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?