Contributor: Arthur Finn

I was what was then called the JAR (junior assistant resident) on Osler ward in late 1959 or early 1960. A young woman came in with juvenile-onset diabetes, in mild acidosis. The third-year medical student on the floor worked very hard and stayed with the patient until about three AM. We then discussed her status and he went back to his quarters. I, of course, remained there with all my other admissions except for a break to play ping-pong with Jim Hurlburt about four AM.

In the morning we all made work rounds, except for the student, who arrived just after we had seen his patient with diabetes and wasn't there for the discussion of what happened after he went home. The student presented the case to Dr. Stead, his head down and mumbling. It was his first encounter with the professor.

After the presentation, Dr. Stead asked how much insulin the patient had received since admission and what her urine sugar was that morning. Since the student had missed work rounds, he guessed and was off by ten units.

"And the urine sugar?" Dr. Stead asked, fixing him with a steely gaze.

"I'm not sure," answered the student.

Without a moment's hesitation Dr. Stead asked, "Can you do serial sevens?"

The student bowed his head even more and responded in the affirmative.

"Anyone who doesn't know how much insulin his patient has received shouldn't pass third year medicine," Dr. Stead said as he stalked out of the ward.

I followed him and said that the student had stayed with the patient until three AM and had worked hard. "Besides that," I added, "he was obviously intimidated by you."

Dr. Stead paused, turned around and fixed me with that Stead stare. "Do you know the patient's insulin dose and urine sugar?"

"Yes, sir," I said.

"Are you intimidated by me?"

"No," I replied.

"Do you consider the student to be a really good one?"

I hesitated, then said, "I guess I have to say no to that."

"Under the circumstances, do you think the student should pass?"

"Yes," I said. "I don't think his performance on this one case would be sufficient to fail him."

Dr. Stead disagreed with me and went back to his office.

The student failed. To this day I am really not sure who was right, and although I don't know what happened to the student, I do know that he didn't take a residency in medicine at Duke.

Title: I Never Again Even Blinked on Rounds

I was on Osler ward, quite tired after the usual long night. I managed to fall asleep while standing in the corridor during rounds with Dr. Stead and the rest of the house staff and student group.

Dr. Stead stopped in the middle of his examination of a patient, turned toward me and asked, "Are you asleep, Art?"

I kind of jumped and said, "Yes."

"Why?" he asked.

"It has been a tough night," I replied, shaking my head, by then fully awake.

His answer to that was a classical Steadism, "Well, Art, we both know that life is hard."

He paused and smiled that half-smile as he added, "You don't have to stay here if you don't want to."

I don't think I ever again even blinked on rounds.