THE GIFT OF SERVICE
Service has a life of its own. A single act of kindness may have a long trajectory and touch those we will never meet or see. Something that we casually offer may move through a web of connection far beyond ourselves to have effects that we may have never imagined. And so each of us may have left far more behind us than we may ever know.
When I was twenty-two and a third year medical student, I was assigned to the wards of Bellevue, the great city hospital of the city of New York, for my first clinical experience. Bellevue Hospital has been rebuilt since then, but the old Bellevue was a colorful place to work, like Dickens in modern dress. I learned a lot of medicine there, and many other things as well.
In 1960, Bellevue was a place of refuge. Managed care was many years in the future, and so it was not uncommon for people to be admitted to the hospital with a chief complaint of “cold and hungry” or “homeless in winter.” Often, such “patients” helped out by making beds, carrying food trays, or even washing the floors. Bellevue was a place with its own culture, its regulars and its newcomers, and its politics. At that time it was probably simpler to place a bet, find a card game, or score drugs inside Bellevue than it was out on the streets of New York.
I started working on one of the men’s general medicine wards. Each ward was a single huge room with three rows of beds, one along each of the side walls and one running down the middle of the room. Good news and bad news, examinations and treatments, family relationships, even deaths, happened in full view of everyone. It was one of my first experiences of community.
As a third-year student I was expected to come an hour or more before ward rounds every morning, pick up the resident’s orders from the night before, and draw all the requested blood work. From the first, I dreaded this morning task. As a female student, I was a bit of an oddity and I attracted a certain curiosity. Under the watchful eyes of fifty men I would go from bed to bed, placing tourniquets on arms, hoping that my meager skills would be up to finding a vein and taking blood from it. As this was my first clinical rotation, my skills were new. Even thought many of the men had done hard physical work most of their lives and had sinewy arms with veins as thick as ropes, I would often have to try several times before I was successful in drawing their blood. I t was painful for them and agonizing for me.
During my second week on this service, I was working my way down the middle row of beds and had just struck a man for the third time without success when I sensed someone close behind me. Turning, I found one of the” regulars” standing there, a big rough-looking man in the blue Bellevue patient pajamas with tattoos covering both of his arms. Without a word, he reached out and picked up one of the unused syringes I had put on the bedside table. With one hand he tightened the tourniquet around the arm of the man in the bed and with the other he drew blood from him. It had been done in seconds. I stood there openmouthed. “Do you have a gauze pad?” he asked me. Silently I produced one and he pressed it on the man’s arm, withdrew the needle, and handed me the full syringe. Hands shaking, I emptied it into the specimen tube. My eyes stung with tears.
Trying to hide my humiliation, I turned and went to the next bed, but he followed me. “Doesn’t anybody teach you kids how to do this?” he asked me. Unable to speak, I shook my head. “Here, look,” he said, and, more slowly this time, he wrapped the tourniquet around the patient’s arm and found a vein. “See?” he said. “Keep the hole in the needle up and the vein won’t roll away from you.” Silently I put the new specimen into another tube, and we went on together to the next bed.
The man in this bed was smiling and extending his arm. “Here,” he said, “you just try.” Larry will show ya’ how to do it better.” I tried and missed. Larry showed me a better way to hold the syringe and it was much easier. We went on from bed to bed, Larry offering suggestions and showing me many tricks I had never seen before. By the end of the hour I was drawing every blood on the first try. “Not bad, kid, not bad,” Larry told me, and he walked away.
The next morning he was there again, and we went to the bed of the first patient together. I placed the tourniquet around the man’s arm and was about to draw from the large elbow vein that popped into view, but Larry shook his head. “This one” he said, pointing to a much smaller vein. I looked dubiously at the patient. He winked at me. “Do it,” he told me. There were almost thirty bloods to draw that morning. By the last of them, I was able to take blood easily from veins I could barely see.
Larry came with me every morning. At the end of a week, I was able to find hidden veins by touch alone and draw bloods I would not have thought possible. Several of the men told me they could barely feel the needle. “A quick learn, kid,” Larry said. “Lookin’ good.” It had meant a great deal to me. Praise was hard to come by in medical training.
The following year I returned to Bellevue for three more months and was assigned to work in the emergency room, one of the most famous in the world. Medically, it was an extraordinary experience, and I was giddy with the drama of it. All of New York City’s suffering came through those doors: accidents, shootings, heart attacks, suicides, beatings, rapes. At the time, it was my idea of being a real doctor. So I was there the evening that Larry was brought in by police ambulance, shot to death over a drug deal gone bad. It had stunned me. Being very young, I had simply assumed that he had been an army medic. It had never occurred to me to wonder where he had learned to be so skilled with a needle.
It is almost forty years since I was a student at Bellevue and touched by Larry’s kindness. There have been many times when my deftness with a needle has made a difference to someone and a few times in a tight situation when that difference was between life and death. Over the years I have taught Larry’s secrets to hundreds of others and perhaps they have passed them on as well. Once this skill is learned, it is something one ever forgets, like riding a bicycle.
By Rachel Naomi Remen, M.D.
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