The next story lacks almost all the elements of the previous Great White Hunter sagas. It takes place well after the Golden Era—occurring as late as 1999, did not involve a hunter who was even remotely great or famous, and does not include lions or elephants or other dangerous big mammals. The hunter is me—hereafter referred to as KDN–the present author; the events took place in Zimbabwe; and they did include some drama.


The story necessarily begins with the Rhodesian Civil War/Rhodesian Bush War/Second Chimurenga/Zimbabwe War of Liberation of 1966-1979. The conflict pitted three forces against one another: the Rhodesian white minority-led government of Ian Smith–later the Zimbabwe-Rhodesian government of Bishop Abel Muzorewa–the Zimbabwe African National Liberation Army, the military wing of Robert Mugabe’s ZANU [Zimbabwe African National Union]; and the Zimbabwe People’s Revolutionary Army of Joshua Nkomo’s Zimbabwe African People’s Union. Note that the civil war ended twenty years before the story about to follow and involves ostensible veterans from the winning side of that war.

There were no military victors; but nonetheless, cessation of fighting and a national compromise led to the implementation of universal suffrage in June, 1979, the end of racist white minority rule in Rhodesia, and the renaming of the country to Zimbabwe Rhodesia under a black majority government. The new order failed to win international recognition. The country returned temporarily to British control and new elections were held under British and Commonwealth supervision in March, 1980. ZANU won the election, and Mugabe became the first Prime Minister of newly renamed Zimbabwe on April 18, 1980, when the country achieved internationally recognized independence.

The elements of impending war included widespread civil disobedience against the racist policies of the all-White government and a rupture of any semblance of peaceful civil intercourse between Blacks and Whites, which persisted in forme fruste even well after the actual war. Very soon after Robert Mugabe’s ZANU government achieved power, he went forward to quash all political opposition and banned the NDP [National Democratic Party, headed by Joshua Nkomo] in December, 1961 and arrested NDP leaders. Nkomo was out of the country at the time where he formed the Zimbabwe African People’s Union. ZANU members formed a militant wing, the Zimbabwe African National Liberation Army, and sent ZANLA members to the People’s Republic of China for training.

The war that ensued was extremely bitter and defied all norms of agreed upon international rules of war. The Rhodesian Security Forces initiated a Chemical and Biological Weapons [Biological agents included Vibrio cholerae–causative agent of cholera–and Bacillus anthracis –causative agent of anthrax–Rickettsia prowazekii–causative agent of epidemic typhus–and Salmonella typhi–causative agent of typhoid fever. Toxins—such as ricin and botulinum to kill guerrillas both inside Rhodesia and in external camps in Zambia and Mozambique]. The effort worked to eliminate guerrillas operating inside Rhodesia by using contaminated supplies. The Security Forces contaminated water supplies along guerrilla infiltration routes into Rhodesia, forcing the guerrillas to either travel through arid regions to carry more water and less ammunition or travel through areas patrolled by the security forces. Finally, they hit the guerrillas in their camps in Mozambique by poisoning food, beverages, and medicines.

Between 1976 and 1979, the Rhodesian Army laid extensive minefields along the country’s eastern and northern borders to prevent infiltration and resupply of fighters based in Zambia and Mozambique. The mines were laid in dense patterns—a Cordon Sanitaire. The Zimbabwe Government estimated that the minefields contained 2.6 million anti-personnel landmines. The rebels conducted extremely violent terrorist raids. Suffice it, there persisted a significant level of racial and political antipathy ever afterwards.

Enter KDN and his big game hunt twenty years later, in 1999: At that time, the Mugabe government was in trouble having driven the economy into a failed state whose currency was not usable anyplace else in the world. The government forces and the prime minister made Whites the scapegoats for the failure and began an active effort at genocide. The only successful farms and businesses were owned and run by Whites; so, Mugabe drove out all the “coloreds”—Indians, Chinese, and Indonesians—thereby worsening the economic woes. Outright assassinations and murders of Whites by so-called “veterans” fighting for their rights such as pensions were dispatched in hunter/killer/occupier squads to murder or drive Whites from the large productive farms they had run for generations. The slaughter included Black Zimbabweans—some who were actual veterans—indiscriminately. By then, the nation of Zimbabwe was a frankly failed state and a general pariah among civilized nations.

There were $1 trillion bank notes floating around; but even that was useless; the citizenry was burning paper money for fuel. Wide swaths of once fertile and productive farmland lay fallow and neglected with no human presence to be seen. Hamlets of mud huts were springing up all along the way—a result of people returning to subsistence farming, the only thing left for them.

I had finished successful hunts in South Africa; and my guides, trackers, skinners, and I headed into Zimbabwe. We drove to a 110 hectare farm owned by a tough Afrikaner family who had carefully husbanded their wild animal populations to maintain a large free-range area and population for hunting. My quest was to take a sable bull—the national animal of Zimbabwe—and a large Greater Kudu [spelled koodoo in the 17th century parlance of the Dutchmen of the fictional story].

On the evening of our arrival, we had a grand supper and sat down to talk and to listen to the CB radio reports of news from around the country. There was considerable angst among Whites we had encountered in our trip to the farm, and the family was understandably on high alert. There was no conventional telephone, radio, or television, services out there on the farms.

A CB [Citizens Band Radio] call came in from the far north from cousins who lived in the Zambesi Valley. The reception was fairly good, and we could hear both ends of the conversation. The gist was that the woman on the Zambesi end was screaming hysterically to tell her southern cousins that all the men in her family were being hacked to death with machetes, and two or three “veterans” were advancing towards her. She was able to blurt out that, “they’re coming for you next, Will. They know your name and the location of your…”

The last sounds were of hacking and of the woman’s death throes. Then silence.

Will, the paterfamilias, calmly stood and gave orders: Jacob—the Black foreman—”round up all the employees and get them to the hiding places in the forest”; John—the eldest son and chief hunting guide—”go out to the bunker and bring the three Suburbans and enough firepower for everyone her”; Trinity—the Black family cook and housekeeper—”fix quick meals for the families and the rest of us who have to get away”; Doug, Ryan, Rolihlahla, Nkosi, Silumko, and Mpilo—the hunting safari men—”take one bag, and your necessary hunting equipment and meet out front in five minutes.”

I walked out the back door and watched the ground open up from what might have passed as nothing more than a potato cellar. Three 1999 black Chevrolet Suburbans pulled out of the under-ground bunker and drove to the front of the farmhouse. I watched the orderly retreat of the entire Black employee staff head off in the direction of the forest as I waited my turn to receive a weapon. Will and his son quickly handed each man entering a Suburban a Belgian FN submachine gun with a terse and to the point explanation of how to work it.

Inside the vehicle was comfortable, but the walls of the car were thick—bullet proofed, as were the very darkened windows. We drove across a wide stretch of the country until we came to Bulawayo, the former capital city of the Zulus when they ruled the territory. We split up, and I was taken to a very backwoods section of the city over rutted dirt roads to a motel. To call it a “hole in the wall” would be pollyannaish.

I slept well because I was very tired. In the morning, I put on several layers of clothes because it was so cold out. At a ridiculously early hour, we and our artillery were picked up, we went to another cousin’s little café for breakfast. Afterwards, we kept to the back roads. Although Bulawayo is a fairly diverse and cosmopolitan city, we saw nary a White face. Even Black people were keeping pretty much out of sight.

We drove north and east for several hours until we pulled into the road of a farmhouse much like Will’s. While I was sleeping, Will and my South African guide had arranged for us to hunt for Sable on the large farm—ranch to you American Westerners.

The paterfamilias gave us a rough map of where to go to find the herd of Sable and some advice, “Take a little detour off road to a camp where “veterans” are staying. You have to get their permission, because they now own the farm.”

He had to grit his teeth as he said it.

We did as we were told. The camp was as rudimentary as they come. Just rough mats on the ground and thin blankets for defense against the cold. There were a few carcasses of rabbits on spits, but no other signs of food. There were four “veterans” of the war of two decades earlier, none of them older than about sixteen as close as I could ascertain. They were filthy with matted hair, no shoes, and ragtag tee shirts and short pants. Their eyes were hollow; their bodies gaunt, and their demeanor beat-down.

The guides spoke to them in a mix of Xhosa, and isiZulu full of tongue clicking. They were genuinely glad to have some adults around; they had no idea why they were forced by the government to come out into the wilds; and they were starving.

We promised to bring them meat as soon as we got some and drove off for the hunt. It was less than an hour away when we first spotted the large herd of Sable feeding in an open grassy area between two copses of thorn trees. We parked our vehicle, checked the wind direction, and made a circuitous approach to the herd.

