Do it all, have it all

Maggie Aderin-Pocock, MBE, is a space scientist and communicator, who builds instrumentation for telescopes intended, she says, “to look to the edge of the universe”. Marie Curie (1867-1934) was a Polish-born, double Nobel-winning physicist and chemist. The first person to describe the nature of radioactivity, she discovered the elements polonium and radium.
I’d known for years that Marie Curie was the first woman to win a Nobel prize—and is still the only woman to win two—but it wasn’t until very recently that I learnt about some of the challenges she faced. Her husband and collaborator, Pierre Curie, died when her children were still quite young, and she found being a working mother so hard that her father-in-law had to step in to run the household. And then there was a bit of a scandal because she began writing love letters to a married man. When I first found out about all this I thought: “That’s not the Marie Curie I knew”—but in fact I liked it. It made her more human.
Before that, I just assumed that Curie did it all. That’s the story we often get told: that high-achieving women are just brilliant, they’re superwomen, they do it all, they have it all, and they have no difficulty in supporting it all. But the fact that Marie Curie clearly did struggle resonates with me: child care for me is often a challenge, and my 15-month-old daughter often comes to work with me. Role models should be real people; if you have a role model who is, or is perceived as, a superwoman, then people think, “Well, that’s not me, I can’t aspire to be that.”
I find her attitude inspirational, too. She was a dedicated and systematic scientist, and spent long, long hours in the lab. As an experimentalist you need that. Some people think that scientists go into a lab, make a discovery, and come out with a Nobel. But success takes years and years of attention to detail, doggedness and stubbornness: and that’s what Marie Curie put in.

The benefits of being a physician will come to you only when you stop expecting them.

The doctors of tomorrow

Jerome David Salinger died a few weeks ago at the age of 91. The famously reclusive author who chronicled the fictional exploits of Holden Caulfield and the precocious Glass children last published a work of fiction in the mid 1960′s. For the past 40 years he has lived an anonymous, unassuming life in New Hampshire. I mean can you imagine an author/artist/actor at the top of his game in this day and age suddenly withdrawing from the public eye, never to be seen again? Rumor has it that Salinger never stopped writing, that his private archives contain volumes of unpublished material.

I’ll get this out of the way in the beginning—I’m an unmitigated devotee of J.D. Salinger. I’ve read everything he ever wrote, multiple times. There’s something slightly embarassing about that fact, I realize. Especially at my age. At the beginning of Hemingway’s “The Sun Also Rises”, Jake Barnes describes how Roy Cohn read a book called “The Purple Land” too late in life and was corrupted by its sentimentality and romanticism. Many say the same about Salinger’s “The Catcher in the Rye”. You’re supposed to read it when you’re a teenager, so you can identify with the adolescent angst and sense of betrayal that dawns on a young sensitive soul when he realizes the world is full of selfish phonies, but then you move on, to richer, more nuanced literary takes on human existence. It isn’t meant to be a book for a mature sensibility; if anything it can be dangerous to read it when you’re into your twenties. I gently disagree. It’s a soulful, meaningful book that I plan on reading many more times before I die. I read about Holden Caulfield and Franny and Zooey and Seymour and all the other Glass children for the first time when I was 23 years old. I was living in my mom’s basement, working at a lousy plastics factory during the day, waiting to find out if one of the medical schools in Ohio would accept me. I wasn’t exactly feeling too enthusiastic about my future prospects. My friends had all seemingly moved on in life, consulting jobs and grad schools and such, while my life had stalled for the first time. Reading Salinger that year kept me sane and hopeful I suppose. When the phone call came in the early summer announcing that I had been accepted, I drove around like a madman, happy and delirious, sort of like Holden at the end of the novel, crying in the rain as he watched his little sister Phoebe spinning in circles on the Merry-Go-Round in the park. I couldn’t exactly articulate why I was so happy, at that point. I had been chosen was all I knew. Chosen to embark upon a life of service and honor. And all that jazz. I think all medical students start out that way, wide eyed and humble and full of idealistic hope. But it doesn’t last; life rolls on and consumes you and the next thing you know you’re anxious about grades and AOA status and what specialty to pursue and which residency program to apply to and all these things that have nothing to do with Phoebe on the Merry-Go Round. Without losing those moments of inchoate happiness completely, a young doctor has to somehow figure out how he’s going to go about fulfilling his promise to himself, his profession, and his patients. How should he go about being an actual doctor? With what mindframe ought he to adopt? Ecstatic joy is no match for the cruel grind of actual existence, the years on top of one another, the petty torments of human aspiration. You need a more enduring strategy.

