THE VULTURE and THE PHOENIX, by Carl Douglass, is the last and the longest of the fascinating six book series: THE SAGA of a NEUROSURGEON. This book of fiction reads more like reality from a not too far distant past.
As I said in my synopsis of Book Four, ACADEMIA: THE LAW of the JUNGLE, I lived through this era as a neurosurgical resident, an academic, and a neurosurgeon and neuroopthalmologist in private practice. In Book Six, Garven Wilsonhulme is no longer a resident training, and now is a fully competitive academic neurosurgeon in a major (albeit fictional) University of California medical school. He now has power, and he wields it with an iron fist in a velvet glove. He is held in awe and esteem by the residents and in a place of equality with his fellow staff men. He has almost arrived, but there are mountain peaks he has yet to ascend; and this man with an unquenchable ego and ambition will not be satisfied until he sits atop the pinnacle of his profession.
It is a publish-or-perish world, and one which the lazy or the timid would do well to avoid. Garven is well up to the tasks presented by the arena of academia. He moves quickly to solidify his position by introducing a novel surgical treatment for spinal cord transection that proves to be somewhat successful, a feat never before accomplished in the treatment of traumatic paraplegia. Early in his academic career, he is offered an advancement from his rank of instructor to that of assistant professor, if he will continue his work at the University of California Osterlund Memorial Hospital [UCOMH]—a fictional place—instead of giving further consideration to the offers he receives from three other universities. It would be considered ungentlemanly to question the veracity of the information about those offers. Garven knows that perception is as important as reality—and it does not hurt to have had a couple of decades of practice playing poker with Apaches.
Elizabeth goes into labor with her second baby, and is treated shabbily by her obstetrician–Garven’s former chief of obstetrics during his internship. That relationship had been frosty, and Garven’s refusal to kowtow to the great man’s authority while his wife suffers rankled the man. The professor of obstetrics makes one remark too many and learns of Garven’s terrible temper. Elizabeth is thereafter treated well, but the professor carries a serious grudge that he will one day use against Garven with full vengeance. Garven, on his part, takes his usual incriminating notes on the professor’s behavior.
Garven’s legend grows with the passing years. He passes his specialty board examination with flying colors, and saves his residents when they get into trouble in surgery; he achieves important assignments on the committees that matter in the hospital, in the university, in the neurosurgery division, and in national organizations. He publishes journal articles that astound his colleagues and bring him fame and fortune. His is a star rises rapidly to the top. He makes enemies along the way, not the least of which are the anesthesiologist from the VA, the chief of obstetrics, and a new one—the neonatologist who takes umbrage when Garven does not punish his chief resident for defying the baby specialist with a Napoleonic complex.
He is now known as the “Jonas Salk of paraplegia” and uses his large account of grant money to devise a use for a finding he made years before with his medical school mentor to develop a nearly innocuous surgical treatment for the universally fatal primary malignant tumor of the brain. He does not deem it necessary to give any credit to his first neurosurgical hero. He also does not make any effort to downplay the hyperbole of the press about his accomplishment.
He brings in friends to positions of authority on the neurosurgery staff and continues to curry favor with his former boss, Dr. Stark, all to solidify his position. He advances in academic rank from assistant to associate to full professor and is recognized as a comer in the UC system. He devises a previously unheard of fee-for-service plan to bring in more money to the university and to his fellow academicians thereby earning their admiration and gratitude. He befriends and treats the movers and the shakers of California and brings in a great deal of grant money. Garven Wilsonhulme, M.D., F.A.C.S is now one of the men with the Midas touch and the clinical following who is shaping the future of neurosurgery in California and the nation.
In 1967, Arthur Fletcher dies in compromising circumstances leaving his fortune to his only child, Elizabeth Fletcher Wilsonhulme , which makes her the richest woman in Arizona—and California, since that is where she now lives. Garven duly records the information about the circumstances of her father’s death but keeps it from her. His practice of deception expands to the use of his position on the National Institutes of Health (NIH)’s board of investigation for new drugs. He discovers a drug that an obscure non-MD researcher has worked on for years and can no longer afford to continue for lack of money. Garven turns down the man’s request and begins to work on a project of his own to develop the man’s useful drug. His secret efforts produce a drug that is an anti-tumor growth factor that not only works but brings Garven a patent, fame, and riches. He publishes multiple papers about separate elements of the drug and its effects, all of which contribute to the remarkably large and diverse bibliography of the boy from Cipher. In the minds of the public, Garven Wilsonhulme’s name becomes synonymous with the word “neurosurgery”. He achieves the chairmanship of the division of neurosurgery by devious means and gets it changed into a full department. The process takes a serious toll on his former supporters, and they will not forget his betrayal of them.
Garven uses his position to plagiarize yet another idea which joins his bibliography and cements his fame. He now makes more than half a million dollars a year and is asked to speak before every prominent medical group, on television talk shows, and before governmental policy committees. He becomes the president-elect of the foremost organization of neurosurgeons in the United States, and, indeed, the world. The Young Coyote is now the Old Man of Neurosurgery, a term of the greatest respect.
A career that meteoric is bound to plummet, and the career of Garven Wilsonhulme is no exception. His plagiarism is discovered as is his latest affaire de coeur, and his enemies within and without the university system beset him. His wife demands a divorce, but he counters in a myriad of cruel and effective ways. Finally, it all catches up with him, and he is forced to resign from his university and neurosurgical positions in ignominy.
However, he is still relatively young and not a forgiving sort. In the end, he gets not only a favorable divorce from Elizabeth, but also half of her money thus making him rich beyond his wildest boyhood imaginations. He tries his hand at corporate medicine and doubles his income and holdings. He exacts revenge.
Riches and vituperative power are his, and he uses them to their maximum. He then retires; but after marrying a thoroughly decent country woman, he begins to reassess his system of values and finds himself not only wanting but bored. He turns to his oldest friends, and together they find a solution to Garven’s problems and his life. That solution is a lesson in the achievement of true success.
I would betray Carl Douglass and his considerable effort if I were to divulge more. You will have to buy Book Six, THE VULTURE and THE PHOENIX, to learn more. And to get the full impact, get the rest of them. They are a treat and an education.
-Harvey Birsner, M.D., F.A.C.S.
Diplomate, American Board of Neurological Surgery
Fellow, North American Neuro-Ophthalmology Society
Clinical Professor, Neurosurgery, Univ. of Texas,
Southwestern Medical School, Dallas
Associate Clinical Professor, Neurosurgery,
University of Southern California, Los Angeles
Purchase your copies of “The Young Coyote”, “Anything Goes”, “Heaven And Hell” ,”The Long Climb”, “Academia: The Law of the Jungle” and ‘The Vulture and the Phoenix” here”.
Having discussed the new and interesting procedures being used or studied by neurosurgeons, it is time to throw a wet blanket on some of that. Evidence-based-medicine (EBM) is valuable and a stringent measure of what is effective, what is safe, and what is not. Insurance companies determine whether or not they will approve of or pay for procedures largely based on the evidence available. When there are large, carefully done studies—and especially a lot of them—regarding a treatment, EBM is a valid determinate of whether or not a doctor and/or a patient should chose the well-studied procedure or not. Let me add parenthetically that EBM is far more accurate than TV advertising or your aunt Minnie’s anecdotal experience. However, EBM has a limitation. Procedures that are well established but not recently studied; studies that have only small numbers of patients because only a few surgeons know how to do the operation; and studies that have only small numbers of patients because the disease condition is infrequent or rare, may not have and may never have sufficient data to rank them as EBM verified as effective and safe.
