After graduation there was not much time to celebrate as my internship period began one week later on July 1. But by then we were so anxious to begin our lives as doctors that I don't think many of us cared much. So off I went to St. Elizabeth's Hospital in Elizabeth, New Jersey. St. E's, as we called it for short, was best described as a medium-sized community hospital right in the middle of the city. By a community hospital I mean that it was not a full teaching hospital with residents and interns in every specialty. Besides a rotating internship program, the only residents were in internal medicine. It was a step up from Newark in regard to its cleanliness and safety issues but it still had a fairly large clinic population. What was really new was that we were also exposed to a large number of private patients. That was the start for me to be involved with and learn how to care for private patients who were actually paying for their care. Not that they received any different care, but it was a matter of how it was delivered. It was there that I learned how to explain illnesses to patients and how to respond to their questions. Without a doubt that helped me very much in forming my bedside manner. So I will always remember St. E’s for that important contribution to my medical career. A classmate of mine from the medical school joined me at St. E's, which helped quite a bit because we were the only American house staff members at the hospital. All the other interns and residents were from other countries and most had been trained in the Philippines.
So there we were on July 1, brand new interns and anxious to start our careers as doctors. Once again, however, we would learn that we still had a long way to go in our training until we could really function as a practicing physician. But it was an exciting change and I still remember how nice it was to not be at the bottom of the totem pole. We did not have medical students on a regular basis, so all the scut work would again be performed by me. Day one was filled with the usual paperwork, however, we were now asked for our Social Security numbers because for the first time, we were going to get paid for our work. What a novel idea! There I was 27 years old and I was about to make my first dollar. Not many dollars, I must add, so my parents were kind enough to continue to support me. As best I remember, I was paid somewhere in the range of $7500 for the entire year's work. But all in all it was still a big deal to me to finally have some money of my own in my pocket.
So following a brief introduction to the hospital and a talk by the Chief of Staff, we went to our first assignments. Because I knew by then that I wanted to be an Obstetrician/Gynecologist, I had asked to start on that rotation. So off I went to the labor and delivery suite where I was to meet with the department chairman. He was a man about 55 years old and was quite dapper looking with a large amount of well groomed grey hair. His name was Dr. Paul Andreson and he would teach me quite a bit about the specialty. His background was quite impressive. He had been trained in the military and served quite a while at Walter Reed Army Hospital. In our private conversations he shared a lot about the military and his life as a military physician. I think that started my interest in the military and as you shall soon see the military would play a large role in my life and training. A stern individual, he was a perfect role model for me for he was all business. He did have a kind heart which he displayed in private to me and in public to all of his patients. He was quite instrumental in shaping me into an Obstetrician. He also was quite involved in getting me a residency at a pretty prestigious institution. I owe him a lot for all he taught me and I will always remember him fondly.
July 1 at any teaching hospital is when new interns and residents begin their training. My best advice is that you should not get sick or be in a hospital on July 1. Every doctor in training happens to be beginning a new level of training that day. Therefore, all the house staff is brand-new to their jobs. That could be of a little concern to a patient who is being cared for by a brand-new intern or resident. I, therefore caution that if at all possible, you not be in a teaching hospital on that day of the year. If you are unlucky enough to be in a hospital as a patient or have to visit the emergency room, you should be aware of the fact that the doctor you are seeing is definitely new to the job. I know I was quite nervous about my duties on that day and I'm sure it showed. I also know that other doctors and nurses are aware of that day and I'm sure everyone is a little more concerned than usual. Speaking of nurses, these first few days with them were quite interesting as they are sizing you up and vice versa. First opinions, as we know, are very important so it is a time where everyone is testing each other as far as personality, competence, and level of trust. That is not a unique occurrence to the field of medicine, but I assure you it happens and is probably a healthy thing that it does. As I have said before medicine is a team profession and it is very important to know your team members and their capabilities. Knowing their level of expertise can be very important in seeing how they will function on the team.
