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Ask Dr. Salvo

June 7, 1994

Dr. Salvo and Tim

Ask Dr. Salvo

Editor's note:

Since this is a question that hankers for an answer. Since nobody else will ever ask this particular one and will know why it should be asked or why have an answer here it is: Salvo, have you ever had any interesting encounters with organized medicine? I mean, such gangs, clubs, and cohorts as the American Medical Association, the American Psychiatristic Association, et al.


Dear E.T.,

Your questions turn up at a timely time, as Salvo is just concluding a year long legal encounter with the emissaries of M.A.S.A., the preternaturally powerful Medical Association of the State of Alabama. In fact he and his legal troops are about to put paid to several committees and their heretofore unchallenged onslaughts against individual physicians. Having never been briskly challenged they have waxed lazy, ignorant, and fat. These Humpty-Dumpties make a satisfying splat when pushed off the wall. However, I digress. As Alice always told me, I must begin at the beginning, proceed through the middle and progress to the end.

When Salvo departed from the defunct Green House and the dying Dr. Simon Bacamarte of the jungle town of Itaquai -- he smuggled into New Orleans several clutches of armadillos, specially trained to feed voraciously on the fire ant, pastoral plague of the South. These marvelous animals formed the foundation of Salvo's modest fortune, dedicated to putting him through Tulane University and School of Medicine, at least till W.W.II came and sent him to school in midshipman's togs with free books, food, and clothes, and lodging, plus $150 a month. He also had a $1,000 scholarship for writing Portuguese English (few have mentioned this idiom), and this large sum paid tuition for four years. Imagine! Rich beyond the wildest dreams of avarice was Salvo, at least by the spartan standards of Itaguai, so he bought a sailboat. It was a trim little eighteen foot sloop which he kept in a slip at the New Orleans municipal yacht basin. It sank every other Thursday at around 3:30 P.M., owing to innumerable tiny holes inflicted by the invisible aquamarine mermite of Lake Pontchartrain. This is the same remorseless devourer that destroyed the fleet of Ptolemy I of Egypt at Salamis in 306 B.C. A victory which has been unjustly awarded to the Greek navy.

It took a bit of scheduling, and coordinating with the Canal Street trolley, to cut class, catch the streetcar, and arrive to bail out before the Squalus -- for that was her name -- sank beneath the small waves of the Lake. One half hour late and Salvo had to produce $2.50 for the Coast Guard revivers to pull her up and pump her out. Most embarrassing, and of course accompanied by salty jibes and marine raillery. However, the Squalus when actually under sail was pretty sharp and could point well into the wind. He finally had to sell her, through travel fatigue and penury, having failed to obtain a special rate from the Green Bullet Trolley Corporation of Greater New Orleans.

Salvo's decision to unload the Squalus on the soonest rash buyer to come along was accelerated by his being fired from De Paul Sanitarium, a private madhouse where he worked for room and board. The proximate cause was his habit of bringing home the sails in a canvas bag and leaving them in the laundry room. This, or some malicious whispers, gave Sister Ann, the directress, the notion that he was bringing his friends' dirty clothes to the laundry for a free wash; or perhaps for his own enrichment! Salvo was cunning, but not the crook she was, as he would never have dreamed up such a scam. The Mother Superior also had a festering resentment against Salvo because he and Tadeo, his studying partner were laughing too much in the library. Or, because they laughed at the wrong thing? Salvo had been reading aloud a learned book on how to administer baptism with a large syringe to a fetus in utero when it is feared the mother and fetus are about to die. The prose was fairly gripping and alarmingly graphic till the writer paused to admonish them: "Great care must be employed at this point -- for it may be a mole"! Here they burst into gales of laughters visualizing the poor drenched mole -- when Sister bulged into the library. She glanced at them and the book, then swept out in an ominous progress. "Just you wait," it signified. Salvo knew he was expelled for irreverence. Or heretical hilarity. And enjoying low company (Tadeo). It was not hard to enjoy Tadeo's company, as he was full of tricks and drolleries. In the senior year it became apparent that Tadeo disappeared about the same time on Thursday that Salvo caught the Green Bullet. Nobody knew where he went, probably strolled down to the Pearl for a cold Jax and some oysters. A nurse said she had seen him several times on a geriatric ward talking and laughing with Samuel, an aged black man on the Neurology Section. Nobody had time to follow up that clue. Samuel was old, emaciated, and illiterate, but lively. He shared with Tadeo a strong dislike for Dr. Tomson, a pompous little Chief of Neurology. Samuel had lues (syphilis of the brain), hypertension, arterio-sclerosis, diabetes and avitaminosis. And, didn't feel too good himself. He possessed all the known abnormal reflexes and signs.

On Grand Rounds one day that spring, Dr. Tomson drew up by Samuel's bed leading a formidable white clad array of residents, interns, medical students, and nurses. Tadeo was near the point of the phalanx. He looked bland.

Dr. Tomson snapped the aluminum covered clinical chart out of its rack at the foot of the bed: "Well, Samuel," he intoned, "What brings you to Charity Hospital?"

Samuel struggled up on his skinny wrinkled old elbows and stared the doctor boldly in the eye: "Doctor, I have certain bizarre neurological manifestation." There was a very brief hush, a roar of laughter, and Grand Round broke up for the day.

Nobody officially accused Tadeo of tutoring Samuel, (assisted by cans of Copenhagen snuff and small bottles of gin.) But, we reasoned, who else could have done it?

Tadeo and Salvo had studied together since the freshman year of medical school, when they had collaborated on disfiguring an otherwise dignified cadaver. They read the same books, had the same friends, and shared many prejudices as well as youthful illusions. One was that medicine, especially surgery, was dirty enough, therefore the thought, speech, and public writings of doctors should be at least clean, i.e. honest.

That same spring of Samuel and the Squalus, their illusion suddenly encountered an unfamiliar facet of organized medicine: Organized lying. In public, in print, in the Times Picayune. In cartoons crudely drawn and sometimes tinted, an alarming story was depicted in a one half to full page ad every weekend, describing the horrors of "socialized medicine."

Those of us who were more enlightened adduced that they intended to say, "national health insurance." But, the Orleans Parish Medicine Society intended exactly what they said, as part of a huge nationwide effort to defeat the Wagner-Murray-Dingell bill, America's first attempt to reform health care delivery.

To the leaders of organized medicine it was Communism pure and simple, plus an alarming threat to their income. Any tactic, including lying, libel, and slander became legitimate strategy for those generals of organized medicine.

Out of morbid curiosity, Tadeo and Salvo sent off for copies of the bill; studied it, and reviewed it on the bulletin board for the edification of students and faculty. They reported it was a bad bill, and should be defeated but not for the reasons put forward by the medical society. The latter was inventing items to alarm the unwary, attributing them to the authors of the bill -- and never mentioning the real weaknesses of the proposed legislation. They could not very well use the truth for persuasion, since they had obviously never read the bill themselves.

Salvo and Tadeo were irate, ashamed for the parish medical society, and a little apprehensive about retribution for revealing their elders as a pack of liars. As it turned out they were reprimanded by the dean for rudeness and unfairness, but not punished at all. The society probably never heard, or cared anyway, that two lowly critics were regularly roasting them and their crude propaganda. A medical student is even lower than a high school student or a buck private. Still, it was worth the trouble.

Well, E.T., that was Salvo's first encounter with organized medicine. Subsequent meetings have been scarcely more inspiring over the past fifty years to date.

And that's what you get when you ask such a leading question! More encounters soon to be revealed!


June 7, 1994

The Harbinger