Careful as we were, the sable became a little spooked and moved into a grove of trees and resumed feeding. My main guide and I crawled on our hands and knees into the edge of the trees where we could see our sable herd. In a matter of minutes, we both fixed our eyes on a magnificent bull who frustratingly wandered around the herd preventing any kind of shot. The sun was still up, but it was cold. I was glad I had put on as many layers as I did.

The herd remained in place, and the lead bull never showed himself alone to allow a shot. In Africa, there is scarcely any dusk. The daylight moved into darkness in a matter of minutes, and the temperature dropped twenty points. My clothes were not adequate then, and I shivered, and my teeth chattered through the sleepless night.

We awakened to the same song, different day’s verse. The bull still refused to accommodate us. So passed another day, and even another. We had brought water but no food because we knew we would be back to the farmhouse for a dinner of Sable steaks before dark of the first day. Wrong.

I was weak from hunger, when, on the third day of being cold, hungry, and exceedingly cramped and uncomfortable, my guide and I both saw our king of sables step out of the shadows and the crowd to bask in the morning sun. I set my .375 rifle on a tripod and took very firm and careful aim, working to control the shaking. I knew this was to be my one shot, and I concentrated, took a deep long breath, slowly exhaled, and squeezed the trigger. The sound was deafening; the herd evaporated into the dense thicket without a trace, and we scanned the ground for our quarry. The guide—whose eyes were considerably better than mine—saw it first.

“Good shot,” he said laconically. Words are precious, and he was a thrifty guy.

Besides, it was not much of a shot. Maybe 30 yards with nothing in the way, and the big sable highlighted in the soft light of post dawn.

Having heard only one shot, the tracker and skinner left the warm truck and hurried to where they had left us, knowing that one shot meant a clean kill. I was glad to help with the gutting and skinning. I am not at all skittish about blood, and the insides of the big antelope were warm. The only thing I did not think I was up to was skinning around the face and especially the eyelids, since this was to be a whole mount.

We wrapped the skinned carcass in a clean blanket and heavily salted and rolled the skin up for transportation. We were back at the farmhouse in less than two hours. Every member of the household was there to welcome us home—Black and White, dog and man. We were bringing food to people’s stomachs could not remember what meat felt like.

Children hugged my legs, big-bottomed women hugged me and swept me off my feet—literally. The farmer’s wife and three children wept for joy and relief. It was a joyful moment.

The farmer remembered his necessary bit of politics, “Ephraim,” he said to the headman of the Blacks, “please go up and invite the “veterans” to brunch.”

Ephraim drove the farm truck and returned shortly with the famished young “veterans” in tow. They willingly and enthusiastically helped the family and the employees cut off choice big pieces of brisket, backstrap, and hind quarters, into three inch thick foot long steaks. One of the “veterans” helped a farm hand dig a foot deep pit and set fire to a pile of acacia sticks and burned them down to glowing coals.

Every person—man, woman, child, Black, White, owner, former owner, and hunting team, took a piece of steak and threw it on the glowing coals and ashes. Then we all sat around the fire, huddling close for warmth, no matter what our status on that day, and feasted.

The farmer sought me out.

“I’m glad you got your sable, Mate,” he told me, “I have a favor to ask. Who knows when we will be able to harvest meat again. The so-called young “veterans” don’t care one whit about you hunting and are pleased as punch to have you provide some more meat. I know where there is a great bull kudu. If you agree, you could pay me the hunter’s fee and keep the trophy. That will give us money enough and meat enough to last the family and our new owners for a year. They don’t even know what money is. That should let us leave this extremely dangerous place and get to somewhere safe and with enough food and barter.”

I agreed, and that afternoon we went to the place the big kudu had been seen. Sure enough, it ran up the road ahead of us. I got out and made a 100-yard shot. We headed back toward the farm house. On the way, we picked up the “veterans” to let them have their choice of the meat, a little nod to good relations. We brought the kudu to the front yard, dressed, cleaned, and skinned it. Different from all other times, we did not discard the gut sack.

The “veterans” were overjoyed to have first choice at the pickings from the massive kudu. They quickly chose the intestines, kidneys, spleen, and a portion of the liver. There was some poorly suppressed disapproval from the household Blacks; they considered it unfair that they did not get their share of the best stuff. The bad stuff—steaks, chops, backstraps, and brisket—left to us was our lot, since the “veterans” outranked us. It was the only oppressive thing they did so far as we could see.

On the way back to the Harare Airport, we paused in Bulawayo to see what Will considered was the best emporium in Zimbabwe. The place was empty of customers. The owner and four black employees stood by yearning to wait on us. The store had a large amount of handsome cutlery, antiques, wood carvings, and stone head carvings. I liked several items, but I could not see how I would be able to carry such large and heavy things in my luggage.

The owner took me aside and told me, “This is our last day in business, Doctor. We need a sale that will give each of us—me and my four employees—to get bus fare and a little food to get us to the border. Mugabe is coming after us… he said so. We have to leave before closing time. Please have a look at something very valuable to us. I hope you will also appreciate it.”

He showed me a beautifully bound collection of African Hunting volumes—twenty in all. The lettering was vivid gold leaf, and the volumes were in perfect condition. He quoted a price for the entire set. I thought I could not afford it, but I could not be party to the man’s and his revered workers’ fate. I agreed.

He called his men together, and they were overjoyed. They told me that this would allow them and their families to start a new life.

“We’ll close the place down right now and take the set to the post office to send it to your home. We have time… barely, but we will help you, and then we can escape.”

He was as good as his word, and the books came to my home in Utah in about two weeks carefully boxed and with a small formal thank you card. I have never been able to contact him again, nor could I find the farm family with whom I had shared meat from an ashes pit.

Karl Douglas Nielson [1940-], B.S., M.D., F.A.C.S., F.A.A.N.S., pseudonym Carl Douglass

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John Boyes [1875-1951] was a British born ivory trader, soldier of fortune, opportunist, and king, in Africa.

In all African history, there is no one quite like John Boyes. There have been better hunters, greater explorers, and finer writers. But almost no one disputes his prowess as an opportunist. During his adventure filled life, he employed himself as a sailor, safari cook, soldier, railroad fireman, officer of the Matabeleland Mounted Police, retail businessman, horse, mule, and camel trader, hunter, explorer, ivory poacher, sheep and cow thief, gambler, reprobate, and even king—as John I–[of the wa kikuyu, a tribe very similar to the Masai]. He ran away from home at age 14 and hopped a ship bound for wherever so long as it involved distant ports. John Boyes ended up making a name for himself in Africa by overcoming man-eating lions, disease, drought, and hostile tribes, and by his many and varied occupations, some of them outright legal.

The death of King Leopold of Belgium in 1909 created an elephant hunters’ free-for-all in the Lado Enclave, a 100-square-mile corner north of Lake Albert in Uganda. The area was home to some of East Africa’s largest elephant herds, which had thrived under the King’s protection. After he died, the local politicians could not decide what to do with the Lado; so’ it became a no-man’s-land without any direct or effective policies, enforceable rules, or official enforcers. The Lado had been off-limits to hunters for many years. Suddenly, in 1909, it became open to them for lack of any other option. The only obstacle for hunters and poachers was the cadre of loyal Belgian police who–acting on their own authority–tried their utmost to protect the elephants from poachers flooding into the area from British East Africa.

Once a hunter crossed the Nile, he took his life in his own hands. Although the rewards were great, he was not protected by British authorities and faced many dangers in pursuit of the “white gold.” The elephant hunters devised a variety of elaborate schemes to avoid the Belgian police. If a hunter did not know the area, he would probably search in vain for the elephants; and if he was not arrested by the rangers, he would probably die from sleeping sickness, black-water fever, mishaps occurring by wild beasts of either the four-legged or the two-legged kind. There was no honor among thieves, and poachers were touchy about their territories and activities. None of that dissuaded John Boyes.

One of the first adventurers to take advantage of the “ivory rush” was John Boyes, who owned a farm in British East Africa. Immediately after the King’s death, he headed out to try his luck in the Lado. John was intelligent, cunning, and aware of the real world he was about to enter. He first went to the Belgian commissioner and told him that he wanted to trade in the Lado Enclave but was nervous about camping among so many elephants. He asked the commissioner to point out on a map where most of the elephants were found; so, he could avoid them.

