"SOME OLD SURGEON’S THOUGHTS ON THE PAST"

As surgeons, much of the development of our future work and success is critically affected by the impact of our resident training program. Our practice patterns and techniques, as well as our approach to problems and patients, are gained, in a large part, by the rigors of the experience as well as our relationships with mentors at both the attending and senior resident levels. Interestingly, different resident groups are often recognized and defined by different achievements and staff personalities during their training.

During my training years, 1963 to 1969, I was incredibly fortunate to be surrounded by several outstanding academic leaders who taught and exhibited not only incredible surgical knowledge and patient care skills, but who also brought forth a heightened sense of responsibility towards both medical and emotional patient care. U of R surgeons like Rob, Schwartz, DeWeese, and Mahoney represented an era of advancement in American surgery whose devoted expertise developed a resident training group that carried the Strong name forward with their foundational training, teaching skills, and academic contributions.

The program was filled with a mixture of difficulties and rewards. Some of the difficulties included a work schedule of 36 on 12 off every other night. Uniforms were mandatory and included the old barber-style shirts with the closed round collars. The A/C in the old Strong Hospital during hot summers was very limited, and most of the ORs had none. The salary was $100/month, but meals were provided. Each service had multiple attendings with high workloads for single interns. The residency was pyramidal with 12 interns cut to 2 at the 3^rd year, with a year in the lab followed by 2 senior resident positions in years 4 and 5. The rewards included phenomenal learning and teaching experiences, a heightened sense of responsibility towards patient care, expansion of work and organizational skills, and the development of close and lasting relationships with the attendings and fellow residents. Many of these relationships have lasted a lifetime.

However, not all of it was hard work or painful toil. Each attending had their quirks, and many had some quite enjoyable and out-of-context behavior. As I pondered on those years, several events were prominent in my remembrances. I have included some instances of my most memorable mentors Dr. Rob and Sy Schwartz.

Dr. Rob was an internationally famous and dominant chairman. He demanded much of his faculty and very much of his residents. In lighter moments he would often regale me/us with his WW2 experiences which we found so outrageous that we knew they couldn’t be true. To my amazement, upon his death, his obituary in the London papers corroborated several of his stories, including parachuting behind German lines to operate on a German general and operating in London while standing in the OR in sewage over his ankles during the blitz. This catastrophe was caused by a bomb that had hit the main sewer line. In addition, the obituary commented on his role as Churchill’s physician during and after the war.

Dr. Rob also found humor in testing his residents in unusual ways. When making rounds, he would take the stairs to the top of Strong and walk across the roof to get to the Q building. Parts of the roof were quite narrow, and when some couldn’t cross the area due to height fears, Dr. Rob would shake his head and question their toughness. In addition, he basically never took an elevator. Whenever rounding, he would always use the stairs. He rounded twice a day with the house staff and once by himself before afternoon group rounds. Therefore, he often knew what was going on with the patients before the busy interns and residents. This usually created high anxiety and considerable uncomfortableness for the staff, especially the interns who were then subjected to the Chief Resident's deadly glare. Years later Rob admitted that this was a game he enjoyed, especially the Chief Resident's discomfort.

Another lasting memory that I have of Dr. Rob is his ability to overcome difficulties. During my time as the Chief Resident on the Vascular Service, Dr. Rob sustained a major leg fracture while skiing at Swain and was placed in a long leg cast. Not to belie his spirit of toughness, the day after the cast was applied, he was back at work. He fully maintained his clinic and completed his operating schedule using a walker. He would stand inside a walker draped with sterile towels at the scrub sink and the operating table. His routine never varied, and he remained at the table until the wound was closed and then hobbled off. Further, he still rounded daily using crutches, and his use of the stairs never varied. He would, however, arrange the house staff for the trips up and down the steps, with the largest resident in the group, often me, behind him going up and, in front, coming down. After each trip he would turn and say with a smile, “you would have caught me if I fell, wouldn’t you?” I don’t believe he ever waited for an answer before moving on, and it’s probably a good thing.

Dr. Schwartz was another truly unique individual. He was completely trained in the U of R system and basically never left home. His accomplishments and international reputation continued to grow throughout his many years at Strong, but he never abandoned his devotion and loyalty to the institution and stands out today as a pillar of excellence in the Department of Surgery. His drive and demands for excellence often created difficulties for his house staff, both in clinical practice and in the lab, but his sense of camaraderie was evident with many lighter moments and activities.

His impact on the surgical world, as well as the Strong surgery department, was enormous. When he decided that the existing surgical texts were not adequately providing the best updated comprehensive knowledge to the surgical world, he undertook the herculean task of writing and editing a new “surgical bible”. His compulsiveness, sense of responsibility, and academic drive, which he inculcated into the house staff, became legend and inspiration to those of us who worked with him on the initial version.  House staff who were on overnight call would regularly see Dr. Schwartz appear around 4:30 or 5 in the morning as he was writing the first edition of the Schwartz book. In addition, following a full clinical and/or research lab day, Sy would go home only to return about 7:30 pm to continue to work on the book until about 10 p.m. This pace never faltered, and those doing a year in his surgical lab, as the chapters developed, were required to review parts of the book that were completed. This created a situation where he would take pleasure in giving “pop quizzes” on the contents, often leading to our stammering and red faces and his head shaking.

To get some relaxation, Sy would often play squash with me and other members of the house staff.  He always played hard to win and when losing he began to call questionable “lets” regularly. When doubted, he would question your sportsmanship and invoke the fact that he was the “professor” and knew best. Over the years, he never remembered losing. These matches led to a lasting friendship long after I finished at Strong. When we would intermittently meet for lunch, I usually had to pay based on his memories of who won those matches.

Besides these tales about Dr. Rob and Sy Schwartz, I am sure there are many other amusing and/or inspirational anecdotal stories of others that are locked in the Strong surgical residency memories of my colleagues and additional graduates.  It would be wonderful to hear of them and document them as an important part of this great program’s history.

Respectfully submitted,

Stanley L. Minken, M.D.                                                                                                                                                                 
U of R Surgical Resident 1963-69  
Charles G. Rob Professor of Surgery, Emeritus, USUHS