As a little boy, my father took me on house calls. He was a doctor in a small village in Austria. In those days 70-80 years ago, doctors still made house calls. I remember the exact moment when I decided that I, too, wanted to be a doctor. I was around six years old. My father had taken me to another house call—this time to an elderly woman who had severe headaches related to high blood pressure. Not many effective treatments were available then. One rather old treatment, that since then has been relegated to the dust bin of outmoded medical procedures, was removing some blood from the patient until the blood pressure went down.
Bloodletting has been around for centuries dating back to ancient Egypt and Greece. It is hardly ever used now except in some rare conditions where it still is the only thing that works. It is when the body manufactures too much blood, polycythemia rubra vera. When I was a child I witnessed this procedure. I recall the patient’s face in anguish from pain, the white porcelain bowl to collect the blood, the tight rubber tourniquet around her arm, the insertion of a large-bore needle into the vein at the elbow, and the bell-like quality of the blood’s sound striking the porcelain. I still remember the smell of the alcohol to cleanse the skin that, in my childhood understanding, was interpreted to be the smell of blood. Mostly I recall her face becoming relaxed. The furrow of the brow was less noticeable, and a subtle smile appeared, sort of like the smile of the Mona Lisa. I knew then and there that I wanted to be a doctor and help people! It took twenty years, but that is what I did from then on. Several lessons emanated from that event. Keep your eye on the ball and do where it leads you to achieve your dreams. Once you do what you love to do, you shall never have to work another day of your life!
I, too, wound up in a small town. I always preferred being a large fish in a small pond rather than being a small fish in a large pond. Santa Paula, California, provided this for me. I became a Board-Certified General Surgeon! My skills ranged from removing deeply penetrating lemon tree thorns from lemon picker’s hands, to removing cancerous colons, breasts, thyroids, etc. that is what general surgeons do in a small town. The town was located on a state highway Route 126, not much of a highway then, more like a two-lane country road. As time went on, it became busier and busier with traffic, as it was the only connection between the Coast and the Central Valley without taking a detour through Los Angeles first. The road was not built for that kind of traffic, too narrow, too many blind curves, too many unmarked side roads that had no stop signs, much less stoplights, too much farm traffic slowing things down for the impatient truckers that had things to do and places to go. That road got the unofficial title of “Blood Alley” and with that honed my skills as a Trauma Surgeon. For several years I was the only surgeon in town.
The growing trauma business created a lot of all-nighters for me. One evening the Neurosurgeon in the next town had invited my wife and me out for dinner. We had several dogs, and they all needed to be let out to pee before we left. There was this little Chihuahua who was quite particular as to where she would leave her messages. We were late, and I became impatient. Finally, she found the right spot, and we were off. Our house was off the aforementioned 126 State Highway. As soon as we rounded our driveway onto 126, the car ahead of me seemed to explode and be thrown into the ditch next to the road. The car’s lights went out, and I could smell gasoline. I pulled over and ran to the car that was turned on its side. I now understood the large bang and why the car left the road. It was a head-on collision. The other car had also left the road, and I did not notice any signs of life, which I confirmed quite quickly. Both the driver and the passenger were slumped over and were pulseless. Now I looked into the other car. The driver was alive but obviously in distress. The passenger in the back was dead. A girl in a bride’s dress in the front passenger side was wedged against the dashboard. She could not breathe. As much as I tried, I could not dislodge the seat to give her an airway, and she suffocated right in front of me. The only live one left was the driver. I could see that if he did not get to the hospital, he too would not make it. There was no time to call an ambulance, and getting him out of the car with neck precautions was not possible. I did what I could, took him up to my hospital right into the operating room. At surgery, I found that his liver had been completely torn off the Vena Cava, the main vein in the abdomen. I did a procedure that I had only read about but never done, bypassing the torn vein with a plastic tube from the heart to below the torn vein. Unfortunately, there are more papers written about this procedure than survivors of it. So he, too, did not survive. Tragically they were all going to their wedding rehearsal. The driver was the groom. Had my Chihuahua found a spot to pee right away, that would have been my wife and me in that car.
Again several life lessons: Life is fleeting, and you need to treat every day as if it is your last on this earth. If some minor inconvenience interferes with your plans, do not fret, as this may prevent you from a much more serious consequence. Whatever misfortune befalls you, accept it with grace, as you do not know what potentially worse scenario is waiting to strike you just around the corner.
That same road provided one other event which I will not forget any time soon. Not far from my home was a blind curve. An 18 wheeler decided he was going the wrong way. Although the truck driver, being high in his cab, could see the oncoming traffic. The oncoming traffic did not see him. He was halfway through his turn when five field workers came around the curve, and their car went right under the semi. For reasons I cannot explain, the ambulance brought five heads up to the emergency room, and I was called, a visual about which I still have nightmares. That curve was now justifiably called “Dead Man’s Curve.” So what to take away here: 1. Do not make U-turns in a curve even if you see the oncoming traffic. 2. Decapitation is not a surgical disease, but I already knew that from medical school.
My father stopped practicing medicine when he was 70 years old. He wanted to stop earlier, but economics would not allow it. When I was 70, I thought that I should do the same, and I did. But an opportunity came along that I just could not pass up. I had some experience teaching young doctors when I finished my surgery residency, and it was a rewarding experience, but it did not last long. The County of Ventura that administered the County Hospital fired all-volunteer surgeons and replaced us with an all-new staff of surgeons that were dedicated to that one institution with no private practice. That ended my first teaching job.
Just as I thought that I was going to retire, I was offered the job of Program Director of a brand new surgery residency. To be Program Director and Professor of Surgery was a dream come true. For the next five years, I did what turned out to be the most rewarding time of my entire career. The title “Doctor” comes from the Latin verb docēre “to teach.” The first doctorates were awarded at the Universities of Bologna and Paris in the 13th century. It was a license to teach in theology, law, and medicine. Later medicine became the standard for the common usage of Doctor (M.D., Doctor of Medicine). The others took on the title Ph.D. (Doctor of Philosophy), J.D. (Doctor of Jurisprudence), and D. D. (Doctor of Divinity). I have always wanted to teach, and here was my opportunity. For the next five years, I first founded a new surgical residency and built it from just one to a total of fifteen residents. I got the program accredited with the ACGME (Accreditation Council for Graduate Medical Education). Believe me, that was not an easy task, but one I am particularly proud of! Teaching is a task that allows the teacher to leave a bit of himself with his students, an opportunity to leave a legacy!
Throughout my career in the health sciences, I have had several experiences when colleagues or even mentors reached an age where they started to show signs of “losing it.” One of the most horrifying of such events was when an elderly surgeon who failed to stop when he should have, became confused during a surgical procedure and had to be escorted away from the operating table. When I took on my new job as a professor, I sought counsel from one of my former mentors and the Program Director of my surgery residency, who was already retired by then. I asked him, “When should I quit?” I was hoping for a lucid and erudite answer. Instead, he said, “You will know!” As it turned out, his answer was very erudite, and I did know. The lesson I learned, “Listen to your good inner angel and your own body. They will tell you.” When your start having to look up answers to questions too often, which your students ask you, and when they are right more often. When you have trouble running up the stairs to cardiac arrest codes, when your Chief Resident calls you in the middle of the night to tell you the patient whom we had operated on that morning does not look all that good now, and you get heartburn, or is it chest pain? YOU KNOW!