Dogmeat: A Memoir of Love and Neurosurgery in San Francisco

By Moris Senegor

Ambitious and cocky, a young neurosurgery resident left his hometown of Chicago for what became an unforgettable adventure in San Francisco, both exhilarating and disheartening, destined to irrevocably change his future. "Dogmeat" was the moniker he was given as apprentice to a famousand famously intimidatingneurosurgeon. Moris Senegor gives a disarmingly honest account of his "Dogmeat" days in the wards and operating rooms of UCSF. He also vividly recounts how he fell in love with San Francisco and a woman he found there. His story is for both surgeons and anyone ever beguiled by San Francisco.

• Language: English
• Publisher: Xlibris US
• Release date: Mar 3, 2014
• ISBN: 9781493173945

Book preview

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ARRIVAL:

FLIGHT TO THE CHAIRMAN

T HE AIRPLANE, ON its final descent into SFO, looked as if it would land on the choppy waters of San Francisco Bay. I looked out my window and saw another plane close by, making a parallel run alongside us. Nowhere before had I seen two planes so visibly, precariously close. In the dim twilight of a premature winter dusk, I anxiously awaited a soothing vision of land beneath. This was my introduction to a much anticipated next phase in what was so far a successful series of rotations as a resident in neurosurgery. My last stop had been Boston. The descent into Logan Airport was not too different from what was happening now, with water all around until the last second, but that other plane on our right wing—this was uniquely San Francisco. I was soon to experience countless more surprises in this city.

Nearly a year earlier I had been in a crowded elevator coming out of J3, at the University of Chicago. Located in the newly built Surgery and Brain Research Center, J3 housed the neurosurgery department, including its ward, ICU, research labs and offices, all on the same floor. It was a special unit, luxurious in its compact convenience in an otherwise vast teaching hospital that sprawled along the Midway from Ellis to Cottage Grove. Some years earlier as a college freshman, I had looked out the windows of the Cobb Building across Ellis, where I took various humanities classes, and observed construction crews noisily digging up the foundations of what would turn out to be J3. I had dreamed of becoming a doctor then, but the goal seemed far out of reach. As the columns of the future brain research center went up, I wondered whether I would one day inhabit it. Now, in 1985, the building was complete, and I was a full-fledged M.D in the middle of my neurosurgical residency. I practically lived in this building, spending long days and many sleepless nights, delighted to be there.

On the elevator ride, I found myself next to my boss, Dr. Sean Mullan, chairman of neurosurgery at the university since the 1960s. A quiet, unassuming man with wispy, whiting hair and thick, round-rimmed glasses, Dr. Mullan usually maintained a quiet, pensive demeanor. His gaunt frame barely held on to his old, oversized clothes, much of them covered under a large white lab coat, itself engulfing his frail body like a tent. He spoke little, and when he did, with his thick Irish accent, he was brief and to the point. As his residents we felt a bit like his children, for he treated us and, in fact, the entire neurosurgery department, from the other professors to the nurses and residents, very much like the paterfamilias he was. We treated him with respect and were formal in our interactions with him.

Ordinarily an elevator ride with Dr. Mullan would be a quiet affair. He would nod a voiceless hello and return to his thoughts, rubbing his lips around and around with his right index finger in a characteristic gesture we all knew well. But on this day, despite others crowding the elevator, he wanted to talk to me. Would you be interested in a rotation at UC San Francisco with Charlie Wilson? he asked. The question came out of nowhere.

Charlie Wilson, Dr. Mullan’s counterpart at UCSF—and as it turned out, his good friend—was a larger-than-life celebrity in the world of neurosurgery, well known to his peers and laypeople alike. His exploits with pituitary surgery were legendary. A recent New Yorker article depicting him as a super-hero neurosurgeon and an avid marathon runner had given him national fame among people who had no contact with neurosurgery but were mesmerized by its mystique. I had heard about the article but not read it. I did not know the man in any more detail. I had no idea what he looked like. Nor did I know what kind of a teaching program he ran, or why he needed someone from Chicago to fill an empty slot in it.

By the time the elevator reached the basement from the third floor, I blindly and enthusiastically accepted Dr. Mullan’s offer, then headed for the cafeteria. It was thus, in the time span of two or three minutes, that I made the most fateful decision of my life, after an impromptu proposal, and with no deliberation of whether it carried any down side.

