New Orleans, 1982. Voodoo spells, prostitutes, prisoners, and veterans who are adamant about the size of their manhood—it’s all just another day at Charity Hospital, also known as The Big Free. It’s a medical free-for-all with the toughest trauma surgery in America, and Elizabeth—fresh from medical school in Charleston, wearing pearls and pink plaid socks—is one of the first women to work there.
Half of the doctors who start the surgery program never finish. Nothing in her proper Southern upbringing prepared Elizabeth for the gritty and gruesome world she now experiences on a daily basis. And even if she’s tougher than anyone first expected, the question remains . . . will she make the cut?
Full of drama, humor, and New Orleans flavor, The Big Free is a young doctor’s coming of age story as only a true medical insider can tell it.
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|Publisher:||Morgan James Publishing|
|Product dimensions:||6.00(w) x 8.90(h) x 0.80(d)|
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Charity Hospital, New Orleans
July 1, 1982
Dr. Elizabeth Roberts walked through the back door of the most notorious trauma center in America. It was her first day as a doctor. Her name tag was proudly displayed on her new, starched, white doctor's coat.
As she passed the noisy, crowded waiting room, she heard a patient shout, "When is it my damn turn? I been here all damn night!" Elizabeth noticed many of the angry and impatient people were speaking out loud to nobody in particular.
The aromas of fear, blood, sweat, alcohol, and dirty diapers filled Dr. Elizabeth Robert's nose.
As she walked through the last of the swinging doors and into the inner sanctum of the accident room, she spotted a woman standing in front of the nurse's desk. She was giving orders to other nurses. Elizabeth had been told to look for a tall woman with skin like caramel. She must be the charge nurse.
"Hi, I am Dr. Elizabeth Roberts, and I am the charge resident for Tulane Surgery this month," said Elizabeth in her friendliest Charleston accent.
"Well, I'll be damned! I heard they were sending me some kind of Southern belle, but I never expected a pink hair bow, pink plaid socks, and penny loafers, for God's sakes!" Head Nurse Lavinia Robichaud laughed loudly.
Elizabeth trembled. She had never liked for anyone to shout. She felt frozen with fear. The nurse did not introduce herself.
Elizabeth stared at the big, beautiful, Creole queen. "Well, I was to report to Nurse Robichaud. I assume that is you? What do you consider appropriate attire for my new position?"
"My God, who talks like that? Just saying 'appropriate attire' tells me all I need to know about you, honey. Just in case you did not happen to notice, this is the busiest accident and trauma emergency room in America! Accident means blood. Girl, people come through that door behind you, shot, stabbed, beaten, bleeding, and crazy on drugs and adrenaline. Many have to be restrained. All you gonna learn in that goofy outfit is how to get blood out of your clothes. Who told you to wear your fancy pearls to work in the ER?" said the nurse.
Elizabeth stood horrified in the middle of the chaotic hall lined with patients, busy nurses, and frightened new medical students. Nobody had spoken to her with such disrespect in her life. Who was this crazy and mean-spirited woman? Elizabeth began to understand why 50 percent of the first-year doctors, called interns, were fired or quit by the end of their first semester in Tulane Surgery.
The nurse continued her tirade as she leaned closer and looked up to read Elizabeth's name tag. "And another thing, Dr. Elizabeth Grace Roberts, do not under any circumstances come down here with your name tag on! Honey, this place is full of prisoners, drug dealers, and criminals. They do not need to know who you are. All those fancy manners that you learned in South Carolina do not apply here. Get that name tag off your white coat now!"
Gathering a hint of her courage, Elizabeth said, "Okay, clearly I have a lot to learn. What would you have me wear? What is the 'dress for success' clothing for dealing with murderers and drug dealers?"
Nurse Robichaud saw the fear in Elizabeth's eyes. But the smirk on her lips was obvious too.
"Get yourself some high-topped black leather tennis shoes. Get something that you can hose the blood off and that comes up high on your ankles to keep the blood from running into your shoes. Get dark socks, unless you want to spend your nights getting the blood out of those pink plaid argyles. Never wear that khaki skirt down here, and that pale pink Izod shirt has to stay in the on-call room for conferences at Tulane only," said the nurse.