After my meeting with Dr. Andreson, he gave me my schedule and I was introduced to the head nurse. As we did not have residents in OB/GYN, she was to be my guide through this area of the hospital. As you may recall, I had met her previously when I was there as a medical student so I knew her and how demanding she could be. The first thing she did was to remind me of how I had knocked myself out my first night on call. "How is your head feeling these days doctor” she asked with a grin. Although she was tough, I considered it a privilege to work with her and, eventually, she did expose her warm side to me in many ways. Throughout my career I have come across people who I would best describe as outstanding at their job and she was one of them. Those people all have similar qualities and while they all have their own personalities they go about their job in a very similar way. Ms. Starger was in her mid-to late 40s, single and very dedicated to her profession. Nursing was her life. Her job involved running the labor and delivery suite, nursery, and postpartum floor. That meant she had about 25 nurses that she was in charge of, creating schedules, and dealing with any problems that patients had in the department. She knew each and every one of her nurses quite well and demanded that they be treated with respect at all times. I think that is what I remember most about her. She wanted and expected her nurses to be respected at all times. She was a person that just seemed to be made for her job. I would come across a very similar woman in the military and, at times in my mind, those two ladies could have been twins. Not obviously in how they looked but in how they went about their jobs. They just had a way of making it all look easy and yet they were so involved with running a complicated area of the hospital. Ms. Starger was feared and respected by her nurses and interns alike and you could not help but respect her. She wanted to make sure that you were working at your best at all times but she was always willing to help with problems be they work related or private. I can tell you she ran one of the smoothest departments that I have ever been in and I thank her for the many things she taught me.
One by one I began to meet and work with the private attending physicians. Each had their own style of caring for their patients and I think I managed to bring a little of each into the way I would care for my own future patients. One of them, Dr. Goodkin, was a real character and sort of took me under his wing. He was one of the most popular Ob/Gyn doctors at the hospital and a real innovator. He was the first physician in the area and indeed in the state to use a new but now common method in Obstetrics called the Lamaze technique. Briefly, this practice involved various breathing techniques to minimize the use of pain medication in labor so the patient would have a healthier, more alert baby at birth. He took it to a new level when he would actually have his patient walk with him from the delivery room to the postpartum floor. Many times we would kid about how far the patient would get before they collapsed but his patients for the most part, did extremely well. The point was that labor and delivery was a natural event and did not need to be masked by medication and anesthesia. It was quite a departure from the old techniques that involved literally sedating women in labor to the point that they didn't know who they were or what was going on. This was combined with the use of general anesthesia for delivery of the baby. These women literally did not remember anything about the birthing experience. One of those techniques involved the use of a drug called scopolamine. If patients were "scoped out” they were not aware of anything that was happening. You could be the worst patient in labor, screaming, hollering, and swearing and yet the next day they had no recollection of the event. I never was very fond of that method, but I can tell you I did use it many times in my career with difficult patients. I was really lucky to be training at that time because I was exposed to a lot of different techniques which I would make use of in the future. Several times Dr. Goodkin would take me with him in the evenings as he traveled around the state giving lectures on the new technique. He was quite charismatic, always dressed impeccably, and loved to smoke cigars. He even took me to his office and I observed firsthand how he cared for his patients. They absolutely loved him and it was easy to see why. One of the interesting touches in his office was that the stirrups on his examining tables were mink-lined. Of course, nowadays that would not sit well with the animal-rights activists but, at the time, it was just his way of making his patients feel special. Years later, I would come across some patients in my office that he had delivered and they would speak of him almost as a God. At that time he was in solo practice and I saw how dedicated a doctor would have to be to do Obstetrics alone without a partner. I soon found out that I could not and would not ever be a solo practitioner. It was just too demanding, both physically and mentally and, yet, I met a few of them who were able to do it so well and their patients obviously just loved it. But they paid a price for it in their health and family life. In my opinion, it is just too stressful a specialty to do it alone. He was a very special man and a key person in my education to whom I owe a great deal.
