I was warmly welcomed back to St. Vincent’s by the entire department. There were quite a few new faces, as the residents I formerly worked with had all completed their training and moved on to private practice except for a few who remained on the teaching staff. One of my old friends, by the name of Kevin Reilly, had joined the teaching staff as a member of the group the department chief was in. Since I had had so much experience in the military, I advanced a full year to become the chief resident along with a nun who had joined the program right after I had left. The attending physicians that I knew from my prior year were all pretty surprised, as well as the department chief, at how much my knowledge and skills had progressed. They still were determined to advance me even further and it proved to be a very busy but rewarding year. I felt very comfortable to be back at St. Vincent’s and I am still very happy I made the decision to return there. Kathy and I bought our first new car, a Pontiac Bonneville, and every morning at 5:30 she would get up and drive me through the Lincoln Tunnel to the hospital and return late at night. It was quite a trek commuting, but the rewards of not living in the city were much greater. We had become used to the suburbs again, which we loved, and there we hoped to stay. I worked extremely hard being on call pretty much every day and night for a whole year except for two weeks of vacation. Each operation that I did taught me either something new or gave me more confidence in doing what I already knew. That is the year in surgical residences that doctors get to do the most surgery and I was quite lucky to be as busy as I was. The time I had in the military had given me quite a bit of experience and, the more cases I did the better I felt about it.
There were many new developments in the field of Obstetrics. The two most important were fetal monitoring and the use of ultrasound both in Obstetrics and Gynecology. Fetal monitoring was just in its infancy and it took many years of observing the fetal heart tracings for us to determine which signaled the baby was in trouble and needed to be delivered immediately and which could just be followed closely. Although we know a lot more nowadays we still occasionally get surprises when a baby is in more stress than we realized and vice versa when we think a baby is in trouble and, after doing an emergency Cesarean section, out pops a nice healthy baby. Of course, the latter is the more favorable outcome, but it also explains the high rate of Cesarean Sections currently being performed. There are still pretty good arguments for and against it as the perinatal mortality has not changed for the better as we would have liked to have seen. It was interesting, however, to be in on the ground floor of this milestone. The earliest machines I would liken to the Model T Ford as compared to the newer Ferrari’s that we have today.
The use of ultrasound, also known as a sonogram, was another major advance in Ob/Gyn. In Obstetrics, it enabled us to look at the fetus from the earliest stages of development up until labor and delivery without the risk of x-rays. I personally feel that it was the more important of the two, but they both have changed the practice of the specialty in major ways. The unfortunate side effect is that it has given patients the misconception that a normal appearing sonogram done around the fourth month of pregnancy guarantees a perfect baby at birth, which is not the case. Many lawsuits over what is called “wrongful birth” in which an abnormality is missed on ultrasound have resulted in massive jury awards. The only way to guarantee a baby will be perfect and without any birth defects is not to have one. Nature is not perfect and somewhere around three to five percent of babies born will have a congenital abnormality. So as valuable as that advancement has been, it has not come without its drawbacks and expectations beyond its capabilities. The procedure itself has had major refinements over the years leading to the detection of more and more defects, but it still is not perfect and I doubt ever will be. The use of ultrasound in Gynecology has helped us greatly in the early detection of diseases of the uterus and ovaries in particular. The detection of ectopic pregnancies, management of ovarian cysts and tumors, and the early detection of ovarian cancer have all become possible because of that technique. I have been fortunate to see this all happen which has brought about so much change in the way my specialty is practiced. There have been more changes in the past 30 years than occurred in the previous hundred. Who knows what the next hundred years will bring? Will parents be able to put in an order for a blonde, blue-eyed girl or a gifted, athletic-type child? Will we destroy those who do not meet our expectations? Will we be able to do away completely with certain types of diseases and finally achieve the super race Hitler had dreamed of but pursued in the most cruel fashion? I am sure the possibilities are endless as mankind’s knowledge expands but we must use these tools wisely and always with a sense of morality.
