Fencing with God: A Surgeon’S Duel for Existence

By Sidney Kaplan M.D. F.A.C.S

For author Dr. Sidney Kaplan, there is no more honorable profession than the one he spent his career in, and to which he devoted his lifetime. In Fencing with God, he shares the story of his journey to become a physician and a surgeon and the maturation process he experienced throughout.

In this memoir, he narrates the obstacles faced on the way to becoming a thoracic surgeon, including an inordinate number of life-and-death traumatic cases in civilian practice that included all varieties of gunshot and stab wounds. Highlighting many cases, Kaplan offers insights into the operating room, from elective surgery to urgent to emergency, sharing what it was like in a race to save lives. He describes both the emotions and the experiences participating in life-threatening surgical procedures as both a surgeon and a patient.

Fencing with God tells the details of Kaplans career, faith, and personal life as well as offering a snapshot of history and medicine.

• Language: English
• Publisher: Archway Publishing
• Release date: Jun 28, 2018
• ISBN: 9781480861046

Sidney Kaplan M.D. F.A.C.S

Sidney Kaplan, M.D., F.A.C.S. has had a career in surgery that spans more than fifty years. He received the credentials of certification by the American Board of General Surgery and the Board of Thoracic Surgery. Following this extensive training, Kaplan developed a successful practice, was a member of the American College of Surgeons, and served as chair of surgery at a community teaching hospital for many years. Kaplan currently lives in Greenwich, Connecticut.

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Copyright © 2018 Sidney Kaplan, M.D., F.A.C.S.

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the author except in the case of brief quotations embodied in critical articles and reviews.

This book is a work of non-fiction. Unless otherwise noted, the author and the publisher make no explicit guarantees as to the accuracy of the information contained in this book and in some cases, names of people and places have been altered to protect their privacy.

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ISBN: 978-1-4808-6103-9 (sc)

ISBN: 978-1-4808-6102-2 (hc)

ISBN: 978-1-4808-6104-6 (e)

Library of Congress Control Number: 2018904892

Archway Publishing rev. date: 06/21/2018

Susan M. Santry, MD, has been the love of my life from the day we first met. She has provided me with all the love and companionship anyone could possibly desire and have in this life. She has seen me through many of the difficult times I have experienced. She served as an inspiration for the writing of this book, and I therefore dedicate it to her.

Contents

Preface

Acknowledgments

Introduction

Chapter 1     Seeds of Desire

Chapter 2     Appendectomy

Chapter 3     The War Years and College

Chapter 4     Applying to Medical School

Chapter 5     Medical School Begins

Chapter 6     Introduction to Surgery

Chapter 7     Graduation

Chapter 8     Internship—Day One

Chapter 9     Surgical Residency

Chapter 10   The Air Force

Chapter 11   Return to Residency

Chapter 12   Thoracic Surgery

Chapter 13   I Need a Job

Chapter 14   Patching Together a Practice

Chapter 15   The Dream Fades

Chapter 16   Adjusting the Practice

Chapter 17   The Fencing Duel Broadens Its Scope

Chapter 18   Struck Again

Chapter 19   Politics and Practicality

Chapter 20   Surgery on Colleagues and Other Types

Chapter 21   The Go-To Surgeon—Pacemakers

Chapter 22   Colectomy Number One

Chapter 23   Intensity of Surgery Increases

Chapter 24   The Abdominal Aortic Aneurysm

Chapter 25   An Associate

Chapter 26   Colectomy Number Two

Chapter 27   The Go-To Surgeon—A Perforated Esophagus

Chapter 28   Carotid Endarterectomy

Chapter 29   The Go-To Surgeon—A Transected Bile Duct

Chapter 30   Time for a Pacemaker, Aortic Valve Replacement, and Coronary Bypass

Afterthoughts

Reflections

Addendum

Preface

Essentially, my view on this book is that it represents an account of my life, concentrating primarily on how I became a physician and then a surgeon with a career that spans over a half of a century. It must be said that this is not a tell-all memoir.

