Читать книгу Confessions of a Park Avenue Plastic Surgeon - Cap Lesesne - Страница 9

After a short lifetime telling myself I was going to do something, anything, but be a doctor, which I saw as a dignified, meaningful, admirable, quiet, unadventurous, even boring livelihood, I started to think only about life as a doctor. Part of it was the realization, while sitting in science courses in college, that the material came easily and felt so familiar, yet I found it stimulating, too. There were formulas and constants, hard facts and other immutables, but science was always changing, too; one piece of knowledge was always built on the back of another, and another would one day be built on that one. To me, that evolution was more animated and exciting than what I learned in the arts and humanities and social sciences, as much as I enjoyed them.

I had what amounted to another epiphany. Of course, one of the reasons I respected my father and his work so much, and the reason he was respected so much by others, was simple: He helped people. He made their lives better.

My realization? What life could I possibly carve out – crisscrossing the globe, being involved in high-powered deals, you name it – that could outdo, for personal fulfillment, a lifetime of helping people? Dad made kids with asthma breathe a little better, so in the summer they could run around like kids. He helped old people. He helped women and men and families.

I could do that. I wanted to do that.

I’d found something exciting, something important, and something I was passionate about: medicine.

By the time I returned home for Christmas break, my grandmother had got wind of my interest, and she arranged for me to meet Dr. Henry Ransom, a longtime acquaintance of hers who was professor of surgery at the University of Michigan. On a snowy December day, Grandma and I drove the hour and a half through a snowstorm to Ann Arbor, to meet the doctor at University Hospital. Dr. Ransom had grown up on a farm in central Michigan, Grandma told me on the drive, and he was known as a great teacher and an excellent surgeon. He had neither wife nor children. He was in his eighties now, a professor emeritus.

When we pulled into the parking lot, it was the first time I’d ever been to a university hospital, and it was not at all like Dad’s hospital – St. John’s in Detroit, the inviting, humanly scaled institution my father had been affiliated with since I was a kid, the place I felt so eager to stop in to see him, always feeling comfort inside its walls, even pleasure. But this place, University Hospital, was gigantic, cold, impersonal. For the first time, I understood the anxiety that ripples through most nonmedical people when they set foot inside any hospital.

While Grandma and I rode the elevator to the top floor, I wondered if perhaps this place wasn’t the norm, St. John’s the exception, and whether I needed to reevaluate my new, curious, nineteen-year-old’s urge to spend the remainder of my waking life in dungeons just like it.

Had you hung a stethoscope around Henry Ransom’s neck and slipped a black leather doctor’s bag into his hand, you could not have made him look more like the classic physician. When we got to his office, he was sitting behind a big desk, in his white coat. My eyes immediately went to the surgeon’s long, thin fingers. Dr. Ransom looked the epitome of an emeritus anything: white-haired, elderly, elegant.

After some pleasantries, the doctor asked about my background. I told him I was at Princeton. Despite my unexpressed reservations in the elevator ride up about the hideousness of University Hospital as a workplace, I said I’d become interested in pursuing medicine.

“Would you want to work in our department of surgery?” he asked me.

The offer was so sudden, and he knew so little about me, that I thought he deserved an equally impetuous answer.

“Yes,” I said, having no idea what the job entailed.

And just like that he was up from behind his desk and motioning for me to follow him. “I want you to meet someone,” he said, and we walked into the neighboring office, where a balding, slightly overweight man sat.

“Jerry?” said Dr. Ransom. “I think this young man would be a good researcher.”

That was it. My grandmother must have been well regarded by the doctor, I thought, because unless I was wrong, suddenly I had a summer job waiting for me the end of sophomore year, in the department of surgery, at the University of Michigan. And I had yet to take organic chem.

To his credit, the man to whom I’d just been introduced, Jerry Turcotte, the chief of surgery, didn’t act put-upon (which said a great deal about his respect for Dr. Ransom). Dr. Turcotte had an easy smile. He’d grown up in Grosse Pointe, too, it turned out, two blocks from my house on Fair Acres Road.

“I know just the spot for you,” said Dr. Turcotte. “We’re doing research for kidney transplants.” Quickly, I was realizing – though I’d had ample evidence to learn it while growing up, from my father the doctor – that medical people, especially surgeons, don’t pussyfoot. They don’t have time to. They make bold decisions – quick, yes, but bold, first and foremost.

The “research” they had in mind for me that summer, it turned out, did not involve my poring over a bunch of medical texts and data readouts.

They wanted me to cut open dogs.

The doctors in the department were working on an important experiment. They wanted to see if a particular drug, administered just after surgery, would improve the rate of acceptance for kidney-transplant patients. Back then, in the mid-1970s, a kidney transplant was a last-ditch, usually unsuccessful strategy to cure someone suffering from kidney failure. But it was hypothesized that if the patient was given cyclosporine, which reduces the body’s rejection of foreign cells, transplants would be much more likely to “keep” and could thus save thousands of lives a year.

Cyclosporine had already been tested on rats, with extremely promising results. It was time to move up the food chain. But before Dr. Turcotte and his team could win approval to test cyclosporine on humans, they would first have to test it on something else.

