SURGICAL HUMANITIES DEPARTMENT of SURGERY | UNIVERSITY of SASKATCHEWAN Winter 2019 Journal of the SURGICAL HUMANITIES

Journal of the SURGICAL HUMANITIES DEPARTMENT OF SURGERY | UNIVERSITY OF SASKATCHEWAN Winter 2019 Journal of the SURGICAL HUMANITIES

EDITOR-IN-CHIEF Francis Christian CONTENTS EDITORIAL BOARD Francis Christian Ivar Mendez Taras Mycyk Justine Pearl Ronald Nguyen Haisen Marlessa Wesolowski David Swann

GRAPHIC DESIGN, COMMUNICATIONS AND MARKETING Department of Surgery University of Saskatchewan

COVER PAGE Photograph of Mildred Codding (1902-1991), brilliant, pioneer surgical illustrator in full surgical clothing. For a fascinating account of the life, times and work of Mildred Codding turn to the biographical essay by Christy Di Frances, Director of Narrative Writing at the Boston University School of Medicine (pp 6-14).

Journal of the Surgical Humanities c/o Surgical Humanities Program Department of Surgery University of Saskatchewan

Health Sciences Building 107 Wiggins Road, 4th floor, Suite B419 Saskatoon SK S7N 5E5 TEL: 306.966.7323 http://medicine.usask.ca/department/clinical/surgery-pages/surgicalhumanities.php

2 | JOURNAL OF THE SURGICAL HUMANITIES 04 GUEST EDITORIAL Henry Woolf

06 MILDRED CODDING'S HUMANIZATION OF SURGICAL ART Christy Di Frances

15 TIMELESS SEABEE Garry Linassi

18 OSLERIUM Francis Christian

21 CHAUVINISM IN MEDICINE PART 3 Sir William Osler

28 POETRY CORNER Lloyd Jacobs

32 ZHIVAGO: DOCTOR IN LITERATURE Excerpts from memoirs of R. M. Kirk Chapter 8

38 SUBMISSION GUIDELINES

Mildred Codding

JOURNAL OF THE SURGICAL HUMANITIES | 3 GUEST EDI TORIAL by Henry Woolf A LIFE WITHOUT ART

Henry Woolf

he word “Art” makes many Heaven forbid that one should How did all this come about? people feel uncomfortable. be labelled “non-cultural,” Modern man has become “top TWhen the word comes up, “uncultured,” because one was animal” on our globe not by they feel a cultural carpet has never seen at the ballet or caring a jot or a tittle about been laid before them in order swooning with delight at some “Art,” but by simply learning to trip them up. heartfelt aria at the opera. how to count, how to do natural experiments and how to think The very group that one The funding bodies that keep abstractly about physical would expect to hold coherent “Art” going are well aware phenomena. From these humble opinions on “Art,” the artists of all this and keep highly beginnings, modern science themselves have no need to expensive “Art” like Opera and technology took the world talk about it because their lives and Ballet funded not only by storm and shook it into its are already crammed with Art to maintain societal prestige modern configurations. - it is the very air they breathe for the financially deserving, Some extremely clever chaps whether they are musicians, but as a proof of our national (the Freudians) estimated singers, poets, playwrights or and provincial sophistication! that only about 10% of our painters, whatever they are. Incidentally, the affluent thoughts and feelings - our But let us not be dazzled by audience of today likes its “psyche” if you like - are open to the mention of so many fields “Art” to be not too disturbing. examination by our conscious, of artistic expression. The sad Which is why “safely dead” Art in rational mind. That in fact is all truth is that however much we symphonic ballet and operatic that is apparently necessary to pay lip service to its splendours, repertoires gets more funding maintain modern man’s mastery Art is held in very low esteem in than Art of any other sort. A of the known world. But what our society. few crumbs of funding are about the unknown world? then left over for avant-garde, That undiscovered country “Sport” for example, is experimental Art - just enough constituting the remaining immeasurably more highly to keep its half dead corpse still 90% of our psyche - and which regarded. Thank goodness a twitching but never enough to apparently only surfaces in certain amount of deference to raise the daunting prospect that dreams, in Art and in (what “culture” is expected of anyone one day, really “living Art” might society regards) “unbalanced” earning a decent income! dominate the Art world. behaviour?

4 | JOURNAL OF THE SURGICAL HUMANITIES Henry Woolf and his friend Harold Pinter Photograph: Eamonn McCabe for the Guardian Source: https://www.theguardian.com/culture/2017/oct/15/haroldpinter-best-friend-reveals-painful-secrets#img-3

What about it? Who really Henry Woolf and his wife Susan live in Saskatoon, Canada. cares about the untidy froth Henry was born in England and was a close friend and of an uncharitable sea? How confidant of the playwright and winner of the Nobel prize many bucks is it worth? It in literature, Harold Pinter. Pinter’s first play “The Room” was never seems to occur to more written at the behest of Henry Woolf who asked Mr. Pinter to than a handful of people that go ahead and write out his idea for a play, so that he could cut off from our intuitive or put it on stage - Pinter wrote the play in three days and Henry unconscious selves (“useless staged it at the University of Bristol in 1957. baggage” some would say), most He is an accomplished stage and film actor himself and has of us are leading deprived lives. acted in productions in the West End, London; in Broadway, New York and in numerous other venues around the world. Becoming the wealthiest, Henry has been writing poetry from “within three weeks healthiest animal that has of becoming an actor” and examples of his searching, ever lived is an empty triumph epigrammatic poetic style were featured in this Journal in a without the addition of Artistic previous issue. Further examples will appear in a forthcoming expression to describe our issue. lives in ways that illuminate From 1983 to 1997 he was Professor of Drama at the what is happening to us. I do University of Saskatchewan and was a founding member of believe that a life without Art “Shakespeare on The Saskatchewan.” Henry Woolf’s memoir is like living in a house without “Barcelona is in Trouble” was released in 2017. windows - no light can come in nor can any of our hopes, joys, Reference: Henry Woolf: “My 60 Years in Harold’s Gang:” The Guardian: fears and questions about life Thursday, 12 July, 2007. itself ever reveal themselves. https://www.theguardian.com/stage/2007/jul/12/theatre.haroldpinter (retrieved 29 Dec 2018).

JOURNAL OF THE SURGICAL HUMANITIES | 5 Mildred Codding’s HUMANIZATION OF SURGICAL ART Christy di Frances, PhD, MA Director of Training & Education, American Heart Association Tobacco Regulation and Addiction Center (A-TRAC) Director of Narrative Writing, Department of Medicine, Boston University School of Medicine

rom ancient medical art created on papyrus example of twentieth-century illustration to the varied iterations of Medieval that endeavors to humanize surgical art by FWound Man, Andreas Vesalius’ Renaissance moving beyond merely technical portrayals of De Humani Corporis Fabrica, and today’s patients’ biological frameworks. Traversing the digitized imaging, paratextual illustrations boundaries of anatomical renditions, Codding’s have long provided a natural—yet to some illustrations comprise a thoughtful, and at times extent overlooked—modality for infusing the deeply moving, consideration of humanities humanities into medical pedagogy.1-3 Patel et within surgery. Indeed, based upon Codding’s al. define such art as “a study of medicine and training under renowned medical illustrator surgery through the form of pictures, instead Max Brödel, some of her technical work can, and of words. Illustrations play a significant role should, be considered through an aesthetic lens. in medical and surgical education. Medical To demonstrate the point, Codding’s original illustrators use the universal language of visual sketches for Matson and Shillito’s An Atlas of imagery to facilitate the understanding of Pediatric Neurosurgical Operations,5 published anatomy and operative approaches, especially in 1982 but over twelve years in the making, in neurosurgery, allowing the communication will be considered from a primarily aesthetic of surgical ideas, techniques, and original rather than technical perspective to demonstrate research.”4 Even in an era defined by Artificial that her training under Brödel, and subsequent Intelligence and advanced imaging technologies, development as a conscientious artist-educator, the data visualization facilitated by illustration unite to infuse a humanistic motif into her work. is still fundamental to health sciences Close examination of her sketches for the Atlas curricula.1,4 Close readings of paratextual reveals a fascinating “humanizing aesthetic” surgical art provide a unique opportunity for encoded into the paratextual materials designed contemplating the historical integration of the for the publication. humanities into medical education. So, who was Mildred Codding? Since her name This essay maintains that the work of Harvard and legacy have to a large extent vanished from Medical School (HMS) illustrator Mildred the public eye, it will be useful to provide some Codding (1902-1991) can be viewed as an background. Codding worked as an illustrator in

6 | JOURNAL OF THE SURGICAL HUMANITIES to work with Cushing on a full- time basis in 1930.7

In an era of rapidly progressing medical technology, when relatively few women were professionally active in medicine outside the field of nursing, Codding exhibited an impressive combination of biomedical expertise and aesthetic sensibility to establish herself as an integral member of the medical community at HMS and its affiliated teaching hospitals. This fact is particularly impressive when grounded in the historical reality that HMS did not admit its first class of Figure 1: Among her greatest achievements are women until 1945—sixteen the 1939 Atlas of Surgical Operations, written years after Codding had begun by Drs. Eliot Cutler and Robert Zollinger, which working there. Indeed, a search was used as a field guide for American military through the PBBH surgical medical personnel during World War II, and staff annual photographs in the Atlas of Pelvic Operations, by Drs. Langdon Parsons and Howard Ulfelder of Massachusetts the BHW Archives at HMS’s General Hospital (MGH), which was recognized for Francis A. Countway Library of outstanding illustrations by the American Institute Medicine reveals that although of Graphic Arts, appearing in the Institute’s listing photos dating as far back as of the fifty best books of 1953. 1915 (Cushing is portrayed in that year) are present, women the Department of Surgery at Harvard Medical do not begin to populate the scenes until i School and at the Peter Bent Brigham Hospital 1953. Staff photos depict Mildred Codding in (PBBH), which was later amalgamated with 1957, 1958, 1959, 1961, 1962 (in which she is several other hospitals to form the present- unnamed but nevertheless recognizable), and 8 day Brigham and Women’s Hospital (BWH), a 1966. teaching affiliate of HMS. Codding had earned a Master’s Degree in Zoology and Genetics at Certainly, Codding’s professional achievements Columbia University in 1926 before embarking as a woman in early twentieth-century academic upon a two-year course in medical art at Johns medicine are noteworthy, since over the course Hopkins University, studying under Max Brödel. of a long and distinguished career in the field She initially came to Boston by invitation in of medical illustration, she created paratextual 1929, following her first year of art school, material for many physician-authors with to work with Dr. Harvey Cushing, known as appointments at HMS. Her drawings featured the father of modern neurosurgery, who was in a variety of textbooks and academic journal 8 Moseley Professor of Surgery at HMS, Chairman articles, as well as in medical exhibits. of Surgery at the PBBH, and author of the Pulitzer Prize winning biography, Life of Sir i This is not meant to represent an exhaustive account of the BWH 6 Archives; it is of course possible that official photos depicting women in the William Osler (1925). Codding returned to HMS PBBH Department of Surgery exist elsewhere in the Archives.