The book has been a work in progress over several years, with much time, thought, and effort put into it. This was in an effort to make it, in my opinion, worth reading and enjoyable, while perhaps helping readers understand the desire, drive, and determination that one has to have in order to accomplish a goal such as this one.

The narrative did not come from notes, papers, documents, or any other pieces of material. Rather, it is based on my memory. The selection of anecdotes was made to incorporate important episodes in my career. There were many more to choose from, but time and space limitations prevailed. This has all undergone a filtration process by a brain that has presumably been functioning for eighty-eight years thus far.

I personally vouch for having made this memoir as accurate as possible. It has all been imbedded solidly in my thoughts over the years. The conversational exchanges are factual. The memory of a conversation held many years ago is certainly subject to filtration. I have told the conversations as they unfolded from my memory bank. I have tried my level best to accurately report them and at the same time make them interesting reading. I certainly cannot vouch for every word, and especially for their original sequence, as if the conversation took place yesterday.

Enjoy it all. I enjoyed the writing and telling of it all. I have not disparaged any individual, institution, hospital or municipality, and there has been no intent to do so.

Acknowledgments

My gratitude to all the individuals I encountered throughout my life’s career must be expressed. Their support and the impact they have had on my career are important to me. This is especially so for the physicians who entrusted the care of their patients to me, and also to the physicians, house staff, and others who worked with me in the care and management leading to patients’ recovery whenever possible.

Additionally, to all the nurses and adjunct staff at the hospitals I have worked at over the years, I also extend my gratitude. None of this would have been possible without the extraordinary efforts of those wonderful and caring people. This includes not only the OR and ICU staff, but staff throughout the other departments as well.

Introduction

This personal narrative of my professional career spans over fifty years, during which I performed and participated in many of the most complex procedures of the day, particularly in the fields of thoracic and vascular surgery.

All of my energy and every deep-rooted part of me has gone into the process of achieving my goals in life. The first of my goals was receiving my degree as a medical doctor. The second was completing the training for surgery. The third was to become the best surgeon that I could possibly be.

To me there is no more honorable profession than the one I spent my career in, and to which I have devoted my lifetime. I am proud to write of my experiences in it and of what I have accomplished in it.

There may be an element of self-aggrandizement here, intimating to everyone how great a surgeon I was. Perhaps you may come to realize that this is just one small element of the story of my career.

I have highlighted a limited number of cases in detail from among the many surgeries I have performed, which probably number well into the thousands. The selected cases are representative of different examples of surgery that appeared in my practice, and run the gamut from elective to urgent to emergency. For a number of reasons, each event stood out in my mind and had an impact. They often reflected life-or-death situations, and often reflected the particular surgical practices of that period. Interspersed with these cases, I relate the circumstances of a number of surgeries I have undergone myself. The story is so personal that I include many of the roadblocks I faced along my path and how I overcame them.

The period when I was in school and training encompassed the era of open direct surgery, when the tactile senses were so important to the gentle handling of tissue and organs. I was able to master this and carry that mastery with me during my entire career. Many transitions followed. There was an unbelievable expansion of procedures in all specialties of surgery, as well as extraordinary changes in the way surgery was performed. This has really been a golden age of surgery.

I came to realize very early in my career that much of my work was devoted to life-or-death situations. One of the ways that I became capable of coping with this seemingly endless stream of death-defying cases was by considering all of these situations as though I was fencing with God. I could successfully prolong life by bringing all of my knowledge and skill to bear in this duel, and that is the way I considered my success in overcoming these most difficult situations. I know that this is a duel that cannot be won in the usual sense. However, if one comes to the operating theater with the best of skills and total conviction, then perhaps a fatal blow can be avoided, and the patient can continue his or her existence for the length of time given by God.