There are talented, intelligent college students right now across this country considering whether or not to make a run at medical school. Nowadays, it isn’t the slam dunk decision it used to be. If you were smart, top ten in your class, Dean’s List— medicine automatically went to the top of the list of possible career options. It had prestige. It payed well enough and possibly even better depending on what specialty you chose. It made your parents proud. It represented a low risk path to legitimacy in life, an assurance that your social standing wouldn’t be contingent on such factors as personal relationships or fluctuations in the business cycle or mere chance. It just seemed to be a smart, conservative thing to do for an otherwise intelligent, hard working youth who harbored vague aspirations of “helping people”.

Things have changed. (Not entirely; you’re parents will still be proud of you.) But medicine isn’t necessarily the default career pathway for a new generation of hard-working, intelligent Americans. Frankly, I don’t know why anyone would want to pursue a career in medicine anymore. It’s a tough gig, one that has lost luster over the past ten years. The pay isn’t what it used to be— there are pediatricians in this country who earn less than high school athletic directors. The debt one must take on to pay for medical school (close to $200,000) is simply absurd. And the prestige has correspondingly dropped. At some point in the near future, the local doctor will be perceived as a mere civil servant, a health provider who is seemingly interchangeable with other providers like nurse practitioners and physician’s assistants and whatever other iteration of primary care develops in the future. And then there’s the mentality in American medicine that errors and bad outcomes are unacceptable. We have “never events” now. Doctors order tests not to identify diseases necessarily, or to search for an unidentified source of a patient’s discomfort, but rather to cover themselves from any future accusations that they “didn’t do enough”. There’s an antagonism that has crept into the doctor-physician relationship, prompted by our corrupt medical malpractice system, unreasonable patient expectations, and physician cowardice and detachment that threatens to permanently blacken the soul of our profession. It’s sad and depressing for those of us young enough to know we will have to wade through this transition phase for the next 25 years. For those who haven’t committed yet, who stand on the brink of life with all its possibility and glory shining before them, medicine starts to seem far less appealing than other choices, even to the idealists.

