May 4th, 2017

Mind On The Run: Thursday’s Pap

By Anthony Kovatch, MD, Pediatric Alliance — Arcadia


Part 2: The wards were larded with the foul musty odor of soiled pulled-ups, the foul language of altercations, the hollow shrieks of autistic communication, and the omnipresent aura of staff frustration and cynicism, as well as overriding existential despair. Into all this, emotionally “naked” came I, like an untamed wild animal, clothed only with the conviction that I might shelter this lot of ragamuffins from further trauma that might lead to the corrosion of all feeling and affection.

Manipulation of the nursing personnel by the sly, foxy inmates was ubiquitous — generally for the purpose of gaining some individual attention. Sighting of the dim-witted doctor instantly produced an epidemic of physical ailments involving just about every organ system (and some not previously described in the medical literature). “He’s here!” The naïve, “naked,” visiting pediatrician was as easy to dupe as shooting fish in a barrel. In spite of entreaties from the “Golden Girls” (the miraculous nurses with enough savvy and experience to see through the shenanigans and debunk the BS artists) to abandon his “bleeding heart” ways, the pediatrician fumbled through his clinical obligations week after week like a myopic fool — in the image and likeness of the venerable Mister Magoo.

Quick with a joke but not immune to cynicism, the “Golden Girls” (a term of endearment) were the “salt” of the organization, while I was little more than the “meat tenderizer.” Every Thursday, one of them (I suspect they drew lots to decide who) would accompany me in the sterile exam room in the performance of routine procedures. Number one, removal of foreign bodies from the ears — insects, crayons, lego, or wads of toilet paper accompanied by old fecal material. Number two, repair of tissue damage from rectal digging. Number three, treatment of complications from cannibalistic biting of the flesh of the inmates themselves or their best friends. These challenges punctuated a steady stream of post-physical restraint exams, from which none of the guys or gals — even the apparently meekest ones — were exempt.

Although I would like to think that our medical care was on the cutting edge, documentation was confined to paper and pen in charts from days gone by, which might be noticed by us to be “gently weeping” when one of our favorites was transferred out. The only computers in the clinic were the patients with Asperger’s syndrome.

Humor became the coping mechanism of choice. I endowed many with nicknames. A driven, hyperactive nine-year-old dude became “Mosquito.” An endearing, pint-sized, non-verbal autistic boy who invaded everybody’s space became “Monkey.” One highly-disruptive lad had been left to die in the nursery with a tracheostomy and a gastrostomy; he recovered and left no disbelievers. In the two years I knew him, he broke many bones and the only time he was controllable was when he was on narcotics around the clock for a fractured femur. He earned my favorite moniker: “Dommy Tsunami.” Others favored “The Dom of Doom.”

“The Hazletonian” received his nickname from the city in northeastern Pennsylvania where he and I were born (in the same hospital). He was quick with a hug to all who would accept it and I proposed that someday we could hitch-hike to Hazleton to see how the old coal-mining town was doing (poorly). “Patrick the Hat Trick” spent time at all three facilities. Eventually he was transferred to another network when he activated the sprinkler system and flooded the entire hospital.

Although I did not prescribe psychotropic medications at the institutions, I was responsible for ameliorating their side effects. The antidote for the cachexia caused by the appetite suppression of the stimulants (and some boys required several) became the nutritional supplement “Boost” — prescribed like a “toddy” after meals and at bedtime to the group of boys I collectively referred to as “chicken bones.” Those made obese by their anti-psychotic drugs were referred to as “Hambone.” For them I ordered a “healthy plate” diet, otherwise known as a “no-seconds” diet, which was virtually impossible to enforce, especially among the guys with Prader-Willi syndrome. The diet sometimes achieved its goal when a Hambone became so infuriated by the restriction that it incited a 30-minute physical restraint and some weight was sweated-off. The shortest dude of the lot at the time I called “Small Change,” after the youngest of the five brothers of “The Fighting Sullivans.” (My primary method of stress relief in the evening is watching the old black-and-white “antiques” on the Turner Classic Movie channel.)

Whether worthy of a nickname or not, all the boys in the RTFs were regarded as “Princes of Pittsburgh, Kings of Pennsylvania.”


“Nothing’s gonna change my world.”

To be continued…



4 Responses to Mind On The Run

  1. What an incredible experience…can’t wait for more!

  2. Thanks, Linda!
    Keep the motif of “taming” in mind as the story unwinds—that is why the Little Prince has made his appearance.
    The motto of the organization: “We make miracles happen”—hence the adjective for the tireless, magnanimous nurses: “miraculous.” In spite of what might seem otherwise, the nurses loved all of the children all of the time.

  3. You left me hanging again, but I love your descriptions and it makes me feel like I’m there, not exactly where I wanted to be tho! I think about a day off being spent this way in this place and I believe it wasn’t just about extra income, you needed to be there and I think your future articles will reveal that!

  4. Thanks, Nancy—you have hit the nail on the head! Perhaps it involves writer-to-writer mental telepathy or you are “killing me softly” with your insight. Did you have a conversation about me with the Little Prince?


    Ned Ketyer, M.D.

    Ned Ketyer, M.D.

    Dr. Ketyer has special interests in developmental pediatrics and preventative medicine, specifically how nutrition and the environment affect health. He earned his bachelor’s degree from the University of Vermont and his medical degree from Northwestern University Medical School. He completed his residency at Children’s Hospital of Pittsburgh.

    As one of the founding physicians of Pediatric Alliance, PC, Dr. Ketyer served as its president from 1997-2004. He has been practicing general pediatrics at Pediatric Alliance since 1990. Dr. Ketyer and his wife have three boys and live in Pittsburgh's South Hills. 

  • Note: The information included in these posts is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice.

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