How Your Surgeon Feels: Lifetime Essays in the Art and Science of Surgery

Contents

ONE MAN’S DR.WILLIAMS

LIFE DEPENDS UPON THE LIVER

SERENDIPITY

DOCTOR IS BUSY

UNCLE PHILO AND THE NATIONAL HEALTH

NATURE’S COSMIC JOKE

BECOMING A SURGEON

CRISIS IN SURGICAL STUDENTS

ONE WAY TO RAISE A SURGEON

MY LAST STITCH

For

My Students

And for those on-call tonight

Surgeons must be very careful

When they take the knife !

Underneath their fine incisions

Stirs the Culprit— Life !

Emily Dickinson

To hold him whom taught me this art dear to me as my parents…….

— Hippocrates

PREFACE

These ten essays were each conceived and accomplished by me at a time of great angst. I was either in a personal crisis about medicine or I perceived the nation’s health was similarly afflicted. First, I sought out the great doctor-poet William Carlos Williams to see how one could possibly be both a surgeon and writer at the same time and wrote An Appreciation. I wrote My Last Stitch after my horrendous last night on-call when, after forty years of practice, I almost lost my first patient on the operating table. Nature’s Cosmic Joke was similarly personal as it was my antidote to the extreme early feminists’ onslaught who had disrupted my life at the time. My message for them was Love, and Esquire made it a once-in -a-lifetime Cover Story. Serendipity stands alone at an interface in my life. I had always decried the research year surgical residents are required to do when I thought they should be in the OR honing their technical skills with me. But the experience of contributing an original discovery to medicine is one of my life’s proudest moments. The story ingredients make for a medical thriller. Doctor Is Busy was my first paid piece of writing. I think I got $ 100. It addresses our perennial Doctor Shortage and is as au courant as if written today. The same can be said for Uncle Philo, which is equally germane to our current National Health disarray, albeit written some years ago. Three essays I have placed together as they concern my abiding love and joy of teaching : Becoming A Surgeon, Crisis In Surgical Students, ‘One Way To Raise A Surgeon. In the latter, character Jeff is in reality my own son Robert who is now a burgeoning surgical resident. Life Depends Upon The Liver was a near-death experience with personal illness which I recommend to every doctor who must care for others. It will change your life forever how you regard your patients.

In the vast array and vitriol of our National Health debate, the doctor’s voice, especially that of the surgeon, is rarely solicited, and seldom heard. It is mostly the clamor of patients you hear or the rancor of politicians. This compendium of lifetime essays will restitute an imbalance that is long overdue. The collection speaks to how a practicing surgeon really feels about the vital medical issues of our day, and what needs to be done to improve his life’s work and his dedicated care for his patients. American medicine is at a desperate crossroads where the qualitative health of ourselves and our beloved country have arrived at critical mass. Herewith a rare insider’s insights, with unadulterated answers.

ONE MAN’S DR.WILLIAMS

ONE MAN'S DR. WILLIAMS

AN APPRECIATION

Many years ago when I was still attempting the impossible, the impossibility of doing imaginative writing alongside maintaining a burgeoning young surgical practice, I managed a novel on that very subject which, not surprisingly, nobody liked but me. There was in it somewhere a conceit that went on ad nauseam about literature's finite debt to medicine. I had it all wrapped up. I think it began with a dilatation on Aristotle, meandered down through several obscure barber surgeons, down through Keats to around Maugham, rather indiscriminately name-dropping medical affiliations along the way. It brought on Chekhov big, and Dostoevski's father, John O'Hara's, Hemingway's, too. I used Henry James's brother for additive, threw in Madame Bovary's husband's profession as proof positive (from the world's greatest novel), and recall, with great discipline having skipped Byron's leg, at the end involving Proust's mother as most likely to have swum after troop ships to lay all that asthma on young Marcel, who then went on to stop literary time forever. At that point, I was deathly afraid to go near one Doctor William Carlos Williams who I was aware kept sending in from the wings such disarming one-liners as, Art Kills Time. I couldn't believe a salvo man like that was serious, and I had reasons.

Foremost, nobody had ever done what I set out to do. It was true they had all started out to be doctors, but all of them quit either shortly after a taste of cadaver or a brief period of practice. Though drawing heavily on medical exposure they had all run off into literature, never again to have to ask anybody how they feel and mean it. Lucy M. Cores's introduction to Chekhov's stories was typical. I could almost recite it.