Dogs. And not just any dog. A specific strain of beagle – one that looked an awful lot like Snoopy from Peanuts – was chosen as the, well, guinea pig, because its DNA displayed important similarities to human DNA. Before the dogs were operated on, they were pampered and fed only the best food (should you wonder if the animals were being mistreated). Two surgical teams would work side by side. The dogs were sedated, a pair at a time. Each was spread-eagled, on its back, its paws gently tied back. A breathing tube was placed down its throat. Each surgeon would cut open a dog’s abdomen, nudge the intestines aside, and isolate the veins and arteries; this was done by dissecting down to where the artery comes off the aorta and the vein comes off the vena cava – the two main valves leading to and away from the heart. The surgeon would dissect on the ureter (the vessel running between the kidney and the bladder) and cut the blood vessels around the kidneys, to free them. The vessels would be tied and clamped so blood didn’t gush out of them. With the kidneys now free, the surgeon would remove them and put them in a bowl, swap bowls with the other team, then plant the foreign kidneys into their new host dog, suture the vessels together, remove the clamps, and make sure there were no leaks (or that we hadn’t accidentally sewn a blood vessel to itself). The abdomen would be sewn up. Cyclosporine would be administered.

It was a straight kidney swap. Very science-fictional.

Finally, blood would be drawn from the dogs to see if the new kidneys were working. Was waste being cleared – proof that the kidneys were doing what kidneys should do?

My “research,” then, was doing actual surgery, right alongside other surgeons, residents, and researchers. The lab administrator put me through intensive training, teaching me the surgical ABC’s – what the instruments were called, what they did, different types of sutures, how to make knots. In my life to that point, I’d cut open all of one frog, in biology class at Andover.

Three weeks after my training began, I was deemed ready to do transplants.

At first, I felt clumsy and pathetic. I put my thumb and index finger through the holes of the instruments so that I had a firm grasp of them, but it didn’t feel natural. Gradually I got to see – got to feel – that if I covered the hole with my palm and exerted pressure with and through my palm, I could move faster and more dexterously. (This technique, called palming, I’ve employed in every surgery I have done since.) At first, I held the scalpel too far down the instrument and way too tightly – more rookie mistakes – but as I grew adept, I realized how lightly I could hold the scalpel, and how far up the shaft, and that doing so allowed for more sensitive touch.

Perhaps as important, the experience that summer gave me my first whiff – and I do mean whiff – of a rough-edge sensibility particular to many surgeons. One day, a pair of surgical residents operating on the beagles kindly offered to show me the intricate and fascinating anatomy of the aorta and vena cava.

“Hey, Cap, look at this,” said one of them, leaning forward and urging me to join him for a closer look at the beagle’s interior. He assured me it wouldn’t hurt the dog because retractors were in place in the abdomen to keep the ribs spread apart.

I leaned forward for a look – at which point the other resident, who’d tiptoed behind me, shoved my face into the dog’s abdomen.

I will never forget the stench of warm canine abdominal cavity.

I shot out of there, blood on my glasses and forehead and mask, and staggered back, head spinning.

“Welcome to the surgical corps,” chided one of the residents, though I couldn’t see which one.

I groaned weakly, teetering in the direction of a window, to replace the smell in my lungs with fresh Midwestern air.

Just then our supervisor walked in. He seemed to know right away what was going on – not that it took a genius. The scene – residents laughing; me, distressed, wiping blood off my glasses – was fairly self-explanatory.

“You boys are in big trouble,” the supervisor warned the residents. Their laughter ceased immediately. Even in my fog I noted my surprise at how genuinely scared they looked.

My head had stopped spinning. I was no longer going to heave.

“We were just having some fun,” I said, shrugging. The supervisor looked at me for a moment, expressionless, then walked out of the room. He never said a word about it.

When he’d gone, the residents smiled at me, grateful.

But I was the grateful one. I was just a kid, yet they’d initiated me into the medical fraternity, where both friendship and rivalry are unusually intense.

As to the kidney-transplant research: It was a spectacular triumph. We succeeded in showing that, at least in this breed of beagle, using cyclosporine as part of kidney transplants helped greatly in the acceptance of the new organs. A paper would be published about it, with Dr. Turcotte’s name on top, and my name mixed in somewhere with the team’s. Years later, the drug was approved for use in human kidney transplants, and a once risky procedure became fairly routine. Today, a kidney transplant involving a living donor has a 90+ percent chance of success. Dr. Joseph E. Murray, the man from Massachusetts General Hospital and Brigham and Women’s Hospital who had, a generation before, laid much of the foundation for all transplant surgery, would win the Nobel Prize for Medicine for his contribution – the only physician, amazingly, ever to win the prize.

The team’s success was a perfect example of what I mean when I say scientific knowledge builds on previous knowledge to increase understanding and better people’s lives.

Just as important to me back then, not one single beagle died during any of the surgeries that summer. Not one of those opened and closed by the surgeons or residents, or by me. My childhood dog, a blond Lab named Fresca, would have approved.

Thanks to Dr. Ransom, Dr. Turcotte, and the rest of the team, my decision to pursue medicine seemed vindicated. And I was grateful for the way they had included me, the youngest guy there. A kid never forgets who’s been good to him.

For all my feeling for those men, though, I did not want to be a surgeon. I had decided on another branch of medicine, one that delighted my mother and thrilled my father.

I was going to be the world’s greatest pediatrician.