifton and to the fifth floor.. He was a “slave driver” and a “son of a gun.” He worked us so hard we had little time to eat or sleep. My classmate Harold Miles from Olean, NY had married the weekend before we started the internship, and Clifton did not give him time off to see his new bride for one month.
Prior to World War II, there was a rule that nobody in surgical training at NYH could be married, because of the belief that a wife and married life interfere with work and training. Because it was a seven-year residency in surgery, this meant that the survivors of the highly competitive pyramidal system were thirty years old before they could marry. Dr. George Heuer patterned his surgical residency after that of Dr. William Halsted, the “Father of Modern Surgery,” at Johns Hopkins Hospital in Baltimore, MD. Dr. Heuer had trained under Halsted, and he was one of many surgical residents whom Dr. Halsted had turned out of the famous residency at Johns Hopkins. Later Dr. Heuer performed a cholecystectomy for acute cholecystitis on Dr. Halsted. Many of the Halsted trained surgeons became professors of surgery at the most prestigious university hospitals in this country, including Dr. Heuer, formerly Chairman of the Surgical Department at the University of Cincinnati, Dr. John Morton, Chairman of the Department of Surgery at Strong Memorial Hospital in Rochester, NY, Dr. Harvey Cushing, the famous Professor of Neurosurgery at Harvard, and the Professor of Surgery at Yale School of Medicine in New Haven, CT, and the University of Virginia in Richmond, VA.
These Halsted residents learned, taught, and practiced the Halsted principles of surgery, including: asepsis and sterile technic, thorough hand scrub, careful preparation of the skin with washing and application of antiseptics, proper draping and walling off the sterile field, the use of cap and mask and sterile gown, and the use of sterile gloves. Dr. Halsted was the first surgeon to use sterile gloves, although all the credit goes to his wife who was his suture nurse. She had suggested that he employ rubber gloves to protect his hands which were affected with a skin disease. Dr. Halsted taught slow meticulous dissection, gentle handling of tissues, careful hemostasis, clamping and ligating individual blood vessels, avoiding trauma to tissue, and the accurate apposition of wound edges.
Remember Dr. Halsted was at Johns Hopkins in the day of its glory when it proudly boasted of its great medical men including: Dr. Welsh, and Dr. William Osler, the great physician who advocated putting a finger into every orifice during a complete physician examination. Both Dr. Halsted and Dr. Heuer believed a preceptorship had no place in the making of a surgeon. They firmly believed that a long disciplined formal residency training program which included all of the branches of surgery was the only way to prepare a young surgeon to handle all types of surgery involving all of the body cavities and the extremities, including brain surgery, thoracic surgery, abdominal surgery, and pelvic surgery. Indeed, while I was in residency training in surgery, orthopedics, neurosurgery, pediatric surgery, urology, plastic surgery, thoracic surgery, gynecology, and cardiovascular surgery were all taught in the general surgical residency. At the time I took my American Board Examinations in Surgery, questions in both the oral Part 1 written and in the Part II oral examination included all of these surgical specialties.
A work ethic was instilled into us that the longer and harder one worked, the better surgeon he would become. Dr. Clifton treated us like slaves. At the New York Hospital there were three entire floors devoted to the ward services of general surgery. Most of my internship I worked on the fifth floor. Female patients were on the east wing and male patients were on the west wing of the fifth floor. Each wing had one large ward divided into four sections of six beds each and there were draw curtains for each bed. There were two private rooms near the nurses station which was located just outside the big ward, which could be seen through large windows. In addition there were semi-private rooms, each with four beds. Each wing had its own dressing or treatment room.
