A Brief History…

In 1965, I decided that, if I were to have a chance at one of the prestigious surgery programs in the country, I should travel east and, at least, visit them. Better yet, several friends suggested I should spend a few months there working as a medical student so that I would have been observed on an equal basis with the students from that school. One professor told me there was no chance that an eastern prestigious program would accept a USC student. He, himself, had of course been turned down by Mass General in spite of the fact that he had graduated from Yale Medical School. My first choices were Mass General in Boston and Johns Hopkins in Baltimore.

Our first leg of the trip was to Spokane where we spent time with friends, John and Sally Whittle. John had been working his way up in the insurance company, Mutual of New York. We had been friends since the Air National Guard and had gone hunting and fishing together for years. We spent a few days with them and their kids, then left for the east. We encountered the same construction tangles near the Montana border that I had seen in 1959. We even were forced to spend a night in the car. Once we got going, we swung south to see Custer Battlefield at the northwest corner of Wyoming. It is a very impressive sight. Even political correctness can’t do much to harm it.

Halfway to Chicago, the transmission in the old VW bus started to go. Irene had to hold her leg over the shift lever all way to Chicago to keep it in gear. Once in Chicago, my father paid to have it fixed, fortunately. After a few days’ visit we struck off again for Boston.

When we arrived in New York City, our friends from California met us and gave us a short course on New York life in August. It was interesting but did not leave me with a desire to spend more time there. We left, driving to Washington DC. Lyndon Johnson was president and a letter from our local Congressman’s office got us a tour of the White House. We were quite a sight with two small children arranged in a folding stroller with diaper bags piled on top.

The stroller looked so odd that a number of people stopped us to ask where they could buy one like that. Elaborate strollers are now fairly common but were unknown then. We visited Mount Vernon where we met a couple of other friends, then we headed north. We dropped off our California friends in New York who were going back to California, and headed for Boston.

Our entrance to Boston was at night and did not inspire confidence. We got off the interstate (called something else then) and wound up a strange looking side street. It was busy and crowded. We noticed an odd scene. Women were sitting in the picture windows of first floor flats with red lights illuminating them. We had discovered the red light district ! We got out of there and found a decent looking motel for the night.

The next day, armed with a map, we found the Mass General, located between Beacon Hill and the Charles River. Driving through the Beacon Hill neighborhood, we saw signs saying “No parking at any time,” then signs saying “No parking 9 AM to Noon, Tuesday.” They were on the same streets!.. We finally stopped a police car to ask about the signs and about parking. The two officers informed us that there was never any parking allowed in Beacon Hill but, on Tuesday when the street cleaner came by, the fine was higher. I asked where we supposed to park and their helpful suggestion was, “Sell your car.” Of course, while we had this conversation with the police, the street in both directions was solid with parked cars. I finally found a small gas station around the corner that would let us park for $20 / month.

Then we had to find an apartment we could afford. One basement office half way down the block on West Cedar Street, had a sign about rentals. We went in to inquire and were directed to the first floor inside. There, we encountered an artificial leg on the floor and a ladder. It turned out that the handyman who did the maintenance work (It appears he maintained the landlady, as well), had lost a leg and, when climbing ladders, found it easier without his artificial leg. After some discussion, we were allowed to rent a one bedroom flat on the second floor. This was good spot because I could walk to the hospital a block away.

The whole area had been the subject of recent slum clearance ( multistory buildings on West Cedar Street were for sale for $1 from the city if the buyer would rehab it.) and looked like recent war zone. Halfway to the hospital was the famous Scollay Square Station of the MTA mentioned in the popular Kingston Trio song. About five blocks away was Faneuil Hall, famous in American history and two large brick warehouses, mostly empty, that became famous as the Faneuil Marketplace and a nightclub scene. In the center was the Bullfinch market building, then a produce market, now the Quincy Marketplace, part of the huge entertainment district. At the time it was populated by produce vendors and a few drunks. One day, after I had been there a few weeks, we drove by the market and sitting on the steps was an old drunk whose head I had sewn up in the EW. He had been mugged and thrown into the Charles River which was a sewer. Of course, his wound had become infected and there he sat with my stitches still sticking out of his forehead and pus running down. I stopped and told him to go to the post-treatment clinic but he ignored me.

I walked over to the hospital after we got settled and found the Director of Training, George Nardi. He had no problem with me doing a clerkship after I showed him my letter. In fact, I was accepted by everyone very easily. The day’s schedule began about 7 AM with rounds on the ward. I was assigned to the West Ward (West is best) , run by Chief Resident Dave Skinner. There was fierce rivalry between the two wards and, when Harvey Cushing returned to Harvard in 1911, both wards refused to accept him, even though he was a Harvard graduate and the most famous surgeon in the world. In the insular world of the Mass General, he was not welcome. At first they arranged a third surgical service for him but then the Peter Brent Brigham Hospital opened and he moved there; the MGH third surgical service disappeared.