JOURNAL OF THE SURGICAL HUMANITIES | 7 HUMANIZATION OF SURGICAL ART... by Christy di Frances

Her willingness to don medical illustrator: Max Brödel in medical illustration, and it surgical clothing and enter (1870-1941), a German-born is worthwhile noting that she predominantly male operating artist who came to the United was essentially handpicked by theaters resulted in innovative States in 1894 to work at Brödel to work with Cushing.7 drawings that won regard from The Johns Hopkins University The two men had met and reviewers within academic School of Medicine. “Brödel’s formed a friendship at Johns medicine (Figure 1). Among skill was well received at The Hopkins while Cushing was her greatest achievements Johns Hopkins and, with the undertaking his residency are the 1939 Atlas of Surgical help of an endowment, he under famed surgeon William Operations, written by Drs. Eliot founded the ‘Department of Stewart Halsted.12 Codding’s Cutler and Robert Zollinger, Art as Applied to Medicine’ at drawing style, initially based which was used as a field The Johns Hopkins in 1911, entirely on Brödel’s training guide for American military the first department dedicated and techniques, evolved with medical personnel during World to the training of medical time and new influences. War II, and the Atlas of Pelvic artists.”10 Brödel’s classical Perhaps unsurprisingly, her Operations, by Drs. Langdon education—first in a rigorous independence of artistic vision Parsons and Howard Ulfelder of German gymnasium and then could lend itself to ideological Massachusetts General Hospital at art school in Leipzig—meant friction with Cushing, who had (MGH), which was recognized that he was extremely well himself studied under Brödel.7,11 for outstanding illustrations educated. In 1888, while still Cushing could be an exacting by the American Institute of attending art school, he began and difficult colleague for Graphic Arts, appearing in the working on medical drawings whom to render illustrations: Institute’s listing of the fifty under Professor Carl Ludwig Codding recounted how he “felt best books of 1953.7,9 (1816-1895), the Director of the the illustrator’s role was to Institute of Physiology at the elaborate and clarify surgical Unfortunately, despite University of Leipzig. Although illustrations for publication. He Codding’s significant Brödel was a talented and preferred this method versus achievements within the field proficient artist, his knowledge relying solely upon the artist’s of surgical illustration, her work of anatomy was limited view.”7 has for the most part eluded initially, so he undertook a self- critical attention. Indeed, a directed course of anatomical Perhaps quite naturally given 2012 article published in the studies.11 He “felt that to be a his primary field of study and Journal of Clinical Neuroscience good medical illustrator, one training, Cushing seems to regarding medical artists who must first be an anatomist have maintained some bias illustrated for Henry Cushing and one must subsequently towards the supremacy of and his contemporaries fails learn how to project both a technical exactitude over a to even mention Codding.10 structural and functional image philosophical aesthetic in However, her contributions to on paper in the form of an all- surgical illustration. Codding the field of surgical humanities encompassing drawing.”4 Brödel was keenly aware of both are significant, especially given thus became a tireless student Cushing’s surgical and artistic the wide-reaching circulation of human anatomy. Indeed, skill; nevertheless, even of her work in textbooks and his perfectionism made him while working under him she journal articles written by an artist who “set a precedent maintained a unique method premier surgeon-educators of in his approach to medical and style. In interviews, the twentieth century. illustration.”4 Codding revealed her preference for “the ‘half-tone’ To some extent, Codding’s Such was the environment technique in which a brush professional journey begins in which Mildred Codding was required to build the base with the story of another received her formal training from which an eraser removed

8 | JOURNAL OF THE SURGICAL HUMANITIES ‘highlights.’ A sharp scratching and findings, striking a perfect material in a textbook “created tool could be used to show balance between photographic especially for the neurosurgeon glistening droplets,” resulting reality and representational in training.”5 Following her in a realistic style that differed simplification, is unique.”13 formal retirement, she “agreed significantly from Cushing’s Codding was also a proficient to work with Dr. Donald Matson, more coarsely shaded sketches.7 operative photographer neurosurgery, to produce with The aesthetic differences but preferred drawing as a him an atlas of neurosurgical between Cushing and his medium for her art.7,9 Codding’s operations. After his untimely illustrator indicate that Codding physical boundary-crossing death in 1969, Miss Codding was developing a definitive from her studio in HMS, an continued to work with Dr. John aesthetic in her work. embodiment of the traditional Shillito, Dr. Matson’s associate” artist’s generative space, to to produce the Atlas.”14 It is On multiple levels—theoretical the operating theaters of plausible to assume that the and thematic as well as the surrounding hospitals is project must have exerted practical—Codding’s a significant illustrations intellectual draw for demonstrate the her, as it represented importance of a time-consuming interdisciplinary and exhaustive collaboration in undertaking for training world-class someone on the brink surgeons. Her work of retirement. played a critical role in elevating the In an interview, status of aesthetics Codding explained and paving the way her artistic process for the contribution in regards to the of the arts and formulation of humanities to artwork for the Atlas, be viewed as a doubtless perfected meaningful element over her many of surgical education years of successful with the potential illustrating: “First, of philosophical she would observe Figure 2 and technical the operation, making significance. Indeed, very rapid and rough the scope and importance indicative of the ways in which sketches on page after page of of her art is exemplified by her art seeks can be viewed as her pad. This usually required comments made in the PBBH infusing a humanizing aesthetic around 12 pages of step-by- annual report of 1962-1963: into the surgical curricula of step sketches. Next, she would “Miss Mildred Codding was her era (Figure 2). review all of these drawings presented with a gift from with the surgeon and chose the Surgical Service and the Codding’s final medical just the necessary steps. After Surgical Alumni, in gratitude illustration project, the finishing the important pencil to her for excellent work, landmark Atlas, provides a sketches on tissue paper, they now known internationally, in fascinating case study for were transferred twice to the surgical illustration. [...] Miss exploring her integration final page by rubbing the Codding’s ability in rendition of science, aesthetics, and back of the original. The final of the operative techniques humanism into paratextual shading and toning to produce

JOURNAL OF THE SURGICAL HUMANITIES | 9 HUMANIZATION OF SURGICAL ART... by Christy Di Frances

the published plate was done generally appears using her brush technique.”7 more raw—and less altered by current Codding’s experience in the conventions—in earlier operating theater, and keen versions of the work. In attention to detail, resulted comparing the sketches in an impressive publication. with the published Indeed, in his review of illustrations, it seems the volume, renowned that the former present neurosurgeon Dr. Paul C. Bucy a purer representation elaborates on the magnitude of of Codding’s aesthetic the work, calling it: “a book that vision. every prospective and novice neurological surgeon should Although Codding’s read from cover to cover while reputation as a surgical studying each of the many, artist rests primarily Figure 3 many illustrations (232 plates) on the technical skill carefully. [...] The numerous of her finalized “products,” it a tour de force in emotional illustrations are largely the can be argued that the sense realism. work of Mildred Codding, who of humanity portrayed in Atlas was an associate of both Harvey is simultaneously striking and From a thematic as well Cushing and Donald Matson. unexplored. In the following as aesthetic perspective, Mr. Lashbrook filled out those sections, several sketches Codding’s sketch recalls illustrations that Miss Codding created by Codding for this early Renaissance art, such was unable to complete. The publication will be considered as Giotto di Bondone’s iconic illustrations are line and through a primarily aesthetic fresco cycle in Padua’s Capella wash drawings that provide lens to consider the humanizing degli Scrovegni (1304-1306), pictographic augmentation of inferences which may be wherein the artist interpolates the text in every detail.”15 located within her paratextual joyful scenes of new life into a work. sequence of somber reminders While the finished illustrations of human mortality, with the in Atlas are certainly The first image to be latter reaching an emotional impressive, this essay focuses considered is Codding’s profile- and aesthetic climax in on Codding’s preliminary view sketch of an infant Lamentation, where a bereaved sketches for the book, which prepared for surgery regarding Madonna weeps over her dead are held in the library archives a dermoid cyst (Figure 3). The (adult) son while child-like of the Boston Children’s published version of this sketch cherubim mourn his impending Hospital. The rationale for is less detailed.5 What strikes entombment. In considering focusing on her unpublished the viewer immediately in this these pieces, viewers are sketches is two-fold: first, some piece is the sheer sensitivity guided towards reflecting upon of the finalized illustrations in of the artistic rendering—in that strange juxtaposition the published work received particular, the profile view which T. S. Eliot so thoughtfully a degree of input from Grant and softened facial details. articulates in his poetry: Lashbrook and are thus not Far from being a work of mere […] There was a Birth, purely attributable to Codding, technical exactitude, this piece certainly, and, second, examining the is reminiscent of the emotional We had evidence and no sketches provides the benefit complexity of fine art: what the doubt. I had seen birth and of investigating a thematic sketch lacks in lifelike detail death, subtext to the art which is more than compensated in But had thought they were

