Princess Parking

In his final years, riding in a car with Dad as he drove became a somewhat risky proposition. During what was to be my last drive with our father, I distinctly remember firmly planting both feet onto non-existent passenger side “air” brakes as he sped along a boulevard, craning his neck fully to the left for a better view of a building that had caught his attention – not once looking at the road ahead of us; it probably lasted no more than five seconds but it may as well have been an eternity. Eventually returning his attention to the road and then to me, he became aware of my manifest fear; letting loose with the heartiest of laughs, he assured me, “Don’t worry! My reflexes are fine!”

As antithetical as it may seem, however, family members might argue that driving a car – while Dad assumed the role of “back seat driver” – may have represented an even worse fate.

With the probable exception of Vespa scooters, men demonstrate an oddly primal need to hold dominion over automobiles and motorcycles.

Dad was certainly no exception.

Regardless of age or pecking order within the family, any unfortunate who drove a car with Dad as passenger was subject to his continuous scrutiny and counsel. End of story.

Our Mother didn’t much like travelling this road alone; I was never sure if she needed one of us along simply for support, to share her misery with company, or to bear witness to any potential breach of the First Commandment.

Dad was not only in charge of every aspect of a moving vehicle but also parking. Our Mother could pull into a parking lot devoid of cars – a thousand spaces from which to chose – and Dad would reflexively insist, “Park right here, Mylla!” While she maneuvered into the sacrosanct space, it became my job to lock eyes with hers in the rear view mirror, offering silent commiseration (and prayer).

Handicapped Parking

I have never been one to waste time or fuel seeking out premium parking spaces. I would also add that I am not a happy passenger when others do the same. My preference is to park as far away from other cars as possible no matter what weather condition might prevail. This surely has something to do with a touch of OCD in addition to a well grounded contempt for thoughtless (possibly intentional) door “dings” and such.

Given that I am also not opposed to walking, I always seek sanctuary at the outer reaches of the lots provided by the massive Mega Stores ubiquitous to most communities. Once parked and confident in the safety of my car, I begin the long trek to the front doors – crossing county lines and the occasional time-zone or weather change along the way.

Long walks seem to be a good time for reflection. As I recently made my way closer to one of these monolithic storefronts, it dawned on me that civility seems to be inversely proportional to proximity to the entrances.

Shopping cart ethics is a good example.

It seems to me that people who park a distance from stores generally seem to make more of a good faith effort to dispense of their emptied cart in a proscribed manner. On a recent trip to Wal-Mart, inching ever closer to the store on foot, I witnessed incredible displays of laziness and disregard for fellow shoppers. Apparently not caring that cars were more densely packed or that one of the receptacles for carts was within spitting distance, I spied more than one shopper expending a good deal of energy shoving empty carts away from their cars with absolute disregard for a final destination (which would have been the side of my car).

While that behavior is wholly unacceptable, I am convinced that the single greatest breach of storefront civility comes with the (ab)use of Handicapped Parking spaces.

I have probably written no more than five scripts in my life for individuals seeking a government issued placard which authorizes a driver to legally use a handicapped space when parking; two of those permits were for patients who had previously undergone limb amputations. It isn’t as though other patients – or even friends – haven’t asked, but amazingly few infirmities actually meet the criteria for this privilege.

Agree with me or not, my bottom line is this: If I authorize a placard for a disabled individual, the script is written with the clear understanding that it will be used only when the patient is physically within a car; being in possession of a valid permit does not represent a blanket license for unwarranted handicapped parking by non-disabled family and friends. From my experience, more often than not, this unfortunately seems to be the rule rather than the exception.

Over the last few years, I began to take a few moments to stop whenever seeing someone take up one of these rare and valuable parking spaces (for a parking lot of 500, the government requires only nine designated handicapped spaces). Almost without exception, the driver (and sole passenger) will quickly abandon the car fairly jogging to the store entrance – their time being valuable, after all.

I know I probably shouldn’t become overly concerned by this, but my blood boils with disgust at the incredible gall of these individuals.

A few months ago I was in a particularly disgruntled frame of mind when I happened onto one of these hapless abusers of a handicapped parking space. Spotting a government issued Princess Parking Permit on the dashboard of her car, I was taken aback by the incontrovertible fact that this “disabled” woman in a trendy jogging suit had somehow managed to juggle multiple bags of groceries while simultaneously devouring a Snickers Bar and guzzling a Diet Coke (offsetting penalties). Sardonically, I asked if she needed any help, to which she replied, “No, thanks, I’ve got it covered.” Really?