Several of the other Ob/Gyns were also very good to me during my rotation. They too each had their own little quirks that made them stand out from their peers . Those men, as there were no females yet in the specialty, taught me a lot about how to deliver babies. Several of them allowed me to deliver their patients, with them present of course. Each taught me a little something different and I would file all the little tricks and methods away in my mind and would use them in the future as the need would arise. So little by little, I was forming my own style, but it really wasn't my own, it was a compilation of the many different styles I had been fortunate enough to be exposed to. I think that is the way most physicians round out how they practice medicine. They knew I was interested in being an Ob/Gyn and they went out of their way to help and teach me. Each day I was learning a little something new in the process of my training. So as you can see it is composed of many little but important steps. All of those men were excellent representatives of our specialty and I thank them for each and every contribution they made to my training. They truly played a big part in forming me into the Obstetrician and Gynecologist I would eventually become.
Besides labor and delivery, the other place I would spend most of my time was in the clinic. Like in Newark indigent patients from the area were seen there. They were patients who did not have private health insurance, or, were unable to afford to have a private physician. The care of those patients went to the house staff. It was a great place for us to get first-hand experience in taking care of Obstetrical patients. Those patients were ours and we took a lot of pride in how well we took care of them. It offered us an opportunity to follow patients throughout their entire course of pregnancy, labor and delivery. Of course we had the supervision of the department chairman and the other attendings who were also in the clinic with us in the event we had questions. It was there that I met another pivotal person in my training. Dr. H. Riva saw his private patients in the clinic and we were able to observe his special care of cancer patients. He, like the department chairman, was trained and practiced medicine in the Army at Walter Reed. He was one of the first Gyn oncologists in the country in what was becoming a new super specialty. Prior to that most Gyn cancer patients were cared for by general surgeons because they needed radical surgery and, at that time, they were the only doctors trained to do that type of surgery. Dr. Riva was a very tall, imposing figure being about 6 foot five and around 250 pounds. He was a legend in the field. He had run the Ob/Gyn department at Seton Hall Medical School where I first met him. I followed him around like a puppy with a new master and I tried to soak up as much information as I could. He was the one who taught me how to do a thorough Gyn examination, which gave me a very important foundation for my career. He also would help me in obtaining my residency in Ob/Gyn. He was a superb surgeon who had all the skills that enabled him to handle any complication that would or could arise in the operating room. It was an honor to just meet that man, let alone to be trained by him.
Following our clinic rotation, it was now time to work on the Gyn floor where we admitted private patients, assisted the surgeons in the operating room and followed them until discharge. As I originally wanted to be a surgeon, I enjoyed that part of the rotation very much. I spent most of the day in the OR with anyone who wanted an assistant and learned much from those physicians. At night I was on call for any emergency surgery and I learned how to wake up fast and be able to function with little or no rest. But I loved it and I couldn't get enough. I knew I had chosen the right specialty and each day made me more sure of my decision. I assisted on operations like D&C's, hysterectomies, cancer surgery, ectopic pregnancies, and infertility procedures. I know if I had gone to a teaching hospital I would have never been exposed to or been able to do as much as I did at St. E’s because there would have been so many people above me. So I knew I had a unique opportunity and I intended to make the most of it. I did and I must say I loved every minute of it.
My next rotation was in general medicine. That would turn out to be my last chance to bone up on and round out my general medical knowledge. It was amazing to me compared to medical school that I was so eager to soak up as much knowledge as possible, whereas in med school I just wanted to make sure I knew the stuff I had to in order to pass. What a difference not having to take an exam can do to your overall desire for knowledge. Because I was not in a big medical center, I was able to do and see more and it really helped me a lot. I was now seeing all the things I had been reading about for years and understanding so much more.
