As I wrapped papers on my first week, the prominent front-page headline was about eight student nurses stabbed and strangled to death by an unknown assailant in a Chicago townhouse. In 1966 mass murder on that scale was incomprehensible. Even by the grim calculus of Chicago homicide, Al Capone’s gunmen killed only seven hoodlums in the notorious 1929 St. Valentine’s Day Massacre. This new crime received instant worldwide attention (“went viral” in today’s vernacular), and Chicagoans and suburbanites, myself included, were gripped by fear of a nameless psychopathic killer on the loose.
As a youngster, I, like so many others, was introduced to violent death by the 1963 John F. Kennedy assassination. The next year, three civil rights workers were brutally slain in Mississippi. But I was too young to comprehend the enormity of those events.
Now I was older, and this was local. Most unsettling was that front page I wrapped over and over again; it carried a police artist’s sketch of the killer, created through details provided by the plucky young nurse who rolled under a bed and remained there all night, lying near the bodies of her lifeless friends.
That day, unnerved, I threw papers on the roofs of my first two houses. I didn’t get paid, and it appeared I wasn’t long for the job. The sketch was indelibly etched in my mind—a man with a crew cut; a thin, tapering face devoid of emotion; and cold, menacing eyes. That such a predator lurked somewhere chilled me to my bones. The surviving nurse provided another detail in her description of the killer—a BORN TO RAISE HELL tattoo on his arm (rendering him even more terrifying). This too was on the front page, and three days later, a young surgeon at Cook County Hospital was summoned to the new trauma unit to examine an alcoholic drifter who had attempted to commit suicide by slashing his wrists. After scrubbing blood from the drifter’s arm, the doctor recognized the tattoo and checked the sketch in a newspaper. The mass murderer Richard Speck was captured. The police sketch turned out to be uncannily accurate except for the hair—not a crew cut, simply slicked back, an understandable mistake.
I soon squared myself with the news agency and kept newspapers off the roofs. But there were more headlines coming: violence and death would become routine in 1966. Two weeks later, Charles Whitman, an ex-marine and University of Texas student, killed his wife and her mother, then climbed to the top of the university clock tower with a high-powered rifle and killed fourteen more people. Within days of the Speck and Whitman murders, Rev. Martin Luther King Jr. came to Chicago to lead marchers protesting housing segregation. In an all-white neighborhood, the marchers were taunted by a group of local thugs, one of whom carried a sign reading KING WOULD LOOK GOOD WITH A KNIFE IN HIS BACK. Suddenly, on that sultry August afternoon, the marchers were showered with rocks and bottles. King was felled by a brick that struck him in the head.
Later that summer, less than ten miles from my home, Valerie Percy, the twenty-one-year-old daughter of then Senate candidate Charles Percy, was killed by a nocturnal intruder who entered the family’s home in Kenilworth through a glass door just like one my family had. The killer was never caught, and for months I imagined him invading our house the same way.
The backdrop to all this was the Vietnam War. In 1966 more than six thousand American soldiers died in Vietnam (more than in the entire Iraq War), five times as many as in 1965. The Vietnam War death rate for Americans rose faster in that year than in any other year of the war.
Fast-forward twenty-five years. As the head of the intensive care unit at Cook County Hospital, I was called to see a high-profile prisoner having chest pain who was in town for some legal hearing. It was Richard Speck. Instantly, my mind raced back to that police sketch in the Daily News. Like a computer re-creation of someone aging, he resembled the sketch—but only barely. His pockmarked face was much fleshier and had taken on female characteristics. He had been taking female hormones, grown breasts, and gained weight. But the sinister visage was unchanged. Before I sent him to the cardiac unit, he made some cheap, sarcastic remark that bespoke pure evil. I sensed no remorse in his taunting smile. That was the only time I ever saw Speck.
Another twenty-five years have passed, but to this day that name reawakens that chill in my spine and the frisson of fear I felt when I was twelve.