As the plane finally touched solid San Francisco ground, I collected scattered pages on my lap that I had attempted to read since take-off from Chicago. It consisted of the various seminal papers Dr. Wilson had published about his famed trans-sphenoidal experience with pituitary surgery. This was an audacious through-the-nose approach to tumors of the gland that resides in an alcove of the skull base under the brain, in the center of the head. It was originally practiced by ancient Egyptian embalmers who sucked out and discarded the brains of their dead before mummifying them. Revived in the twentieth century on live people, it was the domain of an elite few in neurosurgery. Charlie Wilson was one of a unique trio of surgeons who had performed the operation thousands of times. In fact, there was an ongoing race between him and Ed Laws, then in the Mayo Clinic, on how many they were performing. Jules Hardy of Toronto, the third member of this trinity, was near retirement then, and out of the running. During my flight I tried to memorize Wilson’s statistics and lessons, with little success. The subject was too boring when viewed on paper. As I would later discover, his writings would do me little good in his operating room; I shouldn’t have bothered.

There was another document I reviewed with more interest, even though its details were hard to envision during that flight. I had received it two months earlier, while in a cushy neurology rotation with Dr. Louis Kaplan at Tufts, in Boston. By that time I had discovered that Dr. Wilson was a difficult man, with a penchant for firing his residents. That’s why there was an empty position in his program available for me to fill as the Wilson Resident, essentially his apprentice. The document, sent to me by UCSF as part of a welcome package, was titled The Sayings of Chairman Wilson, and it raised concern that maybe I had gotten myself in over my head. Written by Robert Levi, a fifth-year resident who had experienced the position I was to assume, it catalogued in great detail all of Dr. Wilson’s idiosyncrasies, and the do’s and don’ts while serving him as the Wilson Resident. In those days, with the Cold War still raging, there was only one person in the world who was referred to with a raw Chairman moniker: Mao, the communist dictator of China. Since Levi’s tongue-in-cheek reference to a ruthless, absolute tyrant was part of the department’s formal orientation package, it indicated a certain self-deprecating humor on the part of the famous man, for being likened to Mao was no compliment. Nonetheless, it gave me the first hint of what was to come. Levi, as it would turn out, was accurate with his label.

Dr. Mullan’s spur-of-the-moment proposal for me to spend six months in San Francisco during my fourth year of residency soon turned into a full-year sabbatical when I later suggested to him that it be preceded with three months at the famed National Hospital at Queen Square of London, England, and another three at Tufts-New England Medical Center in Boston, both to study neurology, then a prerequisite for satisfactory completion of a neurosurgery residency. Even though this neurology requirement was actually less than what I asked for, Dr. Mullan acceded to my request, and with the added Wilson rotation, sent me out of Chicago for the 1985-86 academic year. This was not common practice in my residency, and I was delighted by the stroke of good luck that came my way for what I perceived as a great adventure in my youthful career.

Until then I had been continuously at the University of Chicago since 1974, having completed undergraduate and medical school there, and now engaged in a neurosurgery residency. I felt inbred. I needed to go out into the world and experience alternative thoughts and practices. While I was a successful resident in Chicago, well-liked by the faculty, students and nurses alike, I knew that surgery was an art, and that there were different ways of practicing it. Those with whom I apprenticed would be critical in shaping me as a professional. This was the main reason I blindly accepted Dr. Mullan’s elevator proposal. Dr. Wilson was famous and I had much to learn from him that I hoped would be different from the dogma in Chicago. My choice of neurology rotations that preceded San Francisco were predicated on the same premise. Queen Square was a virtual Louvre of neurology; Lou Kaplan at Tufts was an excellent bedside clinician with an international reputation. Each had its own special culture, with which I expected to firm up my foundations in the all-important allied specialty of neurology.

As it turned out, those first six months of the sabbatical in neurology far exceeded my expectations. London and Boston were a welcome break from Chicago. The pace in these rotations was slow and gentlemanly. As a guest, I was treated more like a student than a gofer resident. I learned a vast array of material that did, indeed, supplement my void in neurology. The ample free time that the rotations allowed in these exciting, historic cities also facilitated my development of new interests outside of medicine, including classical music, theater, ballet, photography, and history, all of which I would avidly pursue in decades to come. In December 1985, on the verge of my twenty-ninth birthday, as I landed in San Francisco that Sunday night three days before Christmas, I was rested and eager to start what was to be the main showpiece of my year away, with Dr. Wilson.

