Heimlich's Maneuvers

  “No sir, I was here early,” I corrected him.

  He immediately called in his secretary and quietly said, “You know you’re not to keep a doctor waiting.” For the first time since my return, I felt someone had treated me with respect.

  After that exchange, the man recited the routine statement about the surplus of fifty thousand doctors who, like me, were getting out of the service and seeking positions.

  “I’ll know better next war,” I said.

  “Please, doctor, don’t get discouraged,” he said. “I understand your feelings, but I know you have ability and will turn out fine.”

  The surgeon’s words of comfort were the first I had heard since I began looking for a residency, and I never forgot him. Decades later, after he retired, I met that doctor at a surgical conference. I had become quite well known by that time. I went up to him and reminded him of the incident of my residency days and how much his support had meant to me. He smiled, we shook hands, and he said, “I knew you would do well.”

  I soon was offered a position, but it was not as a surgical resident. Instead, a doctor who was an internist had offered to take me into his office, after which I would pursue board certification in internal medicine. I had a hard time deciding whether I should take the position. On the one hand, I knew I wanted to be a surgeon, but I was so discouraged by having been rejected so many times by surgeons refusing to hire me that I wondered if I should settle and accept the internist’s offer.

  I decided I would try one more time to get a surgical residency. This time, I applied at the most prominent Jewish hospital in New York City, Mount Sinai Hospital. Usually, I mailed in my job applications, but this time, I decided to deliver the application personally. I walked across Central Park to Mount Sinai. I asked for the office of the director of medical education and was sent there. The secretary was busy typing. I let her know I had an application to give the director.

  Her eyes remained fixated on her Smith Corona. “Leave it on my desk. I’ll turn it in,” she said.

  “I’d like to hand my application to the director personally,” I told her.

  “He’s very busy,” she said. “He’s got an important meeting.”

  “I’ll just sit in the hall and wait,” I replied pleasantly and sat down.

  After about fifteen minutes, the door to the director’s office opened and he emerged. I stood up, blocking his exit. I let him know that I had served in the war as a physician and was seeking a surgical residency.

  He began to deliver the same line I had heard from so many other physicians, how many other doctors had also gotten out of the service and were also looking for residencies.

  But I stopped him before he could get all the words out, and politely—but firmly—I replied, “Please don’t tell me I can’t get a position because the competition is tough. I want you to tell me whether I’m good enough to be a surgeon.” He stood stock-still. “Come into my office,” he said.

  We sat down. The director asked me about my medical training and military experience. I told him about my time running the medical unit in China.

  He looked at me earnestly. “Dr. Heimlich, a patient has tenderness and pain over the right upper abdomen and is coughing up blood. What does he have?”

  “Liver flukes,” I answered, without missing a beat, speaking about parasites that burrow through the diaphragm and into the lung.

  He smiled and then told me that he was originally from the Netherlands, where, for twenty years, he had taught and researched bone disease. He had come to America in 1938 and soon thereafter worked as a professor of medicine at the Peiping Union Medical College in Peking, China. He asked me many questions about my experiences in China, and we talked for a long time.

  “What will you do if you don’t get a surgical residency?” he asked me. I told him about the internist’s offer.

  “If you don’t go into surgery, you’ll never be happy,” he said.

  “Yes, but I can’t spend the rest of my life doing nothing while waiting for a surgical residency,” I said.

  “Dr. Heimlich, promise me that you won’t take the job with the internist until you hear from me,” he said. “Give me two weeks, all right?”

  I promised that I would. A week later, a letter arrived offering me a one-year surgical residency at Mount Sinai Hospital in the fall. It was the best news I could have hoped for.

  A REAL EDUCATION

  The one-year residency program at Mount Sinai was preceded by a six-month review course at Columbia University College of Medicine, which was designed to bring those of us who had not had formal medical training while in the armed forces up to date on what had progressed in medicine during our absence. I learned about penicillin (which had just burst on the scene), new developments in surgery, and new ways to treat burns. I had expected the course to be useless for me—I had not been away from medicine that long—but I was wrong. It was an excellent review, and I met doctors with whom I would be working at Mount Sinai, and we became friends. Overall, it was a good way to get my feet on the ground as I got back into medicine.

  In July 1947, I moved into the residents’ quarters at Mount Sinai Hospital, was assigned to a surgical team, and went to work. The hospital paid no salary, but I had a small income from the GI Bill of Rights and some money saved from my navy salary. And there was a side benefit: residents didn’t eat in a cafeteria; we ate in a dining room with excellent food that was served by waiters.

  Residents at Mount Sinai were involved only in the care of privately paying patients; we never performed operations ourselves. These patients could select their surgeons and were given private or semiprivate rooms. My goal for the future was to obtain another year’s residency on the ward service, where patients received their care free of charge. These patients stayed in large rooms, separated by gender, holding thirty to fifty patients each, affording them no privacy. Furthermore, the patients had no choice of who their surgeons would be. Here, residents could operate on and care for patients under the supervision of a staff surgeon.