Out of a base desire to humiliate her, my immediate inclination was to get down on my knees and pray out loud to Jesus in thanksgiving for the “Miracle” which had clearly been visited upon her. Fortunately for this woman, there was not a large enough audience; what good is an act of embarrassment, after all, absent witnesses who might applaud or cast stones thereby multiplying her shame.

Instead, I simply asked her about the permit:

RUDE WOMAN: Oh, that is for my grandmother; she has all kinds of problems.

RDMMD: Oh, so she is with you?

RUDE WOMAN: No! I see her every couple of weeks. I got the permit because she has some trouble walking; she doesn’t drive.

RDMMD: I see. Sooooo, why are you using the permit today?

RUDE WOMAN: Because it’s mine! They gave it to me to use!

RDMMD: When you are driving with your Grandmother, right?

RUDE WOMAN: (Becoming indignant) Well, I was pretty damned busy today and didn’t have time to mess around finding an f’ing parking spot!

Abruptly terminating the conversation and closing her car door, I was able to clearly make out her “farewell offer” to me.

In parting, I turned her down with a heartfelt, “Thanks, but no thanks!”

People are quick to offer any number of explanations; my favorite is, “My time is valuable!” As my Grandfather once said, "Explanations are offered absent an appropriate excuse."

I am certain she wouldn’t agree, but I would like to believe all of us feel our time is of equal importance and value. The difference between this woman and the rest of society is that most of us don't take advantage of a special privilege thereby depriving the truly needy appropriate access to stores or other buildings in the name of "our time."

As I began the long walk back to my car, I was amazed at how angry I had become at the audacity of this woman. I couldn't help but think that in an ideal world, all of us would surely enjoy benefiting from such perks. But how could someone not see as contemptible, an inappropriate exercise of her free will for the sake of shaving a few milliseconds of time from an unwanted chore? Each of us has the right to equally regard our time as valuable because it is an illusory commodity; none of us is guaranteed even a moment let alone a life long-lived. The arrogance and selfishness is astounding.

In the end, I was most disheartened by the realization that people such as this woman simply don't get it -- or possible don't even care to understand; life is all about them.

I soon realized I didn't feel great about having confronted her ..... and Kharma can be a real bitch:

I arrived to find my car – parked in the middle of nowhere – surrounded by two cars and an empty shopping cart!

“Ding” and all.

I can hear Dad laughing now.

Let's Pretend

I don't know what to believe anymore.

I am also apparently too stupid to understand what is actually going on up on Captiol Hill in Washington, DC.

But mainly, I am in sensory overload.

"Deem and pass;" Reconciliation Bill; CBO Scoring; Deficit Reduction; Double-Counting Medicare Cuts; New Entitlements based on taxes already pledged to other programs; Cornhusker Kickback; trolling for votes.

One fact I know for certain is that the pharmaceutical giant, Walgreens, moments ago announced they will no longer accept new Medicaid patients come June.

The decision by Walgreens takes this process well beyond politics; the reality of the proposed Health Care legislation has officially landed at our doorsteps.

The Slaughter Solution

Otherwise known as "Deem and Pass," this is the proposed unconventional method expected to be used so as to enact the tenuous Health Care package. Essentially, it would allow the House to "deem the previously approved Senate bill passed" even with amendments and without a conventional vote -- none of which is proscribed by Article I, Section 7 of the Constitution.

So, what?

When Professor Alan Morrison of GWU Law School was asked to define the word "Deem" as it relates to this process, he replied, "In class, I always say it means 'Let's Pretend.' "Deem" means, it's 'not true.'" He went further to advise anyone considering use of the procedural maneuver in passing this landmark legislation "not to do it;" the Slaughter Solution would certainly raise Constitutional issues sufficiently credible for intervention by the Supreme Court -- as it has done in the past.

The high Court has ruled at least twice in the past twenty-five years holding there is but one way to enact laws under the Constitution -- identical Bills (same text) must be passed by both Houses of Congress and then signed into Law by the President.

And curiously, the 1998 Supreme Court decision which struck down the "Line-Item Veto" specifically spoke to this "same text" voting requirement; interestingly, two "friends of the court" briefs in favor the "same text" language were written by both Reps. Nancy Pelosi and Louise Slaughter.

