We and today's fresh-faced interns do have something in common: the one person who taught or will teach us how to really be doctors: a seasoned, bright nurse.
If, like me, you are an ob/gyn of a certain age, you well remember being thrown onto the wards after a 1-day orientation. The senior residents provided the bulk of our training and it wasn't long before we were on every other or every third night. Over the next 4 years, we learned how to do a competent pelvic exam, put on forceps, and conduct vaginal breech deliveries after we had induced deep epidural anesthesia. We could perform a credible MMK and carry out a vaginal hysterectomy and A&P repair in under 45 minutes.
In 2006, Yale interns get a 14-day orientation, including lectures on everything from electronic order entry and electronic medical records to professionalism. They receive HIPAA, electronic fetal monitoring, and ACLS certification, are put through a day-long surgical skills training module, and get lectured on everything from critical care to how to fill out their duty hour forms. Over the next 4 years, residents will learn to perform 3-D gynecologic and obstetric ultrasounds, counsel patients about complex genetic disorders, master transobturator sling placement, and perform advanced laparoscopic surgeries, all within the confines of an 80-hour workweek.
When I was an intern, Mrs. Morris corrected the way I drew blood, started IVs, triaged patients, read fetal monitor strips, assessed fetal weights, walked, talked, and wore scrubs. I remember as if it were yesterday being a new second-year resident and Rita standing behind me while I put on my first pair of Simpson's and began tugging. I felt a tap on the shoulder as she said, "Moishe"-her name for all residents, most of whom where Catholics or WASPs-"pull down first." By the time I graduated, I had accumulated about 250 forceps deliveries, all without adverse sequelae for either mom or baby.
Rita also knew when not to scold. When I did screw up or when disasters struck, she was there to comfort. She did her best to prevent us from making mistakes but well understood that good judgment comes from experience and experience often comes from bad judgment. Rita was there for the good times-marriages, births, birthdays-and the bad ones-illnesses, deaths, divorces-always ready to offer wonderful life advice. She also had outstanding helpers: her nurses. Rita's staff were equally unshy about offering residents and attendings "advice" and made all of us (or at least, most of us) more compassionate and empathetic physicians, as well as technically competent ones. Rita set the stage and created the atmosphere for clinical excellence. She practiced team training 25 years before it was "invented."
Rita Morris was the youngest of nine surviving children of Italian immigrants. Her mother died in September 1943, the month Rita entered nursing school. She married and had children, but in the late 1950s, found herself a single mother raising three boys. To make ends meet, Rita went to work part-time at Pennsylvania Hospital. Once her kids were in school, she began working full-time on L&D. Over the next four decades, she rose to become the head nurse and a fixture in the hospital administration.