After finishing rounds one morning, Art and I made our way to the fourteenth floor of the Mayo Building. We squeezed in the door of the orthopedic residents’ lounge just as three other guys were coming out. Inside, six or seven residents were reading mail, dropping off briefcases, or talking. In the corner, in an old, overstuffed armchair, a resident in a rumpled blue sport coat was sound asleep, his head lolled to the right, his mouth slightly open. A row of mail slots lined the wall on our left. Above the mail slots was a bulletin board crammed with notices from Dr. Benjamin J. (“BJ”) Burke, the director of the residency program:
—“All residents are reminded that the dress code—coat and tie—remains in force on weekends. No resident is to make rounds unless in coat and tie.”
—“The annual Orthopedic In-training Exam will be held on Saturday, September 23. All residents are required to take this exam.”
—“Saturday morning conference is MANDATORY for all residents. NO EXCUSES!!”
As head of the residency program, Dr. Burke ran our lives. He was our lord and master, the engineer at the throttle of the train to salvation. We could not get through the program, we could not become orthopedic surgeons, unless BJ gave his blessing.
“Be careful of BJ,” Art warned me. “Every year, one or two guys get on his bad side and he makes life miserable for them. He picks on them at conferences, stops them in the hall if their tie is crooked, everything. Don’t piss that man off or your ass is grass.”
I planned to stay as far from Dr. Burke as I could. If he found out how ignorant I was, he would bury me. “Do your job. Keep your mouth shut. Don’t draw any attention to yourself” was the message I kept repeating to myself. I was, and planned to remain, the Invisible Resident.
Being the Invisible Resident on Dr. Harding’s service was easy. Within a week, he must have realized how far behind I was. For that reason he did the kindest thing he could have done: he ignored me. When we made rounds it was always Art to whom he spoke. In the OR it was always Art whom he allowed to operate. I wasn’t even sure if Big John knew my name—but I didn’t blame him. I needed to get myself to a certain level before it was worth his while to teach me.
Of course, I had plenty of impetus to learn. It terrified me to realize my decisions could literally kill or cripple someone. Sure, there were safeguards. No one was going to hand me a scalpel on my first day. But someday my turn would come—and I’d better be ready.
I studied harder than I had ever studied before—partly because I was ashamed of my ignorance, partly because I realized that patients’ health and lives would soon depend on me, and partly because I actually liked this stuff. I was falling in love with orthopedics.
Every night I took out the index cards upon which I had jotted down questions and notes. I went over them one by one, often waking at 2:00 or 3:00 A.M., my head slumped forward on the desk, drool staining the page I had been reading. I would stagger to bed and curl up next to Patti for a few hours. The next morning I would start all over again.
Art was always a bit impatient with my constant barrage of questions. He knew if he encouraged me I would pepper him with questions all day long. But he did one thing that helped me immensely: he dumped responsibility on me. He constantly took off and left me to handle things on the service. “Heck of a deal!” was his comment on almost everything.
We were in the locker room changing into our street clothes when Art told me one of Big John’s claims to fame was that he had memorized a long narrative poem about an English boy named Little Albert. An hour later, when we finished rounds, Art nudged me.
“Say, Dr. Harding, I don’t think Mike here has heard Little Albert.”
“Ah,” Big John said with a smile. “You’ve never heard Little Albert?”
I confessed I had not.
He put his huge left hand on my shoulder and broke into a poem about Little Albert and his encounter with a lion. He recited it for us in a cockney accent as we stood outside the elevator on the seventh floor. His big face lit up as he glanced back and forth, eyes dancing, arms gesturing, as he related the comical story of a little boy’s ill-fated visit to the zoo. The story ends with Little Albert getting eaten by the lion, after which his father philosophically observes that “what can’t be helped must be endured.”
I would think of that line often during the next four years.
I had six days left on Harding’s service when Marvella, his secretary, called me. Prince Saleb had invited Dr. Harding, Art, and me to dinner in his suite at the Kahler Hotel. We had done a knee replacement on the prince two weeks before, and this apparently was his way of thanking us.