Now, the self-same Rep. Slaughter, currently the House Rules Committee chairperson, has proposed using this "self-executing" procedure to craft a rule 'deeming' the Senate Bill -- even with the different (amended) language -- enacted without the need for a direct vote.

Our congressmen/women would be wise to remember the classic rebuke by the high Court in past rulings which warns "repetition of an un-Constitutional process does NOT make it Constitutional."

I absolutely have a vested interest in the pending legislation as a medical professional; at this time, absent the specifics of the reconciliation bill, however, all of us are left to simply speculate as to what will emerge with the passage of this legislation. And while I don't know what specifically prompted the decision by Walgreens, I am fearful that passage of this Bill -- especially with the stench of procedural wrangling -- will lead to further erosion in our collective confidence in elected officials and the democratic process, as well as the evolution of a potential avalanche of adverse effects for countless thousands in the months and years ahead. Walgreens may only be the beginning.

More important than my role as a physician, or even consumer, is my position as citizen.

Personally, I see this desperately flawed process, put into action so as to finagle passage of the Health Care Legislation, as an affront to the intent of our Founding Father's and as disrespectful to each of us as citizens. Let me be clear, if there is truly an urgent need to craft legislation that assures every citizen adequate medical coverage while maintaining fiscal responsibility, I am completely in favor of our elected Representatives and Senators working tirelessly toward that end. But I write this remonstration out of disappointment for the shameless move proposed by the House; circumventing the Constitution by enacting this massive Bill through the use of a clever -- if not un-Constitutional -- procedural maneuver is both reprehensible and ill-advised. The old adage reminds all to "be careful what you wish for;" rest assured, this debacle will morph into a never-ending and contentious battle for years to come.

This is not about Red or Blue. To my mind, this is simply about right and wrong. We can do better and deserve more from our Representatives.

Regardless of your point of view, I agree with even the most strident voices asserting each of us has a responsibility to make our opinion heard. The legislation will be enacted this coming Sunday; I implore everyone to take the time (and considerable patience) to make your views known to your Representatives.

Toll Free: 877-762-8762. Otherwise: 202-224-3121

Blame The Fat Guy

I had heard too many horror stories and finally decided to take the collective advice to heart. As a result, with few exceptions, I made the decision to no longer open email that has been forwarded to a thousand other recipients before arriving in my virtual mailbox. Despite CAPITALIZED, exclamation mark-laden subject line warnings of dire consequences if erased, I now make it a habit to delete questionable emails without a second thought, assured (hopefully) I don't miss out on much.

There are a few individuals, however, who qualify for a summary exemption from this rule. I have no hesitation opening email with (somewhat) juvenile humor (to most) that makes me laugh out loud in the otherwise quiet of this room ~ all from a few friends who never fail to deliver.

A Urologist from Florida (why that is important I don’t know) recently sent this picture which reflexively propelled a slug of Diet Coke out of my nose:

GIRL SCOUTS - Maybe Next Time You'll Buy The F****** Cookies

I haven't seen a look like that since, "Children of the Corn."

This picture – or any mention of Girl Scout cookies for that matter – never fails to make me smile and often laugh; it takes me back to the waning days of my Residency, and to memories of Lemon Cream Girl Scout Cookies.

~~~~~~~~~~~~~~~~~~~~

I enjoy a cookie as much as the next guy, but for the life of me, I don’t understand the sway Girl Scout cookies hold over most people.

Every year, countless Mother’s herd pre-pubescent daughters to grocery stores with folding tables and boxes of addictive cookies in tow. The first take home lesson for a Girl Scout newbie is the art of “lying in wait” for any food-starved, grocery shopping unfortunate who makes the fatal mistake of inadvertently crossing her path. Every year, I vow to keep all four eyes open to avoid these all-too-cute, juvenile ponzi-schemers, but as sure as an unopened roll of Thin-Mints lies frozen in my freezer, I always fail.

What happened to the old days when these uniformed, fresh faced purveyors of saturated fat were forced marched door to door hawking their heart-clogging wares? Perhaps, the change of tactics was borne out of an abundance of caution; there are, after all, crazy people about? If even a glimmer of realism exists in the picture my buddy sent, we would all be wise to rethink the notion of who should actually be afraid of whom?