After rounds, everybody had a case to do, the complexity depending on status. The students were given other tasks. I gave ether anesthesia for a number of surgery cases, some of them fairly complex. Ether was an obsolete form of anesthesia but tradition ruled. AT LA County, I was later to learn, it was only used on infants because it was safe in inexperienced hands and did not require an IV.

Irene had a lot of fun learning about Boston drivers. They would double park and lock their cars, often in front of Filene’s Basement, the discount store of the era.

While there, I met many famous people (The point of the trip) and learned a lot about prestigious surgery programs. My first choice was Johns Hopkins but Alfred Blalock, the former chairman, had recently retired and died of cancer of the ureter. His place had been taken by C Gardner Child, a liver surgeon from Michigan. I was not enthusiastic about this as I was most interested in cardiac surgery and had wanted to train in Blalock’s program even though it was a pyramidal one and there was no guarantee of the chief residency. Blalock’s expected successor, David Sabiston, had inexplicably been denied the job by the board and had moved to Duke University where he did a fantastic job. This had happened recently and I did not know how it would turn out.

This was discouraging to me and I decided to go to Mass General if they would accept me. The months at Mass General were educational in several ways. Ben Castleman, the chief pathologist had a session he called “surgery conference” in which he went over each surgical specimen removed that day with the students. He explained the pathology and the pathogenesis, or the course of the disease. There I saw appendicitis in all its stages and cancer of various organs. Castleman was a wonderful teacher.

Wyland Ledbetter, and his nephew, Guy Ledbetter who always wore the same tie, a red one with a story of the life of a bug imprinted on it, ran the urology service. They let medical students assist in surgery and were quite patient. The chief resident in urology, Elwin Fraley, was less patient and taught me the basis of the joke about medical students cutting off excess suture tails in surgery. “Do you want it too short or too long.” All of these people were, or would be, world famous. Wyland invented the ureteral reimplantation operation for reflux, which saved thousands of children’s lives. It also led the way for such things as kidney transplant.

We spent weekly sessions with a famous and elderly surgeon who had been a pioneer, along with Ben Castleman, in parathyroid surgery. His name was Oliver Cope. He also was chief of the burn service at the time of the Cocoanut Grove fire in 1942 that killed hundreds and began the modern treatment of burns. He wrote an entire issue of Annals of Surgery on the event and the lessons learned. He was quite an interesting and friendly man. He told us that he and his future wife had been at the Cleveland Clinic when that institution had a famous fire. The fire was in the x-ray department and killed 123 people, including many doctors and nurses. The fumes from burning celluloid film led to the introduction of safety film, made of gelatin. The Coconut Grove fire included many similar inhalation injuries and most of the deaths were from inhaling the same sort of fumes as had occurred in the Cleveland Clinic fire.

The two most famous clinical surgeons there at the time were Claude Beck and Marshall Barlett. We didn’t see that much of them except at Morbidity and Mortality rounds, or “M&M conference.” There, every case from the previous week was discussed and every death or complication classified as “error in diagnosis, error in judgement, error in technique, or patient’s disease.”

One of my opportunities to assist was with a hand surgeon from Maine, named Hannibal Hamlin and undoubtedly a descendent of Lincoln’s first vice-president. The surgery was for Dupuytran’s contracture , a contraction of the palmar fascia that causes the fingers to flex and remain flexed. As it happened, the surgery was on a man who was first violinist in the Boston Symphony Orchestra.

One day in November, just as the M&M conference was getting started, the lights went off in Boston. Irene was at a friend’s house and was just screwing a new light bulb into a fixture. As she did, the lights went out. She though she had somehow done it but, when she turned on her car radio going home, she heard that the lights were out all over the northeast. They stayed off for hours as the new power grid that was supposed to prevent this, had failed. Worse, the hospitals had been convinced to disconnect their emergency generators since the new grid was supposed to be more reliable. The Mass General was reduced to boiling instruments.

We made a few more trips to visit relatives in Maine, then headed for home. Irene’s mother joined us for the ride back and was a good trouper through our trek. When we got home, having discovered that our canaries had died while we were gone, Irene announced that she hated Boston and would never go back. So much for the purpose of the trip. It was a bitter disappointment for me, especially as I later learned that Johns Hopkins had chosen me for the internship and could not understand why I had chosen LA County first. They didn’t know my wife. Life for me might have been very different. I’m afraid I never quite got over the resentment and we were divorced in 1978.