Chekhov freely owned his debt to his original profession. It trained him in scientific accuracy and developed in him a capacity for clinical observation. His qualities as a writer were the same ones that would make a great doctor: that rare combination of keen perception and human compassion. His clever physician's hands knew how to probe deeply into the wounds of humanity and unerringly touch the dark, the corroded spot that marked decay. He had a characteristic tenderness for the ailing and the helpless. No novelist has had a kinder feeling for children and his stories about them were among his best.

And it was just about that same time that Albert Camus turned on my whole generation. In The Artist and His Time he wrote, But as for me I see in both choices a like act of resignation. We must simultaneously serve suffering and beauty. How I loved that expression, took it to heart, with the added silent satisfaction that Camus was not a doctor and therefore effectively disqualified from what I had in mind. In the wings still went the ghost of William Carlos Williams.

Fate is mercifully seasoned with the kindly sort of disillusionment. This time a snowstorm kept us confined to a lawyer's cabin last winter in the High Sierras. The bookshelves were barren of anything creative, but unnaturally enough some previous visitor had left Williams's Paterson in the bathroom magazine rack, which—let it be clear, Doctor—is a normal accoutrement of all the New West living and carries no pejorative. I opened the book immediately to something I wished I had written myself, which always get me, and there began a romance that will not end. In Book I, Part iii, line 7, he says, My whole life has hung too long upon a partial victory. Whose hasn't? But in this case I had to find out which part. Medicine or writing.

My habit has been to read all established authors in bulk. Unless you read round, round, and round in Yoknapatawpha County you don't journally know no Faulkner. So I began with Williams, mostly however with an eye to sort of peer review him, to see what kind of a doctor he could possibly have been with all that writing going on. I knew others would take care of his literature, but I worried about his patients. Over eighty no golfer, under eighty no doctor. It seemed to me it had to come off somewhere. But the result was astonishing.

Williams, as everybody now knows, had that fantastic rare facility to compartmentalize and integrate his entire creative impulse. Again and again, say in Mann or Kafka, we come on the old saw, artist tormented by conflict of being both within and without society, unable to integrate the requirements of each, becoming the recluse in order to create, then feeling intermittently guilty for his lack of social commitment, and so forth. In a dialogue published some ten years ago Archibald MacLeish marvels at the quality in poet Mark Van Doren who, unlike himself who needed to be hermetically sealed at the same time everyday, was for years teaching at Columbia able to write snatches of good poetry in office hours between airing student complaints.

Williams was able to begin a poem, he says, be interrupted by a patient at the door, quickly break off, retracting the typewriter into his desk, treat the patient, elevate the typewriter again and in a moment resume just where he had left off. Amazing performance! Periodicity of psychological and imaginative energy, he called it in a notebook in 1930. Work all the time—manic depression but learn to use yourself: when you drive in—when down assume the clerk—there's plenty of room for both. And that's the way it sent with him for forty years. It didn't take long, he insisted, five or ten minutes was enough, there was entirely too much writing done every day. In the autobiography he writes, That is the poet's business. Not to talk in vague categories but to write particularly, as a physician works, upon a patient, upon the thing before him, in the particular to discern the universal. Doesn't that say much more of him than no ideas but in things? Because basically Williams was not dealing with things, by his own admission, but with people as indistinguishable to him from his poetry. When they ask me, as of late they frequently do, he writes near the end of his autobiography, how have I for so many years continued an equal interest in medicine and the poem, I reply that they amount for me to nearly the same thing.

Along with many of his critics I had long felt Williams's poetry lacked profundity. He had simply put the hay down where the goats could get at it:

By the road to the contagious hospital

under the surge of blue

mottled clouds driven from the

northeast …

But reading all of him, particularly the prose, gives a whole different window. His profundity becomes a doctor's uniquely profound feeling for what his limited ability, despite all his learning, allows him is even remotely possible with human beings. It becomes clear. His poetry is often irresolute, maddeningly irresolute. But so is life, and what the doctor is called upon to do for it.

The cured man is no different from any other. It is a trivial business unless you add the zest, whatever that is, to the picture. That's how I came to find writing such a necessity, to relieve me from such a dilemma. I found by practice, by trial and error, that to treat a man as something to do with surgery, drugs and hoodoo applied was an indifferent matter; to treat him as material for a work of art made him somehow come alive to me.

Williams was essentially an obstetrician,