A few months after being discharged from the Cardiac Intensive Care Unit, I returned to the wards on the cardiology service. As luck, or fate, would have it, my first patient was a
42-year-old football coach from a small town in Ohio who had developed a
cardiomyopathy. Over the next 30 days, because I was the medical student assigned to him, I saw him every day. I watched, helplessly, as this vibrant young man took on approximately 200 pounds of water and literally drown in his own body fluids.
That was the reason for Dr. Unverferth’s concern for me: when the heart isn’t an effective pump, fluid backs up in the lungs until the patient finally drowns. Most people with a viral cardiomyopathy don’t survive.
In a sense, I became the poster child for people with that disease. Before I graduated, periodically, Dr. Unverferth would come around the ward, collect me, and take me back to the cardiac intensive care unit. He was determined to show his patients that you
could survive that disease.
I just enjoyed being with him, and I loved the physiology of cardiology. I actually ended up doing research the Cardiology Department. Along with Dr. Stephen Schaal, I authored apaper, coordinating the electrical activity of the heart with MUGA Scans and Vector Cardiographs.
(As an aside, just to put things in proper perspective, does anybody believe that I,
as a physician, am not honed in to heart disease? Does anyone really believe
that Donda West’s cardiac status wasn’t evaluated as her niece and the press
tried to suggest? I still cringe at idiocy of that magnitude. Clearly Harvey
Levin didn’t have the conversation with me he lied to Larry King about.)
Nevertheless, despite my history, I took to surgery immediately. I was exactly where I was supposed to be. The chairman of the department at OSU was Larry Carey, and he was a tough bastard whom I loved. He seemed always to be looking at me, checking, making sure I got it andwas doing the right thing. No matter how tough he was being, he would
give me that smile that kind of said, “You get it? There is no room for error here.”
I was interested in neurosurgery at the time, and in my next rotation spent a lot of time with the neurosurgical residents. They were all extremely nerdy, but they were a great group of guys who loved what they were doing. They spent pretty much all their time at the
hospital. I talked seriously with Dr. Hunt, who was the chairman of
neurosurgery, while on that rotation. He candidly told me that he thought I was
a whole lot more like Larry Carey than I was like Bill Hunt. That was a big
lesson. Awareness is a very important thing in life, particularly self-awareness.
A lot of times we walk through our days in a fog, reacting rather than
proacting. We don’t really think about what it is that we do, or where our
talents might best be used. We fall into things rather than work toward them.
We do it and think about it later. What Bill Hunt had shown me was that it’s important
to take a look at yourself, be honest with about whom you are and make an
informed decision about who you want to be.
I chose Lenox Hill Hospital in New York City for my general surgery residency. The interview sold me completely. I met Felicien Steichen, who was chairman of the department of surgery at Lenox Hill Hospital, the New York Medical College affiliate at the
time and later the Cornell University affiliate and that was all it took. He
was French, Belgian actually, and I immediately took to him. He just seemed to
get it, and with his credentials, just being around him was a godsend.
There were a number of things that I liked about Lenox Hill Hospital, but the most important was, its residency program paid the highest salary in the country. I also liked the fact that all the big time Park Avenue surgeons brought their patients there. I knew
I wanted to learn surgery from the best, and the old German hospital had a list
of the best surgeons in New York City.
Lenox Hill Hospital however, had a pyramid program, and that was the most frightening part about it. There were twelve surgical interns that would be reduced each year so that at graduation five years later there would be only two. You had to perform every moment of everyday. There was no room for error. You had approximately 60 masters, because
there were 60 general surgeons on staff, and you knew every second of every day
one of them was watching you. You had to perform every moment of every day, or
fear alienating one of those surgeons who could vote against you returning the
following year to the program. If you didn’t return, you had a hard time
finding a place somewhere else. Each of those programs had already taken in the
general surgery residents they expected to matriculate through the system. New
guys weren’t being brought in to be chief resident from the outside.
I was closest to Dr. Doug Heyman. Most of the interns and residents were afraid of him. In a sense, he was intimidating, but it was really his desire to make certain that the treatment of his patients was perfect that drove him. There was no, absolutely no, margin for error with him. He wanted no excuses and he expected you to do the correct things for his
patienys without having to be told to do so. If he had to tell you then it was
too late. And so I did exactly what Dr. Heyman expected of me and I believe it
was him who championed my matriculation through the system.