10 | JOURNAL OF THE SURGICAL HUMANITIES different; this Birth was emotional alignment with the The gaze of the youthful subject Hard and bitter agony for us, patient. in one of Codding’s instructional like Death, our death.16 sketches for cranioplasty is Another of Codding’s sketches, uncannily direct, even jarring, Birth and death—no matter how this one for surgical procedures inviting viewers to recognize the oppositional the two states concerning depressed fractures personhood of this individual may seem on a superficial level, in newborns, presents in reality they occupy a space a sleeping infant who of inevitable duality. Just as has been swaddled Giotto’s sequence of frescoes tightly, held fast by captures the anomalous two straps that may be juxtaposition of a new life and read as symbolizing imminent peril, so Codding’s the bonds of earthly sketch captivates viewers affliction. Once again, with its mixture of wonder simplification of the and ambiguity: the ventilator aesthetic is evident in is our constant reminder that the published version.5 this child’s life hangs by a Here, the presence of thread, contingent on a delicate a mechanical device— combination of surgical skill perhaps a temperature and biomedical innovation. gauge or blood Her sketch invites surgeons-in- pressure monitor— training to consider the gravity disturbs the moment’s Figure 5 of their interactions with the tranquility, solidifying infant, not merely as a patient imagery of “the unnatural” in (Figure 5). Once again, Codding’s but, far more importantly, as our minds. The perspective in rendition invites a realization a fellow mortal. In so doing, Codding’s artistic rendering that the unique humanity of these drawings awaken an draws the viewer’s gaze the child cannot be avoided empathic sensibility as viewers downwards towards the or lost in his or her temporary are encouraged to create infant, who seems curiously identity as a patient. This inaccessible, an invitation to child’s personhood confronts Figure 4 remember the limitations of the viewer unapologetically, (even modern) medicine. The presenting no mere “stock tightly-wound wrapping of the image,” as we might otherwise child is reminiscent of both an be tempted to imagine from the infant’s “swaddling clothes” superimposed surgical diagram, and grave cloths, both of a technical interpolation for which foreshadow the common educational purposes. Quite resurrection motif of Medieval noticeably, Codding has chosen and Renaissance art, though to depict the child with open Codding’s child appears tethered eyes, although she omits details to earth by some physical of the irises and pupils.ii The malady which necessitates the implications of this rendering corporeal bonds (Figure 4). might be read as pedagogical Yet the latent symbolism here as well as thematic, yet another reminds us that a temporary “resurrection” is possible in the ii Details of the child’s eyes have been completed in the published version. (5. Shillito J, hands of a skilled surgeon. Matson DD, Codding MB, Lashbrook GS. An Atlas of Pediatric Neurosurgical Operations. Philadelphia, PA: W.B. Saunders Co.; 1982. )

JOURNAL OF THE SURGICAL HUMANITIES | 11 HUMANIZATION OF SURGICAL ART... by Christy Di Frances

Figure 6

admonition for surgeons to fetal position. At first glance depiction of a pacifier in the view prospective patients as he strikes the viewer as a baby’s mouth reinforces the individuals rather than “cases.” typical infant—only closer humanizing associations, again observation reveals the line foregrounding the patient’s Codding’s sketches of protruding from his back, identity. We can easily envision unconscious and sleeping perhaps a lumbar puncture the entire surgical team that children prepared for various for the purpose of retrieving a will soon surround the child, craniotomy procedures vacillate sample of cerebrospinal fluid, once the administration of in nature from seemingly an alarming detail that gestures anesthesia has achieved its peaceful to obviously alarming towards the reality of suffering work in rendering death-like (Figure 6).iii Despite being in the otherwise placid world of sleep. unconscious, the young patients childhood dreams. Ventilators often project an appearance often take center stage in Significantly, the tropic of being tired and worn down. these compositions, presenting maternal figure is absent in In some sketches, the child’s immediate focal points—both Codding’s operating theater, attitude is one of wholly aesthetically and thematically. replaced by a surgeon who unnatural slumber: human- The resulting sense is one of functions as a proxy to protect made tubes enter and exit the abject vulnerability, stark visual and preserve the child’s life. small body at its most fragile reminder that surgeon and This binary is less blurred in touchpoints. In one sketch, a child occupy a shared space of the published version of the line is attached to the back of fragility—in which compassion, illustration, where gloves are the head, where a ventricular as much as professional more obvious on the hands, shunt appears, presumably to acumen, is a critical component thus providing a clearer relieve pressure on the brain. of the healing process. distinguishing marker of the holder’s primary role as Another of Codding’s sketches A similar motif can be read in surgeon.5 The notion of such depicts a child with his back Codding’s sketch depicting an temporary code-switching turned towards the viewer, infant immediately prior to between the roles of objective seemingly asleep, his body preparation for a ventricular surgeon and maternal/paternal curled restfully into a semi- drainage procedure—the proxy is certainly contentious newborn held, literally and (even downright uncomfortable) iii For several examples of published versions, see Schillito and Matson 148; Plate 69; figuratively, in the surgeon’s by the standards of modern 268, Plate 126; 288, Plate 135; 324, Plate151; 332, hands (Figure 7). Her medicine—yet it succeeds Plate 155; 362, Plate169.

12 | JOURNAL OF THE SURGICAL HUMANITIES in awakening empathy, not The dual threat of “time” and Codding’s illustrations impress to mention interrogating “fevers” are aspects of our upon a rising generation of the nuanced philosophical shared “ephemeral” existence, surgeons the fragile humanity ramifications of the Hippocratic a constant reminder that the of their patients. The bodies Oath. “grave” is always within our on which they operate “mortal” view. Yet amidst such possess spirit and personality: The surgeon’s task, when difficulties, the child emerges they are intricately unique, properly conceived of, is “entirely beautiful”—worthy of profoundly human. Codding’s surely a daunting one. Yet, every lifesaving effort by the surgical illustrations present when read within a historical- surgical team. trainees with a different— aesthetic context, Codding’s and profoundly humanized— imagery imbues a sense of Codding’s surgical sketches viewpoint. Perhaps after hope in the midst of dire can certainly be contextualized considering her work, they circumstances. Despite the as generative boundary might approach their own from inherent uncertainty of surgical crossings on multiple a new perspective, echoing procedures, her sleeping child levels: they are the unique Eliot’s enlightened narrator: evokes an aura of peacefulness contributions of a woman in […] I had seen birth and and hope. The unconscious a male-dominated field, of death, patient presented in this and an artist-scientist operating But had thought they were other Codding sketches is within an overwhelmingly different; this Birth was indelibly marked by universal quantitative environment, Hard and bitter agony for us, blights of being human. As W. H and of a professional like Death, our death. Auden wrote:iv championing drawing in an We returned to our places, Time and fevers burn away age when photography and these Kingdoms, Individual beauty from film held powerful sway. But no longer at ease here, in Thoughtful children, and the Her work spans decades and the old dispensation.16 grave transgresses social, as well as Proves the child ephemeral: academic, norms of the era. It Certainly such philosophical But in my arms till break of melds scientific clarity with realizations—uncomfortable day humanistic qualities—all the though they may be—are as Let the living creature lie, while offering a fascinating necessary as technological Mortal, guilty, but to me subtext of a philosophical innovation for achieving real The entirely beautiful.17 inquiry that is so eloquently improvement in patient care, conveyed through the vehicle which, after all, is the summum of art. bonum of all medicine. iv This excerpt from Auden’s ‘Lullaby’ (1937) presents a literal approach to these specific Far from simply speaking to the lines in relation to the poem’s title and is not intended to provide commentary on the broader need for technical education, thematic implications of the poem.

Figure 7

JOURNAL OF THE SURGICAL HUMANITIES | 13 HUMANIZATION OF SURGICAL ART... by Christy Di Frances

Figures Eugene Rossitch Jr.. Surg Neurol. 1991;35(5):341-344. Figures 1-2: Brigham and Women’s Hospital Archives, 8. Archives BaWsH. Peter Bent Brigham Hospital Peter Bent Brigham Hospital Records:1830– Records: 1830– (inclusive), 1911–1980 (bulk). Box 11. (inclusive), 1911–1980 (bulk). Box 26. Folder 19, In: Brigham and Women’s Hospital. Mildred Codding, circa 1930s, 1950s. (Photographer: 9. Harkens DE, Moore FD. Mildred Codding— Russell B. Harding, 32 Princess Rd. West Newton, MA.) Surgical Artist—Extraordinary. Brigham Bulletin. Figures 3-7: Codding, Mildred. Sketches. Boston 1955;4(7):1-2. Children’s Hospital Archives. Department of 10. Johnson RD, Sainsbury W. The "combined Neurosurgery Records: 1929-1999. AC 13. Archival eye" of surgeon and artist: evaluation of the artists Collection. Box 28. who illustrated for Cushing, Dandy and Cairns. J Clin Neurosci. 2012;19(1):34-38. References 11. Crosby RW, Cody J. Max Brödel : the man who 1. Wind G. Anatomic Drawing for Medical put art into medicine. New York: Springer-Verlag; Education. In: Katz P, ed. Drawing for Science 1991. Education: An International Perspective. Rotterdam: 12. Udelsman R. Presidential address: Harvey SensePublishers; 2017:67-71. Cushing: the artist. Surgery. 2006;140(6):841-846. 2. Hartnell J. Wording the Wound Man. British Art 13. “Report of the Surgeon-in Chief.” Peter Bent Studies. 2017(6). Brigham Hospital Fiftieth Annual Report: 1962-1963. 3. Cambiaghi M. Andreas Vesalius (1514-1564). J Cambridge, MA: Harvard University. Neurol. 2017;264(8):1828-1830. 14. Shillito J, Jr. Obituary: Mildred Codding, 1902- 4. Patel SK, Couldwell WT, Liu JK. Max Brodel: his 1991. Surgical Neurology. 1991;36(4):319. art, legacy, and contributions to neurosurgery through 15. Bucy PC. An atlas of pediatric neurosurgical medical illustration. J Neurosurg. 2011;115(1):182- operations: By John Shillito, Jr., M.D., and Donald D. 190. Matson, M.D., with illustrations by Mildred B. Codding 5. Shillito J, Matson DD, Codding MB, Lashbrook and Grant S. Lashbrook Philadelphia, W.B. Saunders, GS. An Atlas of Pediatric Neurosurgical Operations. 1982 497 pp., $160 (U.S.), $192 (Canada). Surgical Philadelphia, PA: W.B. Saunders Co.; 1982. Neurology. 1982;17(5):343. 6. Doyle NM, Doyle JF, Walter EJ. The life and 16. Eliot TS. “Journey of the Magi.” The Wasteland work of Harvey Cushing 1869-1939: A pioneer of and Other Poems. San Diego: Harcourt Brace & neurosurgery. J Intensive Care Soc. 2017;18(2):157- Company; 1962. 158. 17. Auden WH, Mendelson E. “Lullaby.” Collected 7. Moore MR, Shillito JJ, Rossitch EJ. Mildred poems. 2007 Modern Library ed. New York: Modern Codding: an interview with Cushing's medical artist. Library; 2007. Interview by Matthew R. Moore, John Shillito Jr.,

Christy Di Frances, PhD, MA, is the Director of Training & Education, American Heart Association Tobacco Regulation and Addiction Center (A-TRAC) and Director of Narrative Writing, Department of Medicine at the Boston University School of Medicine. Her academic and research interests include education, medical humanities, literature and medicine/narrative medicine, and creative/reflective writing. Previously, she worked at Harvard Medical School’s Brigham and Women's Hospital, where she discovered the remarkable surgical art of Mildred Codding. Christy studied humanities in Scotland and Australia and has served as a fiction reader for the Harvard Review.