My first rotation in medicine was through the emergency room. I had seen most of the things I came across because of my prior exposure in medical school in an intercity hospital. So the common conditions of infections, lacerations, gun shots and head injuries were not new to me, but it was my name being written down on the chart so it was a very different experience. It was, however, on that rotation that I came across one of the most terrible tragedies I have ever seen. I was working an evening shift when we received a call that we would be receiving patients from an airplane crash. We were told to exercise the hospital emergency plan, which meant we had to notify as many attending physicians, nurses, laboratory staff as we could get to come in and stand by. Within minutes, ambulances with their sirens screaming arrived. Many of our doctors and nurses arrived almost simultaneously. What I was about to observe looked like something right out of Dante's Inferno. Two airplanes had crashed into each other just south of Newark Airport. Besides the passengers who were on the planes there were several people on the ground who were also injured and unfortunately some of the victims were dead on arrival at the hospital. For anyone who knows the area just south of Newark Airport, there are fields of tanks filled with jet fuel and refineries to process it. In fact, many locals refer to it as the fuel farm or fuel dump. Well, as you can imagine, besides patients with trauma injuries, there would also be patients with severe burns.
As the patients arrived they were screaming in pain and crying out for help. A burn is such a painful injury and those patients were suffering terribly. Initially we ran around giving them morphine injections for pain relief so that we could calm them down enough to evaluate their other injuries. Between the screaming and the terrible smell of burnt flesh, I was almost overwhelmed. I had never seen or heard anything so terrible in my life. Our attendings and nurses were wonderful as they began to triage patients into different levels of injuries. Some required immediate surgery and were whisked off to the OR. All in all we received about 10 patients and 3 or 4 more who were dead. It seemed like much more as our small ER was just packed. Little by little, as each patient was triaged and cared for, things started to calm down a little. Patients who were severely burned were prepared to be transferred to the burn unit at St. Barnabas Hospital in Livingston. What is hard for me to describe was the sheer bedlam that initially occurred and how our staff was able to get things under control so quickly. The place was filled with police officers, EMT personnel, patients, doctors, nurses, and technicians all doing their best to care for those unfortunate victims. It looked like what I had always imagined hell would be like. Yet all those people worked together as a team to provide the care needed. After several hours, things started to quiet down. No more patients were arriving and, one by one, the other patients either went to the OR, to a floor for further care, or were transferred to another hospital for more specialized care. Once it was all over, which took maybe 4 or 6 hours, the crew that I was on with finally had a chance to sit down and absorb what had happened. As I looked around some of the nurses were crying, others were just hugging each other and trying to comfort those of us who had just gone through a horrific event. Being a first responder is a huge responsibility but believe me it affects you physically and emotionally. It is when it is all over that you have time to comprehend what has just happened. It was the first time I had ever experienced a mass casualty like that and I was amazed at how well my colleagues had performed. You are so busy there really is no time to think and you just react. The training takes over and you just go ahead and do your job. Afterwards when it is all over the real horror of what had happened sets in. I can still, to this day, recall that awful stench of burnt skin and the terrible screaming of those poor people and I hope I never have to see or experience that again. A few of the patients died that night, either in the ER or OR. I can remember thinking to myself what an awful way that must be to die because I had witnessed their terrible suffering firsthand. Afterwards the ER looked like a bomb had gone off. There was blood, dirty sheets, clothing, lab tubes, and dressings thrown everywhere and it certainly reflected the horror that had just taken place there. There is nothing in the textbooks to teach you how to deal with something like this and to experience it was simply terrible. I occasionally think of that night and I wonder how some of those patients ultimately made out and I remember in my prayers those who died that evening.
Well after that horrific incident I looked forward to the relative quiet of the medical floors where doctors mull over problems for hours at a time. Medical doctors love to ruminate over all the possibilities of different illnesses that a patient may have. To them an elevated blood test can have 30 or 40 possibilities that could cause it and they relish in sorting it all out. That, to me, was always something akin to mental masturbation. My approach was to always see a problem and fix it as quickly as possible. That's why I wanted to be a surgeon almost from the beginning. I fancied myself a fixer and a doer not a procrastinator or a ruminator. I am sure some of my colleagues will take umbrage with this analysis, but it is purely how I looked at it. Make no mistake, I understand we need both types and thank God we all fit into those different categories that make up the wonderful profession of medicine. There is room for all types and we need them all.
