The Pit Stop

by William E. Byrd, MD, FACP

We are pleased to present this award­-winning article by William E. Byrd, MD, FACP, a runner-up in our Writing Contest. Dr. Byrd is a board certified internist and rheumatologist in private practice in Roanoke Rapids, North Carolina.

During my second year of private practice, I was assigned service call (for patients without a doctor) on Christmas Day. I was not scheduled to take over from my partner until 7:30 A.M., but I did not hit the bed until after 5:00 A.M., some eight minutes after I finished putting together two dollhouses and a train set for my two- and four-year-old daughters. At 5:45 A.M., they were both tugging on my shoulder screaming, “Daddy, Daddy, come downstairs. Santa Claus has come!”

After watching my daughters open their presents and recording the moment on my Nikon, I quickly dressed and prepared myself for what I hoped would not be a busy day. At 8:15 A.M., just as I started ward rounds, I received a call from Dr. Ted Conner, our staff emergency room physician. “Good morning, John. Merry Christmas. I hate to start your day off like this, but I’ve got a snowbird traveling from New York to Florida who just had an MI. She is clinically stable but in a pretty foul mood.”

“How so?” I replied.

Laughing, he said, “I’ll talk to you before you see her.”

Mrs. Margaret Steiner was a 76-year-old widow and realtor from Schenectady, New York, who was on her way to her condominium in Orlando, Florida, where she was to stay for the next five months. She had stopped at one of our local motels at 9:00 P.M. the previous night, hoping to complete her drive to Florida on Christmas Day. At 5:00 A.M., she was awakened with severe chest and throat pain accompanied by nausea and profuse sweating. Apparently, thinking it was indigestion from the previous night’s lobster bisque, she took several Tums and Mylanta. When the pain didn’t ease, she drove herself to the emergency room.

When I entered Mrs. Steiner’s cubicle, she was receiving IV fluids and nasal oxygen. Five minutes before, she had received 10 milligrams of IV morphine for her chest pain. I introduced myself, but before I could ask any questions, she said, “This town’s a dump.”

“I beg your pardon?” I said, wrinkling my forehead and tilting my head backward.

“The motel didn’t have any Kleenex, and the commode ran all night.”

“I’m sorry you were displeased with your accommodations, but I think we had best get down to business and take care of your present problem.”

“I drove myself over here, you know. I was afraid to dial 911. I didn’t know if this town could afford an ambulance.”

I bit my tongue, trying to control my emotions; I really didn’t need this aggravation, particularly on Christmas Day. Our rural community had a population of approximately 25,000; our hospital had 145 beds, enough to handle most medical and surgical problems. Three tertiary medical centers were easily accessible by ambulance and helicopter.

Mrs. Steiner continued to stare angrily at me and was completely alert despite her recent dose of morphine. In hopes of avoiding more unpleasant conversation, I said, “Mrs. Steiner, we’re going to move you to the intensive care unit until we’re sure you’re stable.”

Feigning surprise, she said, “An intensive care unit. How impressive. Maybe I’ll get a shot at twentieth-century medicine.”

Ignoring her remarks, I summoned one of the nurses and an orderly, and we began to move Mrs. Steiner’s bed to the intensive care unit. Before arriving, she raised her head from the pillow and demanded, “Get me a priest. I’m Catholic.” Looking sternly at me with eyebrows raised, she continued, “Don’t tell me. There are no Catholics in your southern heaven.”

“Yes, we have Catholics, Mrs. Steiner, and we also have a Catholic priest. We’ll call the rectory as soon as the nurses get you settled.”

Fortunately, Mrs. Steiner’s myocardial infarction was uncomplicated. She had no arrhythmia or congestive heart failure, and her chest pain came under good control with nitroglycerin.

The remainder of the day, thankfully, was relatively uneventful. I even managed to squeeze in a few hours of sleep. I checked on Mrs. Steiner several times during the day and over the subsequent week. Since her myocardial infarction was uncomplicated and she had no other medical problems, she was quickly moved to our telemetry unit. She remained true to form with a blistering stream of unkind comments directed to our nursing, housekeeping, and dietary staffs.

With careful political sparring, how­ever, I was finally able to acquire some additional interesting information. Her husband of 45 years, a retired attorney, had collapsed and died at the dinner table on Christmas Day the year before. The autopsy had documented an extensive myocardial infarction. The Steiners had one son, a successful television producer in California, but he was out of the country at the time and could not be reached. She volunteered no further details.

I inquired more in depth about her realty business and her son’s many accomplishments. She was obviously elated to talk about these subjects, and I managed to deflect much of her hostility. Every day, I brought a number of inspirational doctor-patient articles for her to read that I had saved from my medical journals over the years. I also loaned her a copy of the bestselling book by Rabbi Kushner, When Bad Things Happen to Good People. Slowly, she seemed to let her guard down.

On the sixth day of her hospital stay, she asked abruptly, “What are you doing in a pit-stop town like this?”

“Practicing medicine and making a living for my family,” I replied.

Pausing a moment, she continued, “People up north recognize quality and exceptional service, and they’ll pay handsomely for it.” I remained silent. She said, “This town seems like a place....” Hesitating momentarily, she continued, “Well, you know, for less-capable people.”

“I’m quite happy, and so is my family,” I responded. “And the town has been good to us.”

Abruptly changing the subject, she asked, “When can I get out of here?”

“Probably within the next 48 hours,” I said, “providing you have no chest pain.”

“Good. I finally got hold of my son. He was in Paris with his fiancée. He’s coming down this evening and will take me home as soon as you can discharge me.”

Mark Steiner arrived as scheduled, at which time I had Mrs. Steiner’s discharge papers ready. After I completed rounds the following morning, I tried to reach him to bring him up-to-date on his mother. Unfortunately, he had arrived much earlier and had quickly facilitated the discharge of his mother. I assumed Mrs. Steiner had filled him in completely regarding her negative perceptions of both the hospital and town.

I shook off the experience and thought little of Mrs. Steiner in the succeeding months. About 10 months later, I received a call from one of our nuns who said that Mrs. Steiner had stopped by on her way to Florida and would like to see me briefly.

Not knowing what to expect, I drove down to the rectory where a smiling, effervescent Mrs. Steiner was waiting for me.

“Dr. Sanders. It’s so good to see you. I just wanted to thank you and your hospital staff for the wonderful care I received last year. I had a triple coronary bypass at the Mayo Clinic, and the doctors all said that I received excellent care at your hospital. Thank you.”

“You’re quite welcome,” I replied cautiously, wondering when the punch line was coming.

Turning toward her car, she said, “Well, I need to get on the road if I’m going to make Orlando by nightfall. But I hope to see you again.” Clasping my hand, she said, “Again, thank you so very much.”

Surprisingly, I saw Mrs. Steiner on several occasions over the next five to six years during her many trips up and down the East Coast between Florida and New York. When our schedules conflicted, she would always call for a brief chat. Amazingly, at 82 she was still actively selling real estate.

Seven years after Mrs. Steiner was discharged from our hospital, I received a call from her son. “Dr. Sanders, I just wanted to let you know that Mother had a massive stroke and died last week without regaining consciousness. When I opened her wallet, the only two business cards I found were yours and mine. She really thought a great deal of you.”

I was completely taken aback and paused a moment before responding. “And I thought a lot of your mother, too.”