Stloraine's Full Review: William A. Nolen - Making of a Surgeon
The Making of a Surgeon by William A. Nolen, M.D., narrated by Richard Poe, unabridged version by Recorded Books, 7 cassettes, 9.5 hours. this is easy listening, highly informative, a must for everybody, because a majority of the population at some time or other will have invasive medical treatment.
While the book was written in the 1970's by Dr. Nolen, who recounted his medical training which he undertook in the 1960's, the prologue to the present edition explains that, notwithstanding organ transplants, high tech equipment and newly formulated drugs, the basic surgical techniques remain the same. And, of course, much of the world is not privy to these latest medical innovations.
Dr. Nolen is quite frank, graphically descriptive, honest in his account of the problems, mistakes and successes he and his surgeon trainee comrades experienced, as well as complimenting the doctors who worked as their teachers.
Surgery had always seemed to me to be the last skill in the world I could possibly acquire, not only from the standpoint of my squeamishness but the complicated techniques and vast knowledge that must be necessary to acquire the aforesaid skill. I'm not ready to enroll in medical school yet, but as I listened to the book, seeing the operations and examinations in my mind's eye, the mystery lessened and understanding unfolded.
After eight years of university and medical school, the aspiring surgeon faces another five to six years as an intern, resident, assistant first resident, and his final step before graduating, chief resident surgeon. A medical student applying to train as a surgeon decides which medical training centers he would like to attend, and the schools evaluate the applicants and so the selections are made.
In the case of William Nolen, he interviewed at the schools that were considered especially desirable, then made his decision to train at what was the toughest hospital on the east coast, New York's Bellevue. It was said that if an intern made it through Bellevue, he or she could make it anywhere, because Bellevue is an intensely busy hospital which ends up with every type of medical emergency and is available to anyone not able to afford the private hospitals or a private physician. The medical staff at Bellevue takes everyone on a first come first serve basis; diagnose, treat, no matter what.
Honest in his account, yes, when he describes the surgical team's effort to help an elderly lady whom they had all gotten to know and like. but when they opened her heart, they found the artery so encrusted with plaque that they could barely loosen it, and in prying too hard, the knife slipped and cut through the back wall of the heart. They managed to sew it up, but her heart's arteries were too far gone and two weeks later she died.
Sympathetic, yes, but faced with a decision during an operation for cancer on an older man patient, again one whom they had grown to know and like, he was faced with a decision that rested solely upon himself that moment, in his capacity of operating surgeon in charge. He found the cancer had spread so badly, that while he could do some surgical work, it would only prolong his life a possible month or so, and he made the decision to close the wound and leave it alone.
The necessity to look beyond the obvious and to take an interest in someone who has been shuffled from one hospital to another because of a cursory diagnosis as was a young black girl, babbling, flailing around and appearing to have some type of psychotic drug reaction. But Dr. Nolen noticed a hollowness around her eyes, because of her dark skin, the pallor associated with blood loss was not noticeable and she was not bleeding outwardly but he followed his hunch, and examination revealed that she was bleeding internally from an ectopic pregnancy which had ruptured, the blood leaving her arterial system and pooling in her abdomen. After transfusions restored her blood level to normal she returned to normal behavior as her brain received once more an adequate supply of nourishment and oxygen.
The doctors worked hard to make their patients well, but many of their patients worked harder to make themselves unwell again, returning to sleep on the cold streets and live on a liquid diet. Every few months they returned to "vacation" in the hospital, to sleep for awhile in a warm bed and have adequate nourishment and the doctors came to think of them as their regulars.
From his first disastrous needle stick when he attempted to draw blood and the nurse had to help him, through is well-meaning blunders as he undertook to learn how to heal the human body, his acquired skill as cardiovascular surgeon, and his last year at Bellevue as Chief Resident, Dr. Nolen provides an understanding and shines a light inside the inner working of our physiological selves.
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