The commissioner was more than happy to oblige. Armed with this information, Boyes set off to hunt elephants. he bagged 3,000 pounds sterling–roughly $13,000 at that time–worth of ivory in just one month. Elephants were so abundant that some hunters earned upwards of 16,000 pounds sterling/$75,000 in less than six months—a very considerable sum at the time.

Despite his early good fortune, Boyes soon realized the difficulties and dangers in elephant hunting. In much of the area the grass grew too tall to see over; often he had to sit on the shoulders of a porter or gun bearer to take a shot. Invariably the recoil would bring both men tumbling down.

The ingenious Boyes eventually used a well-trained mule as his shooting platform; and in time, the mule became his constant and most trusted hunting companion.

Unfortunately, his success came to a tragic end several weeks into his Lado safari. Boyes and his hired men were tracking a large bull elephant in a dry scrub area of the Enclave. They reached a small clearing where he could see the bull, which sported long, heavy tusks. As it turned to face the hunters, the bull let out a deafening scream and then charged at frightening speed.

Boyes fired his rifle, which appeared to stop the bull in its tracks. As the dust gradually settled, Boyes waited to see what damage he had inflicted. To his horror, he realized that the elephant was not at all handicapped. The angry behemoth suddenly emerged through the dust, bearing down on him once again.

Boyes grabbed his second rifle from the gun bearer; but before he could raise it to his shoulder the bull was on him. The bull ripped the gun from his hands with its massive trunk. The shocked hunter could only look on in amazement as the elephant began to beat his rifle to pieces against the ground. Boyes took this opportunity to dive for cover. Just then the bullet in the rifle’s chamber fired, spooking the elephant, and sending it charging down the track and into the bush.

Boyes dusted himself off and went in search of his men. He soon found his gunbearer lying not far from the shattered rifle. The elephant had knelt on the luckless native, crushing out his life, and had plunged his tusks through the man’s chest. Boyes and the porters performed an impromptu burial service and then continued their hunt.

No story about Africa, about hunting in Africa, would be complete without telling the tale of when John Boyes became king of the wa kikuyu. John Boyes was an impostor who ruled Wakikuyu for three years before he was discovered by the colonial government.

When he arrived in Muranga in 1898, there was no British administration in Kikuyu land, a fact which Boyes exploited to the maximum. He first endeared himself to chief Karuri wa Gakure by giving him a present of clothes which the chief accepted with every appearance of pleasure. After that the two became friends; and when Boyes signified his intentions of staying longer in the Kikuyu country, Chief Karuri readily agreed and ordered his men to build a hut for Boyes. Over time, Boyes developed a growing influence over Chief Karuri and his people which eventually made him the supreme power of the Kikuyu country.

He collected taxes, chaired barazas [conferences] and led Kikuyu to war. To defend his new territory, he set up his own army of 5,000 uniformed kikuyu men giving them fake ranks of corporal and sergeant complete with realistic looking rank insignae. He also reinforced his new status as the king of wa kikuyu by flying the union jack outside his compound and also by marrying three Kikuyu women.

By 1899, Boyes extended his territory far beyond Mount Kenya and even became the proud owner of Africa’s second highest mountain having paid 10 sheep to Chief Wangombe and 10 to chief Olomodo of wandorobo. Boyes had also amassed too much wealth—according to British colonial standard–by exploiting the Wa Kikuyu and selling their farm produce to the Mombasa Caravan for a serious profit for himself, much as did all the other chiefs.

When he finally realized that the government was closing in on him, he called all Kikuyu chiefs who had usually supported him together and explained to them that the colonial government wanted to take his place as the general manager of all Kikuyu affairs. So, he made an agreement with the chiefs to accompany him to meet F.G. Hall–the foremost government official–so that he could defend his position as the ruler of Kikuyu.

Unfortunately for him, when the day to meet F.G Hall arrived, all Kikuyu chiefs disappeared. Not even his friend Chief Karuri turned up to accompany him. But—in usual Boyes fashion–he took it in his stride and marched with his army of 5,000 men flying the Union Jack to meet Hall.

After a brief conversation with F.G. Hall, he was told that all his 5,000 askaris were impostors and were being placed under arrest as they had no right to be in uniform.
The colonial officials went further to cut all the fake rank badges off the arms of Boyes men.

Boyes himself was also put under arrest for masquerading and flying the British Union Jack illegally, to which he responded:

“I am British. Did you want me to fly a Russian flag?”

He was then handed a summons to appear before the officer in charge of the fort the same day. The summons read: “I charge you John Boyes that during your residence in the Kenya District, you waged wars, held Barazas, masqueraded as a government official, went to six punitive expeditions and committed dacoity [an act of violent robbery—which includes murder–committed by an armed gang] by robbing Wakikuyu.” He was also indicted for “setting shauris” [making treaties].

Boyes was detained at Fort Jesus Mombasa, where he served a brief sentence. After his release Boyes and Chief Karuri continued with their less than kosher dealings.

Boyes disappeared for many years, then resurfaced in 1932 when he wrote to the Sir Morrison Carter land commission claiming ownership of Mount Kenya.

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Here, I will abbreviate the next twenty years of my life to tell you succinctly why I stopped being a neurosurgeon, and, instead, took up writing novels as both an avocation and a vocation.

                I left the navy in 1979 and moved my family to Lancaster, California (LA County High Desert) to practice with the first resident I worked with in Dallas; he was the one who taught me to put my eye very close to the skull opening to watch as I opened the dura. He also taught me the useful dicta for neurosurgery in a blood-and-guts institution: “All bleeding stops.”, “Never stand over the floor drain.” “And don’t let anyone get between you and the exit door.” We had a lot of violent patients in Dallas, which was the murder capital of the country back then until the city fathers decided not to include African-American murders in its statistics.

                We were busier than a one-armed paper hanger within a couple of weeks of my arrival. That meant a high income–which Vera enjoyed—a great deal of time away from home and family—which Vera decidedly did not like—and a host of malpractice suits—which I hated. California is a litigious society in any given year, for almost all enterprises, and for medical malpractice in particular. I will tell you about two cases that are illustrative.

                I was called to the ER to see a young man whose house fell on his head. Yes, that is exactly what happened; and here’s how. He and his wife moved into a fixer-upper old house and determined to do the work themselves. One of the early projects was to secure the house to a better foundation, and, at the same time, to investigate for mold and termites underneath the old structure. He read up on how to jack up a house and was successful in getting one side well off the ground—far enough to let him climb under and shine a flashlight on the cobwebs, mouse nests, and termite damage. While under the house, he heard a creaking sound. That convinced him to get out. He hurriedly backed himself out and got all his body out of danger, except, unfortunately, for his head. The house fell off the jack and crushed his skull.

                Neighbors came over and jacked the house up again and got the poor fellow to the hospital. I examined him and took skull x-rays. Remarkably, he was alert and neurologically intact. His skull was fractured into a mosaic; but, since he was stationary when the house fell on him, his brain did not get bounced around like it does in a car wreck.

                I met his wife who nicely told me two important things: “We don’t have any money or insurance right now, but we’ll pay you, I promise.” And, “I am a malpractice plaintiff’s attorney, but I promise not to sue you. Just take good care of my husband.” Sure.

                I worked all night in a twelve-hour operation to repair and rebuild him a skull and to achieve closure of his scalp. The closure required full thickness skin grafting and a good deal of dissection and manipulation to swing flaps around to reach areas where scalp had been removed by the edge of the house. He did well, returned to work, and was able to remodel his house in less than a year.

                No, they never paid a dime. Yes, she sued me. Neither of those outcomes was unexpected. I had become altogether jaded by that time. A night call to the ER meant that I was going to see someone with no insurance or intention to pay, and—all too often–who sued in order to win the equivalent of the medical lottery. It was a nothing-ventured-nothing-gained way of thinking that permeated the state at the time. The courts finally refused to let this especially baseless case go forward which was a win, but our suit in small-claims court for our pay went nowhere, which was not only a loss but another lesson about medical practice in California. I often thought of being a senior medical officer in the navy free of malpractice and office administration altogether, but that ship had already sailed.

                The next case occurred when I spent some time in San Francisco learning how to do stereotactic surgery at UCSF. A woman fell off a trolley car and was knocked unconscious. When she came to her senses, she was fortunate enough to meet an attorney patiently waiting at her bedside. They sued the city for damages based on the statement that she was a psychic and had lost her psychic ability–not as a result of the head injury caused by the city’s negligence, but rather because she had undergone a CT scan of the head with contrast. She and her lawyer alleged that her loss occurred because the contrast material was toxic to her psychic powers. The outcome was remarkable because the zany case was not thrown out of court as ridiculous, and because she won. Not only did she win, she was awarded the record medical malpractice lottery prize of two million dollars. Go figger.