But don’t let the negative discourage you too much. Let me tell you a secret: this is still the best job in the world. And not because I’m a surgeon and get to do “cool procedures” and occasionally get to directly affect the course of a patient’s life through a timely intervention. I like that part, don’t get me wrong. I’m not some sort of Marcus Aurelius Stoic saint unperturbed by the dramatic viscissitudes of life, possessing such powers of self restraint that I refuse entirely to pat myself on the back occasionally. I’m only human. But when you do this long enough, you start to realize that whatever good you did for that patient, some other surgeon did just as well in the town next door, and if you weren’t on call, whoever was would have done exactly what you did. You did your job, that was it. It wasn’t about you. What you realize soon enough is that when you save someone or cure them of cancer, the lucky one in the transaction is you, buddy. Anyone can cut out a colon cancer. A million surgeons can do it with sufficient technical excellence. So don’t go getting all high and mighty about it. You did your job as well as you could, based on your training and experience. No one would expect anything less. The patient would have been served just as well at another hospital.You are the one who ought always to feel privileged—that a patient would give herself to you, open her heart and soul, bare herself in all her failings and infirmities and suffering to this stranger who struts into her room in a white coat with all the answers and an indecipherable plan to somehow heal her pain. The sudden intimacy of the encounter is enough to stop your heart if you don’t watch it. The trust and the view that our patients grant us is an incalcuable gift. We see humanity in these unvarnished, stripped down moments of vulnerability. Your gaze upon the stricken is a rare glimpse into the depths of what it means to be human. I like to think sometimes that heaven is all around us, if we look hard enough. I see it in my daughter every morning, standing in her crib in the morning dimness with those deep dark eyes of hers, looking up at me, the nascent beginnings of a smile forming in her lips. But too often we miss it in our everyday dealings. We miss it entirely, consumed as we are in our silly strivings and pronouncements and righteousness and posturing. We miss it all. But in the doctor-patient encounter, there is no averting of the eyes. You must look, gaze upon the wretchedness. Maybe you can close your heart off to it, forget what you’ve seen once the encounter ends, treat it as some detached clinical experiment, a problem to be solved empirically. For some, that is the only way to avoid involving themselves too emotionally in their patients. Regardless, open hearted or closed, you can never forget the things you see and hear and touch. It burns itself into your soul. It is the great Gift bestowed upon a physician. I wrote once about a little old lady who hid a giant fungating melanoma from her family for years as she ministered to her dying husband and how she finally broke down, opened herself up and asked for help. Those moments in my office discussing what had to be done with her and her daughters will never fade from my memory. The piercing brittleness of existence surges to the forefront of your consciousness. The things you will see. The worried, raccoon-eyed mothers in the ER with their young children right before surgery for appendicitis. The elderly husbands who dutifully sit by their intubated wives for hours in the ICU. The way a family will turn a hospital room into a shrine to the grandmother resting in bed; pictures from a foregone time when she was hale and hearty, hair a different color, crazy little scribblings from elementary-aged grandkids, fading bouquets of flowers, the rows of cards. The joy in the post operative waiting room when you tell someone everything went well, your wife is fine. The eruption of relief when you inform a woman her biopsy was benign. The quiet courage and resolve in the quivering, red-eyed visage of a woman told she has breast cancer, the husband who autonomously squeezes her hand white. The 22 year old guy who screams bloody murder when you lance a tiny boil and the old Korean war veteran who tells you about an old girlfriend he once had in Oklahoma the whole time you drain his giant perianal abscess. Broken hearted lonesome single middle aged guys who tell you not to worry about calling anyone after surgery; there’s no one to call anyway. The physical maladies are no different than what you read about in textbooks. But the tapestry of human failings and strengths and triumphs you will experience as a doctor are not described in any textbooks I know of. Perhaps they are portrayed in art or literature, but the thing about art— you never know quite to believe if it is real or not, that small nagging doubt that perhaps it’s all made up. The reality of subjective experience– it’s all yours for the taking buddy. All of it is yours to observe, to learn from, to acquire. The entire spectrum of humanity on display, unadorned, vulnerable and full of absolute trust that you will do the right thing. Fear and joy and sorrow and pain and doubt and weakness reside within us all, to varying extents. You will find yourself through your experiences over a career. In Seymour, An Introduction, Seymour Glass tells his brother Buddy that all we ever do is go from one little piece of Holy Ground to the next. When you walk into a patient’s room, the holy grounds open up endlessly before you. Respect where you tread.

And that’s the catch. You cannot betray this gift of the Gaze. You must never forget that being a doctor is not about you. It’s not a reward for getting good grades and working hard and volunteering at the local hospital. No one cares what your grades were. That AOA plaque on your office wall is meaningless to the suffering souls who come to you seeking solace. No one cares about your fellowship or that you went to Harvard or about your giant research endowment. It isn’t about being president of your local medical society and making speeches. It’s not about you. You owe your patients this Spartan-like self-denial. The benefits of being a physician will come to you only when you stop expecting them.

But how do you do this? How does one adopt the proper attitude necessary to handle the burden of the Gaze? What is the process? Is there a secret? How do I avoid letting it devolve into some voyeuristic sideshow? Well I think the answer is pretty simple once you get down to it. Salinger, I think, articulates it perfectly and succinctly with his admonishment to, whatever it is you’ve chosen to make your life’s work, “do it with all your heart” and to do it for the “Fat Lady” who lives in the hearts of all men. But more on that later. First, I wanted to veer off course for a minute with two stories; one about my Aunt S. and the other about this mentally retarded developmentally delayed(MRDD) young man I saw in the hospital hallway the other week. Bear with me, please.