The other nurses, an orderly, and two patients were staring in Elizabeth's direction. All action stopped to observe Elizabeth's instruction. Even the cleaning lady was leaning on her mop, riveted.
Nurse Robichaud had her hands on her hips as she barked out commands like a drill sergeant to a young recruit.
"Pull that mass of blonde hair back and up so they can't grab it. Get some cheap scrubs and bring lots of them because you will need to change frequently. Forget that white coat you are obviously so proud to wear. It will be ruined the first five minutes down here. Keep it in the call room for conferences with professors. And never, ever, tell anyone your name! You really do not want 'visitation' from any of our customers. That should do for starters," said Nurse Robichaud.
The nurses with whom Elizabeth had worked in South Carolina had been much sweeter and more deferential to the doctors. Nurse Robichaud did not fit her expectations for a charge nurse. She seemed to relish shaming the new intern. At least, Elizabeth thought, she seems passionate about her work. Despite the nurse's aggressive behavior, I am still the doctor and I am still in charge ...
Nurse Robichaud ignored Elizabeth and returned to her chart work. Elizabeth was determined to do her duty. She stepped closer, squared her feet, and said, "Thank you for your advice, Nurse Robichaud. Can you tell me why that man we passed is tied down to that gurney? He is obviously bleeding. And why is he left in the hall with a surgical mask on his face? He must feel claustrophobic with that mask covering his nose and mouth. Why would we treat a patient so harshly?"
Nurse Robichaud, irritated by the interruption of her charting, looked up and said, "Wow! You really do not know anything, do you? That man is on crack cocaine. He has the physical power of two men. He is currently out-of-hismind-crazy, and he is a spitter!"
"Why is he covered in blood?" said Elizabeth.
"He has all that blood all over him because he tried to head-butt one of New Orleans' finest during his arrest for beating his dealer. Head wounds bleed a lot, so it looks worse than it is. He cannot really be helped until he settles down from the crack. If you tried to stitch him up, he would spit his HIV-laden sputum in your beautiful little face, and you'd spend the next hour washing out your baby blues. As he is, doctor, he is closer to a rabid dog than a man. We have to triage in here, decide who might die soon, and be sure to take care of them first. Don't you worry about him, my little crème puff. He will get taken care of as soon as he is in a condition that he won't harm the staff or further harm himself," said the nurse.
"So who makes these life-and-death decisions of triage?" asked Elizabeth.
Losing patience with the new intern, Nurse Robichaud roared, "I do, until you have some damn sense."
"And exactly who determines when I have some sense?" said Elizabeth.
"Dr. Norman McSwain and I do. And if you give me any more attitude, you will take a long time to get any sense. Dr. McSwain is a world-famous trauma surgeon, a tough taskmaster, and a great teacher, if he thinks you are a hard worker. He does not waste time on fools. He and I have been at this together for over fifteen years. If you follow instructions, you will learn a lot. If you give me any trouble over anything, you will have to deal with him. Believe me, you do not want that for yourself," said the nurse, who turned to walk away.
Elizabeth persisted. She needed to know how to do her job.
"But, Nurse Robichaud, I was taught that the doctors are in charge and the nurses follow instructions from the doctors. That's why they are called 'doctor's orders,'" said Elizabeth.
Nurse Robichaud laughed so hard that her buxom chest shook. "You can try that, doctor. But you got your diploma in June. And it is just July. More people are killed in July in teaching institutions than any other month. Ain't nobody with any sense gonna do a damn thing you say until I okay it, in July! Unless they want to lose their jobs, that is. I heard that on paper you look like a smart little crème puff. But you need to remember real people die down here. Hell, girl, they die down here even when we do everything right. If you listen to me, fewer people will die, and that is our goal in July."
The nurses and orderlies and housekeepers nodded in unison. Elizabeth realized all of these people knew more than she. She felt like a toddler just learning to walk.