                Early in my time in California medical malpractice insurance was unavailable, and we went “bare”. Later, we had to purchase insurance at the rate of $60,000 a year. That is more than my Dad made in an entire year in his medical practice. I finally got sick of it and left the practice after ten years and moved back to Utah.

I practiced for three years in Provo and was just building up a good practice again in 1992. I scheduled my largest operating day of my three years for the coming Monday—three major craniotomies and a carotid endarterectomy. That was enough to support my family for more than a month. I had arrived.

On Saturday, I took a group of six-year-old children from church on a day hike to a beautiful falls on one of the world’s great mountains, Mt. Timpanogos. We had a great day and tired out the children. Just as we were about to hike down, I had a strange visual symptom: the vision in my left eye began to fade to zero as if a theater curtain was being slowly dropped. I knew exactly what was happening and what had to be done. It was an emergency retinal detachment. To regain eyesight, I needed surgery ASAP. I could not abandon the children. They were too tired to run, and too little to hurry a mile and a half down a twisting trail. I carried one of the exhausted children for a ways then another then another in order to speed things up.

By the time I reached the bottom of the mountain and was able to get the children back into the hands of their parents, it was too late. I was blind in my left eye. I rushed to see a retinologist who performed three major eye procedures in three days, but it was too late. I never regained the ability to have 3-D stereoscopic vision, without which one cannot practice neurosurgery, especially in our age of litigation. My neurosurgical career was over.

I still needed money; so, I did workman’s comp physical examinations in Los Angeles for a couple of years but had to leave in a hurry when the South Central Los Angeles riots encroached on the clinic were I was working. I worked as a general medical officer at a state mental hospital for another three years before I was able to retire for good, at least from medicine.

I remembered that my mother used to like my storytelling, and my family, friends, and colleagues were fascinated by me as a raconteur of medical, military, and pure fictional stories. I thought about writing novels for my own mental health and perhaps to make something of a living. I was on a hunting trip in Alaska when I met Evan Swensen, a prominent publisher in Anchorage, and pitched my idea for a novel. He told me what was involved, and I set out on a journey that has not yet ended, but which saved my sanity and gave me worlds of pleasure, insight, and increased knowledge. The first novel, The Last Phoenix, was well received and inspired me–over the years–to write twenty-eight more. I am currently writing my twenty-ninth and have plans for my thirtieth.

That’s why I have written this set of blogs, why I am still a client of Evan’s, and why I am so taken with his AuthorMastermind group of authors, who are among the best writers I know. I am proud to be one of them.

My last question for this series of blogs is self-serving, I suppose: Would you consider becoming one of my ideal readers? Now that I can no longer pursue my career as a neurosurgeon, I am making every effort to write good novels. May I ask what is your core reading plan for the upcoming year? I ask because I would like to know if you may find my books interesting enough to become one of my ideal readers. In brief, I write historical action fiction, action thrillers, and stories which hopefully teach my readers about something with which they are not familiar. I see my niche audience as intelligent, educated, interested in a variety of subjects, events, and places, and willing to look at new perspectives. If you think you might be interested, then perhaps you would like to find out more about me by watching my webinar: Also, you can receive one of my e-books free from my publisher through the link: http:/

-Carl Douglass

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When I walked in the door of the Portsmouth Naval Regional Hospital in 1976, I became—as my family said—a real doctor for the first time. The uniform of the day was dress blues because there was some celebration or other going on. I saluted the flag outside the hospital and felt altogether like a naval medical officer. That afternoon—after a brief meeting for introductions of the staff members—I started in the clinic. I had three clinic days and two operating days as my schedule. The clinics were packed. Since the medical care in the navy was free, we saw a great many of the walking, “barely wounded”; people with headaches from a cold; people with low back pain who wanted a chit to get off duty; people with the “pink-slipper syndrome”—more or less neurotic or those with somatization of psychological problems; lonely women whose husbands were deployed abroad and needed a nice man to talk to; and enough actual neurosurgical issues to warrant surgery. The latter group constituted maybe ten percent. Clinic was an exercise in boredom. I swore that when I got out of the navy and really became a “real doctor” things would be different. As it turns out, they weren’t.

                One of the other neurosurgeons and I determined that we were going to make our naval neurosurgery service one where we attracted serious cases: intracranial aneurysms, brain tumors, arterio-venous malformations, cranio-facial malformations, and pain syndromes. Neither of us had any good idea of what a crying need there was. Within a month of letting our intentions be known around the area serviced by the medical center, we were busy enough to enlist one more of the staff to work with us, and shortly, we had a service that required all three of us to operate three days a week, and sometimes to do elective cases on Saturday.

                It was interesting. We served Camp Lejeune, Marine base in North Carolina and found real enthusiasm for our services from the doctors and the brass on the base. Two events stand out: we had to take a helicopter to the marine base. Once, I was riding along trying not to gripe about the cacophonous noise or the bone shaking rattle of the rotors, when the pilot made an announcement that “we are going down, buckle up.” I didn’t exactly see my life flash before my eyes, but I was highly discomfited by my vision of the near future. We landed smoothly upside down. The pilot had just returned from a tour in Viet Nam, and crashes for him were not that big a deal. Aside from a few bruises, and a lifelong aversion to flying in helicopters, none of us was hurt; and we conducted our clinic as usual.

The other thing that happened may be of more interest to you history buffs. On that occasion, my helicopter was diverted to Fort Bragg. I walked into the dispensary and was met by an excited coterie of doctors, nurses, and military police. I was directed to examine and to pronounce dead—if appropriate—a mother and her two daughters. Collette MacDonald was pregnant; so, in fact, there were four dead people. That was abundantly obvious: The scene was carnage. Every victim had been repeatedly clubbed and stabbed in what could only be characterized as “overkill”. I made a blanket pronouncement of death, then I was taken to see the distraught husband, Capt. Jeffrey MacDonald. He did not want to talk, and I pitied him more than I had ever sympathized with any other man. My role was negligible, and my observations were not even formal. Army CID, FBI, and DOJ, personnel attended to the formalities; so, no mention was made of my presence or pronouncements. My last serious interest in the case came during my last year in the navy when I learned on the news that Capt. (Doctor) MacDonald was tried, convicted, and sent to a federal penitentiary for life—first in California and then in the Federal Correctional Institution in Sheridan, Oregon.

I served as chief of neurosurgery and one odious task I had was to testify against one of my colleagues who was accused of rape. I had witnessed the act. After prolonged legal wrangling, he was allowed to leave the navy and to move to Missouri while he awaited trial. He fled the country—probably back to his native Colombia, where someone told me that he set up a lucrative practice. For the most part, my naval experience was positive. When I announced that I was leaving the navy at the end of my tour, the brass tried everything they could to get me to stay because they were—by then—desperately short of neurosurgeons. I refused, and I have wondered ever since if I should have finished a navy career.

                Question: Military medicine, like Medicare, is essentially socialized medicine. It is imperfect, but it works and works well. No one can rationally deny that we Americans need real health-care delivery reform. Why not change over to a one-party (federal) payor system like the rest of the civilized world?

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As my tour of duty as a general surgeon was drawing to a close, several important things happened. In the same week, the chief nurse in surgery and my now good friend and favorite patient–Marlene–presented in my office with masses in both breasts. The nurse assisted me with Marlene’s bilateral radical mastectomies and asked me to do hers. The base and hospital commanders, and several of her friends told her that she could go anyplace she desired to have her surgery. She told them that she had seen enough in Port Hueneme to make her decision. I did her chest surgery and a little later removed her ovaries because her cancers were aggressively metastasizing. She left California to go home in the South for her last days.

                Marlene’s husband and son were both apprehended for having sex with the base executive officer’s underage daughter. They were not criminally charged because the officer feared for the negative repercussions for his daughter, for him , for his wife, and for the navy. They were both enlisted men in the navy. Both were busted down to E-3, seaman, rank and assigned duty in Reykjavik, Iceland beginning in late November. That left Marlene alone in terms of family but fairly rich in terms of friends. She was in awful pain for her last month. I admitted her to the hospital; and then, at her request, released her to her home for hospice care. I had her on an IV drip of morphine, and she was in and out of consciousness but became reasonably comfortable. I stayed with her several nights. The last time, she asked me to give her a blessing. I am not sure if she had an idea of what, if any religion, I followed, or if I had any authority to do something like that, but I did give her a blessing—essentially that her pain would subside, and she would have peace. That came to pass. She stopped fighting the pain sometime in wee hours of that morning. I was holding her hand. I informed her friends and church members that she had died, then I went home and hugged my wife glad that she was well. Then, I cried.