First, the young man. I was cruising through a long hallway on my way to the ICU, reading my patient list as I strode, when I noticed him out of the corner of my eye. He was in a wheelchair and he was washing or polishing a handrail that ran the length of the hallway. An elderly volunteer was watching him. At first I had the reflexive, complacent feeling of pity— awww, look at the poor retarded man forced to do demeaning work in public. But I stopped further down the hall. I turned and watched him for a bit. He was sort of slouched over and his mouth was gaping and he frankly looked a little wild-eyed but he was completely focused on the task at hand. He had a rag in one hand and some sort of cleaning agent in a bottle between his legs. Very meticulously he would spray a little of the solution onto his rag and proceed to carefully wipe down the segment of railing to his right. This was drab, yellowed old railing. It would never look fantastic. And it was interminable, extending far down the length of the hallway, which curved ahead to the right so from his position you never knew when it would end. But dutifully he wiped the two foot segment in front of him, even the back side facing the wall which no one would ever see. He didn’t skip areas. He wasn’t careless. He concentrated. He did a fine job. There wasn’t anything demeaning about it at all. Feeling sorry for him just disrespected his efforts. All work is worthy when done with the clean, humble, simple state of mind of the pure-hearted. It doesn’t matter what it is. Taking out a gallbladder. Paving a highway. Cleaning a toilet. Polishing a unpolishable railing. It’s all the same. We all have our opportunities to match the efforts of that young retarded guy. As doctors we’re no different. It’s easy to just go through the motions sometimes, to zip through an exam, to cut off a patient who rambles on about an unrelated topic during an office visit. But you can’t do that, at least not with any sort of regularity. Every patient we see, every surgery is just another small segment of never-ending hallway railing to be polished as well we can, with all our hearts.

My Aunt S. was an amazing woman. She wasn’t famous or renowned or anything. She was just a very loving, loyal, dedicated woman who constantly put the needs and desires of others above her own. She was always someone’s biggest fan. Once she was on your side, you had an iron willed supporter for life. She was one of those people who, if something really terrific or fortunate or wonderful happened to you, she would be unconditionally happy and excited for you. There were never any strings attached. The older you get, the more you realize how rare a human trait that is. The majority of people are unable to feel such pure and unadulterated joy for the triumphs of someone else. Too often the moment is tainted by jealousy. It isn’t that you aren’t happy for that person. You are. But a small part of you sort of wishes such good fortune were happening to you instead and an incorrigible voice deep within will whisper things like “oh, she just knows the right people” or “his parents were able to pay for all his schooling” or “she’s just about the luckiest son of a gun I know”. The majority of us succumb to covetousness and an overly competitive drive to have all the happiness in the world for ourselves. My aunt was different. She could feel and internalize the joys and victories of another person as if they were her own. The moment I remember most about my Aunt S. was my medical school graduation day. My crazy family had all made the long trip to Toledo for the ceremony and of course they all got there late and had to settle for seats way high up in the rafters. I remember being next in line, waiting for my name to be called so I could walk out across the stage to get my diploma and already there was a commotion coming from somewhere back in the crowd. I couldn’t see because it was so dark, like looking into a murmuring abyss. And then I was announced and there was this eruption of screaming and yelling from somewhere in the rafters. It was so loud and crazy and tumultuous I remember seeing parents in the front rows laughing amongst themselves. But one voice stood out. I distinctly remember hearing someone screaming “way to go Jeffer!!!!” My Aunt S. had always called me Jeffer, ever since I had been a little boy. Specifically, I heard her strident, exuberant voice above the cluttered din of screeches and yells. I turned to that spot up in the rafters and waved into the darkness, smiling like madman the whole time. Two years later she developed a lump in her breast that turned out to be cancer. A couple years after the mastectomy, the disease recurred. She battled for another year or two and then she started to deteriorate. She died two years ago this March. Now I wasn’t such a wonderful nephew to her. I didn’t call her on her birthdays. I didn’t even know when her birthday was. I never bought her gifts. I never looked to her for worldy advice or professional guidance or anything like that. I was her only nephew though and she loved me in a way that I can only now truly appreciate.

These two stories best illustrate the two aspects of “doing something with all your heart”. It’s a delicate fusion of an almost dispassionate utter seriousness, as if what you were doing was the most important thing in the world no matter how banal and tedious it seems, along with an exuberant joy in seeing someone through a period of illness, a joy that transcends anything that has to do with you. One of my favorite passages in all of Salinger is from Seymour, an Introduction where Seymour writes to his brother Buddy about what it takes to be a great writer. The advice could apply to anyone, no matter what your career aspirations. So forgive me a little poetic license to paraphrase old Seymour in doling out some words of wisdom to all those young peope out there who are contemplating pursuing their life’s work in the field of medicine:

When you die and the Man up in the sky reviews your oeuvre, do you know what He will ask you? One thing he won’t ask is how many honor societies you were a member of, that’s for sure. He won’t ask how fast or fantastic of a surgeon you were or how marvelous of a diagnostician you were. He won’t care about your awards or diplomas or honorariums. He won’t ask if your patients loved you or just sort of respected you. He won’t ask if you were nice to all your co-workers and colleagues. He won’t ask how many medical missions you went on or how many indigent patients you treated. I mean, those things are nice and all and certainly worth aiming for. But He won’t ask you about those things. You’ll get asked two things and two things only: were all your stars out and did you practice medicine every day with all your heart? That’s it. It doesn’t get any more complicated than that. So to all of you thinking about venturing off into this holy profession you better make damn sure your skies are clear and your stars are shining bright. Keep your eyes peeled for that secret and mysterious Fat Lady who lives deep in the souls of all men— she can be quite beautiful. And listen close for the exuberant scream of unconditional joy and love coming down from the rafters of your own lives….