Giving Elizabeth her full attention, Nurse Robichaud said, "Please, do us both a favor and try to realize that your butt just fell off the turnip truck. All kidding aside, the best thing new doctors can do in July is realize that they don't know anything and latch onto the smartest, most experienced nurse they can find. Please realize that last month, while you were sitting with a book taking your Advanced Trauma Life Support quiz, I saw and cared for over one hundred real-life patients, many of whom had life-threatening injuries."
Elizabeth felt confused and disoriented. "But why did they tell me that I was the charge resident? At orientation, they made a very big deal about my having to know everything that goes on down here. They told me that I was responsible," said Elizabeth.
"Honey, you are the charge resident. Being the surgical charge resident in the accident room means that for one month, you carry the target. Everything that goes on down here has to be explained by you," said Nurse Robichaud. "It is part of your education. You will be grilled about every four to six hours by a doctor above you. You will have to explain anything that goes wrong on Friday afternoon at a big surgery conference in front of everyone in your department. If you don't wet your pants or cry in public, you will have to do it over and over again. But looking at you today, your time at Tulane Surgery could be short!" said Nurse Robichaud.
"And what happens to the doctors who don't do it your way?" asked Elizabeth. She refused to be intimidated by the nurse.
"Well, the really arrogant ones, I let them sleep through the good cases. You will be so chronically tired after a few days of having your sympathetic nervous system constantly staying on high alert that you could drop and sleep anywhere. Hell, you could probably cuddle up next to that crack addict by the weekend," said the nurse.
Elizabeth shuddered at the thought.
"If you act like a fool, I will usually push you to the side and just do what needs to be done myself. If you really cause me grief, I will set you up with Stormin' Norman McSwain and tattle on you and work to get you fired. It usually works, too. The world does not need one more arrogant know-it-all doctor. I am here to see that does not happen. And in your case, we certainly don't need a frozen-with-fear but obstinate debutante. So what's it gonna be, Crème Puff?" asked Head Nurse Lavinia Robichaud.
After a very deep breath, Elizabeth said, "Well, ma'am, I don't like being bullied. But I am also not stupid. My goal is to leave here knowing as much trauma surgery as a new doctor can possibly know. I definitely want the benefit of your many years of experience. I will do exactly as you wish until such time as I feel it is not good for the patient. As long as you allow me to treat every person who comes in here with dignity, I will do whatever you tell me to do. Even though I did, as you said, just 'fall off the turnip truck,' you will find me to be a quick study and a hard worker. If taking really good care of these patients is the game plan, we will make a great team. I would, however, appreciate it if you could keep the bullying and demeaning to a minimum," said the doctor. Elizabeth had planted her feet firmly in position and was leaning slightly forward and making eye contact with the nurse. She stood erect and felt determined. She thought bullies required firm action.
"You just might make it, Crème Puff. You just might be okay," said the nurse, trying not to laugh.
A young male orderly stuck his head around the door and said, "Lavinia, there's a prostitute and her pimp fighting in Room Eleven, and the police are tied up in the waiting room. Can you send some of the fresh new meat in there to attend to them?"
"Sho, baby, I got just the person right here," said the nurse in her melodic New Orleans accent. "Dr. Roberts is just dying for something to do. Go to Room Eleven with Jorge and see what you can learn, Elizabeth."
As the nurse turned to walk away, she called over her shoulder to Elizabeth, "And just so you know, you ain't in charge of nothing down here! My job is to keep your lily-white butt from killing anybody in the month of July. Because, Crème Puff, you don't know nothing, and I need my job!"
Elizabeth was horrified that the nurse in charge would scream at her in front of patients and other staff members. She had known this month would be challenging, but she had thought the challenges would come from learning large volumes of scientific knowledge, learning better eye-hand coordination in surgery, and getting better at speaking before her esteemed colleagues. She had not realized that verbal abuse and blatant disrespect from some of the nursing staff would be a part of the challenge. She had been at the top of her medical school class, but had to admit to herself that the only person she had ever treated in a trauma scenario was a Low Country boy who fell off a deer blind and accidentally shot himself in the leg.