19
WHO WAS NANCY REAGAN’S FATHER?
* * *
My name is Ozymandias, King of Kings;
Look on my Works, ye Mighty, and despair!
Nothing beside remains.
—PERCY BYSSHE SHELLEY, “OZYMANDIAS”
THE OBITUARIES of Nancy Reagan concentrated on her devotion to the most important person in her life—her husband, President Ronald Reagan. Less attention was focused on her stepfather, Dr. Loyal Davis, unquestionably the second-most important person in her life and possibly in President Reagan’s as well.
Davis, one of the preeminent neurosurgeons in Chicago in the midcentury, ruled the operating room at Passavant Memorial Hospital (now part of Northwestern Memorial Hospital) with an iron fist for more than thirty years. He could charitably be described as a larger-than-life character.
I encountered the legend of Loyal Davis indirectly in 1976, long after he had retired to Arizona. I was a senior in medical school taking my oral final exam in surgery, which was administered by another Northwestern surgery professor. The professor questioned me about anatomy and surgical technique, and I flailed for answers. An honors designation was out of the question; I prayed for a passing grade so I would not have to repeat six weeks of surgery. Then came his last question, which was not about anatomy or technique: “Who is Loyal Davis?”
The name sounded vaguely familiar, but I had no clue. Bluffing was impossible. With visions of another surgical rotation in my future, I gulped and said tremulously, “I don’t know.”
The sword of Damocles hung precariously over my head. Suddenly he shocked me and bellowed, “That’s the right answer! That SOB thought everyone would remember him forever. I just love to hear students say they don’t know who he is.” It turned out the professor was trained by Davis, and every student was asked about Davis as part of his or her orals.
“All right, you passed—barely. Now get out of here.” With a wry smile, the prof sent me on my way.
After that, I wanted to find out about Davis. He was one of the country’s most distinguished surgeons, but by most accounts, he was not a nice man to work with or for. Imperious and a martinet both inside and outside the operating room, he was liked by some residents and students, hated by others, but feared by all. A summons to his office was an encounter to be dreaded.
Politically, Davis was a staunch conservative who detested socialized medicine and any other form of government intervention in medicine. He was quite outspoken, with hidebound views on issues medical and nonmedical. Although personally aloof, Davis took a liking to his new son-in-law when Nancy married Ronald Reagan in 1952. The father-in-law enjoyed sharing his political views with the actor, and many sources credit Davis with being among the most important people in the transformation of Ronald Reagan from a liberal Democrat in the 1940s into the conservative Republican he became in the 1950s and for the rest of his life.
Two years after my exam, my roommate had the same surgical professor for his orals. Before his exam, I told him what the final question would be. My roommate wanted to know who Loyal Davis was so he could correctly answer the surgery professor. I told him but said, “If you trust me, you’ll say you don’t know.” Sure enough, my roommate was asked the trick question and, demonstrating his trust in me, said he didn’t know. I think he got an honors designation.
The epilogue to this story came a couple of years later, when Reagan was elected president and Loyal Davis recommended his partner, Dr. Daniel Ruge, to be Reagan’s White House physician. Ruge accepted and handled the position masterfully. He especially distinguished himself in coordinating Reagan’s care after the president’s 1981 assassination attempt, when his life was truly in jeopardy.
Loyal Davis has been dead for more than
thirty years. I’m sure most current medical students don’t know the name, but I will not forget him. My old surgery professor would probably fail me today.
20
ELEMENTARY, MY DEAR WATSON
* * *
At lunch Francis (Crick) winged into The Eagle to tell everyone within hearing distance that we had found the secret of life.
