Heimlich's Maneuvers

  Most notably, news of the girl’s survival reached the ears of General Fu Tso Yi, the warlord whom we wanted to remain loyal to Chiang Kai-shek.

  A few days after I treated the girl for her pelvic abscess, a Chinese soldier drove into the camp. He explained through our interpreter that General Fu wanted to see me, and we sped off in his jeep to Fu’s barracks about thirty miles away. As I sat down in Fu’s office, the general seemed stiff and formal. He and his senior staff dressed in full uniform. But as we began to talk, he relaxed and appeared pleasant and appreciative. That’s when I came up with an idea to satisfy my secondary mission—that is, to retain Fu’s loyalty.

  Through the interpreter, who spoke to Fu in Mandarin, I proposed an idea that had never been done before: we could develop a medical corps within Fu’s army that I would train. Fu liked the idea and ordered that I be given his best soldiers. Within a short time, twenty-five of Fu’s men were bandaging wounds and learning basic diagnostics and routine care under my supervision.

  I was now equipped with my own two American medical corpsmen and a small but eager contingent of Chinese soldiers.

  AN INNOVATION IN THE DESERT

  I needed all the help I could get. In subsequent weeks at Camp Four, I saw illnesses that were far more advanced than they would have ever progressed in the West and an array of ailments that had been virtually eliminated back home. Some conditions, such as scurvy, were due to a simple lack of proper nutrients, in which case, all that was needed was a regimen of vitamin C. But there were also patients suffering from pneumonic and bubonic plagues because the nearby Japanese army had driven the rats that carried plague fleas out of the areas they controlled and into ours. I saw many cases of advanced syphilis and some cases of smallpox. One man was brought to me with what my interpreter called a “sore throat” only to discover that a syphilitic gumma, an ulceration, had eaten a large hole in the roof of his mouth. We treated these individuals as best we could, but without adequate medical supplies, we simply had to turn some away. For the most part, though, I was able to treat the locals’ illnesses with either vitamins, drugs, or surgery.

  Figure 6.4. Helping the locals: After word spread that I had saved the life of a villager, people traveled long distances to be treated by this new, Western doctor.

  One problem, however, had me stymied. It was a debilitating eye disease that caused blindness if left untreated. My dog-eared medical books called it trachoma, and it was rampant throughout Asia and Africa. As it turned out, a drug called sulfanilamide recently had been found to be effective in treating trachoma, but stationed where I was, I had no way of knowing that.

  Trachoma is caused by bacteria carried by flies—flies that have an affinity for people’s eyes. When a trachoma-carrying fly lands on someone’s eyelids, the microbe incites an inflammation that scars the lids and curls them inward, causing the eyelashes, in turn, to scratch the cornea. After a period of years, this chronic irritation usually results in scarring of the cornea, leading to blindness.

  From the moment I encountered my first case of trachoma, I couldn’t get the problem out of my mind. I began to ponder drugs that had been found to be effective against other infections. One antimicrobial agent I was aware of was sulfadiazine, so it seemed logical to give it a try. The good news was that we had a fair amount of sulfa on hand. The bad news was that the drug was available only in tablet form. Taking sulfa by mouth requires a higher dose than if the infection is treated topically, and I didn’t want to run out of it. Plus, applying the treatment topically is more effective than if the patient swallows tablets.

  I was confounded by the challenge of figuring out how to apply the tablets directly to the eye. This problem brewed in my mind for two or three days until I suddenly thought of a possible solution. The Camp Four commissary didn’t have eye ointment, but it did have an ample supply of Barbasol shaving cream. This was the pre-aerosol era, when shaving cream came in squeeze tubes, like toothpaste. I had no idea if this admittedly unorthodox treatment would work, but I did know that it would not injure the eye. Furthermore, shaving cream was smooth, so it could act as a binding agent. Besides, it was all we had. The only downside, I thought, was that it would probably cause stinging, as Barbasol is basically a soap.