At the conclusion of my year as chief resident, which technically was only my second year, the program was faced with the dilemma of what to do with me for the next year. In order to become board eligible in Ob/Gyn, I needed to complete four years of formal training. So even being given credit for a year based on my military experience, I still needed to complete another year. The department chief came up with the concept of an administrative chief resident for my next year. That also would enable the next person in line behind me to have their year as chief resident. I was given supervision of a lot of the formal training of the residents. I made out all their schedules and supervised all the lectures for them. It also enabled me to pick and choose what surgery I wanted to do. Many of the attending physicians let me do surgery on their private patients, with them present of course.
The most beneficial part of my last year was that I didn’t have as much night call as before. I basically just had to fill in when someone was sick or on vacation. On September 22, 1975, our first son, Pieter Jan Ketelaar III, was born. He was the 14th first son of each generation in my family to be named Pieter Jan and, besides me being a proud father, my father was thrilled the tradition would live on. It also meant that I would soon have to make the difficult decision about where and with whom I would go into private practice. That year went by pretty quickly and, with the extra time I had, I spent a lot of it either studying, teaching, or trying to finalize the plan of where our family was going to live. Because of my father’s seafaring background, I had a keen interest in practicing somewhere near the water. Florida immediately attracted my attention because Kathy and I had been so happy there in the military. I contacted my friend Jeff, who had wound up practicing in the Miami area and he put me in contact with a couple of groups who were looking to take on another partner. I also was told that, if I wanted, I could stay on in the department at St. Vincent’s and teach. I was quite humbled with that offer because of the reputation of the institution and the people involved.That really interested me but I knew it would take quite a sacrifice to raise a family in New York City. Ultimately Florida won out and we headed down to Miami for an interview with one of the groups. The practice that was available was a five-man group headed by an older Southern gentleman and I mean Southern. Having been partially raised in New Orleans, I understood what that meant but I really considered myself to be a Yankee for all practical purposes. The offer involved a pretty good salary with raises over the next three years at which point I would become a full partner. The only caveat was that, at that point, I would have to buy into the practice with an amount to be determined by the group. So we went back to New York very interested in the Miami offer but with a few reservations.
With a few months to go and some pressure by the group in Miami to make a decision, we chose their offer and signed a contract to go there. It was not an easy decision as the people at St. Vincent’s had been very good to me and I really was interested in pursuing a teaching career. But ultimately, the decision came down to which was the better place to raise a family and Kathy and I both agreed it was in Miami. Shortly after I signed the contract, one of our attendings who Kathy had worked for met an old college friend at a conference who was in practice at the Jersey Shore. He happened to be looking for a new partner also. He asked me if I would be interested in meeting with them but, at first, I said no that I had already signed a contract with the group in Miami. Over the next few weeks, he kept after me that they were a group of really nice guys and I should just go down to the Shore and hear the offer. I finally said ok, I would meet with them, but I was pretty sure I wasn’t interested. So I contacted one of the partners of a group called Pineland Associates in Ob/Gyn in Point Pleasant, New Jersey, and we arranged to meet.
