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.