                In June, 1972, my tour of duty with the Seabees concluded. The base and hospital commanders fervently implored me to stay on in the navy and to do my neurosurgery training as a naval officer because the navy was in sore need at that time and would be worse so soon. It was a win-win arrangement; so, I enthusiastically agreed. To sweeten the pot, I was promoted to commander upon re-enlisting. We loaded up and moved to Dallas, Texas for the wildest ride of our lives.

                The first day of my definitive neurosurgery residency I was on call. It was a weekend. The senior resident on call with me was to become my future partner in private practice eight years later. Our first patient from the ER had a through and through gunshot to the head—what was called a “Fearless Fosdick Wound” in those days. The exit wound had not broken through the dura and skin quite yet, and the victim had a subdural hematoma. The resident had me lean in very close to be careful and gentle.

                “After all,” he said, “we are dealing with the human brain.”

                He told me to be gentle, but to make a definitive cut in the dura, taking great care to watch the incision all the time. A massive gush of purple blood geysered out of the opening and soaked my eye and the rest of my face. The resident and the OR nurses had been waiting for several minutes with pent-up merriment to see me get punked, and they all laughed themselves silly. I waited for my laughing jag until after one of the nurses held up a mirror for my face. That weekend, we did six trauma cases. All but one died. I was alone on Labor Day weekend and set the residency record of fourteen cases of all sorts in three days and only half of them died.

                I did more than 3,000 craniotomies and twice that many backs, necks, and peripheral nerve cases during my five-year residency. Our chief got sick during my fourth year and had to take a long sabbatical. He was not available to select a new resident either of those years; so, I became the chief resident for my final two years; and I was without an attending surgeon to hold my hand. I ran into a major issue during the second to the last month of my residency. I was at the Dallas VA to see a consult—a thirty-something-year-old man with excruciating neck pain who—the nurses said, was “low-sick”. That he was. When I saw him, his posterior neck was red, hot, tender, stiff, and swollen—all cardinal indicators of a major infection. I rushed him to the radiology department and coaxed the tech to help me do a myelogram even though it was only five minutes until quitting time. The patient had a complete myelographic block and was beginning to lose strength in his legs. By the time I rushed him to the OR, his arms were getting very weak as well. He was losing consciousness. The Grim Reaper was knocking at his door.

                I rushed him into the only OR room still open and told the nurse to alert the anesthesiology resident that I was there with a patient and that we had a five-alarm emergency case. She returned and timidly told me that the resident could not come into the OR until he had seen his chief. I said some naughty things, but that did no good. I took this imminent bull by the horns and started an IV, put in a Foley catheter, and intubated him—much the same as I did regularly during my navy general surgery days. The nurses and I turned the man over prone and scrubbed and draped his neck for a cervical laminectomy. Every move was done in controlled staccato hyper speed.

                Then, the nurses balked. None of them was willing to jeopardize her job and career by ventilating the patient or trying to manage the anesthetic issues. I put down the knife, broke scrub, and walked out like a stalking bear. The resident—a young man fresh out of his internship, timid, and quavering—looked at my demonic eyes and started to cry.

                “Stop that!” I ordered. “Get in and help me before this poor man dies. It is preventable….PLEASE!”

                Fortunately for him, the chief of anesthesiology marched into the room at that moment looking infuriated. One look at his resident increased that level of fury exponentially.

                “Who do you think you are, brow-beating my resident like this, you rotten bully,” he shouted.

                His face was bright red, and he was sweating.

                He was about to say more but thought better of it when he looked the Devil Incarnate in the eye.

                “This is not over, Scumbag,” he hissed; but he and his resident moved into the OR—not quickly enough for my sense of purpose but at last, they were in the room.

                Everything was going to hell in a handbasket with the patient. The chief took over, got his blood pressure back up to normal, and put him to sleep; not with real alacrity, but the level of motion was faster than before. I did the world’s fastest cervical laminectomy, moving as fast as I possibly could and still protect the man whose life was in my hands.

                When I removed the first of four posterior cervical vertebral elements, pus exploded out of the opening in a most satisfying release of pressure. I could only hope that I was in time. I removed the rest of the posterior elements and exposed the inflamed dura. To my great relief, there was no evidence that any of the infection was under the dura and on the spinal cord itself. Otherwise, all my action, fury, and anxiety, would have been for naught. I got cultures, washed the wound with copious amounts of saline with antibiotics, and placed antibiotic installation and drainage catheters in the wound site. I closed the wound partially and packed it with antibiotic soaked gauze sponges.

                The anesthesiologist decided to wake him up fairly quickly. God smiled that night when our patient began to complain, to cough, and to move his arms and legs vigorously to get up and away from us. Suffice it, he did well. Why he got that epidural abscess remained a mystery. I was entirely willing to settle for the result without having to know the reason why.

                The chief of anesthesiology was still seething with anger. As soon as we finished our paperwork, he stomped over to where I was standing and began to berate me for being a cad. I stood up. I was taller than him by a foot, and heavier by forty pounds; and I was not in the mood.

                “I will have your job, you…you…”

                His vocabulary of invectives failed him. I just waited. I had been on call for four days straight, and I was pooped.

                Finally, he got down to his intended threats, “I will see to it that the faculty fires you, and that you are served with a letter of condemnation from the county and the state medical and legal officials. Then, you won’t be so high and mighty.”

                I spoke quietly but with unmistakable menace, “And we will meet the faculty council together, and they will get to hear us out. I am not so sure whose career will suffer the most,  but my bet is that you will regret for the rest of your life that you took me on when I dispassionately tell them how you were so bent on showing me who was king of the hill at the expense  of a man’s life.”

                He had calmed some and gave what I had to say some thought.

                “I’ll get back to you about this. You haven’t heard the last of it.”

                I was too busy to think about the two anesthesiologists any more for that week. The next Friday, the anesthesiologist sought me out to tell me personally,

                “I have thought about this. You were right about the need for haste. And you also did a remarkable job of getting the patient ready for surgery. I compliment you on how well you moved to do an operation that I would have thought would take hours. That said, I despise what you did to my resident. He is still afraid to go into an operating room. But, I am willing to let it all drop if you are.”

                I certainly did not need trouble; so, I gladly agreed. I found the resident and patched things up, and he found his reservoir of courage again and was a bit tougher in the bargain thereafter.

                Vera and the children were overjoyed that the neurosurgery residency was finally over, and I had my final papers all signed with ever “T” crossed, and every “i” dotted. We moved on to Portsmouth, Virginia to begin my career as a naval neurosurgeon.

                Was I a spherical SOB as many neurosurgeons are described? Was my zeal excessive in my pursuit of benefit for my patient? What kind of doctor do you want? Does the end justify the means?

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It was wartime when our little family drove to the base on the California coast. The general tenor of the times was serious, and the responsibilities of the doctors—fresh out of residency or not—were important. It was evident everywhere; the base was on a war footing.

                My orders directed me to appear in uniform at the office of the senior master chief of the base’s office at 0800 on whatever day it was—I forget. I had not had time to think about things like uniforms. Vera and I were three days early and so were three other new docs. We met up and headed for the base exchange to stock up. I was disappointed to learn than my new colleagues were no better informed than me. By the time we had made our selections, there were a total of six of us new doctors. Since none of us had money, we picked over the used uniform piles to outfit ourselves.

                The result was: I found a good fitting beige uniform with nonmatching pants and coat, brown shoes, and a neat hat with gold braid on its brim.  I checked myself out in a full-length mirror and decided I looked pretty nifty. Another new doc found a similar uniform but with more chevrons on the sleeves and pairs of argyle socks to compliment the outfit. Two docs found the same thing in blue, and the final two had to settle for white. One had to choose black shoes because none of the brown or white pairs fit.

                We arrived at the senior master chief’s office on time and presented ourselves. He took one look and simply groaned, lacking the vocabulary to comment on our choices. When he calmed down, he explained with gritted teeth, the difference between the uniforms of officers and enlisted, the concept of the uniform of the day—white, beige, or blue as ordered by the commandant’s office—the fact that none of us had a rank for which a cap with “scrambled eggs” on the brim was indicated. No argyle or other off-color socks ever; ties are to match uniform colors; clean, white or beige shirts; blue or beige ties matching uniforms; brown shoes with beige uniforms, white shoes with white, and black shoes with navy blue. Belts were to be navy issue, and the color was to match the uniform of the day. By the time we absorbed all this important information and recognized how absurd we looked, all of us—including the senior master chief—had to sit on the floor until our laughing fits settled down. He took us back to the exchange and got us decked out in new uniforms—two of each—with the right shoes, socks, shirts, ties, chest ribbons, and rank insignias.