14 | JOURNAL OF THE SURGICAL HUMANITIES TIMELESS SEABEE

Garry Linassi

Editor's note: As doctors, time management is one of our greatest challenges. In this true account of Angelo, a medical student who in a previous career worked as a geologist, that lesson would come early in his career…

hen Robert Service whether the camp cook also The “Zoo”, a local bar aptly wrote “There are had spots that moved during named for reasons that aren’t Wstrange things done the night. Angelo was hired by usually discussed publicly, in the midnight sun by the the mining contractor whose was their gathering place of men who moil for gold” in his crews consisted of very tough, choice. While officially “dry”, timeless work The Cremation of hardened miners, blasters, the Seabee camp was in reality Sam McGee, little did he know truck drivers and timbermen. a bit damp, though apparently that almost 90 years later, his Club soda was not in their not damp enough for his crew words would continue to ring vocabulary and previous to miss “last call” at the famous true in a little gold mine in incarceration was a rite of northern watering-hole. Northern Saskatchewan. passage recounted often while successively trying to outdo While waiting at the Zoo for Angelo had taken the year each other. Angelo didn’t fit in, the call to board the Twin Otter, off medical school to work at but it paid well. Angelo realized to his horror the Seabee gold mine as an that he had left his watch underground truck driver. He They rotated in and out of the in Saskatoon. Back then, no was nicknamed “doc” by his mine every six weeks with a one owned a cell phone, and crew who often consulted him two-week break between. At working 400 meters below for a variety of ailments ranging the beginning of every six week the surface in the pitch black from the regular assortment of rotation, they would meet at the darkness of a mine required cuts and bruises, to identifying float plane base in La Ronge, accurate time keeping; there spots that moved during the Saskatchewan to fly in to the was the need to not be on night, to questions about isolated Seabee gold mine. the ramp at blast times and

JOURNAL OF THE SURGICAL HUMANITIES | 15 TIMELESS SEABEE... by Garry Linassi

more importantly the desire to he had in stock. It was a twenty fix it. He instructed Angelo avoid the ever present scorn two dollar Timex complete with to leave it with him and to of the shift boss who being a genuine leather strap and a come back before heading from Newfoundland, expected calendar feature. As the float to the mine. About an hour everything to be done a half- plane lifted off the water, the later and to his delight, Dave hour earlier than was possible. keening of the propellers lulled handed over a fully functioning He rushed through the morning everyone into a deep restful watch set to the proper time mist rolling off Lac La Ronge sleep - everyone except Angelo, (and date). When he asked to Robertson’s Trading to buy a who stayed awake the entire what the problem was, Dave replacement watch. Robertson’s flight, willing his watch to mumbled something about the Trading was a meeting place of cooperate. battery. Not wanting to take sorts, where trappers from all up anymore of his time, he across Northern Saskatchewan The rule was that everyone profusely thanked him and left gathered to sell their furs, worked the first shift when they to start his shift. replenish their supplies and got back to the mine. The first get updates on market trends. shift was uneventful, and his He woke up the next day He was relieved to find a small trusty new Timex kept perfect feeling anxious; it was the cabinet buried deeply beneath time. He started to settle into kind of anxiety that can only piles of muskrat, beaver and a routine, if not monotonous 6 be felt when situations get rabbit pelts that contained an week contract, which in itself completely out of control, the assortment of watches. On a was comforting given the long kind of anxiety experienced budget, he bought the cheapest days ahead in a challenging, by someone who depends on watch he could find. Needless sometimes dangerous and something that was completely to say, by the time he got back often unpredictable work unreliable. He was convinced to the Zoo, his new six dollar environment. this had to be how the pilots purchase had already stopped of the Hindenburg felt. Sure working. He awoke the following day enough, the Timex had stopped to discover to his dismay that working again. It read 11:00am Angelo hurried back to the like the other watches, the July 16, but according to his heady smells of smoked Timex had stopped working too. clock radio, it was 6:00 am, July moccasins and industrial Incandescent, he acrimoniously 17. Sheepishly, he went back strength mosquito repellant to proclaimed that $22 dollars to Dave. He didn’t need to say buy another watch. Clutching just didn’t buy what it used anything as the look on his face his prize tightly in hand, he to. Fearing an encounter with said it all. “still having trouble returned to the Zoo and raised live explosives on the ramp with that watch of yours?” Dave a few eyebrows by celebrating and more terrifying, one with asked. with a club soda. As he sipped his highly explosive shift boss, his “sissy” drink, he noticed he leapt out of bed to find the As before, Dave sent him away again in horror that the second camp electrician. while he fixed the Timex. hand on his new watch had When he returned, Angelo already stopped working. Dave was a personable fellow, was puzzled to see that Dave known around the mine as had attached an “AA” battery Angelo felt cursed and ran “Sparky”. Angelo swallowed on the watchband with black back to Robinsons in a frantic his pride and found Dave electrical tape. Two tiny wires daze while the crew lumbered at his workbench in the were soldered to each pole of towards the dock as the call to powerhouse. After quickly the battery and inserted into board the otter had come in. explaining that this was the the back plate of the watch. The startled store clerk sold third watch that had stopped “That ought to do it,” Dave said him the most expensive watch working, Dave agreed to try to confidently. His puzzlement

16 | JOURNAL OF THE SURGICAL HUMANITIES led to concern then to relief. the foreman extended his keep it going. Suddenly, it all The watch was ugly and would hand and demanded to see became painfully clear. Dave garner a lot of unwanted the Timex. Greatly intimidated, hadn’t been replacing the attention in the camp, but at Angelo complied and to his watch battery at all and the this stage, he didn’t care; he horror watched as the foreman lead wires led nowhere; he’d was happy that it was working threw it against the shop floor simply been winding the watch again. Inevitably, there were a and stomped on it. “Why the and resetting the time and date few snickers from other camp heck did you do that for?” he every day. With indescribable employees as they saw the demanded in protest as he embarrassment, Angelo also contraption on his wrist. bent over to salvage the pieces. realized that the entire camp “To save what’s left of this knew what Dave had been He continued to have problems company’s reputation,” replied doing as well. with the watch, but Dave was the exasperated foreman. From always willing to get it going the corner of the shop, his crew He decided to keep to himself at the beginning of every giggled like a bunch of pre- for the rest of the summer, shift by replacing the battery, pubescent schoolgirls. enjoying the anonymity and re-adjusting the wires or re- solitude that can only be soldering the leads. This went With the remains of the found at the bottom of a mine on for several days, and the destroyed watch in his hand shaft. He went on to complete situation was attracting a lot of and in a state of complete medical school and specialty unwanted attention. Suddenly, disbelief, Angelo noticed training in Rehabilitation it seemed that everyone at the something amongst the pieces Medicine. Angelo is of course camp needed to know what that had eluded his attention me. Now, when I look at a time it was. up until then. It was a small watch and the challenges that dial. A small, corrugated dial accompany time management After a few days of repeated designed for grasping and in my current profession, I think time checks, Angelo, turning. The type of small, of myself at the mine, walking embarrassed from constantly corrugated dial used to wind around with a battery taped asking Dave to fix his watch, a watch. The type of small, to my wristband and chuckle took matters into his own hands corrugated dial used to wind about that timeless summer and asked the mechanical shop a watch that didn’t require a spent at Seabee. foreman for a replacement “AA” battery because it only needed battery. Obviously annoyed, to be wound once a day to

Dr. Garry Linassi practices Physiatry in Saskatoon and occasionally yearns for the peace and quiet of the mine. He writes stories for his two young daughters who think he has too much time on his hands. Gary is the provincial head (Saskatchewan), Physical Medicine and Rehabilitation.

JOURNAL OF THE SURGICAL HUMANITIES | 17 Every issue of “Surgical Humanities” carries an excerpt from Oslerium the works of the pre-eminent Canadian physician Sir William Osler (1849-1919).

he life of William Osler in itself provides a Tfundamental justification for an education and engagement in the surgical humanities. Osler’s medical textbook, “Principles and Practice of Medicine” (first published 1892) widely used as a standard and acclaimed though it was during his lifetime, has largely been forgotten, or remembered only in relation to his other achievements. But in the other great body of his work - his speeches, his essays and his commentaries on the profession, on the business of daily living, on professionalism, on our profession’s imperative for humane practice and on the wisdom of our forbears - he has achieved immortality.

Osler’s father the Rev. Featherstone Osler was a missionary sent from Cornwall, England, to the backwoods of Ontario. William Osler was born in Bond Head, Upper Canada (now Ontario) to Featherstone and Ellen Osler on the 12th of July, 1849.

This was a remote town in an already remote country at the

18 | JOURNAL OF THE SURGICAL HUMANITIES About SIR WILLIAM OSLER time, and Osler was sent for beginning of a very fruitful Oslers made the last move of his schooling to Trinity College association with the “Big Four” their eventful lives, across the School, an independent school - the pathologist William Welch, Atlantic, once more, to England. for boys in Port Hope, Ontario. surgeon William Halstead, Another distinguished period of In the fall of 1868, Osler gynecologist Howard Kelly (and William’s career followed - he enrolled in the Toronto Osler himself). was knighted and continued to School of Medicine, but write and deliver memorable soon transferred to McGill, Together, the “big four” would addresses to distinguished because it had better clinical introduce far reaching changes audiences and societies. opportunities. He graduated in medical education that are from the McGill University still felt today - the clinical Sir William Osler died School of Medicine in 1872 and clerkship for medical students of pneumonia in 1919, a taking advantage of an older and the residency system of complication of the influenza brother’s generosity, Osler spent training were both products pandemic of 1918-1920. the next two years studying in of this association. About Europe and visiting the great this time, Osler also began a Harvey Cushing, the pioneer clinics and hospitals of Berlin, series of brilliant speeches and neurosurgeon and Osler’s Vienna and London. addresses whose impact would biographer called him, “one be felt far beyond the audiences of the most greatly beloved Upon his return to Canada, he for whom they were intended. physicians of all time.” was appointed to the faculty The “Principles and Practice of McGill University and spent of Medicine,” a monumental Sources: the next five years teaching treatise, was published in 1892. “Osler - A Life in Medicine” by physiology and pathology in Michael Bliss. Hardcover, by the winter term and clinical William Osler and Grace University of Toronto Press, medicine in the summer. Revere were married in 1892. 1999. Also available for Kindle. In 1884, Osler was appointed Their only child, Revere to the staff of the University of Osler was killed in action in Note: Pennsylvania as Professor of Belgium during one of the Sir William's brother, Edmund clinical medicine and this was many disastrous and ill-fated Osler (who was a railway baron) the start of a 21 year period of campaigns of the first world has a living connection with work and achievement in the war. Saskatchewan - the town of United States. His appointment Osler (about 20 min North of to the founding professorship In 1905, Osler was offered Saskatoon) is named for him; and and staff of the new John the prestigious Regius there is an "Osler Street" close to Hopkins Medical School in professorship of Medicine the Royal University Hospital. Baltimore in 1888 marked the in Oxford, England, and the