—JAMES WATSON
WHEN THE HISTORY of medicine in the late twentieth century and early twenty-first century is written, one of the key figures and greatest contributors will be a native Chicagoan who was not even a physician. That man, James Watson, earned his place in the annals of medicine as a molecular biologist and scientific visionary. In 1953 Watson, along with Francis Crick and two less heralded scientists, Rosalind Franklin and Maurice Wilkins, discovered the DNA double helix, a discovery that provided the avenue for the current genetics revolution in medicine. (Some have opined that Dr. Franklin should have shared the 1962 Nobel Prize in Physiology or Medicine with Watson, Crick, and Wilkins, but the award is limited to three people. In addition, she died four years before the prize was awarded, and the honor is limited to living recipients.)
Their work was the starting point for the worldwide effort to sequence the human genome, the holy grail of man’s unique genetic heritage. Translation of the human genome will change the practice of medicine more than the discovery of the microscope, anesthesia, or antibiotics. Physicians will eventually be able to practice medicine by tailoring care for each individual according to their genetic profile, something past generations of physicians could not have imagined.
More than a half century after his momentous discovery, Watson was involved in another step in the genetics revolution when he was presented with a custom-made DVD, which took two months and $2 million to produce. The DVD contained virtually his entire personal genome sequence, and even at that cost was truly a bargain because it was produced with new technology that afforded the cheapest, quickest complete human gene sequencing to date. By comparison the government’s Human Genome Project’s first reference genome, released in 2003, took over a decade and cost $3 billion to complete. Current advances in DNA testing and computer chip development will soon bring the cost of human genome identification down to a fraction of the cost of Watson’s and will make the sequencing available in a matter of days.
Meanwhile, simple genetic tests, identifying small fractions of the entire genome, are becoming available for use in the physician’s office. These tests have the theoretical ability to predict specifically which patients are likely to respond to different medications and what doses are most effective.
Genetics may change the practice of many specialties. Researchers have identified genes associated with higher risks of developing breast and ovarian cancer, as well as malignancies of the gastrointestinal tract. Based on genetic profiles, oncologists are creating strategies for early diagnosis and treatment of these tumors. Reproductive medicine and in vitro fertilization will benefit from improvements in genetic profiling. On the other end of life, researchers will soon understand more about the genetic mutations involved in the aging process and Alzheimer’s disease.
One of medicine’s great twentieth-century clinicians, William Bean, once wrote, “The one mark of maturity, especially in a physician, and perhaps it is even rarer in a scientist, is the capacity to deal with uncertainty.” Though he knew nothing of the human genome, Bean understood that uncertainty was an inevitable part of medical practice. There would always be things that would remain unknown to medical science. If he were alive today, he’d tip his hat to James Watson, who, though he never cared for a single patient, was responsible for eliminating a bit of the uncertainty of medical practice through the discovery of the double helix and his work with the human genome.
21
THE SACRIFICE OF OUR
VALIANT MEN AND WOMEN
* * *
The surgery of wounds arising in military service concerns the extraction of missiles. In city practice experience of these is but little, for very rarely even in a whole lifetime are there civil or military combats.
—HIPPOCRATES
THIS QUOTE BY HIPPOCRATES from the fifth century BC (often paraphrased and simplified as the more familiar “War is the only proper school of the surgeon”) is evidence that since antiquity war has been a primary impetus for medical progress and specifically trauma care. The ancient Romans developed sophisticated field stations behind battle lines to treat wounded foot soldiers. To control hemorrhage, Roman surgeons refined the art of the tourniquet and practiced amputation to prevent the spread of gangrene.
In the Middle Ages, European surgeons routinely perfected their craft at so-called schools for surgery—the battlefield—where gunpowder caused injuries unknown outside combat. French surgeons, notably Ambrose Paré, employed innovative modes of therapy for war wounds. Paré used ligatures to tie off blood vessels after amputation and abjured the use of boiling oil to cauterize wounds. However, success was limited as a consequence of the notoriously poor hygiene on the battlefield.
During the Crimean War in the 1850s, the practice of nursing was revolutionized and dignified by the legendary Florence Nightingale. A decade later American nurses gained similar status and esteem during the Civil War, the first war in which triage of patients from the field was implemented on a large scale. In the Franco-Prussian and Boer Wars of the late nineteenth century, doctors discovered the value of antiseptic technique in penetrating gunshot wounds.