We were expected to finish breakfast and to be on the floors to make rounds by 6:30 A.M. and to be in the operating room by 7:30 A.M. The operating suite was on the tenth floor, and the private operating rooms were on the eleventh floor. As interns, we “scrubbed” on every “case” from our respective floors. The OR schedule was heavy, and it was always filled. Daily we operated from 7:30 A.M. until 4:00 P.M. or 5:00 P.M. with or without a short break for lunch. We had a daily conference with the members of the house staff assigned to each floor. The concept of the surgical residency training was that senior members of the house staff were responsible for teaching and training the assistant residents and the interns under them. Usually the senior resident assisted the professor of surgery with his operations, and occasionally the professor or one of the assistant professors assisted the senior resident with his more difficult operations. It was a pyramidal system which meant that some members of the house staff were eliminated each year until there were only three senior surgical residents in the seventh year of the residency.
For the most part the senior seven year residents operated independently without the help or interference of a junior or senior attending surgeon. He was assisted by the members of his house staff. There were always plenty of assistants. Frequently there were so many assistants that the lowly intern was out in “left field.” Either he couldn’t see what was going on, or he really wasn’t needed. No one ever left the operating table unless he was specifically excused by the superior resident. Even if nature called, the intern was expected to pull on those retractors, until he was excused.
The senior resident was responsible for arranging the OR schedule. He determined which patients needed surgery, and the operation they would receive. Then he assigned the operating team. He determined which operations he would perform and which operations he would “turn over” to the first assistant, second assistant or third assistant residents. If the fourth year resident was the assigned surgeon, the assistant resident on the ladder above him and the one below him would assist him-and the intern was always the “fifth wheel.”
In reality the intern was there to “hold the hooks,” to provide retraction of the surrounding viscera and exposure of the operative site. He was constantly being commanded to pull harder, or not to pull so hard or to replace the retractors or rakes. Somebody should have invented a better handle for those big Deaver retractors which gave the intern blisters and callouses on his hands.
After a long day in the operating room, and after the afternoon conference reviewing the care of the surgical patients, and after reciting from memory the blood counts and urinalyses of the patients, because many of them were on sulfa drugs, the intern was excused for supper. After supper we were expected to perform complete histories two or three pages long (the medical interns had to do four or five page histories) and physician examinations. These had to be written up in long hand before presenting them for review to the assistant residents who in turn wrote up a shorter history and physical examination. The senior resident reviewed the histories and physical examinations of the assistant resident and the intern, and then he wrote a paragraph about the patient on the chart. After evening visiting hours, we were expected to be on the floor to discuss the patients’ conditions with the relatives and visitors. Then we made our own evening rounds and ordered medications. We sat near the chart rack, and wrote progress notes on each patient’s chart. Also we wrote operative notes on the charts of the patients operated upon that day, and preoperative notes on the patients to be operated the next day. Under the supervision of one of the assistant residents we wrote the orders for the patient.
Dr. Clifton insisted that the intern, and not the nurses, do all of the daily colostomy irrigations daily, and there were many of them. We were not allowed to do the colostomy irrigations in the morning before surgery, and he forbid us to have BM’s before surgery, because he felt these activities could affect the postoperative infection rate. In the late evenings we went down to the record room where we dictated on the old dictaphones lengthy discharge summaries of all the discharged patients.
We were on first call for all surgical emergencies in the E.R. one night out of three, and we were on second call one night out of three—the third night was theoretically free. That third night “off” was frequently the busiest of the three nights—catching up with the ward work, the dressings and the chart work. In the record room there was always a pile of discharge summaries to be dictated. We seemed to have a lot of cases of intestinal obstruction, and Clifton had a rule that no intern would go to bed until the Miller Abbott tube had been successfully passed through the pylorus into the jejunum to decompress the small bowel. This was easier said than done. We placed the patient lying on his right side, elevated the head of the bed, manipulated the long tube, and took repeated x-rays throughout the night to check the position of the tube. This made us very unpopular with the x-ray technicians and the x-ray department. Clifton must have set his alarm clock, because routinely at 2:00 A.M. and 4:00 A.M. he would phone the floor to be sure the intern was with the patient, and to check on the progress of the naso-gastric tube.