I stepped out of the airport onto the curbside and experienced, for the first time, what I would always savor for the rest of my life. The air smelled different in San Francisco. It was clean and crisp, and perfumed with a scent of pine and eucalyptus. At the time I didn’t know what the smell was. I had just come from the more familiar, gritty smell of Chicago, which in this season, ten days before New Year’s Eve, was bitter cold. Here in San Francisco, despite the early evening chill, the weather was mild and that noticeable aroma, welcoming. I was always depressed whenever I stepped out of O’Hare Airport returning home to Chicago. In San Francisco, however, from this point on, I would always be happy to come back.

The taxi driver asked me if it was okay to take Highway 280 to UCSF. It was dark now, and I had no idea where we were going. Sure, I said, with an air of assurance, trying my best to give the impression that I knew my way around the city. Looking back, this was the first time I pretended to be experienced in something I was not. It happened as soon as I touched down in San Francisco, and it was to happen over and over in those fateful first six months of 1986, with disastrous consequences.

The cab dropped me off on top of a hill with a commanding view of the city below, and the Golden Gate beyond. Parnassus, as it was called, after the main street that cut through it, was populated by various giant buildings of the UCSF medical complex. I stepped out of the cab and into the center of the complex, two adjoining buildings called Moffitt and Long. The neurosurgery department, upon receiving the news that I would arrive after hours on a Sunday during their Christmas break, had given me instructions to contact the resident on call and he would see me to my lodgings.

The resident turned out to be Jonathan Hodes, then a third-year, one year behind me in rank. He had prematurely filled a vacancy in the Wilson Resident position, the consequence of another firing I presumed, and these were his last days in this demanding job. Jonathan was a loud, brash man who despite being my age, had already completed a full residency in Internal Medicine before switching specialties and starting neurosurgery. He was lean, prematurely bald, and had a lanky, waddling walk.

Considering he had been on call since Friday night, and in the hospital continuously for some sixty hours, he was bright and energetic. He was expecting me, and had been provided with appropriate instruction to lead me to Milberry Union, a guest house UCSF conveniently kept across the street from the Moffitt Building.

What are you doing here? Jonathan asked, upon first greeting me.

I explained that I was to be the Wilson Resident for the next six months.

Yes, I know, he cut me off, but why?

I had no answer. Was I to tell this stranger, friendly as he seemed, my aspirations to become a world-famous neurosurgeon, like Dr. Mullan or Wilson? Was I to tell him the complicated story of my academic inbreeding and what I had done so far to break its mold, and how fruitful it had been in London and Boston, and how much more fruitful I expected it here? It didn’t matter. Jonathan wasn’t expecting any answers.

Let me tell you one thing first. Your role here is to be Wilson’s dogmeat. You do all the work and he gets all the credit. Then he added, with a sardonic smile that lifted the tips of his black moustache: Welcome.

I unpacked my bags in my comfortable lodging at Milberry, the word dogmeat swirling in my head. It was late now, near midnight, and I was tired. My fatigue was breaking through my defenses and creating much anxiety about what was to come. My formal orientation was to start in three days, when everyone returned from Christmas break. My actual duty with Dr. Wilson would not start until after New Year’s. UCSF had given me some lead time to search for housing before I plunged into its clinical world. Suddenly I missed Boston, where I had safely resided in Dr. Kaplan’s comparatively civilized world, as opposed to the jungle that Hodes had just welcomed me into.

Still, I was eager to receive an introduction to what I had signed up for. I returned to Moffitt after I unpacked for a unique personal introduction, courtesy of Jonathan, and with much acerbic humor. We toured the 8th floor of Moffitt and Long together and he introduced me to as many night shift crew as he could. They were all friendly and curious as to who I was. Jonathan then reiterated much of what I had read in The Sayings of Chairman Wilson, bringing this strange document to life in all its stark reality.

I went to bed past 1 a.m., weary from my journey and the improvised orientation. Above all I was now apprehensive. I had dismissed The Sayings of Chairman Wilson while enjoying a beautiful, leisurely autumn in New England. Now here in San Francisco, Jonathan’s blunt and honest account painted a dark picture I could no longer ignore. I felt the way rookie soldiers must feel arriving at the battlefront from stateside and encountering men in their platoon who have already been fighting there for a while. I pulled the covers over my head and thought, It can’t be that bad. No matter what happens, I will survive. I always have.