  I had a navy corpsman grind up sulfadiazine tablets into a fine powder. I squeezed out a few tubes of shaving cream, mixed the powder into it, and looked around for some initial test subjects. General Fu obligingly “volunteered” several of his trachoma-afflicted soldiers, and one bright afternoon, they trooped into Camp Four, reporting for duty as ordered to the mei gwa daifu. Since there were no chairs available, I asked them, one by one, to lie on their backs on the ground. Then I dipped a small, sterilized stick into the sulfa-and-Barbasol mixture and dabbed it carefully into the edge of each soldier’s eyelids.

  The treatment was no picnic for the soldiers; they moaned and groaned, twisting on the ground as if they had been stabbed in the eyes. This continued for some time, and we had a tussle or two, convincing the young men not to wipe the ointment away. I repeated several more treatments a few days apart. As I had hoped, the drug began to work. The soldiers’ trachoma cleared up, and the eyelid inflammation healed. Using this primitive cure, we had triumphed in beating an epidemic disease, one that no one in China—or as far as I knew, the rest of the world—had previously solved.

  Figure 6.5. My first medical innovation: When I saw how trachoma was causing many Chinese to go blind, I whipped up an antidote of sulfa and shaving cream.

  News of the soap-and-sulfa cure traveled fast, and people again swarmed my clinic—but this time, the clinic was filled with individuals who suffered from trachoma. I soon began a strange, daily routine: First thing in the morning, fifty or sixty trachoma-infected locals, townspeople, and even soldiers showed up at the door of my clinic. By this point, I had trained my Chinese corpsmen in applying the ointment, and we treated the new arrivals as I had treated the first round of Fu’s soldiers. For the next fifteen or twenty minutes, dozens of patients squirmed and screamed on the ground in agony. Then they would leave, and the same madhouse scene would be repeated the following day.

  A few months later, after the war ended, our first mail arrived. I read a notice in an armed-forces medical journal that other doctors in other parts of the world had also discovered the sulfadiazine cure for trachoma. It was gratifying to find that my first “research” had been independently confirmed—although, as far as I recall, I was the only one to have to resort to using shaving cream!

  A PATIENT DIES

  My medical challenges at Camp Four continued, but there was one incident in particular that has stayed with me even to this day.

  On August 15, 1945, the war officially ended with the surrender of Japan. We Apostles waited with anticipation for our orders to leave Camp Four and return home. But we received no word from the navy. It was a precarious and dangerous time. Without the Japanese in the picture, we knew, with terrible foreboding, that a conflagration between Chiang’s and Mao’s forces was just around the corner and that General Fu would be one of the leaders of the conflict. Without orders to leave, we wondered if the navy was intentionally keeping us there to be used as pawns. Had we become casualties, it would have given the military a prime excuse to enter the developing civil war and try to defeat the Communists.

  One day, about two months after the war ended, I was sitting in my dispensary. It was not much past dawn. I could hear the guerrillas’ guns firing in the distance as they practiced their marksmanship. I had become used to those drills, as the men were in a constant state of readiness in anticipation of the domestic upheaval that might begin at any minute. I hardly noticed when the firing ceased, an indication that something terrible had happened. Then one of the interpreters ran in.

  “A man’s been shot!” he yelled. “They’re bringing him here.”

  In a few minutes, two Chinese soldiers lumbered in, carrying in their arms the blood-covered body of a third soldier. The victim
was a young man who had been riding his horse in formation with other guerrillas when a fellow soldier’s gun accidentally fired, shooting a bullet into his companion’s back. The bullet traveled straight through his body and out through his chest.

  The wound was terrible, a raw gash five or six inches in length, shattering flesh and bone and tearing into the young man’s lungs. In those days, even at Boston City Hospital, where I’d done my brief surgical internship, chest surgery was still in its infancy. I had never seen or heard of a surgeon who had opened a chest before.

  I did the best I knew how to do. First, I sutured one of his torn lungs and tried to close the cavity. But the damage was massive, and with the limited equipment available, I could not find a way to properly drain the chest cavity. This was critical, because it would have relieved a life-threatening pressure of air and blood pushing down on the man’s lungs. There was no way to control the bleeding. As I closed up the wound, the soldier died.