  But in my first year, I could only assist in operations. We residents were on call every morning; during this time, we made rounds in our assigned teams, checking on patients. We broke for lunch, assisted in surgery through the afternoon, broke for dinner, and, again, made rounds. Every other night, we were on call for emergencies; we saw postoperative patients who had complications, assisted on emergency operations, visited patients in the emergency room, and worked up new patients who had been admitted for surgery.

  My real education in surgery truly started during my early days at Mount Sinai. There were some great surgeons there, and I got a close-up view of their handiwork on a daily basis; the best surgeons worked quickly and efficiently. The postoperative care of the patients was left to the residents, who called the surgeon’s assistant when a complication developed.

  But I learned more than just how to treat patients medically. I learned how arrogant surgeons could be. I witnessed political battles and the bitter competition, jealousy, and animosity that can exist among doctors. Most surgeons were gruff at the operating table. If they were dealing with a particularly troublesome operation, they were nasty to all the staff, especially the residents. (Regrettably, I later found that I, too, committed this same offense, often due to the stress of the moment.)

  One day, I was scheduled to assist one of the busiest thoracic surgeons in town. He was removing the tubercular lung of a twenty-six-year-old woman, a common operation before the days of antituberculosis medications. He was a very capable surgeon, but he was particularly surly to residents. He never allowed us any responsibility, not even suturing. We just stood across from him at the operating table, occasionally sponging up blood and holding open the incision with retractors. Throughout the operation, the surgeon bragged about his wartime experiences. “I could have saved the leg of one German soldier,” he said, “but I hated the Nazis, so I amputated it.” Then he said, “You were probably in medical school during the
war, Heimlich, and had your tuition paid for by the government.” I didn’t bother to correct the doctor; I simply could not have cared less for what he thought of me.

  An hour after the operation ended, the nurse on the floor called me to come quickly to see the patient. I ran up to the ward and found that the patient was dead. On the floor was a large bottle to which the chest-drainage tube was attached. The bottle was filled with blood. The diagnosis was evident. When a lung is removed, a silk suture is tied around the large vein to the lungs before the blood vessel is cut so the lung can be removed. That suture had slipped, and the patient bled to death instantly. I called the surgeon and he rushed back to the ward. I stood with him as he faced the patient’s parents. It was the first time I’d seen him appear humble.

  When the end of my year’s residency was approaching, it was time to apply for two additional years of training. I wanted to get those two years at Mount Sinai Hospital because, as a second-year resident, I would have been allowed to perform all surgeries and had full responsibility for patients. That experience was required so that I could take both the American Board of Surgery and the American Board of Thoracic Surgery exams to become certified as a surgeon. Extending my residency at Mount Sinai was tough competition; only one person would be appointed, and there were lots of applicants. I believed I had a good chance for the position but lost out to another resident. I would have to find a residency at another hospital.

  Even though I was armed with excellent recommendations from leading surgeons at Mount Sinai, the Jewish hospitals I applied to repeatedly turned me down. Thankfully, my father came to my rescue. Through his connections with the district attorney’s office, Pop was able to get me a meeting with New York City’s commissioner of health. When Pop and I sat down with him, the commissioner told us he had arranged for me to continue my residency at Bellevue Hospital. I would be guaranteed only one of the two years of residency that I required, but working at Bellevue was a plum I never could have attained on my own. Unlike private hospitals like Mount Sinai, Bellevue residents provided all the patient care, including surgery, under the supervision of staff surgeons.

  The surgical experience at Bellevue turned out to be invaluable. In addition to carrying out the types of tasks I had done at Mount Sinai, I was also able to perform all kinds of surgery and in areas that were new to me, including abdominal surgery, orthopedics, and gynecology.

  But the best part of being a surgical resident at Bellevue was coming upon a shocking discovery that would lead me to meeting the woman I would later marry.

  Bellevue Hospital Center is run by the city of New York. It was founded in 1763, making it the oldest large-scale hospital in the United States. Bellevue pioneered the idea of the emergency room in 1869, when it was the first hospital to receive patients in horse-drawn ambulances. In the 1940s, when I began my medical career, I remember it was said that you could see all kinds of emergency situations at Bellevue, from car accident injuries to last-minute births.

  What also made Bellevue unusual was that it contained various divisions, each overseen by a medical school, so the hospital offered residents like me unique learning opportunities. I was assigned to the Cornell Medical College division, and so all the patients in that division were under my care while I was on duty.

  One night, I was making rounds in the emergency room, seeing my Cornell patients, when a nurse called me to pronounce a patient in another division dead. She summoned me because the patient’s regular doctor was asleep and she did not want to wake him.

  The man who lay before me had fallen out of a third-story window a few days before and had suffered multiple serious injuries. When I examined him, I saw that he was not breathing but I could find a weak pulse. Quickly, I observed his jaw, which was broken, and realized that his facial injuries were blocking his airway. I instantly performed a tracheotomy, inserting a tube through his neck and into his trachea to get air into his lungs. The man soon began breathing, a full pulse returned, and he regained consciousness.