Of particular fun for me was the fact that he had a young daughter, Alexa, who in a sense gave me back some humanity and broke up the monotomy of being a surgical resident. Lenox Hill Hospital’s general surgery program required you to be on call every other night
and every other weekend for five straight years. There wasn’t a lot of personal
time. On Saturdays, your day off, you’d meet the attendings at the hospital and
go on rounds. That generally would last until around noon.
Dr. Heyman used Saturday to spend with his daughter and there were times when he would bring her to the hospital with the intention of spending the remainder of day with her. In surgery though, the best laid plans can often go wrong with no help whatsoever from those involved. If he got tied up, this eight-year-old and I would have lunch.
I attended her Bat Mitzvah. It was both joyous and sad. I listened as my little friend recited the scriptures she was required to memorize. Her words made me sad. Maybe it was that she was growing up and I had lost my friend, or maybe it was just because I wanted
everyone to believe, as I believe: that we were all one. Where we grew up and
what problems the planet threw at us defined our culture, but ultimately I
wanted to believe as always, that we were one. Our relationship changed after
that and that is perhaps as it should be. She was growing up and it was time
for even me to see that. Nothing in life, it would seem, is permanent.
Dr. Steichen, the chairman of surgery, had developed squamous cell carcinoma of the throat and required operation. This affected his voice and his ability to speak, but not his
spirit. I resented the other attendings for plotting against him behind his
back. They suggested that he no longer was able to be chairman because of the
raspiness of his voice. Ultimately it was because they all wanted his job. The
person most adamant about him not being physically able to perform his duties was
the guy who had, in fact, done his surgery. That was my first lesson about
jealousy amongst doctors. Unfortunately, that pattern of jealousy has shown
through no matter where I’ve been. It’s a part of medicine and life that I have
come to hate. But it is a part of medicine and life that seems to always be there.
Lenox Hill Hospital eventually put out a search for a new chairman. And lo and behold, those attendings, which would undermine Dr. Steichen, learned the lesson of their lives: “Be careful what you wish for – you might get it”.
Dr. M. Michael Eisenberg arrived on the scene at Lenox Hill Hospital and his first order of business was to demonstrate to everyone that he was in fact in charge. He didn’t need to be
here, he chose it. By far they had gotten something much worse than they had
gotten rid of.
The most frightening moment for me and the most telling moment about Dr. Eisenberg happened before I even had an opportunity to meet him. I was attending a conference in Brooklyn, and a doctor, who I had never met, came up to me and said, “I hear Dr. Eisenberg’s with you guys now. Man, that guy’s a bastard.”
I thought “that must really be true, because this person doesn’t know me from Adam. Dr. Eisenberg and I could be the best of friends. For him to say that publically without
knowing me meant that he must really believe his assessment, was also passionate about it, and didn’t care who knew it.
Dr. Eisenberg, though, was not as bad as people tried to paint him. He was, however, as big a bastard as they had suggested. He seemed uncomfortable around people. There was warmth lacking that I believe as surgeons we all have to have, and yet he had none. Perhaps he had spent way too much time as an administrator. Perhaps it was his predicament. He had taken over a job where there were residents in place, that he had no part in choosing. He was running a ship that he had not taken to sea, and I think he
was determined to put his stamp on Lenox Hill Hospital. The problem was his
skills didn’t fit that. He had a very hard time being friendly or winning
people to his way of thinking. I tried as much as possible to establish a
relationship with him, but it never seemed to take. You just could not trust
that he was genuine, and any display of warmth on his part would quickly be
followed by a coldness that would give you chills.
I chose, during my fourth year of residency, to apply to plastic surgery programs without going through Dr. Eisenberg. All of the programs required a letter from your chairman. I chose Dr. Steichen to write that letter, rather than Eisenberg. He believed that to be a slap in the face (which it was) and whatever chance we had of even being cordial went away
with that; but I saw a letter that he had written for my co-chief resident, Dr. Morad Tavalalli.
Morad was an Iranian national who had studied in London and the U.S. He had this
awesome British accent. Morad worked as hard as anybody, and all Eisenberg
could say about him was he had a great speaking voice. My slap to his face was
And so I went about my application process without him. And lo, and behold, the University of Michigan accepted me. That was perhaps the biggest coup to this day in my medical career. The program at the University of Michigan was one of the best in the
nation, and had a very proud history of medicine, including the Mayo brothers.
I had also interviewed at Wright State University in Dayton, Ohio. My intention was and always has been to one day return home to Middletown. Somehow I just never got around to it. I believe that my life is somehow less for that, but my hope is that I will get around to
it before it’s too late.