One of the oldest medical schools in the country, Tulane is known for its long tradition of surgical excellence. From Rudolf Matas to Alton Ochsner, from Michael DeBakey to Ted Drapanas (chief of surgery during my time, as well as editor of Surgery), the school was home to a number of world class surgeons, helping to explain why almost 60% of my medical school class entered surgery or one of its subspecialties. “A chance to cut is a chance to cure” was a favorite maxim on the service, appealing to those who wanted to find a problem, fix it right away, and not have to deal with the chronic management problems posed by diseases like diabetes or hypertension.
As students, we found surgeons to be a charismatic lot, strong in ego and self-esteem. Let’s face it – you have to have a big ego to cut into a human body, take out a part, and be confident you can put it back together and have it continue to function. “Right or wrong, but never in doubt” was another maxim thrown about by the surgical teams, along with the machismo “Incisions heal side to side, not end to end” with its corollary “Small minds operate through small incisions.” And for the worried, there was the black humor of “All bleeding eventually stops.”
Surgical residencies were notoriously competitive with a pyramid structure, where each year there were fewer slots in the five year basic program than the prior year. For those who did not make the cut, the choice was to apply for a less prestigious program hoping to be accepted, or change fields to another specialty. This hyper competition made for the development of survivors who sometimes turned out to be misanthropes or prima donnas in their field. They may have been excellent technicians, but not infrequently lacked in bedside manners or kindness to their underlings. I had the misfortune to be on my surgical rotation with one such individual, a visiting professor from another major institution, where as chairman, his name was attached to a rare but well known disease. He was an almost cartoonish caricature of the short man syndrome, overcompensating of his 5’5” frame with a fusillade of humorous vitriol that would not be tolerated in our current environment.
While we were making bedside rounds on the service’s patients, he found one whose IV bag had been allowed to run dry. “Why is this man’s IV been let run dry?” he demanded in his high pitched voice. “I’m sorry, sir, but the nurse must have forgotten to change it” stammered the nervous resident. “And whose patient is this, doctor?” he yelled. “Mine, sir,” said the resident meekly. “Good,” he smiled coldly. Then he grabbed the IV tubing and tied the resident to the IV pole. “Now, you will stand here and make sure your patient’s IV doesn’t run dry. If I come back and you’re not here doing your job, I’ll kick you out of this program myself, and make sure no other residency touches you with a ten foot pole!” Sadly, in those days, he could make good on his threat. In the spectrum of tyrannical chiefs, he was probably one of the worst, but there were other lesser evils that still were capable of inflicting damage.
One of my classmates on the service was a tall, gentle-spoken man from Georgia from one of the old line Southern families. His father was a surgeon as well as a Tulane alumnus. The two of us were scrubbed in on a case with the visiting dignitary when, after berating the junior resident for not cutting the sutures right, threw another instrument across the room, yelling at the circulating nurse for bringing him the wrong one. By now, everyone was so nervous trying to work with him, that they were making unaccustomed mistakes. At this point, my classmate put down the retractor he was tasked with holding, stepped back from the operating table, and proceeded to walk out of the OR. “Where the hell do you think you’re going, sonny?” screamed the tyrant. My classmate quietly replied, “Sir, my daddy taught me to be a gentleman, and to only operate with other gentlemen. Sir, you are no gentleman!” he said, as he walked out, removing his gloves. After the case was over, the surgeon charged into our chairman’s office, repeated the tale of the uppity student, and demanded that the student be kicked out of school. Our chairman responded by laughing, “But he’s right, Bob. You are no gentleman.” My classmate became the hero of the residency, and went on to become a good surgeon of the right kind.
Drapanas, the Tulane chairman, was not the monster this man was, besides being blessed with good looks and a friendly smile. The nurses called him “The Golden Greek”, and one of them made him gold lame scrub caps to wear in his surgeries. These were kept separate from the regular hospital laundry, and washed separately to have available for his use. One day, however, his golden dome covering ended up in the regular laundry pile, and everyone from chief resident on down was picking through the five tons of dirty laundry in the basement of the hospital looking to recover it for him. This was the key moment when I decided I would never be a surgeon.