~~~~~~~~~~~~~~~~~~

My Girl Scout story occurred during the season of "The Cookies" which comprised those last few months of my Residency.

I finished my first case of the day, had seen the patient settled into the CVICU, and then headed to the OR office to take a short break before another patient arrived. As is the case in most offices this time of year, there happened to be several boxes of the damned (not-even-very-good) cookies strewn about one of the tables. This was Clarice’s evil way of foisting her intention on all of us to, “eat them before I do!”

Being a lowly, underpaid Resident, who was I to argue with free food?

I began by eating a single Lemon Cream cookie. While it tasted pretty good – certainly better than most – I only intended to eat the one. I also have a vague recollection of an unexpected delay to my next case, so – of this I am almost certain – I probably did go on to eat at least one more Lemon Cream. Beyond this my memory is a blur.

Anyone who has come through the (formerly) rigorous, long hours of clinical training both in Med School and Residency would agree the crazy lifestyle inculcates a manner of eating which surely would disgust most of our parents. The mere sight of a Drug-Rep (at feeding time) still has a pavlovian effect of begetting, in me, the appetite of a vulture on carrion. During those long days and nights of training, once food was secured (preferably free), all interns and residents learned to shovel it down  ~ all the while trying to remember to breathe between bites.

So, in fairness to me, considering many years of this frenzied, mindless feeding, I would concede only to a remote plausibility to one of the eventual rumors that had me finishing off an entire row of Lemon Creams. But, an entire box? Are you kidding me? The thought actually disgusts me.

What I DO know with certainty is that, at some point, the surgical delay was overcome and I headed over to the holding room to greet our next patient.

~~~~~~~~~~~~~~~~~~~~

An hour or two later, a fellow Resident and friend, Pat Cooney, DDS MD, entered my operating room in a pique of pseudo-anger barking,

“Hey, Marvin. Did YOU eat all of Dr. Nelson’s Lemon Cream Cookies?”

I do recall laughing at the thought of what he had asked; not knowing (remembering) if there was any proof substantiating the allegation, I obviously replied, “No.”

Cooney followed with a definitive,

“Well, it sure as hell wasn’t me!”

Only later, once free of the Operating Room, did I finally learn what had transpired before his interrogation:

(Dr. Nelson, Alan Alda look-alike, mentor and boss, walks into the OR-side departmental office intending to eat one of his precious Lemon Cream Girl Scout Cookies. Allegedly finding only an empty box, he directs his inquiry to Clarice, his trusted aide-de-camp/Girl Friday/brains of the operation):

Dr. N: “Clarice, do you know who ate all of my Lemon Cream Cookies?”

Clarice: “No; the only person I have seen lately is Cooney.”

(Cooney Enters)

Dr. C: “What’s hangin’?”

Dr. N: “Cooney, I came in here expecting to enjoy a Lemon Cream Cookie but it appears you beat me to it! Hell, you beat me to all of them!”

Dr. C: (Indignant) “Sure, ........... BLAME THE FAT GUY!”

Pat has an entirely different take on the story (which probably speaks more to years of exposure to inadequately salvaged Nitrous Oxide while a dentist):

"You (as in me) and I were coming back from pre-op-ing patients, around 18:00 hours. We ran into one of the perfusionists who told us about the Girl Scout cookies in the office. Then as YOU were in the process of eating ALL of the Lemon Cream cookies, I told you to ease up because, in the end, when Nelson finally realized all of his precious Lemon Creams had gone missing, everyone would blame the Fat Guy!

The next morning, I got in to the office before you had a chance to tell Clarice your biased, sanitized version -- because I KNEW what you would try to do and was determined to beat you to the punch.

When you walked into the office trying to frame ME for YOUR gluttony, the cat was already out of the bag!"

(And, I am CERTAIN everyone believed the FAT GUY had nothing to do with the disappearance of all those cookies, Pat!)

~~~~~~~~~~~~~~~~~~~~

A few months later as the academic year drew to a close, Dr. Nelson et al presented both Pat and I with two very large, gift-wrapped boxes. Having expected a golden laryngoscope, I was truly excited at the prospect of what could possibly come in such large packages!

