MELISSA BLOCK, host:

Commentator Elissa Ely is a psychiatrist, and recently she opened a book that took her back to the beginning of her career as a doctor.

ELISSA ELY:

I was looking at a medical manual, trying to remember whether blood levels of magnesium rose or fell after a seizure. I hadn't taken the book off my shelf since internship almost 20 years ago. It was a small paperback sized for the white coat called A Clinician's Pocket Reference. We preferred the subtitle, A Scut Monkey's Handbook. There were chapters on blood gas analysis and IV fluids, suturing techniques, EKG readings. For the truly anxious, there were also about a dozen blank pages available for writing illuminating notes to self.

I could remember the despair but also the hope I'd felt writing these notes at the end of the book. All would be well, as long as I knew that chronic GI bleeders are transfused with packed red cells at a rate of one unit over three hours through an 18-gauge needle followed by 40 milligrams of IV lasix.

Each page was organized by emergency topic: ketoacidosis, arrhythmias, neonatal bacteremia. No detail was too small to neglect. Under emergency deliveries, I had written, `Number one, turn on the lights.' That was a desperate year for the patients and the intern. `Penicillin G is not for staphylococcus, gram negative rods or bacteriodes unless it infects above the diaphragm.' These facts were all that prevented homicidal mistakes. `Aminophylin in a child's asthma attack has to be ballasted 5 to 7 milligrams per kilogram over 20 minutes but infused at 0.9 to 1.4 milligrams per kilogram per hour.'

I slept on call with the Scut Monkey Handbook, clutched it in my white coat and osmosed its facts through the cloth. There was no other life that year.

It hurt my heart a little to see the drab technical notes. I turned back to the index to look up seizures. Then, at the end of the Z's, below Zyloprim, I noticed a half-page more of handwriting. I squinted: `Cookies for 30. Six eggs, three cups butter, two and a quarter cups brown sugar, one cup cocoa, six cups flour with three teaspoons baking soda, 52 Reese's Cups in quarters, 325 degrees, eight minutes.' Cookies from the Scut Monkey Handbook copied from some long-forgotten magazine in some long-forgotten radiology waiting room. I'll never make them, but I'm glad to know there were dreams back then of better times to come.

BLOCK: Elissa Ely is a psychiatrist in Boston. Transcript provided by NPR, Copyright NPR.

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