His mantra was: We don’t read the textbooks, we write them. Just try it! Tom Scalea
“What do we have?” Ledgerwood
Every single day, is to always do what is right for her patients. Dr Blackstone

A case can get a little scary, and you keep your cool, stay ahead.  Then it gets really scary, and you must be even cooler.

Reminds me of the beauty of a universal skill. Like Mayer here, a surgeon can make it happen with any team, anywhere in the world.

Don’t start something you can’t finish.

With much practice and concentration comes a chance to perform beautifully.

Concentration, precision, and endurance

Simple, complex, beautiful work.

Precision takes practice. Performing takes guts.

Discipline. Work ethic. Instinct to go where the action is.



Doing good for your senior, doing right for the patient!

ethical and moral imagination
http://laurentledoux.blogactiv.eu/2008/09/15/should-you-develop-your-imagination-to-be-ethical-as-a-manager/

surgical personality
surgical life
art of living

defining moments
respect in a world of inequality

history of surgery, an illustrated book

Second face of power, the soft power

Soft power lies in the ability to attract and persuade. Whereas hard power—the ability to coerce—grows out of a country's military or economic might, soft power arises from the attractiveness of a country's culture, political ideals, and policies.

Hard power remains crucial in a world of states trying to guard their independence and of non-state groups willing to turn to violence. It forms the core of the Bush administration's new national security strategy. But according to Nye, the neo-conservatives who advise the president are making a major miscalculation: They focus too heavily on using America's military power to force other nations to do our will, and they pay too little heed to our soft power. It is soft power that will help prevent terrorists from recruiting supporters from among the moderate majority. And it is soft power that will help us deal with critical global issues that require multilateral cooperation among states. 

Power is the ability to influence the behavior of others to get the outcomes you want and there are several ways one can achieve this: you can coerce them with threats; you can induce them with payments; or you can attract and co-opt them to want what you want. This soft power- getting others to want the outcomes you want- co-opts people rather than coerces them.^[3] It can be contrasted with 'hard power', which is the use of coercion and payment. Soft power can be wielded not just by states but also by all actors in international politics, such as NGOs or international institutions.^[4] It is also considered the "second face of power" that indirectly allows you to obtain the outcomes you want.

"a country may obtain the outcomes it wants in world politics because other countries – admiring its values, emulating its example, aspiring to its level of prosperity and openness – want to follow it. In this sense, it is also important to set the agenda and attract others in world politics, and not only to force them to change by threatening military force or economic sanctions. This soft power – getting others to want the outcomes that you want – co-opts people rather than coerces them."^[5]

Soft power resources are the assets that produce attraction which often leads to acquiescence.^[6]Nye asserts that, “Seduction is always more effective than coercion, and many values like democracy, human rights, and individual opportunities are deeply seductive.”^[7] Angelo Codevillaobserved that an often overlooked essential aspect of soft power is that different parts of populations are attracted or repelled by different things, ideas, images, or prospects.^[8] Soft power is hampered when policies, culture, or values repel others instead of attracting them.

In his book, Nye argues that soft power is a more difficult instrument for governments to wield than hard power for two reasons; First, many of its critical resources are outside the control of governments; Second, soft power tends to “work indirectly by shaping the environment for policy, and sometimes takes years to produce the desired outcomes.^[9]” ^[10] The book identifies three broad categories of soft power: “culture,”“political values,” and “policies.”

less ambition, more achievement

change my views of what it means to be a doctor and a patient, to be sick and to be well
feel bless for where i am today, the place i ve always belonged

for what we used to be, here
to be everything, anything

Genius on the Edge: The Bizarre DoubleLife of Dr. William Stewart Halsted

This biography is the first of William Stewart Halsted in a half century. The author acknowledges it was not intended to be the definitive biography of America’s greatest surgeon but rather to tell of his life. Imber, himself a surgeon, has outlined with insight, the unlikely coincidence that was the source of Halsted’s magic: his rehabilitation from serious illness at Johns Hopkins just as this unique institution opened and his lifelong narcotic addiction. Imber focuses on Halsted’s personal life, which is the stuff of legend: the greatness achieved by this drug-craving Jekyll and Hyde, his unexplained disappearances, his probable closeted homosexuality.