As it turns out, Dr. Nelson found himself passing through Chicago O’Hare airport in the weeks that followed the drama that became known as the "Day of the Missing Lemon Creams." While waiting for a flight, he fortuitously happened onto yet another prostituted Girl Scout who was desperate to sell the last of her cookies ~ she desperately wanted to get home to play her Grand Theft Auto video game.

He wasn’t the least bit interested in her Tagalongs, Thin Mints, Do-Si-Dos, Somoas, or Shortbread.

He had but one request on his mind. Actually, two.

Two cases of Lemon Cream Girl Scout Cookies.

~~~~~~~~~~~~~~~~~~~~

For the record, I don't eat Lemon Cream Girl Scout Cookies; the fact they are no longer sold is irrelevant.

Trained Monkeys

In addition to a general dislike for anything relating to physicians, there was little in my background that would have pointed to a career in medicine. As my youngest brother approaches his graduation from medical school, I started thinking of what led me to practice medicine.

This is my story ... Undergrad (Part II)

I am sure most everyone has experienced the feeling before.

I refer to the sense people often relate when arriving at some new destination or environment – and immediately feel at home. It makes one believe, “This is meant to be.” It could be an apartment, a home, a far flung college campus, or even a potential workplace.

From the moment I stepped into the frigid, sterile confines of a suite of operating rooms, I knew I had arrived.

My first wakeful exposure to an operating room came while a summer student at the Texas Heart Institute in Houston, Texas. Neither Marcus Welby nor any other television drama could have adequately prepared me for the excitement, tedium, and routine choreography of operating rooms that were to eventually become an integral part of my life’s work.

To my way of thinking, one unfortunate aspect of the "I want to get into Medical School" circus comes with a ridiculous mandate for pre-med students to work in some health-care related capacity prior to actually applying to medical school. While the notion is laudable, the requirement should actually come under the heading of “resume padding.” Many of my peers shadowed a beloved family physician or toiled at local hospitals drawing blood or carrying out other grunt work. I was always hard pressed to understand the degree to which most of us would actually form any valid conclusion about a future in medicine based on the experience of drawing blood or pushing patients around winding corridors. Regardless of my opinion, admissions committees at every medical school insisted on this vacuous demonstration of a serious intent to practice medicine from every applicant.

Pre-med students who could spend summers in the Houston area certainly had many options available to them which afforded the potential for truly eye opening experiences; some of these summer positions successfully offered more than a tangential sampling of the reality of medicine for medical wannabes.

The Texas Medical Center must surely be one of the largest in the world; from a distance, it appears to be a city unto itself. At last estimate, the complex employs well over 100,000, is home to two medical schools, a dental school, various nursing and allied health programs, world - renowned cancer and pediatric centers, one of the largest VA hospitals, multiple private hospitals as well as two world-class heart programs built by Dr. Cooley, and the late, Dr. DeBakey.

During the spring semester preceding my senior year of college, I learned that both of the heart programs in Houston offered highly competitive summer programs for prospective medical students. (A belated "Thank You" to Sally McDonald, (now) MD.) Having spent the majority of my college years immersed in Chemical Engineering studies, I was pretty much out of the pre-med loop and had no foreknowledge of either of the prized programs. I was beside myself with disbelief at my lack of prior initiative or insight; with the late date, I was clearly behind the eight ball and had to move quickly in order to realize any hope of securing one of these positions.

In a fortunate twist of fate, my parents “knew someone” who also happened to be a lifelong friend of Dr. Denton Cooley of the Texas Heart Institute. While a personal appeal to Dr. Cooley in support of my application was certainly helpful, my academic record would have to stand alone in order to support an appointment to the program.

Ask any friend who knew me during the interregnum after applying and each would probably cringe at the thought of my crazed anxiety as I awaited the decision. Like so many prospective medical students, I had somehow latched onto a notion that failing to secure this job could be a death blow to any future in medicine. (FACT: pre-med students are a breed apart.)

I was pleased and much relieved when a letter eventually arrived inviting me to be one of ten students who would spend the summer with Dr. Cooley and his associates. I would have liked to think my academic credentials propelled me across the finish line in good stead; when finally meeting my fellow summer students, however, I quickly learned many of them were the scions of referring cardiologists and other medical attending physicians, as well as family and business friends. For all my hard work in college, it had apparently mattered more that my parent’s physician/friend played college ball with Dr. Cooley. Beyond a moment of reflection, I doubt I gave it another thought.

