Dogs. And not just any dog. A specific strain of beagle – one that looked an awful lot like Snoopy from Peanuts – was chosen as the, well, guinea pig, because its DNA displayed important similarities to human DNA. Before the dogs were operated on, they were pampered and fed only the best food (should you wonder if the animals were being mistreated). Two surgical teams would work side by side. The dogs were sedated, a pair at a time. Each was spread-eagled, on its back, its paws gently tied back. A breathing tube was placed down its throat. Each surgeon would cut open a dog’s abdomen, nudge the intestines aside, and isolate the veins and arteries; this was done by dissecting down to where the artery comes off the aorta and the vein comes off the vena cava – the two main valves leading to and away from the heart. The surgeon would dissect on the ureter (the vessel running between the kidney and the bladder) and cut the blood vessels around the kidneys, to free them. The vessels would be tied and clamped so blood didn’t gush out of them. With the kidneys now free, the surgeon would remove them and put them in a bowl, swap bowls with the other team, then plant the foreign kidneys into their new host dog, suture the vessels together, remove the clamps, and make sure there were no leaks (or that we hadn’t accidentally sewn a blood vessel to itself). The abdomen would be sewn up. Cyclosporine would be administered.
It was a straight kidney swap. Very science-fictional.
Finally, blood would be drawn from the dogs to see if the new kidneys were working. Was waste being cleared – proof that the kidneys were doing what kidneys should do?
My “research,” then, was doing actual surgery, right alongside other surgeons, residents, and researchers. The lab administrator put me through intensive training, teaching me the surgical ABC’s – what the instruments were called, what they did, different types of sutures, how to make knots. In my life to that point, I’d cut open all of one frog, in biology class at Andover.
Three weeks after my training began, I was deemed ready to do transplants.
At first, I felt clumsy and pathetic. I put my thumb and index finger through the holes of the instruments so that I had a firm grasp of them, but it didn’t feel natural. Gradually I got to see – got to feel – that if I covered the hole with my palm and exerted pressure with and through my palm, I could move faster and more dexterously. (This technique, called palming, I’ve employed in every surgery I have done since.) At first, I held the scalpel too far down the instrument and way too tightly – more rookie mistakes – but as I grew adept, I realized how lightly I could hold the scalpel, and how far up the shaft, and that doing so allowed for more sensitive touch.
Perhaps as important, the experience that summer gave me my first whiff – and I do mean whiff – of a rough-edge sensibility particular to many surgeons. One day, a pair of surgical residents operating on the beagles kindly offered to show me the intricate and fascinating anatomy of the aorta and vena cava.
“Hey, Cap, look at this,” said one of them, leaning forward and urging me to join him for a closer look at the beagle’s interior. He assured me it wouldn’t hurt the dog because retractors were in place in the abdomen to keep the ribs spread apart.
I leaned forward for a look – at which point the other resident, who’d tiptoed behind me, shoved my face into the dog’s abdomen.
I will never forget the stench of warm canine abdominal cavity.
I shot out of there, blood on my glasses and forehead and mask, and staggered back, head spinning.
“Welcome to the surgical corps,” chided one of the residents, though I couldn’t see which one.
I groaned weakly, teetering in the direction of a window, to replace the smell in my lungs with fresh Midwestern air.
Just then our supervisor walked in. He seemed to know right away what was going on – not that it took a genius. The scene – residents laughing; me, distressed, wiping blood off my glasses – was fairly self-explanatory.
“You boys are in big trouble,” the supervisor warned the residents. Their laughter ceased immediately. Even in my fog I noted my surprise at how genuinely scared they looked.
My head had stopped spinning. I was no longer going to heave.
“We were just having some fun,” I said, shrugging. The supervisor looked at me for a moment, expressionless, then walked out of the room. He never said a word about it.
When he’d gone, the residents smiled at me, grateful.
But I was the grateful one. I was just a kid, yet they’d initiated me into the medical fraternity, where both friendship and rivalry are unusually intense.
As to the kidney-transplant research: It was a spectacular triumph. We succeeded in showing that, at least in this breed of beagle, using cyclosporine as part of kidney transplants helped greatly in the acceptance of the new organs. A paper would be published about it, with Dr. Turcotte’s name on top, and my name mixed in somewhere with the team’s. Years later, the drug was approved for use in human kidney transplants, and a once risky procedure became fairly routine. Today, a kidney transplant involving a living donor has a 90+ percent chance of success. Dr. Joseph E. Murray, the man from Massachusetts General Hospital and Brigham and Women’s Hospital who had, a generation before, laid much of the foundation for all transplant surgery, would win the Nobel Prize for Medicine for his contribution – the only physician, amazingly, ever to win the prize.
The team’s success was a perfect example of what I mean when I say scientific knowledge builds on previous knowledge to increase understanding and better people’s lives.
Just as important to me back then, not one single beagle died during any of the surgeries that summer. Not one of those opened and closed by the surgeons or residents, or by me. My childhood dog, a blond Lab named Fresca, would have approved.
Thanks to Dr. Ransom, Dr. Turcotte, and the rest of the team, my decision to pursue medicine seemed vindicated. And I was grateful for the way they had included me, the youngest guy there. A kid never forgets who’s been good to him.
For all my feeling for those men, though, I did not want to be a surgeon. I had decided on another branch of medicine, one that delighted my mother and thrilled my father.
I was going to be the world’s greatest pediatrician.
Focus and drive.
It’s hard to find two words that describe better what it takes to become a successful surgeon.
Focus and drive.
It’s what defined my last two years of college. I took all the premed courses I didn’t take my first two years.
Senior year, I also managed to find the time, somehow, to fall in love for the first time. Victoria was a sophomore from New York City. Smart, intellectually curious, five feet eight, brunette, nicknamed Tory. We biked and played tennis. Our time together was always sweet. I knew that someday I wanted to be married, have kids, probably lots of them – not at all surprising for someone who came from a big family, and who has mostly happy childhood memories.
On graduation day, Tory was there. Life was perfect. But even greater joy lay just ahead.
The challenge of medical school.
It was at Duke Medical School that I learned how to be a doctor.
Sounds dumb, right? You go to medical school to learn how to be a doctor.
Except it doesn’t always, or even often, work that way. Yes, of course medical school teaches you, in class