JOURNAL OF THE SURGICAL HUMANITIES | 19 OSLERIUM

hroughout his illustrious career, Osler distinguished Thimself from most of Observe, record, tabulate, his peers by the universal, broad and truly international communicate . approach he had to medicine and its practice around the world. Use your five senses. Learn

Chauvinism, as Osler defines to see, learn to hear, learn it, is the very opposite of the essential humility and to feel, learn to smell, receptiveness that made this universal approach possible – an approach that recognized and know that by practice our common humanity and the close fraternity of physicians, no alone you can become matter their nationality. expert. “Chauvinism in Medicine” was addressed to the participants of the 1902 meeting of the Sir William Osler Canadian Medical Association in Toronto. that the histories of Chinese It is generally regarded as and Indian systems of medicine something of a mystery as to Of course in Osler’s time, when were only systematically how Osler from rural, small- travel and its means were much documented in the West during town, Bondhead, Ontario, the more limited, it was mostly of the 20th century and especially son of missionary parents from Europe and its many different during its latter half. England, grew up with such a medical traditions that North generous view of other people American physicians possessed In an age that revelled in and and the world in defiance of any degree of familiarity. This celebrated various degrees the age in which he lived. If we is reflected in Osler address, of anti-Semitism, Osler’s believe with Wordsworth that where he invokes the great recognition of our common the “child is father of the man,” contributors to medical science humanity and appreciation perhaps these were attitudes that Western Europe made in for the achievements of he learned, together with his the 19th century. other nationalities and siblings, from his parents. races, extended to his Jewish But in spite of having lived colleagues as well. Surrounded Previous issues of this Journal in the age of colonialism, as he was by prejudice and carried the first two parts where students were taught bigotry, he wrote two very of Osler’s address. In this that all knowledge and all appreciative essays – “Letter concluding portion, Osler turns science began with Greece, from Berlin” and “Israel and the attention of the profession Osler acknowledges the great Medicine” – that celebrated to itself and to each individual advances made by Islamic the achievements of the Jewish physician’s duty to resist the (“Arabian”) medicine in the people and physicians and temptations of chauvinism in middle ages as well as the condemned all forms of anti- his or her own life. “Alexandrian and Byzantine” Semitism. schools. Readers will remember F.C.

20 | JOURNAL OF THE SURGICAL HUMANITIES CHAUVINISM IN MEDICINE Part 3

Sir William Osler

f the parochial and more turn and bound in chains the we feel in our teachers, in the personal aspects of most commonplace and sordid, university from which we have OChauvinism I hesitate to lives which illustrate the graduated, in the hospital at speak; all of us, unwittingly as liberty and freedom enjoyed which we have been trained? a rule, illustrate its varieties. by minds innocent and quiet, He is a "poor sort" who is free The conditions of life which in spite of stone walls and iron from such feelings, which only round us and bound us, whether bars. On the other hand, scan manifest a proper loyalty. But it in town or country, in college the history of progress in the easily degenerates into a base or institution, give to the most profession, and men the most intolerance which looks with liberal a smack of parochialism, illiberal and narrow, reeking disdain on men of other schools just as surely as we catch the of the most pernicious type of and other ways. The pride, too, tic of tongue of the land in Chauvinism, have been among may be in inverse proportion which we live. The dictum put the teachers and practitioners to the justness of the claims. into the mouth of Ulysses, "I in the large cities and great There is plenty of room for am a part of all that I have medical centres; so true is honest and friendly rivalry met," expresses the truth of the it, that the mind is its own between schools and hospitals, influence upon us of the social place and in itself can make only a blind Chauvinism puts environment, but it is not the a man independent of his a man into a hostile and whole truth, since the size of environment. intolerant attitude of mind at the parish, representing the the mention of a name. Alumni number of points of contact, is There are shades and varieties and friends should remember of less moment than the mental which are by no means that indiscriminate praise fibre of the man. offensive. Many excellent of institutions or men is apt features in a man's character to rouse the frame of mind Who has not known lives of may partake of its nature. illustrated by the ignorant the greatest freshness and What, for example, is more Athenian who, so weary of nobility hampered at every proper than the pride which hearing Aristides always called

JOURNAL OF THE SURGICAL HUMANITIES | 21 CHAUVINISM IN MEDICINE: Part 3... by Sir William Osler

the Just, very gladly took up the Nothing, perhaps, has done is a settled hostility and a oyster shell for his ostracism, more to place German medicine. narrowness of judgment but and even asked Aristides in the forefront to-day than little in keeping with the true himself, whom he did not know, a peripatetic professoriate, spirit of science. Worse still is to mark it. owing allegiance only to the the "lock and key" laboratory in profession at large, regardless which suspicion and distrust A common type of collegiate of civic, sometimes, indeed, reign, and everyone is jealous Chauvinism is manifest of national limitations and and fearful lest the other in the narrow spirit too restrictions. We acknowledge should know of or find out often displayed in filling the principle in the case of about his work. Thank God! this appointments. The professoriate the scientific chairs, and with base and bastard spirit is not of the profession, the most increasing frequency act upon much seen, but it is about, and mobile column of its great army, it, but an attempt to expand I would earnestly entreat any should be recruited with the it to other chairs may be the young man who unwittingly most zealous regard to fitness, signal for the display of rank finds himself in a laboratory irrespective of local conditions parochialism. pervaded with this atmosphere, that are apt to influence to get out ere the contagion the selection. Inbreeding is Another unpleasant sinks into his soul. as hurtful to colleges as to manifestation of collegiate cattle. The interchange of men, Chauvinism is the outcome, Chauvinism in the unit, in particularly of young men, perhaps, of the very keen the general practitioner, is is most stimulating, and the competition which at present of much more interest and complete emancipation of the exists in scientific circles. importance. It is amusing to chairs which has taken place in Instead of a generous read and hear of the passing most of our universities should appreciation of the work of the family physician. There extend to the medical schools. done in other places, there never was a time in our history in which he was so much in evidence, in which he was so prosperous, in which his prospects were so good or his power in the community so potent. The public has even begun to get sentimental over him! He still does the work; the consultants and the specialists do the talking and the writing; and take the fees! By the work, I mean that great mass of routine practice which brings the doctor into every household in the land and makes him, not alone the adviser, but William Osler, William Francis, H.A. Lafleur, and W.S. Thayer the valued friend. He at Johns Hopkins Hospital, 1891 22 | JOURNAL OF THE SURGICAL HUMANITIES is the standard by which we wings, but this sustained effort clinical laboratory as to the are measured. What he is, we is so hard that many give up the dispensary. One great difficulty are; and the estimate of the struggle in despair. And yet it is that while waiting for the profession in the eyes of the is only by persistent intelligent years to bring the inevitable public is their estimate of him. study of disease upon a yoke, a young fellow gets A well-trained, sensible doctor methodical plan of examination stale and loses that practised is one of the most valuable that a man gradually learns familiarity with technique assets of a community, worth to correlate his daily lessons which gives confidence. I wish to-day, as in Homer's time, many with the facts of his previous the older practitioners would another man. To make him experience and of that of his remember how important it is efficient is our highest ambition fellows, and so acquires clinical to encourage and utilize the as teachers, to save him from wisdom. young men who settle near evil should be our constant William Osler with Doctors, Nurses and Patients at the care as a guild. I can only refer University of Pennsylvania Orthopedic Hospital and here to certain aspects in which Infirmary for Nervous Diseases (Summer of 1887) he is apt to show a narrow Chauvinism hurtful to himself and to us.

In no single relation of life does the general practitioner show a more illiberal spirit than in the treatment of himself. I do not refer so much to careless habits of living, to lack of routine in work, or to failure to pay due attention to the business side of the profession – sins which so easily beset him – but I would speak of his failure to realize first, the need of a lifelong progressive personal training, and secondly, the danger lest Nowadays it is really not a them. In every large practice in the stress of practice he hard matter for a well-trained there are a dozen or more cases sacrifice that most precious man to keep abreast of the requiring skilled aid in the of all possessions, his mental best work of the day. He need diagnosis, and this the general independence. Medicine is a not be very scientific so long practitioner can have at hand. It most difficult art to acquire. All as he has a true appreciation is his duty to avail himself of it, the college can do is to teach of the dependence of his art and failing to do so he acts in the student principles, based on on science, for, in a way, it is a most illiberal and unjust way facts in science, and give him true that a good doctor may to himself and to the profession good methods of work. These have practice and no theory, at large. Not only may the older simply start him in the right art and no science. To keep man, if he has soft arteries in direction, they do not make him up a familiarity with the use his grey cortex, pick up many a good practitioner – that is his of instruments of precision points from the young fellow, own affair. To master the art is an all-important help in but there is much clinical requires sustained effort, like his art, and I am profoundly wisdom afloat in each parish the bird's flight which depends convinced that as much which is now wasted or dies on the incessant action of the space should be given to the with the old doctor, because he

JOURNAL OF THE SURGICAL HUMANITIES | 23 CHAUVINISM IN MEDICINE: Part 3... by Sir William Osler

and the young men have never Arnold's line "We mortal self-confident, self-centered been on friendly terms. millions live alone." Even in man, whose worst faults often populous districts the practice partake of his best qualities. In the fight which we have of medicine is a lonely road The peril is that should he to wage incessantly against which winds up-hill all the way cease to think for himself he ignorance and quackery among and a man may easily go astray becomes a mere automaton, the masses and follies doing a penny-in-the- of all sorts among the slot business which classes, diagnosis, not places him on a level drugging, is our chief with the chemist's weapon of offence. Lack clerk who can hand out of systematic personal specifics for every ill, training in the methods from the "pip" to the pox. of the recognition The salt of life for him of disease leads to is a judicious scepticism, the misapplication not the coarse, crude of remedies, to long form, but the sober courses of treatment sense of honest doubt when treatment expressed in the maxim is useless, and so of the sly old Sicilian directly to that lack Epicharmus, "Be sober of confidence in our and distrustful; these methods which is apt are the sinews of the to place us in the eyes understanding." A great of the public on a level advantage, too, of a with empirics and sceptical attitude of quacks. mind is, as Green the historian remarks, "One Few men live lives of is never very surprised more devoted self- or angry to find that sacrifice than the family one's opponents are in physician, but he may the right." It may keep become so completely him from self-deception absorbed in work that and from falling into leisure is unknown; he that medical slumber has scarce time to eat into which so many drop, or to sleep, and, as Dr. deep as the theological Drummond remarks slumber so lashed by in one of his poems, William Osler performing an autopsy in Erasmus, in which a "He's the only man, I the Blockley Mortuary in Philadelphia man may write letters, know me, don't get no (1886 or 1889) debauch himself, get holiday." There is danger drunk, and even make in this treadmill life lest he and never reach the Delectable money – a slumber so deep at lose more than health and Mountains unless he early times that no torpedo-touch time and rest – his intellectual finds those shepherd guides of can waken him. independence. More than most whom Bunyan tells, Knowledge, men he feels the tragedy of Experience, Watchful, and It may keep the practitioner isolation – that inner isolation Sincere. The circumstances of out of the clutches of the arch so well expressed in Matthew life mould him into a masterful, enemy of his professional