It was very difficult as I bided my time through the completion of the term and finals, and then anxiously awaited a starting date of June 1st.

Following two days of orientation as well as an education in operating room decorum and hygiene, we were finally led down a winding staircase to the ten operating rooms which made up the heart of Dr. Cooley’s domain of old. Every day we were to consult a master OR schedule then make our way to an assigned room; we would remain in that operating room until all the work for the day was complete.

Imagine.

Dr. C and the Trained Monkey

It is 7:30 am. You walk into one of the ten operating rooms all of which are bustling with activity and a disarming ambient temperature of 55 degrees. All ten patients simultaneously have IV’s, central and arterial lines placed followed by the induction of anesthesia and intubation; the patients are then shaved, prepped and draped but only after foley catheters and rectal temp probes have been inserted; the activity reaches a pitched climax as a chorus of pneumatic saws in the hands of ten surgeons carry out midline sternotomies – throughout the oval of the suite, all ten chests are “cracked” in unison. The movements are fluid, precise and surprisingly absent any of the anticipated drama. As quickly as it began, the rooms palpably settle into the routine - even mundane - practice of open-heart surgery. To these seasoned professionals, this performance is a well-worn ballet of sorts, but to the myriad visiting medical professionals it is instantly a heady and memorable experience. Each of the fledgling summer students was immediately awestruck by the good fortune that had landed at our feet.

The ten surgeries were completed and, following fifteen or twenty minutes of turn-around time, the dance began anew. The cycle was repeated multiple times throughout the very long days until all of the scheduled cases were complete. As an example, within the Institute museum each of our names is permanently immortalized on the framed, faded surgical schedule from a day in July of that year when the Texas Heart Institute carried out a personal record of 52 open heart cases in a twenty-four hour period.

What were the duties of the summer students? Surely, we were instructed to stand out of the way of the professionals and observe?

Not a chance.

From the start, all of the students in their assigned rooms, scrubbed and gowned, were placed either at a patient’s chest or legs to assist the surgeons as they went about their work.

And we were quickly taught how to sew.

At that time, balloon angioplasty was still in its naissance and, as a result, formal bypass grafting was the norm – even for single vessel heart disease. Every patient who underwent a “bypass” had at least one of his legs splayed open and a segment of vein removed which was then used as the bypass conduit. After the vein "harvesting" was complete, the incisions were left for the summer students to close.

While there was certainly a learning curve for each of us, it gradually became the clear but unspoken goal of every summer student to outdo the next when it came to craftsmanship. It would not be an exaggeration to state that most of the surgeons, by the end of our stay, truly came to appreciate - often prefering the work of the students on loan for the summer. This notoriety became a source of great pride - as well as a few swollen egos.

As with other friends who also worked that same summer across the parking lot with Dr. DeBakey's team, each of us at the Texas Heart Institute was truly blessed with the opportunity to work with Dr. Denton Cooley and his associates. It is a real tribute to these surgeons that the medical community remains truly awed by their abilities; each of them somehow managed to make their work appear effortless – whether they were bypassing blocked coronary arteries, retooling or replacing valves, implanting mechanical left ventricles, or transplanting hearts.

In the years following medical school, I went on to complete a fellowship at the Texas Heart Institute. At our graduation service, Dr. Cooley introduced me to the audience as the, "summer student who never left." "Dr. Marvin was personally responsible for bankrupting our summer program; after he clocked in on June 1st, he never clocked out!"

Afterward, I reminded him of the axiom he taught us as our summer at THI came to a close; as we prepared to return to college, I believe he wanted to temper the naive assumption of many a student who may have somehow mistaken the ease with which the surgeons work and our new-found abilities, as he asserted,

“Any monkey can be trained to perform surgery. We spent the summer teaching a bunch of college educated monkeys how to close legs, hold hearts, and assist at the chest. The difference between you and me is that I have the knowledge and experience to know when surgery should be carried out.”

In four sentences he had aptly reined in my youthful enthusiam but also reduced my glorious (and lucrative) experience into the mockery that was, “How I Spent My Summer as a Trained Monkey.”

He laughed out loud and in a few minutes ended our conversation by offering up a true revelation:

If given the opportunity, what would Dr. Cooley choose as a surgical specialty today?

Without hesitation came a Graduate reply,

“Plastics.” Chuckling, he added, “Where is Mrs. Robinson when you need her?"