                When we sheepishly went through the line to pay for all of our attire, we had another group laughing fest, and Marlene–the attractive African-American lady who waited on us–was infected by our unseemly fit of mirth. As we were leaving, she caught me and asked if I would fit her into my clinic schedule because she was worried about a lump in her breast.

                A note to help the readers understand the context of the times: As I said, we were at war. All of us, like most of the other young men around us were draftees, and many were not the least bit happy about it. All five of the doctors were overtly hostile to the fact and voiced the general anger about the war and about having to serve. I was the odd man out because my wife and I actually liked being in the money. For one thing, it would be the first time in our married life when we had any money. For another, I looked forward to being an officer and to having responsibility to be the doctor in fact for a large population navy base. No stealing cases necessary.

                Certainly, no stealing cases was necessary. These were strange times. There were riots in the streets. In keeping with the tenor of the times, five out of the six of us individually mounted a quiet strike. Four of them decided to go as slow as they could possibly get away with and do as little as could be done without being brought up on charges. The new anesthesiologist was the worst of the lot. He claimed that the equipment and support staff were not up to the standards he was used to having trained at Harvard’s Mass General Hospital. He let that fact drop on as many occasions as he could possibly include it. He flatly refused to do anesthesia, and it was beneath the dignity of so grand a personage as an anesthesiologist to see the low-class masses in clinic.

                That was one of two things that changed my career. The other was that the surgeon who had been appointed chief of surgery as a starting position and who started as a lieutenant commander came three days late. He was from the Philippines and had a rather lackadaisical “mañana” attitude. The brass were indulgent to a point. To begin with, they presumed the protestor doctors would come around. Then, came a more testing issue. The Filipino Lt.CDR requested a three-week vacation leave to visit his family in the islands. To everyone’s total surprise, he left and never came back; he was at first labeled AOL [absent over leave] and finally as a deserter. At the end of my first week in the navy, I was designated chief of surgery, in large part because I was the only one who would actually see patients, work patients up for surgery, and perform surgery. I was advanced in rank to Lt.CDR on my seventh day of service.

                Trouble was brewing. Of course, the work and attitude situation could not go on as it was going. Since the anesthesiologist would not give or manage anesthesia, and the nurse anesthetist was not allowed to do many of the things necessary, and since I was determined to do surgery, it fell to me to assume the anesthesiologist’s role as well as my own. I boned up on how to pass gas, and thereafter started the IVs, gave the sedation, placed the endotracheal tubes, and initiated the inhalant anesthetics. Then, I turned the responsibility over to the nurse anesthetist. When a spinal anesthetic was necessary or preferable, I did that as well. For OB, I did not feel confident enough to do epidurals; so, I either did spinals, or paracervical blocks, or partial general anesthetics. I did everything from soup to nuts while the other specialists grumbled at my effrontery but still boycotted the OR. I did appendectomies, gastric bypasses, surgical trauma, gall bladders, hysterectomies, deliveries, thoracotomies, and open bowel procedures. I learned how to do colonoscopies, and even simple TURPs. I drew the line at neurosurgery.

                The nurses loved me for being willing to work, and they were more than willing to help, including holding the pages of the “how-to-do-it” books open for me during operations. I loved doing the surgery and having such a free reign, but it did chap me that the rest of the lazy bums were getting away with their boycott. That came to a head on a day when the hospital captain’s daughter went into labor. He insisted on being with her, and I had no reason to try and exclude him. It did not take long for him to realize that I was not an obstetrician, and he was steaming by the time the successful delivery of her baby was accomplished.

                He demanded to know why I was doing the delivery when there were two perfectly capable obstetricians on the staff. I felt no need to cover for them; they deserved what they were going to get; so, I told him the whole story. Since I had just presented him with a pretty little grandchild, he was favorably disposed to accept my side of the story.

                “Come to my office this afternoon, Commander. This is not going to continue.”

                The base commandant and the hospital commander were waiting for me.

                I had just had a haircut and had put on a fresh uniform; so, I looked spiffy when I arrived.

                “Are you aware of the hair styles sported by the other five surgeons and the new internist, Commander?”

                “I am, and they paid no attention to me or to the base senior master sergeant about haircuts or anything else.”

                The commandant said, “I have some orders for you. Execute them today. Order each of the lieutenants separately to cut their hair, change into fully regulation uniforms—with shined shoes—and to agree to begin clinic work and to build a surgical schedule in two days’ time. Give the orders three times in a row—as per JAG regulations. Report back to me and to Captain Henry about what takes place, and we will proceed from there. As of now, I am ordering the clinics to close. I know you have a full OR schedule. Keep that up, okay?’

                “Aye, aye, Sir,” I said and saluted.

                I did as I was told and met with stony disdain and snotty shrugs indicative of refusal—three times in succession.

                I reported as ordered, and the commandant—a rear admiral—told me to sit and wait while he called the CNO [Chief of Naval Operations, and member of the JCOS], Admiral Zumwalt. Like everyone else in the navy, I knew that Zumwalt was a flaming liberal and quiet sympathizer with the anti-war sentiment. It was going to be interesting to hear what he had to say.

                Commandant Adm. Parker was connected with the Office of the Joint Chiefs. He spoke his piece then listened. Then, he handed the phone to me.

                “Admiral Zumwalt wants to talk to you directly.”

                The conversation was one-sided and simple to summarize: Ignore the offenses; it is a sign of the times. If they won’t work, send cases out to civilian hospitals. We can’t afford the scandal of what could be interpreted as a growing mutiny. That would be worse than the actual offense against the regs.

                The scoff-laws won, and I lost. However, I certainly gained friends in high places.

For all that has been written and televised about the war in Vietnam and the men and women involved in it, I suspect that this vignette might come as a surprise to you. It happened; what do you think about it? Do you think I should have been more assertive? You can read about this and other Viet Nam related stories in my books, The Last Phoenix, and Saga of a Neurosurgeon.

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Much of my second year of general surgery training was spent at the Minneapolis VA Hospital. It was a bread and butter, common kinds of surgery, place. There was a great deal of work; so, the idea of stealing cases was absurd and unnecessary. The concept for the residents was to do useful work and to refine our technique. The goal was to turn out competent, confident, general surgeons with genuine concern for the patients. The boss was Dr. Humphrey, a big, jolly, enthusiastic pragmatist. When we made mistakes, he corrected us and helped us to understand and to improve. When we did well, we all had little celebrations; it was about being a surgeon—and a doctor—were supposed to be. About a third of the year was spent back at the mother ship—U of Minn Hospital and in the St. Paul Hospital ER.

We got to see and to treat the lowest circles of society: homeless, unclean and lice ridden, alcoholics, addicts, and criminals, lots of criminals. I learned an essential element of being a doctor there which was every person, however odious and malbehaved, was a human being and should receive the best of care we could provide. It is difficult–but not impossible–to treat a wounded gang-banger responsible for several murders, a prostitute with loathsome sores, a schizophrenic responsible for terrible injuries to children, etc.

At St. Paul’s, we had a DDT chamber for the bums who came in jumping with lice. The nurses were old hands. The patient would walk in with bright lights at his or her back which illuminated the halo of flying fleas. The nurses kept a broom each to herd the gentleman or lady gently into the DDT chamber for a thorough delousing. Then, they were strongly encouraged to shed every article of clothing into a receptable that happened to have a direct link to an incinerator a floor below. They then received a co-ed shower and a brisk brush scrubbing. Finally, they got a new set of old but clean clothes and were ready to be examined and treated.

At the VA, tuberculosis was rampant. TB bacilli show up as red rods on Ziehl–Neelsen staining, hence the common appellation of “red-snappers”. One of the most common questions we asked when hearing a history of a new patient was, “does the old vet have red snappers.” We relatively healthy lads did not want to get the red snapper disease, but we also wanted to give good care. A crucial question therefore was, “if I see an old vet unconscious on the floor, Dr. Humphrey, what should I do?”



                Then Dr. Humphrey would demonstrate how he preferred to perform emergency resuscitative therapy safely. He had us all gather around. Then he indicated an invisible old vet lying face-up on the floor of the hallway. He raised his size 14 foot off the floor then brought in down on the invisible chest.

He pushed his foot up and down rhythmically and said in a dead-pan voice, “Out with the bad air; in with the good air, repeat.” He looked at each of us and said, “repeat after me—out with the bad air, in with the good air.”