“Wives, too?” I asked. Patti could use a night out.
“No, Doctor, just the three of you.”
Uh-oh. Pat wasn’t going to be thrilled. She would have to stay home and eat Hamburger Helper with Eileen while I dined in a penthouse suite with a prince. I was already figuring out how to break the news to her when I asked Marvella, “When is the dinner?”
“Wednesday night.”
I groaned. “Oh, no, not Wednesday. I’m on call.” I paused, waiting for her to say, “No problem. I’ll just check with the prince and see if we can make it another night.” Instead she said, “That’s a shame.” Princes and department heads don’t rearrange their schedules to accommodate junior residents.
Art told me later that the hotel catered the entire affair. It was a dinner of candlelight, crystal, and silver, served in the prince’s suite on the top floor of the Kahler. The prince had rented out the entire floor for the month he stayed in Rochester.
I asked Art later if the prince had expressed any regret that I was unable to attend the dinner. Art laughed. I suppose there must be a Kuwaiti equivalent for a junior resident, and whatever it was, no prince was going to bother with him. I wondered if my declining the invitation might even have been regarded as a snub on my part. Perhaps they thought it inconceivable that Dr. Harding’s “slave” would have the temerity to refuse them.
Art told me the meal went reasonably well. They ate in silence. The prince’s translator stood unobtrusively several feet behind him. There was limited call for his services. The Kuwaitis were intimidated by Harding’s Western aplomb, while Art and John were intimidated by the Kuwaitis’ wealth.
When they were leaving, John thanked their host for a fine evening. The prince shook his hand and then spoke the only words of English any of us had ever heard from him.
“I am very much to thank you for your generous goodness on me,” he said, bowing gravely. He reached over to a table upon which three small boxes were resting. He handed one to John and the other to Art.
“That last box,” Art told me the next day as he stretched out his arm to show me his new Rolex watch, “was yours. Pity you couldn’t make the dinner.”
“He gave you a Rolex? You son of a bitch.” I wadded my surgeon’s cap into a ball and threw it in the corner. “While you and Big John were eating lobster and frog legs, I had four consults, a wrist fracture, and a pussed-out knee in a drug addict.”
“Perhaps it’s just as well,” Art said. “After all, I would hate to see you become overly concerned with material things.” He stabbed a piece of French toast and popped it in his mouth. “Heck of a deal!” he said.
I was just starting to feel comfortable with Dr. Harding when, in mid-August, it was time to switch services.
Chapter Four
August
There were certain surgeons to whom every resident at Mayo wanted to be assigned. Tom Hale and Antonio Romero were up-and-coming stars in the department. They loved to teach, and they let their residents do a lot of operating. Fred Hastings and Garrett Freiberg were world-renowned hand surgeons. Bob Filmore was making a name for himself in the world of shoulder surgery. But the plum of them all was Mark Coventry.
Mark B. Coventry was the towering figure in the Department of Orthopedics at Mayo. Tall, distinguished, and white-haired, Dr. Coventry had a regal bearing that seemed both n
atural and deserved. So commanding was his presence that even some of the other attendings couldn’t bring themselves to call him by his first name. He had pioneered a number of surgeries, and had performed the first total hip replacement in the United States. Although in the twilight of his career, Dr. Coventry was probably the most highly regarded orthopedic surgeon in the country. In mid-August I finished with Dr. Harding and started with Dr. Coventry.
From the very first day on his service, I loved being with Dr. Coventry, but I trembled to think what would have happened if I had been assigned to him first. He would have been appalled at my ignorance. Where Dr. Harding largely ignored me, Dr. Coventry constantly challenged me.
“What muscles are innervated by the L-4 nerve root?”
“What is a MacIntosh procedure?”
“How much does a short leg cast weigh?”
“What is the minimum acceptable hourly urine output in a post-op patient?”
