My Most Unforgettable Patient*
By Benjamin Felson, M.D.
W OULD YOU repeat that, Bill?” I asked,
incredulously.
“You heard me. I want you to x-ray a cow.”
“You can’t be serious!”
“Listen, Ben,” he said. “I was never more serious
in my life. This cow has been feeding in grass con-
taminated with large quantities of chemicals. We
want to know if its bones show evidence of fluoride
poisoning. So we need x-rays.”
“On the hoof?” I asked. “Why don’t you slaugh-
ter it and let us x-ray the bones? It would be a
darned sight easier. And,” as an afterthought, “you
can pay for it with the beef.”
“No, that won’t work,” he said. “We want to
make some other tests, too. Besides, we’ve got to
see what happens to the animal. Thousands of
cows have been exposed to the same feeding area.”
“Well, I don’t know-how would it look to bring
a cow into the hospital? Oh, boy!” Then the full
impact of the picture struck me. “OH, BOY!”
Kettering Laboratory, a research institute for in-
dustrial diseases, is on our university campus about
a quarter of a mile from General Hospital. The
General is a busy city institution and its X-ray De-
partment hums with activity.
“1’11 tell you what, Bill,” I said. “Let me think
about it a while and I’ll call you back.”
I immediately phoned the superintendent’s of-
fice. “Henry, are you sitting down?”
“What’s wrong?”
“Now, I’m not joking. I’m dead serious. Please
don’t laugh. Can we x-ray a cow?”
“Sure, Ben. Say, I hear there’s a constipated lion
at the Zoo. Why don’t you give him a barium
enema? But be sure to tell him not to roar.”
“Now cut that out, Henry! I told you I was
serious.” I then explained the problem to him.
This at least convinced him that I was not leg-
pulling. But approval was another matter. Each of
my arguments met with arm-folded resistance until
I pointed out that we could claim scientific
priority. I felt absolutely certain that no live cow
had ever been x-rayed in a general hospital before.
‘This is an approximation of an article published on
January I, 1962, and copyrighted January I962 by Medi-
cal Economics, Inc., Oradell, N.J. It is reprinted here by
special permission of Medical Economics, Inc.
Seminars in Roenfgenology, Vol. XI. No. 2 (April),
“Well-o.k.,” he said hesitantly. Then, incisively,
“Now, Ben, it’s got to be after midnight and you’d
better make sure that there aren’t any patients
around. You’ve got to be there yourself and,”
menacingly, “if this ever gets out-”
At 12 o’clock that night the chief x-ray tech-
nician and I were waiting in my office. The X-ray
Department is on the basement level of the hos-
pital, at the end of one of the many underground
tunnels that catacomb the institution. We didn’t
have long to wait. A low-pitched but penetrating
moo-oo-oo-oo reverberated through the tunnels,
heralding the approach of our expected guest.
We hurried into the hallway. Some distance
down the dimly lighted corridor we could make
out a balloon-like contour accompanied by several
shadowy human forms. As this entourage came
closer I identified the latter as Bill, the physician,
and two laboratory helpers, one carrying a gal-
vanized bucket and the other a bushel basket. Two
of them were pulling on a rope halter strung loosely
about the cow’s neck and the third was providing
supporting action from the rear. I looked the
animal up and down, fore and aft. A strange feel-
ing of recognition struck me. Why, she was a
veritable reincarnation of my Aunt Bessie-the
same enormity, the same lumpiness, the same dig-
nified mountain of power.
At this moment our eyes met and I thought I
detected a glint of the devil in their brown depths.
Bessie herself seemed reluctantly passive as she
moved slowly in the direction of least resistance. I
pointed toward the door of the x-ray room, but
apparently she did not see my finger for she con-
tinued blithely up the hallway. With this, the pull-
ers pushed and the pusher pulled. But their inertia
and Bessie’s ertia, combined with the slick floor,
had little effect on her forward progress. The entire
retinue slithered along toward one of the main
hospital corridors. Since Bessie obviously had no
intention of backing up, it was fortunate that the
hallway was wide enough for a U-turn. After
several such gyrations we calculated an arc which
managed to bring her full center through the open
doorway into the x-ray room.
Our first project was to x-ray one of her forelegs.
Having planned our campaign well, we had rigged
up a two-step staircase with an x-ray filmholder
1976 77
78
taped to the back of the first step. The x-ray tube
was aligned to the film and all that remained now
was to place Bessie’s forefoot on the bottom step.
Unfortunately, this proved to be no simple matter.
She permitted us to lift her foot to the step, but
refused to hold it there. After a number of at-
tempts ended in failure, one of the laboratory as-
sistants lost his temper and shouted an epithet.
With that, Bessie put her foot down firmly-right
on top of his. He stood in painful silence, teeth and
fists clenched, for some seconds before we cor-
rectly deciphered the imploring look in his eyes
and came to his rescue. While he was recovering, I
made a quick estimate of Bessie’s weight and
divided by four. Thereafter I remained strictly a
consultant.