“When do we quit, Dr. Humphrey?”

“When you get too tired to keep going or when the patient is dead.”

“Who makes the pronouncement?”

“You do. You are the doctor, the decision maker.”

With that useful preparation behind me, I was ready to enter the navy and be a surgeon—having patients of my own. No Dr. Humphrey to help, no fine and experienced surgeon to back me up. The moment of truth was fast approaching. It was time for Vera an I to pack up or family in a reasonable size van and to head for California. We realized that it was time to find out where Port Hueneme was located and to learn the correct pronunciation for the town—not “Port Juanenema” as we had been calling it, but “Port Wine-eeme”.

I ask whether or not it is disrespectful for medical personnel to speak lightly of their patients with all the very serious problems, difficult histories, and propensities for evil. Remember, the people who have to get up in the night and have to endure bad smells and foul images and to hear seriously bad language day after day might just be humans also.

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The next year was more of the same old thing: stealing cases, fibbing about my experience to get to do things, and otherwise being a good boy; so, the possessors of cases would share. My responsibilities and ability to be somewhat independent increased, and so did my chance to fail and to learn from failure. I had two failures of note. I was the resident on the cancer ward when an older man with a tonsillar cancer came onto the ward with pneumonia. He was in agony from his cancer and looked grey as if he had one foot on a banana peel and the other in the grave. I got labs and a chest x-ray which showed an obvious and very significant pneumonia of his entire right lung. Great. I made the diagnosis and started IV penicillin. I was so smart. The next morning the attending oncologist took one look at his patient, all awake, breathing well, and in his usual terrible pain.

He took me aside, and with a look that could kill, said, “Are you really that stupid, Doug?”

I was sure I was missing something; so, I waited for the other shoe to fall. He wasn’t interested in any reply I might make anyhow.

“Don’t you know that pneumonia is the old man’s friend? His family is furious and rightly so. They brought him in to die—to finally be rid of his terrible pain. What’s the matter with you?”

I gave a moment’s thought to saying, “what we have here is a failure to communicate,” but thought better of it. I just took my licking and chocked it up to lessons learned. I had many occasions to remember that lesson in dealing with the lethal illnesses and injuries of my neurosurgical patients over the coming years.

The second mistake was more costly. I had come to the University of Minnesota to impress Dr. French, the head of neurosurgery that I should be one of the two residents he selected for the next year. I did my level best during my rotation on neurosurgery and thought things were looking good. Things got better when one of the two first year residents on the service quit and became a radiation oncological resident. Dr. French asked me to take the resident’s place, and I jumped at the chance even though it meant that I would seldom see my wife and family, which now included three children. I was on call two out of every three days, and we worked like galley slaves. I learned at an accelerated rate from residents and attendings who were justifiably world famous. As a further indicator that I was in Dr. French’s favor, he asked that I take over sole care of his private patient in what we affectionately called the “pus ward”. Dr. French never publicly admitted to having an infection, and I was subtly sworn to silence.

The infection was a large gaping canyon down the man’s back were the disc spaces had become infected during a large lumbar laminectomy and spread to his muscles and fascia. The poor soul had been lying face down on a narrow bed being treated for the infection for nearly a year. I trotted in full of wound care expertise from my general surgery experience and full of wim, wigor, and witality at the prospects that this assignment would likely ensure my future.

Dr. French happened by to watch me work. I removed the wet and pus-filled cotton pads in the depths of the wound, washed it out carefully with sterile normal saline, and rebandaged it. He asked if that way of doing things was something I learned on the neurosurgery service, and I told him, no, it was standard practice on the other surgery services. You would have thought that I advocated spitting in the wound.

“That is not my way, Doug. And my way is the only way on the neurosurgery service in this hospital and at this university. I will take some of my very valuable time to teach you how infected wounds are treated.”

He was not smiling. He removed my carefully placed bandages and ordered the nurse to bring him a bottle of betadine soaked strip gauze. He proceeded to layer the entire bottle of gauze into the wound until it was filled to the surface of the skin.

“That is how you put it in, Doug. Capiche?”

I capiched.

“Now for the hard part,” he said with intended insult. “Beginning tomorrow, you are to cut off one inch of the gauze until it is all removed. At that time, the wound will be free of infection, and this man will be able to go home. Never let me hear that you did what ‘they do on general surgery.’”

I nodded my complete acquiescence, thereby admitting my stupidity and foolhardiness. I guessed it was probably not the best time to ask if I was going to be chosen to be next year’s resident. He wasn’t finished.

“Doug, I hope you have learned your lesson here; it is not just about wound treatment—it is about obedience. It is evident that you are too independent to be on my service, and I will not be taking you on as my resident next year.”

He did an about face and left the room.

Well, I certainly learned my lesson that day. Now, I did not have a job for next year, and a sense of low-grade panic set in. I finished my work in the pus put and marched down to the surgery office. It happened that a former Minnesota resident was visiting his alma mater from his place as head of surgery at the University of Kentucky. He overheard my request for help to get some type of general surgery residency somewhere. As if I was not there, he asked the chief of Minnesota what kind of a surgeon I was.        To my surprise, Dr. Najarian answered, “Dr. Nielson is the best surgeon we have, but also the most independent and least likely to follow the rules. He steals cases from the senior residents and can cut and sew with the best of them. I would not take him here because this is a “do-it-my-way-or-the-highway sort of place.”

“Sounds like my kind of guy,” the Kentuckian said and offered me his hand. “I have a slot for a proctology resident, and I will offer you an attending spot when you finish your general years.”

The year’s end was three weeks away, and I could not let it pass without having a job.

“Thanks, I’m your guy,” I said, wistfully knowing that my dream of being a neurosurgeon had just blown away on the winds of change.

There was another change in the wind. The next day, we all heard from the Department of Defense about our assignments in the draft. We had had three choices for our preferences and would be chosen for the best choice available when the conscription department reached into the hat. We could enter the military immediately or be allowed to complete one year and then be commissioned, or we could luck out and be allowed to finish the entirety of a residency and then be commissioned as specialists. There were six of us who had been competing for the Minnesota residency position. Of those, five got their choice to complete their residency programs. The sixth—me—was allowed to get one year of general surgery residency and then to be drafted—commissioned.

The day after that the mercurial Dr. French caught up with me on the ward and glared at me with pure venom.

“What is this I hear that you have abandoned neurosurgery and are going to become an [here he said a naughty word related to the location of the procto] surgeon. That is not acceptable. You are a neurosurgeon. Get over this nonsense.”

It did seem appropriate to point out that, “You have to have a neurosurgery residency before you can become one. And I don’t have that option. You may recall that you would never take me.”

“Oh, posh, [or something. Maybe I and tightening up a bit on the translation here] I will get you a place today. I have just the place, in fact. It is in Dallas where they like wild, wooly, and go-it-alone cowboys. The chief’s name there is Dr. Kemp Clark. He runs the most interesting program in the country. You will get to work your [once again, either a naughty word, or an oblique reference to a Biblical beast of burden] off. What do you say?”

My world had just turned right side up; so, I said “Yes.”

I caught a plane to Dallas that night, had an interview with Dr. Clark, and secured a residency position. I told Dr. Clark that it would be three years before I could get Dallas: one for the residency, and two for my opportunity to be a general surgeon during the unpleasantness in Viet Nam.”

“Is your word good, Doug?”

“It is.”

“So is mine. From this day forward you are a neurosurgeon. Keep in touch, and I’ll see you in three years.”

                 I made calls to Kentucky to resign my potential proctology residency place, and back to Minnesota to tell Vera the newest news. She had some news for me as well. There was a letter from the Department of the Navy. I was to be commissioned a lieutenant in the navy with my assignment as a general surgeon in the west coast’s Seabee base in Port Hueneme, California—wherever that was.

                Hey, my only question for you at the end of this blog is, “Would you like to read about all of this zany stuff?” You can do so in my six-book series of The Saga of a Neurosurgeon. I did my best to make the series at least semi-auto-fiction and true to the times, the places, and the things that happened.

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During training at the University of Minnesota hospitals, I was on call every-other-day most of the internship year. I was a very determined aspiring young surgeon and not for a moment shy about stealing cases. I became friendly with one of the less renowned and less popular staff surgeons. One day, it happened that no one senior to me (as was almost everyone else in the universe), he asked me to assist him in a bilateral radical mastectomy for breast cancer. That radical operation resulted in total removal of the breasts, the lymphatics, and the chest muscles. Both sets of axillary lymph nodes were also removed in the classical procedure. We scrubbed in, and I entered the OR first, prepared the patient’s skin, and put on the drapes. The surgeon entered the room late and looked like death warmed over.