One Saturday morning in May of 1976 I met with the two doctors who were looking for a new associate. Kathy and I along with our 8-month-old son met in the parking lot of a restaurant called the King’s Grant Inn. Who knew that would be the start of my relationship with Pineland for the next 39 years. After exchanging the usual formalities, they took me to the hospital where they practiced. Point Pleasant Hospital was a lovely small community hospital located on the Manasquan River in Central Jersey.. I was starting to get interested as we toured the area and observed the beautiful beaches, rivers and Barnegat Bay. It was a beautiful day and all the sailboats on the bay really caught my attention. We ended the tour at one of their homes in Wall Township where we discussed the offer in greater detail. Little did I know at the time this would be our home town for the next 40 years. I would be one of three in the group. They were currently in a five person group but the older three were going to give up Obstetrics shortly and practice Gynecology on their own. The initial money was not quite as good as the Miami offer, but both the doctors and their wives were much more friendly than the ones in Florida. In fact I had never even met all the Miami doctors or their wives. I told them that I had already signed a contract in Florida, but we would consider the offer and get back to them. The only thing I didn’t like was that I would be working every third night instead of every fifth. As we drove back to North Jersey, we began to have a few doubts about Florida. They gave me a few days to think about it and then began to call on a daily basis looking for an answer. I didn’t know if I could even get out of the contract in Miami, so I gave them a call and told them I was beginning to have a few doubts about their offer. I was told that if I didn’t want to join them it was ok with them, the decision was all mine. So the situation was one group really didn’t care much either way and the other wouldn’t leave me alone. So that’s how I ultimately wound up at the Jersey Shore. After the usual review of the contract by lawyers on both sides, I became a member of Pineland Associates. But because I returned to St. Vincent’s early in August after my military obligation, I would have to delay joining the group until August 1, 1976.
Once again, as luck would have it, one of the patients I took care of during my residency had a home at the Jersey Shore and kindly offered to rent it to us until we found a permanent home of our own. So as things began to fall into place at the Shore, I was winding down my time at St. Vincent’s. It was a bittersweet feeling to be leaving there, but I was most anxious to start the private practice of medicine. During the last few days of my residency, there were the obligatory customs, rituals and partying to go through. One custom was that on the last day of residency a Cesarean section was to be performed by the two chief residents. What was unique about that was it was a timed event which would be compared to the best previous times. The record for the surgery from start to finish was 17 minutes. Well, my partner and I were close to the record but our time of 17 minutes and 20 seconds was just off. If we had been lucky enough to have had one less blood vessel to tie off, we might have broken the record. This may sound quite frivolous, but it was well supervised and if an error was detected it would lead to an immediate disqualification and the problem would be taken care of. The chairman of the department always held a going-away party, which pretty much consisted of a roast by our junior residents. It was their way of getting back at us for all the hard work we had put them through over the years we were together. It was a lot of fun and exposed many idiosyncrasies none of us realized we had. Presents were exchanged and kind words from the chairman left me with a very warm place in my heart for those people who had taught me so much. I will never forget and feel privileged to have been trained at St. Vincent’s Hospital and Medical Center. That feeling is even stronger now that it was closed and torn down in 2010. I cried when I heard the news. At the end of the last day, the other chief resident and I, would have to visit and imbibe at as many of the local pubs in Greenwich Village as possible. It was quite an evening, most of which I have no memory of. My training was finally OVER. The long hard years of college, medical school, internship, the military years and my residency were supposed to get me ready for that moment in my career. Like most upon completion of their training, I felt very confident that I was ready to practice on my own. Theoretically I was trained to handle any emergency that I may encounter. Obviously that is impossible but expected nonetheless. And no physician just after completing his training thinks that he or she can’t handle any situation they may be called on to treat. No longer did I need someone standing over my shoulder offering me advice on how to do something. And yet I was very thankful for all those who spent the time to pass on to me their knowledge and skills. The system of passing on this knowledge to those who follow is so important in medicine. It is something that is so important that it is part of the Hippocratic Oath. It would be impossible to build upon our basic knowledge without that process. But for me, my apprenticeship was finally over. I was very proud to have completed all those years of hard work and sacrifice. There were many times that I had thought about quitting but it was finally all over. I had made it to the end and what a journey it had been. I was 33 years old and I felt ready and well prepared to begin to offer my future patients the skills I had amassed over those years. I was filled with a deep sense of accomplishment that I cannot fully explain and I reveled in the fact that my dream had finally come true. I really was a fully-trained Doctor of Medicine and no one could ever take that away from me. But I also thought about all the people who had helped me along the way and without whom I would have never made it to this day. How could I ever repay them for all they had done but to continue their sacred tradition and promise them I would pass on my knowledge to the others who would follow me.
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