Internship

“Lieutenant, tomorrow at O-800 you WILL report to staff sick call.  You WILL obtain your medical record and you WILL report to the ophthalmology clinic.  You have an O-830 appointment with Commander Edwards, the neuro-ophthalmologist.  You WILL receive an MRI.” Captain S, Chief of the Department of Urology, sternly ordered me.  Immediately, I stiffened in fear and thought “Oh shit”.  I wasn’t concerned about the ophthalmology appointment.  I had been evaluated by CDR Edwards two months previously as part of my flight surgery application.  I had been selected and would not have had the orders in hand to report for flight surgery training that summer had I had not passed the eye exam.  It was the MRI I feared.  That test had the potential to discover, uncover, reveal, ruin… and save me.  During my surgery Internship at the San Diego Naval Hospital, I was generally referred to as doctor.  So when a captain referred to me as lieutenant, I knew the only reply was “Yes Sir”.

From July 1, 1993 to July 1, 1994 I did a basic surgery internship, the toughest year of my life and the one of which I am most proud, at the Naval Hospital in San Diego, preparing me to repay the Navy four years of active duty service for the four year scholarship to medical school they had given me.  Early in July 1993 on my trauma service rotation, I began having some difficulties with touch sensation.  Feeling femoral artery pulses in order to phlebotomize the vessel to obtain an arterial blood gas measurement was difficult for me, sometimes impossible.  It became the running joke of Dr. G, one of the staff surgeons.  At times I felt the tears wanting to erupt but I refused to show my true emotions, laughing along with him.

As the year progressed, I started noticing other difficulties.  I had more trouble than most with fine motor tasks.  As the rest of my team would glide rapidly down the staircases, their feet seemingly not even making contact, I would be left slogging behind.  On call nights when I stayed overnight in the hospital and was awakened and summoned to assess a patient, I found it difficult to begin the long trek from my call room to the patient wards, spending the first 20 yards or so bouncing of the walls for balance.  One day I asked Dr. P, a fellow surgery intern if he was tired.  He emphatically replied “SHIT YEAH I’M TIRED!  I’VE BEEN UP FOR THE LAST 36 HOURS!”  So I tried to convince myself that it was just a hazard of the job.  But deep down I knew there was something more.

I had been a surgical intern on the urology service for the month of April 1994.  The interns rotated Fridays,  performing vasectomies and circumcisions with Captain S, the department chairman.  The previous Friday was my turn.  Apparently he had noticed something in my surgical technique that caused him enough concern to lead to our Monday morning meeting in his office, and warrant a mandatory ophthalmologic evaluation.  The reasons for his concern would not be made clear to me until a few months later.

At the appointment,  CDR E performed essentially the same exam he had performed two months previously.  This time he asked more directed questions focusing on my peripheral vision.  He was looking for signs of bitemporal hemianopsia, the classic symptoms of a pituitary adenoma, a growth in the pituitary gland at the central base of the brain that compresses the optic nerves affecting peripheral vision.    Untreated it could cause blindness, endocrine disturbances, and potentially death.  My responses to all of his questions where “No”.  “Your exam is unchanged from the last time I examined you.  I don’t see a justification for an MRI.”  “Whew.” I thought, finally releasing the breath I was holding.  “Well”, he said, “actually I do. If the captain wants an MRI, the captain will get an MRI.”

“Fuck!”