This short story is about a friend I lost on November 22, 2022. I met Joe four and a half decades ago. I had been a Country General Practice doctor for about ten years when I realized that I really wanted to just do Surgery. To do that, one must have a Certificate that says, “You are a Surgeon.” That takes five years to complete. My wife and I just had our first (and only child), a little girl we called Amber. I asked my wife’s permission to go off to “Surgeon School,” and she cheerfully consented, only to say to me six weeks later, “What have you done to our lives?” I was gone every other night on duty at the hospital, and when I did come home, I went to sleep immediately, to rest for the next call night. My income shriveled to subsistence levels, and we had to move to the city where the large hospital that gives out Surgeon Certificates was. Joe was a PGY-4 (4th postgraduate year), and I was a PGY-2 (2nd postgraduate year).
The making of a Surgeon is a complicated process. One must learn a whole new set of skills that require a lot of learning, training, and practice. Surgery is a “trade” that requires not only book learning but manual skills that are not easily acquired. Besides, one has to have some innate ability and inclination that are the foundations upon which one builds with building blocks of new knowledge and new skills. An old saying claims that Jewish boys that can tolerate the sight of blood become surgeons, and those that don’t become lawyers. To an extent, that is true, even though you don’t have to be a boy or Jewish.
The method of the education of a Surgeon goes back over 100 years ago to a man by the name of William Halsted. Prior to him, there were people that just did Surgery with little if any training. Many of them combined cutting hair and Surgery. Barbers could cut hair and had cutting tools, so why not wittle on the rest that is below the skin? That made for some very bad outcomes to say the least! Halsted brought a new standard to the field. He set up a school at Johns Hopkins University to train Surgeons to do better Surgery. It is that system of training that became the American standard for learning how to do Surgery. All of his “residents” became superb Surgeons, and most of them went forth to then become teachers of the Halstedian methods of Surgery. His trainees were called “residents” because Halsted required them to live at the hospital day and night – “in residency.”
Surgical skills are obtained by doing Surgery. My program had four residents in every year. Altogether there were twenty of us residents. The professor could not teach all of us at the same time. Much of the teaching was done by the senior residents who had already achieved competency in many of the lesser skills and passed them on to us at the lower levels. Of course, the generosity of what the senior wanted to give to the junior was always an issue. Joe was more generous than most, and I learned much from him. One small skill was placing an Art. Line. The Art. Line was a thin plastic cannula that was put into the radial artery at the wrist to monitor blood pressure continuously. Blood pressure is one of those measurements that tells us how the patient is doing during the surgical procedure. If it is too high, it means the patient is feeling some pain, and his system is reacting by his adrenal glands putting out adrenalin which raises the blood pressure. Conversely, if it is too low, it could mean that the patient is getting too much anesthetic or has lost too much blood. Customarily the anesthesiologist placed those lines while he was putting the person to sleep, but Joe would always insist that we were in the operatory while the patient went to sleep. That way, we could beat the anesthesiologist in placing the Art. Line. It was a small item in the whole picture, but if one knows how to do it, it makes one a better Surgeon. It takes more than a couple of placements that make one “good.” Joe saw to it that I became good at it just like he was. That was just one small thing I learned from Joe. There was also taking out the appendix, the spleen, and even the pancreas, one organ that I believed that God never meant us to touch until I met Joe. It is the most complex thing a Surgeon does! There were at least another thousand things I had to learn.
Joe was an avid surfer. Any free time he could wrangle, he would be surfing. At seventy-six, he still had it in him! He was outside the break where he could get away from the crowd. People who saw him, said he was sitting straddling the surfboard when suddenly he slumped over and slid into the water. He was 300 feet from the shore, and by the time they got to him, he was gone. Joe was a unique person, smart, kind, generous, and a very capable Surgeon. He cared for the sick, the weak, and the dying. I knew him as a mentor and as a friend to me. And I know that if he could have scripted his demise, it would be exactly as it happened.