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A LONG WALK ON

CHRISTMAS EVE

O N CHRISTMAS EVE, two days after I arrived in San Francisco, I had not yet found a place to live. With the department on vacation, all activities were at a standstill. It was a strange lull before a coming storm that Jonathan Hodes had already presaged in full color. I made rounds with him that morning on a skeleton neurosurgery service, most patients having been discharged home to spend the holiday with their families. The wards and ICU were decorated in Christmas colors, and tiny Christmas trees adorned their nursing stations. Paper-train words like Season’s Greetings and Merry Christmas were tacked onto the walls.

I had first experienced Christmas in a neurosurgery ward soon after my arrival in the U.S. at age eighteen, when my uncle Yako, who was my family’s sponsor, host and lifeline in our new country, had a brain tumor removed at Northwestern Hospital. It was my first experience with this holiday, for in Turkey, my country of birth, Christmas was not celebrated. Wesley Pavilion at Northwestern had been similarly decorated for the season. We spent endless hours in waiting areas for a brief chance to visit my uncle in the ICU, where he remained in an extended coma. He spent three months in that hospital and so did I. By the time he was discharged, the decorations were long gone. But I came to associate what most considered a cheerful holiday with the first disaster of my life. My uncle subsequently died of his brain tumor at age fifty-one.

Now as I toured a similarly morose neurosurgery ward, I was well habituated to the routine, having lived through countless holidays in hospitals. It no longer moved me as at Northwestern so many years ago. I nonetheless had no inkling that these decorations I saw with Jonathan could be harbingers of a second disaster in my life as I prepared to be Dr. Wilson’s apprentice. I hardly noticed them as Jonathan chatted incessantly from bedside to bedside about Dr. Wilson’s routines.

In the afternoon I found myself all alone. Such solitude had become customary in my prior new cities and I had been initially depressed in London and Boston. Now with San Franciscans secluded on the holiday eve, the rest of the day promised to be similarly dismal. Having nothing else to do, I decided to take a walk—a very long one, as it turned out. I had only one companion that day, a Canon TL SLR camera, circa 1972, which that same uncle Yako had purchased for me as a gift when we visited him from Turkey a few years before we immigrated to Chicago. At the time it was my most prized possession. I had not used it much until London and Queen’s Square in the summer of 1985. There I discovered that it gave aimless walking some purpose. With a beginner instruction book on photography, I embarked upon many walks in London, where I honed my skills as an amateur photographer. Soon I had what everyone considered striking results, and with each new city, lonesome photography walks became a fixture in my life.

I started at the Medical Center atop Parnassus and descended west. At the foot of the hill the name of the street changed to Judah all the way to Ocean Beach, and there a streetcar line dominated the middle of the wide boulevard. This was the N-Judah line, which I would soon come to know well. The weather was bright and sunny. Back in Chicago, where winter was raging, the color of the city would be a monochrome gray, occasionally interrupted by white snow that would soon turn black with dirt. Here in the Sunset district of San Francisco, to my delight, winter was more like spring. The trees were lush with green leaves, the smell of eucalyptus faintly overhanging in the air stronger than at the airport. Bright sunshine bounced from multicolored two-story houses arranged in neat rows, with slight up-hills and down-hills here and there.

The streets of the Sunset were in a strict grid pattern, the north-south ones numbered and called avenues, from 2nd near the UCSF complex, to 48th near Ocean Beach. There was one avenue that did not carry a number and it was between 12th and 14th. I suppose those who labeled the streets were a bit superstitious, or maybe they presumed no one would live on an address carrying a number 13. This avenue had a name instead; it was called Funston.

Here at Judah, at the corner of Funston I came upon a large church. It was the size of a European cathedral, with giant triple Romanesque arched doorways and two bell towers on each side that were uneven at their top. What really caught my eye was its color. It was a cross between salmon and pink, and radiant in the sunshine. Above its arched doors were countless white statues of Biblical scenes, densely populated by blanched apostles radiantly reflecting the sun. In front of those doors there were four palms evenly spread on the sidewalk across the width of the church facade. They were short and could not compete with the doors in majesty. The church was called St. Anne of the Sunset, and it rose like a magnificent pink mountain in what was otherwise a sea of two-story multi-hued houses. At the time I failed to recognize salmon as a color. The church was strikingly pink to me, and I had not seen anything like it anywhere else, including Chicago, Boston and London. Agnostic as I was, this pink church appeared