24 | JOURNAL OF THE SURGICAL HUMANITIES independence – the pernicious gullible public. Even the most of the practitioner by the literature of our camp-followers, respectable houses are not free manufacturing chemist and the a literature increasing in bulk, from this sin of arrogance and revival of a pseudoscientific in meretricious attractiveness, of ignorant dogmatism in their polypharmacy are too large and in impudent audacity. To literature. questions to be dealt with at modern pharmacy we owe the end of an address. much, and to pharmaceutical A still more dangerous enemy methods we shall owe much to the mental virility of the But there is a still greater more in the future, but the general practitioner, is the" sacrifice which many of profession has no more drummer" of the drug house. us make, heedlessly and insidious foe than the large While many of them are good, thoughtlessly forgetting that borderland pharmaceutical sensible fellows, there are "Man does not live by bread houses. No longer an honoured others, voluble as Cassio, alone." One cannot practise messmate, pharmacy in this impudent as Autolycus, and medicine alone and practise form threatens to become a senseless as Caliban, who will it early and late, as so many huge parasite, eating the vitals tell you glibly of the virtues of us have to do, and hope to of the body medical. We all of extract of the coccygeal escape the malign influences know only too well the bastard gland in promoting pineal of a routine life. The incessant literature which floods the mail, metabolism, and are ready to concentration of thought every page of which illustrates express the most emphatic upon one subject, however the truth of the axiom, the opinions on questions about interesting, tethers a man's mind in a narrow field. The practitioner needs culture as well as learning. The earliest picture we have in literature of a scientific physician, in our sense of the term, is as a cultured Greek gentleman; and I care not whether the young man labours among the beautiful homes on Sherbrooke Street, or in the slums of Caughnawauga, or in some sparsely settled country district, he Osler family out for a drive cannot afford to have (circa 1908) learning only. In no greater the ignorance the which the greatest masters of profession does culture count greater the dogmatism. our art are doubtful. No class for so much as in medicine, and Much of it is advertisements of men with which we have to no man needs it more than the of nostrums foisted on the deal illustrates more fully that general practitioner, working profession by men who trade greatest of ignorance – the among all sorts and conditions on the innocent credulity of ignorance which is the conceit of men, many of whom are the regular physician, quite as that a man knows what he does influenced quite as much by his much as any quack preys on the not know; but the enthralment general ability, which they can

JOURNAL OF THE SURGICAL HUMANITIES | 25 CHAUVINISM IN MEDICINE: Part 3... by Sir William Osler

appreciate, as by his learning potions. But what of the men of training. If we had only to of which they have no measure. of the type of Mr. Robert Levet, deal with one another the The day has passed for the or "Ole Docteur Fiset," whose difficulties would be slight, but "practiser of physic" to be like virtues walk a narrow round, the it must be confessed that the Mr. Robert Levet, Dr. Johnson's men who do the hard general practice of medicine among our friend, "Obscurely wise and practices in the poorer districts fellow creatures is often a testy coarsely kind." The wider and of the large cities, in the and choleric business. When freer a man's general education factory towns and in the widely one has done his best or when scattered rough a mistake has arisen through agricultural lack of special knowledge, but regions – what, more particularly when, as so I hear you say, often happens, our heart's best has culture to sympathies have been engaged, do with them? to be misunderstood by the Everything! It is patient and his friends, to have the bichloride evil motives imputed and to which may be maligned, is too much for prevent the human endurance and justifies infection and a righteous indignation. may keep a It is hard to say whether as a man sweet and whole we do not suffer just as whole amid the much from the indiscriminate most debasing praise. But against this evil we surroundings. Of are helpless. Far otherwise, very little direct when we do not let the heard value to him word die; not to listen is best, in his practice though that is not always – though the possible, but silence is always poor have a possible, than which we have pretty keen no better weapon in our appreciation of armoury against evil-speaking, a gentleman lying, and slandering. The – it may serve bitterness is when the tale to prevent the is believed and a brother's degeneration so good name is involved. Then apt to overtake begins the worst form of ill- the overworked treatment that the practitioner practitioner, receives – and at his own whose nature is hands! He allows the demon of Back of an advertisement for Sal-Codeia Bell only too prone resentment to take possession featuring a portrait of William Osler (1905-1919) to be subdued of his soul, when five minutes' like the dyer's frank conversation might have the better practitioner is he hand to what it works in. gained a brother. In a small or likely to be, particularly among a large community what more the higher classes to whom Whether a man will treat his joyful than to see the brethren the reassurance and sympathy professional brethren in a dwelling together in unity. The of a cultivated gentleman of gentlemanly way or in a narrow bitterness, the rancour, the the type of Eryximachus, may illiberal spirit is partly a matter personal hostility which many mean much more than pills and of temperament, partly a matter of us remember in our younger

26 | JOURNAL OF THE SURGICAL HUMANITIES days has been largely replaced from any and every Advertisement for Sal-Codeia Bell featuring by a better feeling and while source, the attitude of a portrait of William Osler (1905-1919) the golden rule is not always, as rational receptiveness it should be, our code of ethics, rather than of we have certainly become more antagonism to new charitable the one towards the ideas, the liberal and other. friendly relationship between different To the senior man in our ranks nations and different we look for an example, and in sections of the same the smaller towns and country nation, the brotherly districts if he would remember feeling which should that it is his duty to receive characterize members and welcome the young fellow of the oldest, most who settles near him, that he beneficent and should be willing to act as his universal guild adviser and refuse to regard that the race has him as a rival, he may make evolved in its upward a good friend and perhaps progress – these gain a brother. In speaking should neutralize of professional harmony, it the tendencies upon is hard to avoid the trite and which I have so lightly commonplace, but neglecting touched. the stale old chaps whose ways I began by speaking of are set and addressing the the art of detachment young, to whom sympathy and as that rare and encouragement are so dear, precious quality and whose way of life means demanded of one so much to the profession we who wished to take love, upon them I would urge a philosophical view the practice of St. Augustine, of of the profession as a whole. their true light. In such an whom it is told in the Golden In another way and in another atmosphere pity for himself is Legend that "he had these sense this art may be still more so commingled with sympathy verses written at his table: precious. There is possible to and love for others that there is Quisquis amat dietis each one of us a higher type no place left for criticism or for absentum rodere vitam, of intellectual detachment, a a harsh judgment of his brother. Hanc mensam indignam sort of separation from the But as Sir Thomas Browne noverit esse sibi: vegetative life of the work-a- – most liberal of men and day world – always too much most distinguished of general That is to say: Whosoever loves with us – which may enable a practitioners – so beautifully to missay any creature , that is man to gain a true knowledge remarks: "These are Thoughts absent, it may be said that this of himself and of his relations of things which Thoughts but table is denied to him at all." to his fellows. Once attained, tenderly touch," and it may With our History, Traditions, self-deception is impossible, be sufficient to remind this Achievements, and Hopes, there and he may see himself even audience, made up of practical is little room for Chauvinism as he is seen – not always men, that the. word of action in medicine. The open mind, as he would like to be seen is stronger than the word of the free spirit of science, the – and his own deeds and the speech. ready acceptance of the best deeds of others stand out in

JOURNAL OF THE SURGICAL HUMANITIES | 27 Poetry Cor n er

THE SURGEON SPEAKS

his issue’s poet is Lloyd Jacobs - Professor Emeritus of General and Vascular Surgery Tof the University of Toledo, Ohio. Professor Jacobs is a surgeon, a poet and writer and was the 16th President of the University of Toledo from 2006 to 2014. Since becoming President Emeritus, he has embarked on a career of actively writing and speaking on medical ethics. He is the author of two books, several book chapters and more than 50 articles in peer- reviewed medical and scientific publications. His book, “Practical Ethics for the Surgeon” (Wolters Kluwer, Philadelphia) is due to be released in 2019.

Prior to coming to Toledo, he was Chief Operating Officer of the University of Michigan Hospitals and Health Centers and Senior Associate Dean for Clinical Affairs at the University of Michigan Medical School. He also held a faculty appointment as professor of surgery and maintained an active vascular surgical practice.

28 | JOURNAL OF THE SURGICAL HUMANITIES Non Sequitur

The She came complaisantly when called to the consult Surgeon room, docile, resigned but unafraid. There is a loneliness unique She sat when asked to to surgeons and officers in war wait for the surgeon. which grows from the indelible She cradled in her lap traces of their work and against her breasts Mastery and threatens the soul the fractured, pavement scored the fates are constrained to motorcycle helmet she had alter course brought. The apprentice surgeon lives in the dream A loneliness not unlike Her holding it reminded me that there really is something that of a priest who standing of the protective gesture out there maybe in there alone before God, creates him an astronaut used he gathers the consecrated of looking back upon the earth. Dissection is discovery instruments How she came to have the in an amorphous ghee his devotees surpliced alike helmet in which is hidden some the supine sacrifice awaits in the short interval culprit to be separated the miraculous elevation since the crash she didn’t volunteer The master surgeon Their ardour may fail and no one asked. knows the creative act erases confidence may become pride the subject object distinction exactitude become She stood when I entered the ghee gives up its secrets perfectionism and sat again at my gesture, perseverance a stubborn helmet clutched now not His dissection is sculpture obsession cuddled. planes are created not found these like the amputated leg I uttered the platitudes. the medium of blood and flesh or excised kidney are “Autopsy?”, she said, “My son’s in becomes one with him irretrievable Denver”.