Dr. Coventry demanded a lot from his residents. If there was a problem with bleeding, drainage, pain, or an abnormal lab, God help us if we didn’t know about it, have an explanation for it, and have already instituted treatment for it by the time it came to his attention. These high standards were Dr. Coventry’s way of reaffirming the importance of what we did. By his attitude, by his bearing, and by his insistence on perfection, he impressed upon us the seriousness of our calling.
In addition to being a renowned surgeon, Dr. Coventry was a splendid athlete. He had been a standout hockey player at Michigan in his undergraduate days. When he moved to Rochester he played semi-pro hockey for the legendary Rochester Mustangs. He told me the only reason he quit playing was because of pressure from the Clinic. After a particularly rough game, the headlines of the Rochester Post-Bulletin sports section read: “MUSTANGS WIN. MAYO DOCTOR IN BRAWL.” That was the final straw for the Clinic administrators who objected to the unfavorable publicity. Dr. Coventry was forced to give up his hockey career.
Jim “Whit” Whitmer was the senior resident assigned to Dr. Coventry’s service with me. Since Dr. Coventry insisted that his residents make “pre-round” rounds each day, Jim and I would meet every morning at six. We would see every patient on the service, and then meet Cuv, as the residents called him behind his back, for formal rounds at 7:30 A.M.
I had been on Cuv’s service for two weeks and was preparing to see a patient when I found a strange-looking X-ray of the pelvis. “What the hell?” I muttered to myself. On the right side I could see a typical total hip replacement. On the left was a normal-looking hip except for wires around the greater trochanter. All hip replacements at that time involved wiring the trochanter at the conclusion of the case, but I had never seen a trochanter wired without the hip having been replaced.
I called to Jim Whitmer who had just come out of a dictating booth. “Hey, Whit, get a load of this.”
He walked over. “What’ve you got?”
“This,” I said, pointing. “Look at that left hip. It looks like—”
“Thomas Rodnovich,” he said immediately.
“Thomas what?”
“Rodnovich. Thomas Rodnovich.”
“You know the guy?”
“Everybody knows Thomas Rodnovich.”
“Okay. Who is he? And why does he have wires in his left hip?”
Whit took a step closer. “Listen,” he said, lowering his voice and looking to see if anyone else was around, “I can’t believe you never heard of this case. He’s a guy Cuv operated on last year. It was the last case of the day. Maybe everyone was tired, I don’t know. Anyway, the case was done in a second room, and the residents somehow prepped the wrong hip. To make it worse, Stan Warczak, the junior resident, put the X-ray on the view box backward, making the right hip look like the left.
“Cuv came in after the patient had been prepped and draped. He made the incision and had just removed the greater trochanter when he sensed something was wrong. He had one of the nurses check the consent and then realized he was doing the wrong hip. Thank God all he had done was open it. He hadn’t replaced the joint, but he had made an incision and had removed the trochanter on the wrong hip.”
I could hardly believe such a catastrophe had happened to one of my idols, one of the gods of orthopedics.
“So what’d Cuv do?”
“He didn’t say a word. He wired the trochanter back down, closed the incision, and did the other hip. Then he went out and talked to the family. He told them what happened and took all the blame himself.”
Since my first day in orthopedics I had worried about what horrible things might happen if I screwed up. This story made me realize that my fears were justified. People do screw up. Terrible things do happen.
I was afraid to ask the next question. “What happened to the residents?”
“Warczak went to Cuv after the case and apologized, said he was responsible for the error and offered to resign from the residency program.”
My heart was pounding. Resign from the program!
“Cuv heard him out and then said Stan had made a serious mistake. He should have paid more attention to what he was doing. But Cuv said he should have caught the mistake himself. He told Stan not to resign, but said God help him if he ever made a mistake like that again.”
I had just reached over to the X-ray to point at something when Whit whipped the film off the view box.
“Hey! I wanted to—”
“Gentlemen.” Cuv had come up behind us and nodded his hello. He took the X-ray out of Whit’s hand and put it back on the view box.
