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.
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| 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?"
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