                “Sick,” he said, “very, very, sick. Flu.”

                I said, “You look sick. You better lie down before you fall down.”

                He did just that because he could no longer stand.

                “What should we do, Doug?” he asked.

                I liked that he never referred to me as “thing”.

                “Operate,” I answered hoping not to sound brash.

                He looked at me thoughtfully for a moment then asked, “Have you ever done one of these?”

                “Yes,” I said.

                Technically, that was not entirely a lie. I had scrubbed in several times; and, in my defense, I have to say that I had studied the procedure for the previous three days so that I could quote the textbook and several scientific articles almost verbatim.

                “Can you do it?”

                “I can.”

                The OR, like the court room for litigators is not a place for shy and retiring folks, nor for the faint-of-heart.

                He asked one of the nurses to assist me, then said, “All right, let’s get on with it.”

                Just to make sure he didn’t have time to change his mind, I took the scalpel and made a football shaped transverse incision across the chest.

                By now, the real doctor had forced his way onto a chair.

                He said, “Hey, we always do a vertical incision. I’ve never seen a transverse one.”

                “I prefer it,” I said, quietly quoting several technical articles in my mind.

                “Okay, you’re the surgeon here. I’ll sit back and learn something.”

                As big and difficult as the procedure is for the patient, the operation is not particularly difficult technically nor does it require hard to learn techniques. It is hard work and tedious, but I moved through it all right, and the patient did well. I got a real compliment from the attending surgeon who said he was going to use a transverse incision himself from there on out.

                The good stuff ended there. As soon as I had helped lift the patient onto the gurney to send her to the PAR, the chief resident on general surgery broke into the room, obviously furious.

                He yelled at me, “Thing,” he said, “who do you think you are, and what did you just do?”

                The attending answered for me, “He is an intern who just demonstrated that we run a good program here. I was and am sick and couldn’t do it myself; so, I determined that he is well qualified. No one else was available. He did just fine.”

                “He’ll never do another case as long as I’m chief,” the grandiloquent chief resident said and stormed back out of the room.

                I laid low for a while before stealing a hernia and a gall bladder, both on the same day. It is a dog-eat-dog world trying to get to be the surgeon, and I was determined to be one of the big dogs as soon as possible.

                Speaking of not being a place for the faint hearted, I did a stint on the urology service. During that time, the university was doing a major study of transsexual gender change surgery. Many—even most—of the surgery staff and residents had moral compunctions against the concept of sex change in general and of performing the operations in particular. Not me. When no one else was ready to do a procedure on the service, I volunteered. It was a traditional “see-one-do-one-teach-one” set of circumstances. I got pretty near to the “teach one” level with castrations, plastic repairs, implantation of breast prosthetics, creation of quasi penises for those changing from female to male. On ENT, I did nose jobs on the same people; on general surgery I did a vascularized large bowel transfer to create a pseudo-vagina; on gynecology, I did bilateral oophorectomies and salpingectomies (ovary and tube removals); and on vascular surgery, I did big unsightly varicose vein resections. My lack of prejudice netted me something of a rich and varied surgical experience, one that would serve me in good stead when I got to the navy.

                Just one more story to convince my readers that I also learned to be humble and self-effacing. I was on cardiovascular surgery assigned to the cardiac intensive care unit. We had some very sick cookies on the unit, and we did more than a dozen CPRs a day, some of them successful. I worked on a patient whose wound dehisced and got blood all over my scrubs. There was a short lull in the generally frenetic level of activity; so, I rushed down to the showers, threw my scrubs into the basket and had a life-restoring hot shower. I was clean for the first time in days and felt great. That lasted a minute. I looked around for fresh scrubs; there were none. The dirty scrubs had been sent to the laundry, but no clean ones had been brought up yet. It was a devil of a conundrum. I shrugged and tied the biggest towel I could find around my waist and sheepishly went back to the ICU. The minute I entered the room, another patient decided to crash; and it was up to me to do the CPR and to order the meds. That one survived; and immediately, I had to run to a second patient. By then there were four CPRs going at once. It was like a Chinese fire drill.

                All CPRs finished within a minute of each other. Everyone heaved a small sigh and leaned back for a moment’s rest. I closed my eyes during my moment but awakened to hear a roaring of laughter all around me. I looked around to see what or who was so funny. One of the young nurses, tittered, put her hand over her mouth, and pointed at me. I looked down. Some where in the chaos, my face—etc.—saving towel had gotten lost in the piles of linens. I could not think of any kind of a speedy retort or anything dignified; so, I just took a little bow and made my exit.

The question: what would you do to break even or to get ahead in a very competitive world? What is kosher in the knock-down-drag-out world—something like what are the rules in a knife fight?

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                We moved to Minneapolis with all our belongings in the smallest U-Haul trailer available. There was a hurricane blasting through the city the day we arrived. We had to dodge falling trees, to find alternate routes of travel, and finally the incredible wind and driving torrents of rain beat us. We were afraid, which drove us very reserved and independent people to walk up to the door of a humble little house and knock on the door to ask for help for the night. People are good. We happened to knock on exactly the right door. It was home to a pleasant young couple who happened to be co-religionists of ours, and they invited us in without demurrer. They put us up for the night, told us how to find temporary quarters in the university dorms, and got us in touch with the local bishop. He found us a house to rent, and maybe (who knows) caused the storm to move on to torment the unfortunates in Coon Rapids.

                The house was in a run-down area on the west bank of the Mississippi River. It was spring, and the weather changed over to delightful and welcoming.  We settled in after making a trip to a garage sale to rebuy the things that neighbors stole from us as we were moving in. I said the area was run-down; that is a euphemism. That year, Minneapolis had its worst winter in a hundred years—more snow, lower temperatures, fiercer winds, longer cold spells, lower highs and lower lows. The university and the hospital were directly across the river which was reachable by a mile walk down river to a low rail bridge. Most days when I left home, I had to crawl across the bridge to avoid being blown off into the river. I wore mukluks and an Alaskan parka every day for eight weeks. Our children sat on the old tall radiators in the front room for warmth and stamped on cockroaches for exercise and fun.

                I learned a great deal, saw a great deal, and became aware that not all doctors adhere to the Hippocratic Oath with enthusiasm. One cardiac surgeon left a patient on the table for an aortic valve operation for hours while he gave a speech in Chicago. The surgery should never have been scheduled according to several of his colleagues on the faculty who preferred not to be named. She died from being on the bypass machine for too long. A study was done over several years using a machine to freeze the lining of the stomach of patients with severe gastric bleeding that could not be controlled by nonsurgical means. The results of nonexperimental surgery were excellent in Minnesota and all over the country. The results of the experimental procedures as reported were lies. How do I know that? Because my assignment—and I was set-up—was to report on the ten-year results of the program at monthly Grand Rounds for Surgery held in the medical school auditorium. State and city surgeons and internists, having heard that the subject was to be presented, attended, filling the auditorium beyond fire safety capacity.

                When I say I was set up, I mean my efforts to find raw data were futile and obstructed at every step. The named surgeons on the many reports seemed to have developed amnesia, misplaced the data, or were too busy to accommodate a “thing” as interns were called; secretaries gave me the run-around, etc., etc. I appealed to the surgeon who gave me the assignment, and he simply smiled enigmatically and told me that I would be all right, just report your findings.

                I felt like a fool, but I stood before that packed audience of men and women whose average IQs were genius level and whose years of experience dwarfed mine.

                I said simply and humbly, “I could get no data whatsoever. It is either lost to follow-up, or was withheld.”

                And I sat down. I needn’t have worried about myself. A firestorm of invective began to hurl across and around the auditorium. There were scientists who provided evidence that the procedure was not only no good, but bogus. The authors’ responses were essentially, “how dare you?” The community of surgeons unanimously demanded that the data be produced forthwith, or they would send a letter of censure to the state. One surgeon even offered condolences for the poor sucker who had been inveigled into being the presenter.

                Like all the other interns and residents, I wrote papers and had a professor take credit with my name appearing at the end of a long list. I learned how to write an academic paper, how to evaluate data and evidence, and the difference between the truth and otherwise. I had already learned that from my father, who, despite other shortcomings, was always exactly and assiduously honest.

                Maybe this kind of thing shocks you. Maybe you think such things are better left unsaid. My question this time, is what do you think? And will this turn you towards or away from me as a fiction writer because I am not meek about exposes, although I do change the names and places to protect the guilty.

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