“One should never be afraid to confront one’s mistakes, Dr. Whitmer.”
Whit, embarrassed, nodded weakly.
“Dr. Collins, you have heard the facts of this case?”
“Yes, sir.”
“And what have you concluded?”
I was about to say something patronizing about how bad breaks can happen to even the greatest of surgeons, but the look in Cuv’s eye told me he didn’t want bullshit. I took a deep breath.
“Well, sir, it scares the hell out of me.”
“And why is that?”
“Because I’ve always been afraid that I would make some terrible mistake. This case is like my worst nightmare come true.”
He nodded. “You owe it to your patients never to lose that fear, Doctor.”
He reached over and straightened the X-ray, as if giving it permission to beam out his error to the whole world.
“This,” he said, “is what happens from a lack of vigilance on the part of the surgeon.” I could tell he was speaking as much to himself as to us. “Everything that happens in that operating room is your responsibility. Everything. On the operating table lies an unconscious, helpless patient who has placed his confidence and trust in you—not in the resident, not in the anesthesiologist, not in the institution, but in you.”
His shoulders sagged. He was visibly shaken. Even a year later, he was still suffering from what had happened that day. Whit and I looked at each other. There was nothing we could do to comfort him. Any words mere residents could say would only make it worse.
“Gentlemen,” he told us, “you will find that you can learn much more about yourself from your failures than from your successes.”
If there had been any doubt in my mind about going into orthopedics it was removed on Mark Coventry’s service. He showed me how rewarding and fulfilling life as a surgeon could be.
I had chosen surgery instead of internal medicine because I wanted to do things. Too often internists seemed interested only in the process of discovery. They wanted to learn things. What was the diagnosis? What caused it? The emphasis was always on examining and discerning, not fixing. “Internists diagnose and surgeons treat” is the old expression. Of course, internists put it another way: internists think; surgeons act.
Back then, orthopedic surgeons had the unfair reputation of being the dummies of the medical profession. We were the not-very-bright plodders who fixed broken things. Orthopods, so t
he internists claimed, were usually ex-jocks who were “strong as an ox and twice as smart.”
I attended Loyola Stritch School of Medicine in Chicago. Every year on the feast of St. Luke, the patron saint of physicians, the school held a big dinner. Skits were performed lampooning each specialty. Jokes would be made about anesthesiologists passing gas. The obstetrician would wear a catcher’s mitt. The pediatrician would have a lollipop in her mouth. And always, the orthopod would be some big, dumb guy with a tool belt strapped to his waist. His only dialogue would be something like “Bone broke. Me fix.”
Despite the jokes about orthopedics, I felt drawn to it. I had always liked to work with my hands. As a child, I constructed models and forts and castles. I enjoyed building things, starting with nothing and making it into something.
On Dr. Coventry’s service everything came together. He showed me the nobility of our calling. He showed me how seriously we must take our responsibilities. But, above all, he showed me how wonderful it felt to do something for others.
I learned from Dr. Coventry to enjoy the time we spent in the clinic. Like most orthopods I preferred the operating room to the clinic. The OR was where our hearts lay. That’s where great things were done. What happened in the clinic always seemed a preparation for, or a postscript to, what we did in the OR.
But there was a difference with Cuv. Going to the clinic with him was a heady experience. Every day, in almost every room, were people he had helped, people who were so incredibly grateful to him. I couldn’t get over it. Just thinking that someday I might be able to accomplish similar things made me giddy.
Frank, Jack, and Bill were jealous that I got to be with Cuv.
“So what’s he like?” Jack asked me one Friday night at Tinkler’s.
“Well, he’s a no-bullshit kind of guy,” I said. “He’s always asking you questions, always checking to be sure you haven’t overlooked something. He seems kind of cold and aloof when you first meet him, but he grows on you. What’s amazing is seeing him with patients. He’s all business when he examines them; but when it’s time to sit down and talk, he’s a different guy. All the sternness is gone. You can feel his warmth, how genuine he is.”
Hot Lights, Cold Steel Page 4