As she looked down the corridors of the trauma emergency area, she saw more pain and suffering and fear and bleeding than she had seen in four years as a medical student. To her right was a half-clothed drunken woman with abrasions on every limb. She had a large cut over her left eye, and blood was running down her chin. To her left was a sobbing man who was curled into a ball on a bloody gurney, speaking in Spanish, while intermittently asking for his mother in English.
This is what I wanted, Elizabeth reminded herself. If she was going to be one of the first women in urology, she'd have to survive the gauntlet of general surgery, and she was hoping to learn as much as was humanly possible. Since Elizabeth was a little girl, she had watched all of her relatives work hard and do their duty. Her family was full of quiet heroes who got up every day and took care of their jobs and their families. She thought that greatness was nothing more than doing what you were supposed to do every day, whether you felt like it or not. She had chosen medicine as her duty, and it was very important to her to do her duty well. She hoped to return to South Carolina and be a local surgeon.
She thought about the rules of etiquette that applied in South Carolina and wondered why they did not seem to apply here. Nurses at home had been respectful to doctors. She yearned for that respect. She knew that she could adjust to anything. She just had to learn the ropes.
Her thoughts were interrupted. "Come with me, Elizabeth."
Elizabeth turned and followed Nurse Robichaud to the nurses' station. The nurse tossed Elizabeth a pair of green paper scrubs. "Here, put these on. They will save your clothes for today. Just be careful because they are thin and tear easily. Lord only knows what you got on under that prom queen get-up," said the head nurse.
Elizabeth appreciated the scrubs and tucked them into her on-call bag to change into later.
"I'm ready to start," said Elizabeth.
"Okay, so you want to get right down to learning, do you?" said Head Nurse Robichaud. "Go to Room Eleven and take a policeman with you. There's a prostitute in there who apparently did not complete her work assignments for the night and has been stabbed multiple times by her pimp for her poor work ethic. Try to clean her up, and remember all those gals likely have that new virus that's mysteriously killing folks."
Mischief in the form of a nurse strutted away as she called over her shoulder, "Oh, and remember to protect your own self, girl. That one doesn't usually spit, but she has been known to bite. We don't know how the patients can give you that virus, but it is always best to act as if anyone can give you anything infectious and protect against it."
Before Elizabeth opened the door to Room Eleven in the trauma suite, she was hit with a smell that combined the metallic odor of blood, the sour sweat of poor hygiene, and the acrid essence of fear. Elizabeth knew that opening that first door was the beginning of a life of exploration that would continue for many years, if she managed to make it through this first month.
The examination room was small, old, and shabby; its walls were covered in peeling mint-green paint. The floors were sticky and yellow. Many years before, they might have been cream-colored tile. Now they were the color of tobacco-stained teeth. The aging monitors hung from the ceiling. Blood pressure cuff, paddles for resuscitation, and tubes for intubation were all within an arm's length. Everything necessary for running a code was attached to the walls with heavy metal bolts and locks. Surgical lights that no longer functioned were overhead. A small aluminum goose-neck floor lamp took their place. Three people were crowded into the cramped, dingy space.(Continues…)
Excerpted from "The Big Free"
Copyright © 2018 Martha B. Boone.
Excerpted by permission of Morgan James Publishing.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Chapter 1 Charity Hospital, New Orleans,
Chapter 2 The Elevator,
Chapter 3 The On-Call Room,
Chapter 4 Sister Marion,
Chapter 5 The Louisiana Rain,
Chapter 6 The Bet,
Chapter 7 Buster,
Chapter 8 A Manual Should Come with This,
Chapter 9 The Male GU exam,
Chapter 10 Gunshot Wound to the Chest,
Chapter 11 Dinner at Commander's Palace,
Chapter 12 Death in the ER,
Chapter 13 The French Quarter,
Chapter 14 The Autopsy,
Chapter 15 The Soap Incident,
Chapter 16 The Death and Complications Conference,
Chapter 17 Joe's Bar,
Chapter 18 The Cut,
About the Author,
New Orleans’ Charity Hospital provides the setting for the horror and humor that transforms one of the first women surgeons from a naïve southern girl into a competent woman surgeon.