Dr. Clifton had another strange idea. He felt that no patient on his service should die, and he insisted that if a patient was critical or in extremist, the intern should not leave the patient at night. Thus, one of the two of us interns assigned to his floor and his service had to stay with a dying patient all night on the remote chance that his life could be salvaged.
We were working more than 110 hours per week, and we kept our adrenals pumping out the adrenaline. A few years ago there was much publicity given to the fact that in New York State many hospitals were working members of their house staff more than sixty hours per week. There was controversy over whether the house staff was alert and functioning well after so many hours of work and so little sleep. Believe me, we were putting in forty and fifty hours more work per week than the proposed cap.
Dr. Wangensteen in Pittsburgh became famous for his pioneer work in intestinal obstruction, and the merits of nasogastric suction, and intestinal decompression which he published in his outstanding book on “Intestinal Obstruction.” Everyone was awakening to the importance of long tube intubation with the passage of a long intestinal tube (either the Miller-Abbot tube, the Cantor tube or the Lyons tube) through the nose, through the stomach, and into the small bowel, and connecting it to nasogastric or Wagensteen suction to decompress the bowel either before surgery or after surgery or both times, and in the presence of intestinal obstruction. Incidentally, in those days because there was no wall suction or other suitable suction available, we used Wangensteen’s suction which consisted of two large jugs, one at a higher level than the second, and one filled with water, so that the water flowed by rubber tubing from the upper to the lower jug, continuous low suction was obtained. Later, we did not have to lift the individual jugs because they were mounted onto a rotating assembly which could be turned when the top bottle was empty. Next portable suction machines operated by electric motors appeared in the hospitals. Of course, the Wagensteen suction bottles and drainage seemed primitive now that we have suction piped into every patient room and into every operating room.
One out of three Sunday mornings we were expected to be in the Surgical Follow-up Clinics. On the north wing of the “Whistle-Works” or “Ivory Towers” there were four or five large floors devoted entirely to our patient clinics. In those huge clinics we examined and conducted follow-up studies on all postoperative patients for the past five years. The patients were notified by mail which Sunday to report, and there were usually over fifty patients to be seen every third Sunday morning.
This Sunday morning assignment to the Surgical Follow Up Clinic happened to fall on the third Sunday when the surgical intern was theoretically “off duty.” Remember we were “on duty” two out of three nights a week and two out of three weekends. This was really “slave labor.” Granted we were seeing huge volumes of patients and gaining a lot of experience; but the pace was grueling.
Some surgical interns “dropped out” and “switched” to ophthalmology or dermatology, because it was “madness,” and they sought an easier life. We all began to realize that after one completed his arduous surgical residency training, the practice of surgery would be very strenuous, difficult and demanding.
Although we all had our M.D.’s and our licenses to practice, we received no pay and our total remuneration during our internship was our board and room. I had a nice single room on the twenty-first floor of the hospital. We did eat like kings the first six months. We ate in the private dining room on the fourteenth floor where they served fantastic meals, including delicious steaks and fancy desserts. This luxury ended when the hospital authorities decided to open the hospital cafeteria, and require all members of the house staff to eat there. In order to determine how much food allowance they should pay us there was a one month trial of tabulating the cost of the food the house staff ate. The entire house staff was “up in arms.” Dr. Clifton stood at the cafeteria lines, and made us all take several meat dishes and double desserts and return for “seconds” and “thirds” during this evaluation period in order for us to win a good food allowance.
For the two years following the internship the assistant resident received twenty-five dollars per month, plus room and board allowance. The salary was then progressively increased until the senior seven year residents received one hundred dollars per month. The internship was a great educational and a fantastic learning experience with huge numbers of patients with a wide variety of surgical conditions. I’ll never forget it, but I would never want to go through it again. That Fall I received my “Greetings and Salutations” letter from Uncle Sam. I was notified to report for active duty in the U.S. Army Medical Corp. AUS by midnight on 12/31/43. I must confess that I looked forward to the end of my internship and to going into the army.