JOURNAL OF THE SURGICAL HUMANITIES | 29 POETRY CORNER: Lloyd Jacobs

The Surgeons Knowledge

Lived forward understood Night backward the philosopher said. Operation But the thrust of the notion here is how we are forced It was late, well past midnight, to begin in the middle of things, he was old, my training near its to join the show already end. underway As was the custom then, I had and to leave the theatre been assigned Amputation before it is over. Upon reflection to assist the frail declining most of what we understand surgeon. A third year trainee should we enter from the middle know with inadequate preparatory The dressing room, prepared for its best to bevel the shin bone base. morning, half an inch perhaps, so that no The infinitesimal calculus for conduced to recognition of son sharp edge impinges on the example, and father. skin. one embarks into its great He was pensive, regretful. There The resultant stump should utility; had been taper its foundations may be severe blood loss, sutures slightly, but with a rounded end, vouchsafed tearing through, an effect facilitated by cutting at some later time or never. the operation’s purpose unmet. the fibula an inch or two Most of what the surgeon He sat with knees akimbo. shorter than the shin. knows about I remember a case long ago And, of most importance what it is to be a human when the severed limb should be creature I thought the woman couldn’t handed off begins with the imperative of survive. discreetly, as if it were slightly the middle: My impulse in the morning was shameful, a cancer well begun, an avoidance, covered quickly, as one covers appendicitis but she was alive, radiant even, the far advanced. “Thrown” another eager to assure and comfort me. pudenda, and never joked about. said This may be difficult due into an urgency for handiwork Suddenly he became wary and to the awkward angle of the of which experience forms the glanced about. ankle base, The funny thing: she stood up and the protruding heel and the theory of the work comes and touched me. toes. only afterward. Perhaps again tonight

30 | JOURNAL OF THE SURGICAL HUMANITIES Surgeon’s Surgeon’s The Inner Life Lament Intention of a Surgeon

Who interposed It is an act of faith to think Surgeons are never solipsists devices with electronic circuitry the universe to be constrained as was joked by an American between us? to react in a patterned way philosopher to our setting of conditions. who conflated solipsism with Who tied our hands All faith is hubris. narcissism. until the simulacrum became the reality? The naturalist would have Operating rooms often in God subject to Pavlov’s rules former times Who decried the unitive touch or failing that posit a universe had galleries adjacent. binding us together? fraught by accident and chance. Operating Who destroyed our art? All faith is hubris. Theatre is a phrase still heard.

The surgeon knows great rents The surgeon is always exist conscious in the fabric of the universe; of a sea of presence about him. there is but a loose coupling The anesthetized patient between an act and its hovers. consequence. Human certainty is hubris. The famous painting by Thomas Eakins Unlike the alchemist or shaman of Samuel Gross declaiming who may engage in sleight of makes clear his perception of hand other minds. the surgeon knowingly confronts There are degrees of solipsism, the hole in human efficacy. the notion is a slope, only Certainty is hubris. in the extreme do no other minds exist. The stock in trade of the surgeon A common stopping place on his identity and being the slope is his venturing into this space is to perceive no other minds where evil spirits may reside. but those Certainty and faith are hubris. upon a substrate of diodes and neurons.

Surgeons are never of this ilk. Their experience of human blood and flesh unexpectedly reveals the spirit also

JOURNAL OF THE SURGICAL HUMANITIES | 31 n 2015, we were graciously granted permission to serialize the life story and memoir of one of Ithe preeminent surgeons of our time, Professor ZHIVAGO: R.M. Kirk - and the Spring 2015 issue of this Journal carried Chapter 1 of his life story.

The Doctor Raymond Maurice Kirk (“Jerry” Kirk to his friends) is perhaps best known to most surgeons and surgical trainees throughout the world on in Literature account of “Kirk’s General Surgical Operations” – the textbook of operative General Surgery that has been the standard in Britain and in many other parts of the English speaking world. Now into its 6th Edition (2013), it is available in both print form and (as some of our residents know) for the ipad as well.

he doctor not only writes His other books are almost equally well known and Prof. Kirk’s elegant, practical and poetry, novels, essays and short pithy writing style and editorship are widely Tstories - he or she also lives recognized and admired. in them. This column celebrates works of literature that celebrate (or Professor Kirk’s career as Consultant academic denigrate) a physician and his or her Surgeon was spent almost continuously at work and times. Its authors will only the Royal Free Hospital and Medical School in London. Many innovators and pioneers in uncommonly be physicians - it would medicine and surgery worked in the ferment surely be a fallacious presumption of intellectual activity that was the Royal Free to assume that only a doctor can (including the pioneer hepatologist Sheila comment on his or her own life and Sherlock) and Prof. Kirk made widely recognized manners. contributions to surgery of the stomach and esophagus. During the seven years that he was Editor of the Annals of the Royal College The title is from Russian novelist of Surgeons of England, the journal rose even Boris Pasternak’s immortal, lyrical further in standing and ranking among the novel, “Dr. Zhivago.” The film, bearing surgical journals of the world. the same name was directed by David Lean and starred Omar Sharif and The story of how Jerry met Peggy is contained in Julie Christie. the “life story” and has appeared in a previous issue in the pages of this journal. Jerry and Peggy live in Hampstead, London, not far from where The Editor that other English surgeon John Keats lived and wrote his immortal, “Ode to A Nightingale.”

The Editor is deeply grateful to Jerry for the privilege of allowing this Journal to carry serialized excerpts of his life story. And now for a continuation of Jerry’s story, Chapter 8, in his own words …

32 | JOURNAL OF THE SURGICAL HUMANITIES LIFE STORY Excerpts from the memoirs of R. M. Kirk

Chapter 8

ike my revered trainer Norman Tanner, who copies (I think), were needed to be submitted. called everyone ‘Doc,’ I have always had a This was achieved with the aid of carbon paper Lpoor memory for names, now even worse. interleaved with the paper. The keys needed to At Willesden I was greeted by two anaesthetists, be struck forcibly to ensure that the last sheets and two house surgeons called Margaret. were legible. I was eventually able to share Married to Peggy (Margaret) I thought I had the secretary, Joyce Lindsell who worked with found a solution by applying the same name to my delightful friend Ewart Jepson, the junior everyone in my team. It collapsed in face of the physician. Joyce was a superb typist and her boot-faced response from my registrar when I command of English far exceeded mine. Indeed, tried it out on him! when I eventually left, she quietly and without any malice, mentioned to me that she had been The unfinished thesis nagged. As soon as I had in the habit of correcting habitual errors in my settled into the work at Willesden I concentrated spelling and grammar. She gave me a list of on writing up my thesis on the study of defective them. It was chastening. lymphatics in the legs. I had had no supervision. I learned nothing. Scientific logic never The thesis was finally finished, bound and appeared. I had spent years acquiring two capital submitted. After an interval I was called to letters, MS (Master of Surgery), after my name. It defend it. The chairman David Patey, was was usual to engage one’s secretary to undertake extremely kind and generous. The physiologist typing. There were two difficulties. My secretary was fussy, picking up trivial points. The third was utterly incompetent and surly. She also was Bill Irvine, Professor of Surgery at St Mary’s announced that she could not start for a year – Hospital. He was notorious for his aggression at and her fee was much higher than that charged scientific meetings toward young researchers. to my friends. I bought a portable typewriter He attacked me. When he had finished, Patey and typed my own. It was at that time necessary, gently asked me, ‘Kirk, who supervised you?’ ‘No when adding or erasing any substantial part, one, sir. It was not obligatory, so I worked alone.’ to retype the whole of the subsequent thesis. I ‘How much spare time was given to allow you drowned in rejected typescript. Moreover, five to carry out your research?’ None sir. I was fully

JOURNAL OF THE SURGICAL HUMANITIES | 33 ZHIVAGO... The Doctor in Literature committed to a very busy surgical service.’ ‘How we did not offer a comprehensive service, local did you fund your research?’ ‘I had no funds. I general practitioners and the public would made my own equipment or borrowed it.’ His lose confidence in the hospital and doctors. obvious intention was to point out that I had Within a few days of taking up my appointment worked in difficult, unsupported circumstances. a motor cyclist smashed into a brick wall. He To my delight Bill Irvine unexpectedly rang me was admitted wide awake but suddenly became later to tell me I had passed and I could have unconscious. This was a classical sign of some access to his department. I thought this was increase in intracranial pressure, assumed to generous but his motive became clear, later. be from bleeding within the brain or remaining He wished to unload to me several patients extra-cranial spaces. We did not then have any suffering from lymphoedema since he had no means of reducing his increased intracranial interest in the condition. I recently encountered pressure except by draining blood or the a wonderful quotation cerebrospinal fluid. of the American Guided by a pre-war financier, John emergency operating Pierpoint Morgan – ‘A textbook, I drilled four man has two reasons burr holes through for doing anything: a the cranium. There good reason and the was no evidence of real reason.’ Apt? Sadly, extra-dural or extra- Irvine became an cerebral bleeding. alcoholic, surrendered I gently inserted his Professorial chair needles through the and eventually died, brain, aimed at the presumably from liver reservoir of intracranial failure. cerebrospinal fluid. At the fourth attempt In the course of my a jet of cerebrospinal career at Willesden fluid nearly hitting the I operated within theatre light. Almost all the specialities, immediately the either because it patient began to regain was expected of a conscientiousness. ‘general’ surgeon, or I thought he might because there was no David Howard Patey, (1899-1977), British surgeon. climb off the table and sub-speciality expert Described the Patey (modified radical) mastectomy hurriedly recovered the available. My first in 1948. needle. To my relief he Smith-Peterson pinning of a fractured neck of made an uneventful recovery. I never see or think femur was performed without having seen one of the famous Jet d’’eau in Lake Geneva without previously. As new techniques became available, recall my first, naive attempt at neurosurgery. we were often faced with the need to perform them without any practical training. Whenever During my training most surgeons avoided possible we tried to visit and watch a convenient operating for ruptured abdominal aortic expert. I invited an expert in parotidectomy aneurysm - weakened, dilated arterial trunk. (an apt name for a salivary gland sitting just When plastic stents became available, we beside the ear. G para– beside + otos = the ear), acquired one and read the technical reports. On to teach myself and my registrar. This earned my first patient I struggled to apply an occlusive an admonishment from George Qvist for being clamp across the aorta just below the renal disloyal to the hospital. His logic was that if arteries, to avoid prejudicing renal function. I

34 | JOURNAL OF THE SURGICAL HUMANITIES hesitated to take the risk without seeking help and may obstruct the flow through the gut. and telephoned a vascular surgeon friend. He He did not feel able to embark on yet another arrived, dressed in a dinner jacket, hurriedly extensive and hazardous exploration and asked changed, scrubbed and joined me. After a me to undertake it. I drove to his hospital and struggle he succeeded in applying the clamp, spent several hours dissecting out the totally confirmed that I was happy and rushed away. solid abdominal contents. The current method of Next morning I learned that he had left his preventing recurrence was described by Noble marriage engagement party to assist me. in 1937. The freed bowel was laid back and forth like a jumping jack firework and the contiguous A man discovered when blood emerged beneath segments were sutured together. The resulting a public lavatory door, was admitted having cut path resembled the track traditionally followed his neck. My registrar reported that the larynx by an ox-drawn plough and was therefore called was absent in the almost moribund, choking, ‘boustropic,’ (G bous = ox + tropein = to turn). The suicidal who had cut his throat from ear to bottle of antacid tablets remained unopened ear. The ear, nose and throat (ENT) senior that evening. registrar who had been called was leaving as I arrived, muttering that he refused to take Success was elusive. I seemed to attract minor any responsibility. At operation it was obvious surgical procedures alone. I did my best for that the patient had succeeded in completely them – and attracted further ones. One general transecting the pharynx just above the laryngeal practitioner sent me nothing but in-growing cartilage, allowing the larynx to sink out of toenails. Why? He explained that he took great sight. Miraculously, he had spared the carotid efforts to match his referrals to the available arteries and the internal jugular veins. The bleeding was from the cut external jugular veins. It was remarkably easy to insert a simple continuous repair and he made a complete recovery. His vocal apologies attested to his intact peripheral nerves. I am reminded that one of my patients had had a partially paralysed vocal cord following excision of an upper oesophageal carcinoma by me. I had damaged the nerve which controls its movements – the recurrent laryngeal nerve. He courteously refused my offer to bulk up the affected cord with the plastic substance polytetrafluoroethylene and so appose it to the other active cord. He explained that he earned a successful livelihood as a salesman using the telephone. He believed that his slight breathy speech impediment was very much admired by his lady customers, who found it sexy.