So off I went to the medical floors to quietly absorb as much as I could about different disease processes. It is very important for a surgeon to know exactly how different diseases can affect surgical patients and their outcomes. My whole outlook was geared toward surgery and I tried to see how everything applied to it. Many times a patient’s medical problem will dictate when or if he or she can be operated on safely. Most of the residents in Medicine were Filipinos and I got to know many of them very well. The majority of them came from very well-to-do families in the Philippines. They are hard-working and sweet people who are raised with the philosophy that education is very important. I learned a lot about their country and how they yearned to return there. Almost all of them spoke English very well as they had studied it beginning in primary school. Those warm and kind people taught me a lot and I enjoyed their friendship very much. Some were supporting family back home while they advanced their education here and then returned home to practice medicine in their country. Our country offers physicians from around the world great opportunities to train here. It is something our country can be very proud of to help train these physicians to relieve suffering around the world. Many countries look to us as the leaders and innovators of medical care. I think that this is something we often lose sight of when we think of healthcare in the United States. You need only to go to other countries in the world to see what a great system we have here in America.
Every once in a while throughout my career I was privileged to care for what we will simply call a VIP. I managed to care for several, but one of the sweetest was the sister of Admiral William F. Halsey, Jr. Born in Elizabeth, New Jersey, he rose to be a four-star admiral in the U.S. Navy and commanded the aircraft carrier USS Enterprise in many battles in the Pacific after Pearl Harbor had been attacked by the Japanese. Their father, Captain William F. Halsey, Sr., also had chosen a naval career. I will not violate her privacy by discussing her illness or care, however, I really enjoyed talking to this marvelous lady about her brother, "Bull”, as he was nicknamed. She was very proud of her famous brother who graduated from the United States Naval Academy in Annapolis, Maryland, and revelled in telling stories about him as they were growing up. Medicine brings you so close to many people and occasionally gives you access to some very interesting people. Unfortunately Admiral Halsey had passed away in 1959 and I took care of his sister in 1970. He is buried in Arlington National Cemetery with many other military heros. She told me she would have loved to introduce me to her distinguished brother. I would have considered it to be a tremendous honor. What a sweet lady she was and I feel so honored just to have been able to meet and to talk to her.
One of my best rotations in medicine was through the intensive care unit and coronary care unit or ICU and CCU as they are known in the hospital. It is there that some of the most critically-ill patients are cared for. They are so sick that they require constant attention and monitoring. That is where I was first exposed to a lot of the new fancy electronics that were filtering their way into medical care. Those machines would drive me nuts at times as alarms went off and my heart would also be tested with a jolt of adrenaline. It was, however, an interesting time on that rotation and whatever cardiology I was to learn I learned it there. Once again the attending and nursing staff welcomed me and sought to pass on as much information as they could to me. I felt like a giant sponge just absorbing as much knowledge as possible. I also became exposed to really ill patients for the first time, many of whom were fighting for their lives and I was always amazed at how calm and at peace many of them were as they faced life-threatening illnesses. There is very little that is routine in medicine and each life is important and full of lessons to be learned. But in the back of my mind, I was just biding time for my next rotation which was to be in general surgery.
As I began my surgery rotation, I wondered how close I would actually get in the operating room. In medical school, I felt like I was barely in the room because there were so many ahead of me in their training but now I was hoping to really get up close for the first time. My first day in the OR was akin to a child opening up his Christmas presents. I awoke very early and showed up hours before the first case was to begin. I struggled to make sure I remembered how to scrub my hands properly before entering the operating room as I didn't want to make a fool of myself by not knowing the proper technique. An operating room has to function like a well oiled machine and I didn't want to be a distraction on my first day. I anxiously awaited to be introduced to the surgeon who, for me, was on a similar level with God. Some of them actually thought they were God and I was soon to meet some real interesting characters. Surgeons are held in very high esteem by everyone in the hospital because of their skills. Some of them have let that go to their heads but most are quiet and very respectful of others. Some of those characters were known to dress in a dapper fashion with expensive suits and fresh flowers in their lapels and walk around with a confident gait airing a persona of importance. I think I can pick out a surgeon in any hospital just by observing the mannerisms he/she displays and the way they carry themselves. But more of that later as we now meet some of those interesting men and women.
