SQUARE BREAST VS ROUND BREAST

May 22, 2023
I just came across a rare photo of James W May Jr. He was my Chief Resident as a Junior surgical resident on the Massachusetts General Hospital plastic surgery service. Tall, handsome, brilliant, bow tie, Brooks Brothers, consummate gentleman and master technician. Totally unassuming, modest, generous, and an unquenchable thirst for knowledge. My first day on the plastic service, I was assigned to assist Brad Cannon, a senior master surgeon. We were performing a breast reduction. As the case proceeded, the breast seemed kind of square to me. I asked, “Why does the breast look square?” Brad explained, “when you pull the flaps down, they all come out square”. At that point the scrub nurse fainted and started to fall. I wheeled around and got my gloved hand under her head before it struck the floor. I lifted her legs and she recovered. We had both broken scrub and had to leave the room to re- scrub. Brad continued the surgery as if nothing happened. “Get me a new scrub” he calmly ordered.

TWO MINUTE BALLET #3

May 6, 2023
I had just come down from Boston to Nassau County Medical Center on Long Island, New York. I did not yet have a dorm room assigned, so I slept in empty hospital beds of opportunity. I had to go back to Boston in two days to pick up and move my belongings down. The medical intensive care unit (MICU), was adjacent to the surgical intensive care unit (SICU), separated by an open through passage. I was wandering about, getting the lay of the land and checking out the nurses, when I noticed the medical team resuscitating a patient in the late afternoon. He would arrest and they would get him back. This occurred numerous times over a few hours. Then they posted a chest X-ray on the backlit frosted glass x-ray reading boxes along the wall across from the patient cubicles filled with blinking and beeping machines punctuated by the slow crescendo swish of ventilators, separated by curtains.

TWO MINUTE BALLET #2

May 5, 2023
As a Junior Surgical Resident at Massachusetts General Hospital we had a rotation through Lynn Hospital. I had just come up from my Shock Trauma Internship at the University of Maryland. A 55 year old male presented to the Emergency Room with a severe heart attack. Back in the early 70s, people routinely died from heart attacks in community hospitals. There were no cardiac catheterization services, CAT scans, MRIs, sonograms. There was only one trauma center in the entire country! I just came from it, at the University of Maryland. Open heart surgery was in its infancy. During my rotation in open heart at University of Maryland in 1973, mortality was 80% and worse at other times!

How I learned NOT ALL DOCTORS ARE CREATED EQUAL. 


Case #1 Two Minute ballet


During my first week as Intern at St Frances hospital in Baltimore a 50 year old male presented to the emergency room with a gunshot to the heart.  He was leaving a restaurant with his wife.  A man demanded his wallet.  He gave it without resistance and was shot through the heart.

His pupils were fixed and dilated, but his heart was still fibrillating.  I intubated him and started large bore IVs with fluid resuscitation.  But what next?  I called the Chief Resident.  “I have a gun shot to the heart, fixed a dilated.  Can you show me what to do if he came in still salvageable?”

“Keep resuscitating”, he commanded. “On my way”.


I feigned resuscitation on his brain dead body until the Chief Resident arrived.

He flew into the room.  His fingers glided down the left chest starting at the clavicle like a grand pianist counting ribs.  “Knife” he calmly requested with outstretched hand. In two swift deliberate strokes he was through the ribs avoiding the lower margin where the blood vessels run along in a groove. With gloveless hands, he pulled apart the ribs with a cracking sound.


He pushed the lung aside and cut the pericardium (the sack surrounding the heart) open.  “Suture”.  Without hesitation he placed a figure of eight suture in the front hole.  He flipped the heart over and placed a figure of eight in the exit wound.


Less than two minutes!  I had witnessed a ballet of fluid, graceful, purposeful, efficient movement.  It was love at first sight.  Me and trauma were destined for a long love affair.


Like WWII aces remembering a dogfight, this memory is etched in my mind a gets played over and over in slow fluid motion.


Months later I witnessed another emergency thoracotomy at the main hospital. The attending asked for a tray (instruments).  He then meticulously prepped the patient with Betadine. He laid sterile towels. He proceeded to daintily cut the skin until he finally entered the chest. He asked for a retractor to spread the ribs.  He pushed the lung aside and asked for a retractor to hold it out of the way. He cut the pericardium and reached the heart.  Eight minutes. The patient did not survive.


I learned a valuable lesson.  NOT ALL DOCTORS ARE CREATED EQUAL !


I was determined to be the ballerina. 


I got to perform the two minute ballet a number of times In my career, but that is a story for another time.


First of three part series.