  Physicians always recall the first patient who dies in their care, and the memory of the Chinese soldier who died on my operating table at Camp Four in 1945 tore me up. Afterward, I got on my horse and headed into town to have dinner. I just wanted some time to be alone. When I got halfway between the camp and the town, I wearily scanned the gray expanses, and my eyes picked up an oxcart on the eastern horizon heading across the fields, moving away from me. As I drew closer, I could make out a man walking alongside a cart that was jostling and bouncing as the wooden wheels caught ruts in the field. There was a coffin in the cart. A lump stuck in my throat as I realized that it held the body of the young man who had died in my hands that afternoon.

  I never forgot the sight of the soldier’s coffin and vowed that, one day, I would make amends to him.

  TRANSPORTING A KILLER

  On October 29, 1945, we were finally given our orders that we would be transported back to the United States. Our struggle to treat patients under base conditions in the middle of the Gobi Desert was over. No longer did I have to think of diplomatic ways to appease Chinese military leaders. Yet it would be seven months before I was again able to feel American ground under my feet.

  I spent several months stationed on a ship in Shanghai, where I treated US soldiers. One day, a commanding officer summoned me to his office to tell me that I was to work on a landing craft used to transport prisoners from Japan. I knew the conditions on that particular ship were abysmal. Because the prisoners were not given proper facilities, the ship stunk of excrement and urine. After having been in Inner Mongolia, I had lost forty-five pounds and developed dysentery. I didn’t think I could last living in those conditions.

  After the commander gave me the news, I pointed through the porthole to a hospital ship that was docked.

  “Commander, see that hospital ship? I’ve been in the interior of China in a guerrilla army for months. You have a choice. You can send me there as a doctor or as a patient.”

  I must have been convincing, because I soon received orders to be transferred to the hospital ship, the USS Repose (AH-16). The Repose was a beautiful, fully equipped, 400-bed facility. Its only action was to deliver female nurses to the Pacific as the war ended. There was a lot of partying, and the ship was brilliantly lit up at night. (It was said that no crewmember actually slept on the Repose, at least alone.)

  Living on the hospital ship was a great experience. I led the ship’s band, and we played jazz on the deck. But I still had my medical duties. I treated men with serious conditions. Some died from infectious diseases. In one case, a man arrived from China on a stretcher and was foaming at the mouth. The ship’s medical crew was puzzled about his condition, but I had seen similar cases before in China. “This man has pneumonic plague and will be dead in less than an hour,” I told them. The man, indeed, died as I had predicted. Later, a smear of his saliva examined under a microscope was found to have plague bacteria.

  My ticket home came one night in April of 1946, when a US Navy sailor was carried aboard the Repose on a stretcher, a victim of a stab wound to the belly. I soon learned that the wound was self-inflicted and that the man had murdered nine of his fellow soldiers.

  Earlier that night, nineteen-year-old Seaman Second Class William Vincent Smith had come off guard duty of his ship and went to his bunk, carrying a rifle and wearing a revolver and a sheath knife. The ship’s men were asleep in their bunks, which lined the bulkhead. Smith sat on his own bunk, aimed his rifle, and began picking off his sailor mates, one by one, as they slept. Sailors who awakened came after Smith, but he shot them with his pistol. Then Smith stabbed himself in the abdomen with his sheath knife. He had shot ten men; nine died immediately. I never learned if the tenth man survived.1

  I operated on Smith’s knife wound. Although the knife had deeply penetrated his abdomen, it had missed internal organs, so I only had to sew the incision closed. Smith was placed in a lock ward where he was guarded at all times. I occasionally visited Smith to change his dressing and asked him if he felt what he had done was wrong. He said no. “My father took me hunting when I was small and we shot squirrels. I don’t see any difference,” he said matter-of-factly. A number of psychiatrists were brought in from the States to evaluate Smith, but none would make a decision as to whether he was sane enough to be tried for the murders.