In an OR there is only one chief and that is the surgeon. He is ultimately responsible for the patient's care and, believe me they each take this quite seriously. TV has portrayed many surgeons as arrogant, nurse chasing, knife throwing characters and, indeed, especially in my younger days as a physician, that was true in some cases. Fortunately that has changed drastically over the years as that type of behavior is no longer tolerated, but there are still surgeons who display rude and crude behavior in and around operating rooms and elsewhere. I think that it is a cover for their own inadequacies, but that is just my personal opinion. Most of the really good surgeons I have been exposed to do not have to get attention by doing such things. Their skills and ability to handle difficult situations in a quiet confident manner commands the respect they get and deserve. It is how they handle real difficult cases that shows who is the best. If you ever need to know who the good surgeons are in a hospital try to find someone who works with them in the OR.
So Day One in the OR began with the removal of a gallbladder. A cholecystectomy, as it is called, is a major surgical procedure usually performed on patients with gallstones. The surgeon was a mild-mannered middle-aged man who was the chief surgeon of the hospital. I could not have picked a better person to start off with. Dr. O’Connor was a really nice man who just loved to teach and I was ready to learn as much as possible from him. Even though I was only an intern he informed me before the case that he was going to talk me through doing a good part of the operation. He had heard that I was interested in becoming a surgeon and I think that was why he was going to let me do as much as possible. I was nervous but thrilled and it was a tribute to his skills that he could walk me through the procedure.
I had held a surgical knife in my hand quite a few times in the past but that day was different. This time I was going to make the initial incision into a living body and I strained to keep my hands from shaking. As the knife broke through the skin, blood began to well up and I had trouble seeing. He gently wiped the blood away with a lap pad and also used a suction catheter to keep the field visible and urged me to continue. As I made my way through the different layers of the abdomen, I began to think of those days in the anatomy lab and how important they now seemed. Once inside the abdomen, we located the gallbladder and began the dissection to remove it. Everything seemed to be going well until I managed to nick one of the major blood vessels. Blood began to pump everywhere and I found myself paralyzed to do anything but watch. He managed to get me focused again by showing me how to pressure the area that was bleeding with one hand, and quickly removing all the blood that had escaped so that I could see again and clamp the blood vessel with an instrument. The bleeding ceased and my heart rate slowly returned to normal. Sweat was pouring down my forehead and one of the nurses dabbed it gently with a sponge so it would not drip into the surgical field. That was what made surgery so exciting to me. One minute you are faced with a potentially life-threatening situation but with the proper training you learn to handle it and move on like nothing happened. After we removed the gallbladder, all the layers of the abdomen needed to be sutured back together. By now he knew I was reaching my saturation level, so in order to save time, he showed me how to do it. His hands moved with such purpose and so effortlessly I was utterly amazed. He made what he was doing look so easy and that is the sign of a good surgeon. Nothing phases them. They have seen it all before and they know how to handle any complications that may arise. Granted that takes many operations and years of experience, but I was on my way and it seemed like with each operation I did or assisted on I was being taught valuable lessons to use in the future. Once the operation was over we escorted the patient to the recovery room where she would be watched closely as the anesthesia wore off. Dr. O’Connor showed me how to write the postoperative orders in the chart of exactly how he wanted his patient cared for including monitoring vital signs, diet, activity, medications, special instructions and fluid administration. Every operation was to be followed by this ritual which is formulated to make sure that the nurses know exactly what to do to care for the patient and make sure nothing is omitted. It is necessary to do it in the same manner each time to make sure that each element is addressed. The selfish part of it is no one wants to be called in the middle of the night for medication or an order that should've been taken care of in the recovery room. But we are not all perfect and, occasionally, things are forgotten. It is then that it is important to remember that the doctor made the error, not the poor nurse who has to call another doctor to correct the problem at 3 AM. Then the surgeon goes to a dictation machine and records step-by-step exactly what was done during the operation. That is very important to record accurately so that if the surgeon should not be available if a complication arises later on, everyone will know what exactly had been done and how. When we were done with the case and all the recordkeeping, I was exhausted. He asked me if I wanted to help with his other four cases, but I politely declined and went to the surgical lounge and tried to contemplate everything I had just seen and done. I was overwhelmed, to say the least.