My most enjoyable Christmas dinner was one that I was forced to abandon before I reached the post-prandial heartburn trigger point. A friend from another hospital telephoned to Geoffrey Keynes (1887-1982) - surgeon and author, younger brother of the famous English tell me that he had just admitted a patient economist John Maynard Keynes. First described with recurrent adhesive intestinal obstruction, limited surgery for breast cancer (lumpectomy) in which the bowel loops stick to each other and local radiation therapy in 1937.

JOURNAL OF THE SURGICAL HUMANITIES | 35 ZHIVAGO... The Doctor in Literature expertise. I was such an expert that he had them I introduced a newly developed procedure labelled me ‘Mr in-growing toenails’ - not what I for the management of peptic ulcers from was seeking! I continued to do very little private Seattle, having watched it performed by David practice, attributing it to lack of interest – but Johnston in Leeds, who had just returned from possibly it was ineptitude. an attachment there. It consisted of a highly selective separation of a nerve, the vagus (L Having worked with some inspiring teachers I = wandering, describing its wide distribution), was fired with ambition to make my mark and from the stomach, thus reducing the stimulus to attempt to climb the greasy pole of success - secrete acid. Sir Francis heard of this and sent so defined by Benjamin Disraeli (1804-81). By one of his surgical colleagues to watch me. He making great efforts, publishing experimental did so and adopted it – briefly. His first patient and clinical papers, attending meetings and developed a fatal gangrenous perforation of acting as one of the College of Surgeons’ tutors, the stomach, the first of several described. The I gradually established a modest presence. originator of the procedure, Chuck (Charles) This was augmented by gaining a post within Griffith visited me, we became friends and I the Royal Free Hospital group, in 1964. The was able to demonstrate my own procedure success was achieved at the cost of being for preventing or dealing with recurring and treated as a leper for about a year. The staff intractable ulcers. at Hampstead General Hospital had voted for another candidate and were resentful that I had The eminent and much loved Norman Tanner usurped him. I shrugged my shoulders and was was preparing to retire from my prestigious eventually accepted except for one lady surgeon; teaching hospital, Charing Cross Hospital. I she ignored me for several years – but eventually had hopes for succeeding him. One of the became a strong supporter. anaesthetists there also worked with me at Willesden. To my intense surprise, one day It was difficult to establish a name as a surgical he conspiratorially sidled up to me with, upper gastroenterologist. In a nearby hospital ‘Jerry, would you like to join the lodge?’ In my was the international medical expert in the field, innocence, ‘lodge’ signified hunting and I told Sir Francis Avery Jones who had his own superb him I had no knowledge of it. He corrected surgical team. In the hope of cooperating with me by saying this was a Masonic lodge allied to Charing Cross. ‘What do Rooyal Free Hospital you do?’ ‘We do a lot of good things.’ ‘But you are a secret society. I would not know what I was committing myself to.’ He answered rather petulantly, ‘We do not ordinarily invite people. They ask to be admitted. Do you wish to join or not?’ Very flippantly, I told him I believed that initiation to secret societies involved arcane practices and if I came home in disarray, my wife, who respects me now, would lose it. More importantly, if I joined and subsequently achieved success, I would wonder if this resulted from my ability

36 | JOURNAL OF THE SURGICAL HUMANITIES following simple mastectomy with adjunctively inserted radium needles or external radio-active beam therapy. Many years later the then President of the Royal College of Surgeons of England, Sir Reginald Murley, (Keynes assistant in his studies), kindly dropped me off at my home after a College meeting. He identified the house and to my astonishment informed me that the previous owner had been the St Bartholomew’s Hospital statistician, who had statistically verified the benefit of Keynes’ modified management. In my visit to Baltimore, I asked the academic surgeons if they still retained Halsted’s radical operation. All of them had abandoned it – except St. Bartholomew's Hospital for one elderly surgeon. Asked why he retained it, he tersely as a surgeon or because I had joined the lodge.’ responded in a gravelly Southern drawl – I hope He was seething as he left and I heard nothing with tongue in cheek, ‘Ah git a bigger fee!’ more of it. Tanner’s post was advertised, I applied and was not short listed. I came to know that virtually all the London teaching hospitals had Masonic lodges and assume that my anaesthetist considered himself to be showing me a helping hand.

I succeeded in getting financial support and leave of absence to take up a Royal Free Hospital School of Medicine Travelling Professorship in America for 3 months. We preceded it with a wonderful national tour with the children, visiting New York, Denver, San Francisco, Los Angeles, Las Vegas, and Washington DC. I then visited colleagues in Baltimore, Tennessee, San Francisco, Seattle, Chicago, Minneapolis, New York and Boston. Baltimore was famous for its founding Professor of Surgery, William Halsted, considered the Father of American surgery. He had devised the standard operation for breast carcinoma, ‘radical’ (by the roots) mastectomy on William Stewart Halstead (1852-1922) - pioneer American surgeon and innovator. Introduced which I was trained. Sir Geoffrey Keynes (1887- the “Halstead” (radical) mastectomy. With Sir 1982) of St Bartholomew’s Hospital, London, had William Osler, founder of the John Hopkins demonstrated the equally good survival rates School of Medicine.

JOURNAL OF THE SURGICAL HUMANITIES | 37 Submission Guidelines

Submissions to the Journal will be acceptedSubmissions in two to thecategories: Journal will be accepted in two categories: • Written Work: poetry, essays and • historicalWritten Work: vignettes. poetry, essays and historical vignettes. • Visual and Musical Work: • submissionsVisual and Musical in digital Work : reproductions,submissions in of digital paintings, photographs,reproductions, music of paintings, and sculpture.photographs, music and sculpture.

All submissions must be accompaniedAll submissions by amust cover be letter in Microsoftaccompanied (MS) by Word a cover format, letter with in aMicrosoft short (300 (MS) words) Word biography format, with ofa shortthe author, (300 words)name, addressbiography and telephoneof the author, number. name, address and telephone number. All submissions should be sent in byAll email submissions to should be sent in [email protected] email to [email protected] If you wish to submit by traditional mail,If you please wish toaddress submit your by traditional submissionmail, please to: address your submission to: The Editor, Surgical Humanities DepartmentThe Editor, of Surgery UniversitySurgical Humanities of Saskatchewan Saskatoon,Department SK of S7N Surgery 0W8 University of Saskatchewan Saskatoon, SK S7N 0W8

38 | JOURNAL OF THE SURGICAL HUMANITIES SUBMISSION GUIDELINES

WRITTEN WORK • May include poetry, short stories, essays or historical vignettes. • Submissions must not exceed 5,000 words. • All email submissions of written work must be in MS Word format, double spaced, 12-point font, with title and page numbers clearly marked. • The work submitted should not have been published previously.

PAINTING PHOTOGRAPHY SCULPTURE AND CRAFTWORK • Photographic digital • Up to 4 photographs may be • Photographic digital reproductions of the painting submitted at a time, each of high reproductions of the sculpture submitted must be in high definition, in JPEG or TIFF formats or craftwork submitted must be definition JPEG or TIFF formats (300 dpi or higher). in high definition JPEG or TIFF (300 dpi or above). • The photographs may be linked images (300 dpi or above). • 3 photographs must be submitted: by a similar theme, but this is not • A total of 4 photographs must be • the painting as a whole; essential. submitted: • an illustrative inset/detail of the • Each photograph must be titled • The sculpture/craftwork captured painting; and appropriately - captions are in at least 3 angles, each • a photograph of the artist at work. optional; titles and captions may photograph addressing a different • Each photograph must carry a be submitted separately, in MS angle title - captions are optional. Titles Word format. • A photograph of the artist at and captions can be submitted in • An essay of approximately work. a separate, MS Word document. 1000 words to accompany the • Each photograph must carry a • An essay of approximately 1000 photographs must be submitted title - captions are optional. Titles words must accompany the separately, in MS Word format. and captions can be submitted in submission, in MS Word format, The essay can address the a separate, MS Word document. with a description of the painting photographs, or be a story of • An essay of approximately and its story/meaning, as seen by the photographer's life and 1000 words must accompany the artist. motivations. the submission, in MS Word format, with a description of the sculpture/craftwork and its story/ meaning, as seen by the artist.

PERFORMANCE COMPOSITION • Music may be of any genre, • The composition may be in any genre of music, with the composer’s provided the performer recognizes musical score sheet, in musical notation, forming the centrepiece of the his/her performance as a serious submission. art form. • The musical score sheet need not be in classical music notation - but the • Submissions must be accompanied reader must be able to reproduce the music by following the score sheet. by an essay of approximately 1000 • Singer-songwriters can submit their compositions, with the music in words on the performance itself musical notation and the words of the song accompanying the notation/ or on the importance of music in chords. the performer’s life. A YouTube link • Submissions must be accompanied by an essay of approximately 1000 to the performer must be clearly words on the composition itself or on the importance of music in the included in the essay. performer’s life. A YouTube link to the composition being performed must be clearly included in the essay.

JOURNAL OF THE SURGICAL HUMANITIES | 39 JOURNAL OF THE SURGICAL HUMANITIES

ISSN 2368-0407