  While Smith sat in his holding cell, recovering from his injuries, I finally received the news I was waiting for. On May 18, 1946, not quite a year and a half after I had left the United States, my commanding officer told me that I could leave for home the next day. There was just one catch: I would be taking Smith with me.

  It was a top-secret trip because word was out that friends of Smith’s victims were planning to kill him. I knew that if anything happened to Smith while he was in my care, I could be court-martialed. But I didn’t worry too much about that. I was going home.

  An ambulance took Smith, four hospital corpsmen, and me to the Shanghai airport. Smith wore a straightjacket and was tied to a wire-mesh stretcher. We boarded a C-46 plane and landed in a navy base on the island of Guam. Smith was placed in a locked cell, still wearing his straightjacket. While we waited for further orders, a navy psychiatrist from New York City took me in hand and showed me around the area. We swam on beautiful beaches and had our meals in the officer’s club.

  But while we were enjoying ourselves, I began to feel anxious about my mission, about getting Smith to the United States. A few days after arriving in Guam, I wrote a memo to the admiral in charge, stating that we should leave immediately. The next day, the admiral called me in and gave me some shocking news: The psychiatrist who had taken me around and acted so friendly had apparently been telling officers that he was worried about my mental state. He then suggested that he, rather than I, take Smith to the United States. Fortunately, the admiral disagreed with the psychiatrist’s recommendation and let me leave with Smith the next day, along with a small group of corpsmen. On May 25, I delivered Smith to a navy hospital on Mare Island, off the coast of California. In August of 1947, I read in the newspaper that Smith had hung himself and died in jail while awaiting a court martial.2 On June 18, I arrived in New York City to a wonderful homecoming.

  On July 1, 1946, I was given my US Navy discharge papers and assigned to the US Navy Reserves.

  I look back on my time serving as a military doctor in China as one of the most challenging and rewarding times of my life. That war-torn, impoverished, and remote part of the world certainly provided a most interesting location in which to practice medicine. Apparently, Hollywood agreed, for in 1953, Twentieth Century Fox released a dramatic movie about Camp Four. Destination Gobi, starring Richard Widmark, told the story of US Navy weathermen who teamed up with Chinese Mongol nomads to fight the Japanese. The film was not completely fictionalized: United States soldiers in the camp were protected from the Japanese by Chinese guerrillas—250 of them—who lived in makeshift barracks just outside the walls of Camp Four.3

  But, as my wartime service drew to a close and I was
back with my parents in New York City, it was time to move on. And so I began to fulfill my lifelong dream of becoming an accomplished surgeon.

  Figure 6.6. The Repose: I spent six months on this ship, the Repose, after the war ended.

  By the summer of 1946, I was back in New York, a civilian, ready to find work as a resident in surgery. Surgery naturally fit with my character. I like to fix problems, and as I had learned in China, every surgical situation presented a new set of challenges, new puzzles to solve. I appreciated surgery’s demand for delicacy and precision.

  At the time, one of the newest fields was thoracic (or chest) surgery. This excited me. But I soon learned that obtaining a surgical residency in postwar America would not be easy. I dropped into several hospitals to inquire about positions only to be received by the surgery-department secretaries who uttered the same response: “Doctor, fifty thousand physicians have returned from the war. We have to take those who were on staff here before they went into the service.” Every doctor slightly older than I was, who had exited the armed forces a year or more before I had, had grabbed the available residencies. I could have looked for jobs outside New York, but I wanted to stay close to my parents. I was further limited by anti-Semitism. In the mid-1940s, the only hospitals that were not reluctant to hire Jewish physicians were Jewish hospitals.

  I inquired at a handful of hospitals and, one by one, each turned me down. However, one visit to a physician’s office gave me hope. He was the chief of surgery of Lenox Hill Hospital, and I had made an appointment to see him at his private practice on Park Avenue. I got there on time for my appointment but waited a long time before his secretary admitted me to see him, even though there were no patients in the office. When I entered his office, he criticized me for being late.