One does not need to be reminded, but sometimes it is helpful to remember that much of what we do, whether as an individual or socially, is basically in the hands of God. I have often reminded patients of this prior to surgery. In the case of my own surgeries, I have whispered it to the surgeon about to operate upon me.

Why do you want to become a doctor?

What does becoming a doctor mean to you?

The answer to these questions lies totally with the individual doctor. The motives vary greatly from one person to another. A great deal of reflection is required by each individual, since the decision to embark on this career is a lifetime commitment and requires intense effort. The answers often come down to focusing on the good that one can do to improve patients’ lives.

The path that one chooses to take in life is a meaningful decision and so personal. A student who is considering medicine as a career should be encouraged as long as he or she has a full understanding of what is in front of them. Medicine offers much in the way of satisfaction, prestige, and diversity, but in return demands long hours working in what is often a stressful environment. How stressful one’s practice is, of course, depends on the specialty chosen, to a large extent.

There are basic elements necessary to achieving the goal of becoming a physician. This book may be helpful to some individuals who share that goal. However, every individual must find his or her own path.

If I can impart some understanding of my surgical career to my readers, then perhaps I can say that I have accomplished another goal.

My path took me on a journey that has been fascinating and enlightening to me. There is much that can be accomplished by a single individual. It is not easy, but it is certainly deeply satisfying. I hope that you will find it so as well!

Chapter 1

Seeds of Desire

The seeds of desire to enter medicine as a career are often acquired in unusual ways. They may be related to personal incidents early in life. Upon reflection, I realize this was the case with me.

Our family circle was quite small, since only a few members of my parents’ families chose to make the journey from Russia to the United States at the turn of the century. My aunt and uncle lived in Coney Island. Visits were not only fun, but a way to remain close to key members of our family.

Just imagine going to the beach and enjoying the huge expanse of sand and water, the waves crashing into the shore. This was just part of the excitement of trips to Coney Island for my sister and me.

These were great trips most of the time, especially for children. But to get there took a full day on its own account, in that era. We often drove down from Spring Valley, New York, which is located just across the Hudson River, northwest of the city. We could drive over the George Washington Bridge, recently built and opened to traffic in 1932, or we could take a ferry across the Hudson and then continue the drive. It was even more exciting to take the train to New York City and transfer to the subway to Coney Island, a below- and aboveground trip. Either way, it didn’t matter to us as kids. We were fully anticipating hitting the beach as soon as possible after arriving.

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My parents

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My father at work

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My mother, sister, and I

On one of those occasions, the sun was shining, the sand was soft and hot, and we had to dig our feet in deeply in the sand to cool them off. All the while, the waves were crashing on the shore. As kids, it seemed we were always playing in the area where the waves and beach met in a thunderous crash—not where the sand was soft, but where it was packed down hard by the ocean.

I was running into the water when one of those waves struck me unexpectedly, and I was thrown to the ground. The hard, wet, sand felt like concrete. I was stunned and about to be swept out into the sea by the undertow. Suddenly the strong arms of my uncle Edward grabbed me and pulled me up to his body. I was gasping for breath, my mouth and throat having filled up with salty ocean water. When I was finally able to breathe again and be myself, I realized that he had just saved my life. I never really had a chance to express my gratitude to him properly.

In addition to the beach, there was Steeplechase Park, which was a really fun collection of rides and things to do. Our relatives lived in an apartment building practically across the street from this fun house. My uncle worked in a nearby bank, and we always knew that he would come up with the passes that would get us in and onto all the rides. There seemed to be an endless supply of attractions, cotton candy, and ice cream. To a child, what else is important in life?

One day, soon after my encounter with the wave, my sister and I were told that Uncle Edward was not feeling well. He had been admitted to the hospital with the diagnosis of indigestion. After staying there for several days he was released and appeared to be better. After seeing his doctor, he was allowed to return to work, since he appeared to be all right. However, he collapsed at work the next day and died at the hospital!