Born of a wealthy New York family in 1852, Halsted was educated at Yale and Columbia’s medical school. After brief training in New York hospitals and two years visiting European clinics, he became one of New York’s most successful surgeons — fast, innovative, and bold. The gregarious young man and a friend shared a well-appointed house, at which they frequently entertained young professional men.

In discovering (through self-experimentation) that cocaine produced local anesthesia, Halsted became addicted. Hospitalizing himself for detoxification, he accomplished only a switch from cocaine to morphine. The brilliant young surgeon was compelled by his illness to give up his peripatetic New York life and relocate to Baltimore at the invitation of his friend who would become the first dean of Johns Hopkins, William Welch, with whom he lived for several years and became completely absorbed by a contemplative, research-based life. Initially confined to research, Halsted proved himself sufficiently within two years to be named chief of surgery. For the next 30 years, Welch and his other powerful faculty friends put up with his eccentricities, long unexplained absences, and total lack of interest in teaching students other than the best of his residents.

Both in personality and surgical style, Halsted had undergone a striking metamorphosis. The electricity had gone out of the extroverted, young New Yorker. Gone also was the bold, rapid surgeon, replaced by a methodically slow, meticulous operator. Despite this change, or in fact probably because of it, Halsted made a series of landmark contributions in treatment of breast cancer, hernia, thyroid, intestinal, biliary, and vascular surgery. Most of these innovations are now outmoded, but two others became the basis of modern surgery.

The first was a deliberate approach to operative surgery based on laboratory research, emphasizing careful asepsis, meticulous hemostasis, gentle handling of tissues, and attention to physiologic changes. Halsted’s obsessive adherence to these principles required lengthy operations at a time when surgeons were rated by their speed. The result of Halsted’s method was safety in surgery. His outcomes proved so superior that eventually all surgeons would adopt “Halstedian” technique.

The second innovation was a revolutionary system of training surgeons: carefully selecting of a large group of interns and over a period of years, choosing the best few, who were then given graded responsibility, so that as senior residents they required no supervision. The survivors of this pyramidal system were the subsequent generations of academic leaders, through which US surgery became preeminent in the world. Halsted’s residency system is considered by many to be his greatest contribution.

Whether Halsted was a homosexual, as Cushing believed, is supported only by innuendo. His marriage at age 40 was to a plain woman who wore masculine clothing. In their large house, she and Halsted had separate quarters. Assessment of Halsted’s sexual preference was recently confounded by discovery of profoundly affectionate letters he wrote to a woman 40 years his junior.

The Jekyll and Hyde simile is fully explored by Imber. In the hospital, Halsted was stiff, painfully shy, reclusive, unapproachable, often severe, sarcastic, and even cruel. This was the only side seen by students, residents, and most others. But with his few close friends, at his club after his afternoon morphine, his charm, humor, and animation approached his demeanor of the pre-cocaine New York era. During routine 4–5 month vacations on his farm, where he was similarly relaxed and happy, he could be a delightful companion or host.

While Imber skillfully places Halsted in the social setting of his era, he devotes little space to the medical world other than Hopkins. He writes “there was Hopkins and then there was everywhere else.” While one acknowledges that Hopkins as an institution and Halsted as a surgeon revolutionized American medicine, there were other medical centers and other important surgeons, especially several in Europe from whom Halsted borrowed some of his best ideas.

The book is well researched and accurate. Purists might object to an occasional exaggeration. For example, in the prologue’s account of his emergency operation on his mother, Halsted is said to have “successfully performed the first known operation to remove gallstones.” In reality, J.S. Bobbs of Indianapolis had done so 5 years prior.

Lay readers of Imber’s homage to this strange surgical genius should be intrigued by his enigmatic life and his monumental accomplishments in the face of a lifelong handicap. For surgeons and medical historians, there will be no revelations, but emphasis of the fascinating Halsted personality will make it a good read.

just need some beautiful escape
to lose myself
to find myself