  The patient’s name was Dick Yeatman. After saving his life, he was placed in my care. Over the next nine months, I treated his fractured jaw, broken legs, and other injuries, and I got to know him pretty well. Dick was in his forties and had nearly met his demise after he leaned out the window of his Fifth Avenue apartment to wipe it off and lost his balance. He was an officer of the Texaco Company and was married to a woman named Constance, or “Connie,” as she was called. While Dick was being treated at Bellevue, Connie sat at his bedside every day. She was from a prominent Tennessee family, and often her friend Mary Dillon came along, too. Mary was a blue-eyed, soft-spoken Irish woman in her sixties, and she was also powerful. She was the first female chairperson of the board of a public utility company, the Brooklyn Union Gas Company, and had been appointed president of the New York Board of Education by Mayor Fiorello LaGuardia.

  Dick and Connie loved opera and had box seats at the Metropolitan Opera House. One day, Connie asked if I would like to go in Dick’s place. I accepted without hesitation, having been an opera fan since college. (At Cornell, I had taken a course on Wagner, and during the Christmas vacation of my junior year, I went with a friend to the Met to hear Tannhäuser, the first and only opera I’d ever attended.) Plus, the Yeatmans’ seats were center parterre box seats, the best in the house. (They had originally been held by the industrialist Cornelius “Commodore” Vanderbilt.)

  To get to the Met, I took a bus from Bellevue, dressed in my best suit. I thoroughly enjoyed the opera and was fortunate enough to join Connie, Mary, and several of their elderly women friends for other Saturday evening performances. As I took in the mesmerizing sounds of Verdi, Puccini, and Mozart, I considered myself the luckiest man on earth. But my luck was about to increase tenfold.

  JANE

  By Christmastime 1949, I was in my third year of residency. My year at Bellevue had drawn to a close, and Bellevue’s chief of surgery, who also held that position at Triboro Hospital, helped me secure a position there as chief resident in surgery. Triboro Hospital was located in New York City and specialized in tuberculosis treatment. One day, Connie called me and said Mary Dillon was giving a dinner party for a young woman named Jane Murray, a writer who was visiting from San Francisco. Would I escort her? I agreed. To my surprise, Connie immediately put Jane on the phone, and we arranged that I would pick her up that night and take her to the party. It was a small dinner party with only a handful of couples. I remember the delicious steak dinner Mary served but little about Jane, except that she was very pretty. One guest spent the entire evening telling everyone about her recent honeymoon, so by the time Jane and I parted that evening, we still knew next to nothing about each other. The next day, Jane went back to San Francisco.

  A year later, I again received a call from Connie Yeatman. “Guess who’s visiting me?” she chirped. “It’s that darling Jane Murray.” Once again, Connie shoved the phone in Jane’s hand. After some small talk, I asked what she was doing that night. She said she was fixing dinner for a sick friend. When I asked her what time she would be free, she told me ten o’clock. I said I would pick her up at her friend’s house. (As it turned out, the sick “friend” was her boyfriend. I later learned he was not too happy about this arrangement.)

  I picked up Jane and took her to a Howard Johnson’s ice cream shop on the corner of Fifty-Ninth Street and Park Avenue. As we ate our ice cream, Jane asked me meaningful questions about my work, including my duty in China. She was a writer and I liked her inquisitive nature.

  Jane wrote about that ice-cream date in her memoir Out of Step. As she described it, I chose “the least expensive option” for a place for us to get acquainted, noting that I was not getting paid a salary. Jane wrote that she quickly honed in on the fact that I wasn’t a big talker, except where my work was concerned:

  Seated in a booth across from him, I studied his craggy good looks. The bushy eyebrows, a hawk-like nose, and firm chin complemented his lean six-foot frame. While he wor
ked his way through two scoops of butter pecan ice cream, savoring each spoonful as if he wanted it to last forever, I plied him with questions. I knew he had been in China during the war.

  “What was China like?”

  “Interesting.”

  He took another spoonful.

  I plowed on. “Did you always want to be a doctor?”

  “I guess so.”

  Years later, it came as no surprise when the man who became my husband admitted that he was uncomfortable talking one-on-one.

  When I asked him about his work, I hit pay dirt. It turned out that his medical passion was the esophagus, which I soon learned was the tube that carries food from the throat to the stomach.

  . . . I listened, entranced, to his medical talk.1

  By the time we finished our ice cream, I looked across the table and thought, “I could marry this girl.” (Years later, Jane let me know she had thought the same thing.) Soon after that, Jane decided to move back to New York and live with her parents.

  I knew right off the bat that Jane and I came from two very different worlds. We were both Jewish, but that was about where the similarities ended. Whereas I had grown up in a family struggling to make ends meet, Jane had grown up in high society, the privileged daughter of celebrity parents. While Jane’s grandparents on her father’s side were Yiddish-speaking immigrants who were almost penniless when they settled in New York’s Jewish Lower East Side, her father literally danced his way out of poverty. Arthur Murray (whose original name was Murray Teichman) had a mail-order dance-lesson business and built an empire of dance studios. Later, he and his wife, Kathryn, starred in the long-running, popular television show The Arthur Murray Dance Party. Jane had attended Shipley School (a boarding school in Pennsylvania) and Sarah Lawrence College.