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SQUARE BREAST VS ROUND BREAST

22 May, 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

06 May, 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.

NOT ALL DOCTORS ARE CREATED EQUAL

By Luis Villar • 04 May, 2023
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.

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!


CPR failed, the medical crew could not stabilize him and when he went flat line, I performed the two minute ballet with no gloves as a last chance.  Time was of the essence.  Count down from the clavicle like a pianist.  Two sweeps of a #10 blade staying away from the lower margin of the rib which has a groove containing the blood vessels.  Push the lung aside and open the pericardium. Upon squeezing the heart, it started right up giving us time to administer medications and oxygenation.  Then off to the operating room to close the wound.



At first I was so excited!  I had saved a life in no uncertain terms.  I beat the Grimm Reaper! I pulled off the two minute ballet flawlessly.  I was hot shit!


After a few days it became evident that we saved the body, but not the brain.  The patient could not remember his wife or the past.  It gave me pause. Was it worth it?  Should I have let nature take its course?  I left that rotation without ever knowing the long range outcome of that reflex decision.  It was sobering.  It shook my foundation.


This skill set, however, served me well in the Emergency Room and Operating Room over the next years of residency.  Dozens of gunshot and stab wounds to the heart and pulmonary arteries and veins received a second chance in life by fast and decisive treatment.


Then finally, late in my surgical training, those skills and expertise intersected my date and time with destiny.  But that is another story.


Part two of three.

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