At this point, without a by-your-leave, Bessie
began to empty her bladder. I now discovered the
purpose of the galvanized bucket. With one motion
the other helper grabbed the bucket, dove beneath
Bessie to catch the drippings, and-missed. As the
golden rain deluged over his neck and shoulders,
he did a “slow burn.” Immobile in his rising fury,
his face grew redder and redder as his body became
wetter and wetter. None of us dared utter a sound,
even Bessie. It was the most remarkable piece of
group self-restraint in which I have ever partici-
pated. As I look back upon this poignant scene, I
recall with pardonable admiration Bessie’s prodi-
gious capacity.
BENJAIvllN FELSON
After we mopped up the mess and consoled the
now sullen man, we again proceeded to the busi-
ness at hand. We anchored Bessie’s foreleg tightly
to the step with rope and the two helpers held it in
place while we exposed the x-ray. The film, when
developed, showed mainly two pairs of human
hands. The examination was repeated with more
rope and less hands and we were rewarded with a
beautiful picture of Bessie’s bones.
We proceeded to the hind leg with equal success,
solving the problem of the overlapping tail very
neatly by letting it swish back and forth. Since it
moved constantly during the prolonged x-ray ex-
posure, its image was not recorded on the film.
There was now a distinct lull in the proceedings,
so Bessie decided to pep things up, utilizing the
biological method long known to her kind. Having
walked barefoot across farmland on one occasion
in my boyhood, I had had good reason to forewarn
the referring physician to come prepared for this.
The bushel basket, containing sawdust and two
small shovels, was his ingenious response. The two
helpers immediately leaped into action, flinging
sawdust across the floor at a remarkable rate. Un-
fortunately, their efforts proved futile since every-
one had failed to reckon with the tile floor and the
resulting defiance of all laws of gravity.
Hurriedly retreating into the hall, I was stunned
to see an elderly man lying quietly on a stretcher
outside the door. Apparently the Receiving Ward
MY MOST UNFORGETTABLE PATIENT
orderly had forgotten my instructions to withhold
all patients from X-ray. As luck would have it,
Bessie took this unpropitious moment to moo-oo-
00-00. I detected in the sound a tone of triumphant
exultation at the turmoil she had wrought.
The patient sat bolt upright and said apprehen-
sively, “What was that?” I quickly pulled the door
shut behind me and said as casually as I could,
“Oh, it’s just an old man with whooping cough.”
“Sounds like a cow,” he said, suspiciously. Ig-
noring this as I rapidly wheeled the stretcher up
the corridor, I said solicitously, “We wouldn’t
want you to get whooping cough, now would we?”
“It wets a cow,” he stated firmly. By this time we
had reached the Receiving Ward, where I left him
mumbling to himself. I again warned the personnel
not to send us any patients until further notice.
On my return to the x-ray room things had
quieted down considerably. I now announced that
we would obtain a skull x-ray. Gingerly stepping
around the more contaminated areas, all hands
proceeded to move Bessie towards the x-ray table.
There was now among us a quiet spirit of con-
fidence and unity. After all, hadn’t we been
through a baptism of fire together? Besides, what
else was there left that Bessie could do? She cer-
tainly didn’t look pregnant.
The problem now was to get her head in the mid-
79
dle of the x-ray table. We were pleasantly surprised
to discover that she could extend her neck like a
turtle if the halter were pulled hard enough. I set
the x-ray factors to the highest limits on the ma-
chine and made an exposure sufficient to penetrate
the fat lady in a circus. On developing this film we
could barely see the outline of Bessie’s cranium.
We repeated the x-ray with three such exposures.
The x-ray tube became quite hot but didn’t ex-
plode.
At this moment the door opened and Mac, the
chief surgical resident, entered the room. As he
abruptly came face to face with Bessie, his eyes
widened and his jaw dropped. Then a broad grin
enveloped his face. Without a word, he turned on
his heel and ran out the door and up the hall. I sub-
sequently learned that a few minutes later he
strolled into the Resident’s Lounge and, with a
straight face, casually announced, “There’s a young
gal down in X-ray with four nipples.” No one com-
mented but, one by one, the young physicians
sauntered out of the room, ostensibly heading for
bed, but then taking a beeline to the X-ray De-
partment .
For the next twenty minutes we were busy
shooing off unwanted visitors. I was personally
deeply impressed by the wide variation in the hu-
man surprise reaction.
By this time the skull x-ray had been developed.
Although its quality was not soul-satisfying, under
the circumstances I felt considerable pride in our
accomplishments, and dismissed the patient. It was
sheer anticlimax that all the x-rays proved to be
normal.
I decided not to leave a note for the Housekeep-
ing Department but planned to be around the fol-
lowing morning when the attendants came to clean
the room. Unfortunately, I overslept. On my arrival
there was a note on my desk from the head house-
keeper: “I don’t know what happened in x-ray last
night, and I don’t want to know, but it better not
happen again.” I vowed that it wouldn’t.