Each day I tried to scrub in with a different surgeon on an operation I had not seen before to continue to expand my surgical knowledge. Some of the surgeons let me do a lot and there were some that I basically just watched. I think that just depended on the particular person and whether they were good teachers or not. I believe most surgeons are good teachers but some are better than others. It is a special art to be able to pass on information to another and such an important part in our training. Thank God I had so many good teachers to make my education that much easier and more complete. I thought teaching was so important in medicine that I would actually consider doing it in the future.
So each day I was exposed to different surgeons in the various subspecialties of Urology, Eear-Nose-Throat, Vascular disease, Orthopedics, Gynecology and Neurosurgery. I enjoyed my time in the OR so much, but it went by amazingly fast. As much as I enjoyed being in the OR, I really liked talking to and taking care of patients in the postoperative period. It was there that I learned how to care for a wound and when a patient could be safely discharged from the hospital to begin their recuperation at home. After surgery problems like infections, medical complications, and wound healing problems can occur. So as exciting as surgery is it does not end once the operation is completed. I also enjoyed the interaction with patients following surgery. It is sometimes too easy to think in terms of the gallbladder operation in room 12 instead of Mr. Smith. It is a person we are caring for and, as routine as it may get, I have tried very hard to never forget that. I've always enjoyed talking to people and it is so important in medicine to put the patient at ease, especially when it comes to surgery. Patients are usually very frightened and it is a great satisfaction to be able to reassure them that all will be well. That may not always be the case but it is important to always give a patient hope.
My last rotation as an intern was in anesthesiology. That specialty involves putting the patient to sleep prior to surgery and, more importantly, waking them up following the surgery. I was always impressed by those doctors because of the vast amount of medications that they dealt with. For each one they must know the proper amount to give, how to give it and when not to give it. As medicine has advanced, anesthesiology has become more complicated. It is a good way to study the changes that have occurred in medicine over the years by studying the way anesthesia has evolved. From the horrors of amputations during the Civil War without any anesthesia, to the discovery of ether, to the complicated and sophisticated anesthetic agents that are used today, it is a good model of how medicine has progressed. Unfortunately I did not have a lot of interest in being a gas-passer, as they are known in the profession. That probably stems back to medical school and the study of blood gases which is so important in anesthesia. I had very little interest and was never very good at understanding their complicated formulations. But as a surgeon I could not do my job without these doctors so I tried my best to understand how they practiced their craft. I also came across many characters in the specialty as well. While most are very dedicated individuals, I have also found that some are frustrated wanna-be surgeons. Those are the people that are always offering the surgeon advice during the operation. That can be extremely annoying, but something that happens and has to be dealt with. I remember one anesthesiologist in particular when I first went into private practice who would not shut up while I was trying to deliver a set of twins. I guess he thought he was just trying to be helpful to the new kid, but it was really annoying and very rude. Yes, I was new on staff and probably he had seen more twins delivered than I had, but it annoyed me so much that I finally asked him if he would like to come down to the other end of the delivery table and do it himself. He finally shut up and I found over the years of working with him that was the only way to handle him when he got that way. But he was a very capable doctor in his specialty and I respected him for that, but he really could be annoying at times. Surgeons spend a lot of time in operating rooms with anesthesiologists and as I’ve said before it is important to try and work together as a team rather than being adversarial.