It was heartbreaking. I couldn’t comprehend how Uncle Edward could have died after being under a doctor’s care. What could have gone wrong?

In that era, a patient’s complete trust in the doctor led to the expectation of a full recovery. It was only years later that it became clear to me that his diagnosis may have been missed. It was probably an inferior-wall myocardial infarction that caused his death.

Looking back, these two events were most likely the factors that implanted the seeds in me of the desire to become a doctor. Perhaps I could prevent what happened to my uncle from happening to my patients.

Ed, if you can in some way sense what I am saying or thinking, you must realize that your having saved my life, as well as your untimely death, have had a significant impact on my life. My interaction with you, and then the loss of you, shaped my desire to become a doctor. I thank you again, Uncle Edward.

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My uncle Edward

Chapter 2

Appendectomy

I was eight years old. One evening, shortly after dinner, I suddenly developed a stomach ache and realized all was not well with the world. My mother’s cooking was not meeting the high standards that I had set for her.

I went to my mother, holding my abdomen in pain, and told her I was sick. My parents called the family doctor, as my pain seemed out of proportion to the usual gastrointestinal distress that kids can develop from overindulging in food or candy after school.

Dr. Schwartz arrived shortly. As usual, he was well-dressed in a neat suit, with a rose pinned in the jacket slit. He presented himself so well that even a youngster like myself took notice of his impeccable appearance. He had the aura of a dedicated man.

It also seemed to me that he showed dedication in his availability to patients and their families. I found this same attitude in most physicians throughout my lifetime of practice. House calls were more commonplace back then, due in some degree to the lack of equipment and the lack of emergency rooms for ordinary care. Some of the same problems persist today.

When I looked at Dr. Schwartz, I felt that there was much to learn. I immediately wanted to emulate him. However, not at that moment—I had more pressing things on my mind.

After asking me a few questions and having me lie down, he began gently touching my abdomen. He then took my parents aside. It was obvious that there was something seriously wrong. I heard the words go to the hospital, appendicitis, and probable surgery.

In spite of my reluctance, I was quickly bundled up in my clothes, put into our 1936 Dodge—a black sedan with a beautiful bull ornament on the front—and whisked off to the Good Samaritan hospital in Suffern, New York, several miles away.

In a blur of events, I had blood drawn from my arm, my clothes were taken away from me, and I was given a hospital gown. I began to realize that I was being prepared for the operating room! It was time to get scared. I told everyone that I was better, but my parents were no help. I met the surgeon and told him the same thing, and also that the pain was gone. Most likely he had experienced that trick before, and he didn’t believe me.

It appeared that the decision had been made. I could tell they were planning to operate and I couldn’t get out of it. Little did I know that I was destined to spend years and years of time in a similar environment, as a surgeon as well as a patient.

As they wheeled me into the operating room, I saw several people waiting for me: nurses and aides. Another doctor in a scrub suit appeared in a cap, mask, and gown, looking very foreboding. He was preparing what appeared to be a series of cocktails for me. In a few minutes a shadowy figure told me to start counting backward from one hundred. I breathed in as he dripped a fluid onto a mask he held over my face. The fluid had a distinctive odor, never to be forgotten. To this day I remember counting down to ninety-three—and then I lost all consciousness. Later, I found out the fluid was ether, which was abandoned many years later as an anesthetic agent because it was so flammable.

Sometime later I awoke without my severely inflamed appendix. Several days after that, the surgeon came by to remove the enormous-looking sutures in my wound, and I went home.

In conversations with some of my friends, I found that this experience was of no real interest to them. It was certainly no match for the experiences of several days’ vacation in Coney Island or elsewhere. Perhaps this was due to ignorance as well as the uncertainty and nervousness that often accompany this type of occurrence. A vacation is a happy time without a worry in the world. Perhaps I shouldn’t have made it sound as scary as