From a medical standpoint, the carnage of World War I produced advances in orthopedics, neurosurgery, and psychiatry, as well as measures to prevent the spread of infectious disease on the battlefield, including advanced wound antisepsis, tetanus antitoxin, and typhoid vaccination. Ironically, despite the lives saved by these interventions, the close quarters of trench warfare and military training and the ensuing demobilization at the end of the war gave rise to the influenza pandemic claiming more than fifty million victims worldwide—the deadliest epidemic in the history of mankind.
After blood typing was discovered in 1901 by Austrian physician Karl Landsteiner, direct blood transfusion from patient to patient became feasible but was limited throughout World War I because blood could not be stored for prolonged periods. The work of Bernard Fantus at Cook County Hospital led to the ability to preserve blood for ten days, an astounding advance. In 1937 Fantus established a “Blood Preservation Laboratory,” later renamed the Cook County Blood Bank, the world’s first blood bank for prolonged blood storage. Stored blood was used for transfusion during the Spanish Civil War and on a much greater scale in World War II.
Penicillin, discovered in 1928, was first used extensively in World War II. The effect was close to miraculous, both on wound infections and for bacterial pneumonia. Infected battle wounds had been the scourge of every previous war, and now penicillin saved countless soldiers. In addition the mortality rate from pneumonia, 18 percent in World War I, dropped to under 1 percent in World War II. From January to May 1942, four hundred million units of pure penicillin were manufactured. By the end of the war, American pharmaceutical companies were producing 650 billion units a month.
Combat surgeons became essential battlefield personnel in World War II, and that “greatest generation” of military physicians trained several future generations of surgeons. The training of these physicians played a large role in the subsequent development of trauma units in the United States. Many of these combat surgeons also served in the Korean War, where helicopters were first employed extensively to transport soldiers and the mobile army surgical hospital (MASH) unit was developed (think Elliot Gould, Donald Sutherland, and Sally Kellerman or, if you are a little younger, Alan Alda, Wayne Rogers, and Loretta Swit). The MASH units were designed to bring experienced surgeons closer to the front lines to operate on wounded soldiers more quickly. Along with improvements in the treatment of shock and hemorrhage, these units were demonstrably effective in reducing the mortality of wounded soldiers
.
These innovations, along with extensive research on resuscitation in hemorrhagic shock during the Vietnam War, led to a dramatic fall in battlefield mortality. In World War II, 30 percent of all Americans seriously injured in combat died. In Vietnam, despite more lethal weapons, 15 to 25 percent of all serious wounds proved fatal.
The twenty-first-century wars in Iraq and Afghanistan accelerated the pace of medical miracles and changed the approach to battlefield medicine. Formerly, the guiding philosophy of military surgery was definitive wound repair as quickly as possible. Now more lives can be saved by emphasizing rapid control of bleeding in the field, on-site resuscitation, and after stabilization, transport of patients for definitive surgery to larger support hospitals in-country or in the case of more complex injuries, transfer back to the United States.
On the battlefield, small, mobile medical teams have been equipped with sophisticated equipment and drugs undreamed of in previous wars, including chemically treated bandages that stop bleeding, genetically engineered drugs to promote clotting, and portable diagnostic ultrasound equipment. In the second Gulf War, once a severely injured patient was stabilized, the average transport time to a US facility from a Middle Eastern battlefield was four days compared to forty-five days from Vietnam back to the United States in the 1960s.
These advances, along with the refinement of Kevlar body armor and helmets, kept the harrowing figures of nearly seven thousand American deaths in Iraq and Afghanistan from being much higher. The mortality rate for wounded soldiers was somewhere between 8 and 12 percent. Given equivalent injuries, today’s soldier is 50 percent less likely to die than his Vietnam counterpart fifty years ago.
The Doctor Will See You Now Page 7