I did not get to do a lot in anesthesia rather than observation. There really is not a lot to do other than controlling the different gases that are used and injecting various medications to put the patient to sleep and reverse them when it is time to wake them up. To me it seemed quite boring but that was just my opinion. I did however learn to intubate a patient and this proved to be very valuable in the future. This is a procedure where a flexible tube is inserted via the mouth down into the main airway then pasted the vocal cords and down into the lungs. I also enjoyed learning how to give what is known as regional anesthetics. That included giving spinal anesthesia for deliveries and later on epidurals and caudals for management of pain during labor. Not all doctors are good at doing those procedures. Some do seem to have a particular knack for doing them as it requires finding a rather precise location in the spine for them to be fully effective. I got a chance to do many of those procedures on the rotation and it helped me quite a bit when I went on to my residency in obstetrics. I also learned how to use local anesthetics which I would use regularly for deliveries and repairing episiotomies. I was fortunate that I was on that rotation while I prepared to apply for my residency program in OB/GYN. It did not require a lot of time commitment so I was able to get all the paperwork ready that was needed to apply to the various programs I was interested in.
Dr. H. Riva was a GYN cancer surgeon who was very helpful in getting me into the residency program at St. Vincent's Hospital and Medical Center in New York City. He was known throughout the world in the specialty and had a lot of contacts with many of the program directors. I was initially interested in going to Yale University Medical Center and was accepted but switched at the last minute because the program director suddenly resigned. Dr. Riva did not feel that it would be a good time to be there during a major change to a new director. So with his help I went to St. Vincent's Hospital in Greenich Village New York City for my interview with the program director Dr. B. Pisani. He was an impressive figure like Dr. Riva, quite tall and distinguished looking. He was mild-mannered and we seemed to get along right from the start. At the end of the interview, he told me that I would be their first choice in the matching program. I then got a tour of the department and the hospital, which was huge. St. Vincent's was a very prestigious institution and I was very pleased that I might be going there for my training. I really have to thank Dr. Riva for pointing me in the right direction and helping me to get into that program. I felt so lucky that I had met him during my internship and how his hand had guided my future. It has always amazed me that many times in my career fate provided me with the right opportunity or enabled me to meet the right person at the right time. Thank you, Dr. Riva, I owe my entire Ob/Gyn career to you and I don't know what I would have done or where I would have wound up if it had not been for you. Who knows maybe I wouldn’t have even become an Ob/Gyn doctor.
So as I completed my internship, I waited with anticipation for the results of the residency matching program. That was a particularly stressful period in my life as my first marriage had failed and the process of the divorce was especially difficult to undergo with everything else that was going on in my life. Medicine is a very demanding profession and I blame part of the failure of my marriage on it. Once again I had to wait as someone else decided what lay ahead in my life. As I look back on my internship year, I think it was one of the most productive years in my career. I met so many people who helped me gain the knowledge and confidence I needed to have and I often think of them. I could never repay them for what they gave me. But I do thank them from the bottom of my heart. I am what I am today and can do what I do because of them. They generously have passed on their knowledge and experience to me and I hope that I will be able to do the same. So as my internship came to a close, I readied myself for the next step in my training. Residency is the final step in the training of a specialist in medicine. It can involve as little as two more years of study or as many as five. Although I was pretty sure that I would match up at St. Vincent's it still was not final until I received written notification. As I opened the letter, my hands again trembled to find out where destiny would take me. Thankfully I had matched with my first choice of St. Vincent's Hospital and Medical Center. This hospital, as some of you may remember, was the place where literally hundreds of physicians stood by to help the survivors of the September 11 attack on the World Trade Center. Unfortunately there were so few survivors that many just stood around for hours that awful day. What great experiences lay ahead for me there, from meeting my second wife and to training under some of the giants in my specialty. A New York City hospital is one of the prized training grounds for a physician. I looked forward to it with great anticipation and as you will see I would not be disappointed.
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