By tradition, postgraduate medical training -- internships, residencies, and fellowships -- begins in July. I'm sure on July 1, 1965, I was not the only intern, dressed in stiffly starched white jacket and pants, looking in a mirror and thinking, "What in the hell have I got myself into?"

I don't know what bothered me more, apprehension over how I would meet the new responsibilities awaiting me, or how ridiculous I looked in my baggy white suit that felt two sizes too large for my small, but lean, supple frame.

Transitioning from a fourth-year medical student to an intern was a frightening challenge. Depending on the service one was assigned to -- medicine, surgery, Obstetrics-Gynecology, ER, etc. -- numerous adjustments had to be made, and they all required learning to be comfortable with a new level of responsibility.

My first rotation was on medicine, where I was responsible for doing a "work up" on new patients as they arrived on the floor.

This meant taking a medical history, doing a physical exam, and recording both in the chart, along with a diagnosis and preliminary nursing orders.

As medical students, we were usually the fourth or fifth person to "work up" a patient; now I would be the first. Not a difficult adjustment to make, or so I thought. Years ago, large city teaching hospitals usually admitted "charity patients" to multiple bed wards where medical students, under the supervision of residents and attending staff, learned to be doctors.

The patients we helped care for were usually old, and suffering from one or more chronic illnesses. I cannot recall ever seeing a patient of my own age. Because I chose to do my internship at a community hospital, the spectrum of patients we encountered was more representative of the community at large, and included younger individuals with acute illnesses unencumbered by associated chronic disease states.

I was a seasoned intern with almost a month's worth of experience when the admissions office paged me to tell me of a new patient needing a work up.

I made my way to the patient's room prepared to show off my growing self confidence and calming bedside manner, and found myself confronting an absolutely stunning young woman who was my own age, or perhaps a few years younger. At the risk of offending some readers, I must be truthful and say that I was unsettled. This would be a new experience.

Let me explain.

This was 1965, before CAT scans, MRIs, and ultrasound. The history and physical exam were important diagnostic tools, nothing like what one experiences today. Patients were disrobed and not examined through layers of clothing. After checking the head and neck, lymph nodes were palpated, the chest, heart, and breasts examined, the abdomen carefully palpated and bowel sounds evaluated, all pulses checked, and a brief neurological exam done. Pelvic and rectal exams were done if indicated.

This was the standard routine procedure for all patients.

Another bit of useless information is that this was a time when doctors kept their stethoscopes in their pockets or with the earpieces around their neck and the rest of stethoscope hanging on their chest, rather than draped around their neck as we see today.

I introduced myself, sat in the bedside chair, and used the time taking her medical history to recover my winning, professional bedside manner.

Feeling much more "settled," I started with the exam.

After a routine check of her head and neck I proceeded to exam her heart to evaluate the quality of the heart sounds and listen for abnormal sounds -- murmurs and clicks -- as well as to try to determine the approximate size of the heart. This requires listening with the stethoscope over different locations on the chest. In a female, this usually means placing the stethoscope both above and below the left breast.

Very casually I placed the stethoscope against her chest above the breast and listened thoughtfully. I heard nothing.

I moved it slightly higher, then lower, and still could not hear a heart sound. I was momentarily perplexed before I realized what was happening. The earpieces were still around my neck.

Mortified, I casually checked to confirm that the patient was unaware of what just happened. Making sure she could not see me, I used my free hand to place the earpieces in my ears. I then continued the exam.

An internship is a yearlong learning experience. That was one I will never forget.

Bill Renzulli is an artist and retired physician who lives in Lower Town. Reach him at Follow his blog at