Some answers for Doximity

Let’s start with something fun:

How is retirement treating you?

            Amazing. There is life outside the operating room. I retired to care for my wife, who had developed a frontal lobe dementia.  Knowing I wouldn’t be able to stay inactive, I applied to several colleges for a writing program.  Bennington College was close enough that I could manage my wife’s situation and still be “in residence” for the traditional two weeks per term.          Literature opened the world to me. Two years later I was granted an MFA in Creative Writing.  I haven’t stopped since.  I also retained my editorship of Nutrition, The International Journal of Applied and Basic Nutritional Sciences, which I had founded thirty-two years previously. Now I’m editor emeritus, just to keep my hand in.  But the bulk of my past eight years were directed to writing. So, “retirement” is indeed a fun yet a busy time. I haven’t swum in my pool nearly as often as I wish.

What are you writing lately?

            My first book, Roots and Branches, is a family saga, like no other. My mother was German and my father Egyptian so I grew up in a tempest of cultural clashes. The story starts

with my parent’s meeting in pre-war England, tells a bit about my grandparents and ends with my struggle to leave Egypt to go to University College Hospital Medical School in London. It’s finished and, in the process, to be published.       

            I’m putting the finishing touches on Mastering the Knife, a story about how I found identity and belonging as a surgeon. It centers on my training as a medical student in London in the 1960s. When I took it to an agent, she suggested it would make a good podcast, so it became the basis of the thirty-episode podcast Making the Cut.

            I’ve started two more books, one about my experiences with the human side of surgery—called A Surgeon’s Tale—and one on stories about patients with breast issues. 

What do you like to do in your spare time? 

            I have always been and still am an avid reader.  English is my third language, so I’m not fast but persistent so I manage to read several books a month.  My bad back due to a life as a surgeon limits the physical activities I so enjoyed as a younger man.  These days it’s time in the pool or taking the dog for golf cart rides, which are the highlight of her day.  I’m a bit of a movie buff and have had a love of airplanes since I was small, so seeing aviation history and the innovations in that industry which interests me.  All that and keeping up with friends leads to a full life. 

Warm-up question on your experience as a surgeon:

Do you have a “most memorable” surgical case?

            I used to tell my kids, “Imagine they pay me to have fun.” I really love surgery so every operation was memorable.  The one that perhaps takes the prize is a felon who shot two police officers at close range. In patient A, the entire abdominal wall and some of the organs such as the colon were liquified. I operated on him continuously for 18 hours and together with my team fixed his internal organs and recreated his thoracic and abdominal wall. He survived. His partner, patient B didn’t. After 18 hours my posture was frozen and I had to be laid down on the OR floor before I could move again and get up.

A particularly stressful one?

            Two inebriated men were snowmobiling in the north country of upstate NY on Route 81 during a blizzard and got entangled with an eighteen-wheeler. They were both near death when they were helicoptered to our hospital. Despite all our lengthy efforts in the two operating rooms we were not able to save their lives. Had they been brought in by ambulance, they would not have reached the OR. This event still haunts me.

Something particularly strange or complex? 

            Operating on a woman who had a supernumerary nipple on her abdomen along the milk line. Third nipples usually aren’t a health risk. But it had grown. I removed it, and to my surprise the underlying breast tissue was cancerous. Work-up didn’t show any spread or metastasis. She went home with two healthy breasts.

Now, let’s talk about the podcast, Making the Cut: The (mostly) True Life Story of a Retired Surgeon. I was really struck by your personal narrated introduction to the first episode of the show, in which you say: “There are two critical factors to establish a person’s self-identity, and they are place and parents. I had neither. This is my search for identity and belonging.”

What was it like for you, emotionally, to embark on a creative project that really interrogates your most intimate self?

              One of my favorite quotes is that of Socrates “the unexamined life is not worth living.”

It’s only when you begin to explore an event from all sides that you can write about it. Examining one’s life is intimidating, painful yet enlightening. I am thankful to my editors for the psychological insights that encouraged me to go deeper into matters I would rather have avoided.

And some of the revelations are surprising! 

Do you feel you discovered the deeper sense of self you set out to find?

            I’m much closer to understanding myself. Writing and researching my family’s past has helped me start the process of forgiving past grievances. It has also broadened my understanding of the forces that shaped those around me. Still, self-discovery is an ongoing process. 

Even from the first episode of Making the Cut, the script doesn’t shy away from sharing a variety of memory landscapes from your early life. These include everything from heartrending instances of parental abuse and neglect to other sometimes harrowing events that can invoke feelings of shame, fear, and anger.

Were you at all uncomfortable or nervous during the process of the show’s writing or broadcasting with airing such intimate details?

            I was, very much so! It’s not easy to put your life in someone else’s hands, but 1C Production and Rebeca Seitz my director did a great job of making my story into a podcast. 

How do you think the decision to include such details has influenced the way the audience interacts with the story?

            I know that most people carry remnants of their personal traumas deep inside.  Since the podcast began people have approached me and spoken about the content.  They all find some part to identify with—and they’re often very different issues.  That’s my joy in it—having told a story that many people can connect with.   

Autobiographical projects, even when we know they’re dramatized, often seem to require the storyteller to be honest but also be other things — like entertaining, impactful, or otherwise appealing to a larger audience. The podcast probably has that word “(mostly)” in the title for a reason!  

In the dramatized accounts, how did you make sense of where to simply recount events objectively and where to embellish certain interactions or details? Or did you embellish at all?

            Well, first, I’m a storyteller.  I started out by trying to tell the story in a way that people would find it a “nice read.”  I wanted it to flow, and to make sense, to give information, history, and some laughs.  If I embellished a bit or two, I’ll never tell!

How did you reconcile the emotional and subjective with the objective?

            Some emotional parts of the story were difficult for me to bring myself to examine and to write.  For example, the part about putting the laxative in the landlady’s tea.  How could I do that?   Working some chapters I would be in a near depression until I worked out how to deal with them objectively.  Some parts, like Hanna, are still hard to read or to face.   

Having been “shuffled” throughout so many vastly different countries and cultures in your early life and young adult life seems to be a hugely formative part of your work.

            Anyone who has lived in different cultures has a leg up in understanding the world.  I’m grateful to my parents that I can speak four languages and that I’ve seen much of the world.  On the other hand, with my parents coming from such different cultures and not blending their differences in our home, I longed to belong somewhere. Finding new friends again and again and changing grades and school requirements was tough.

            Surgery became my “home.” Once I had the surgical letters after my name, I could belong anywhere I found another surgeon or doctor. 

What was it like first coming to the U.S. to work in medicine?

            My first few rotations as a surgical resident at the Peter Bent Brigham in Boston were a nightmare. The culture of training surgical residents differed greatly from what I was accustomed to in London. In England you took your cues from the professor. Here you are expected to show initiative and to work independently right from the start. It took me about three rotations to change gears. Then surgery became my oyster.

            In American it didn’t matter who you were or were you came from, but only that you were able to do the work and contribute to medicine. The hierarchy system had much less weigh.  

Are there things you wish more people knew about working in medicine in Europe vs. in the U.S.?

            Both systems have their strong points.  Europe really believes that a strong healthcare system benefits their society.  Your financial status didn’t enter the equation. Here the insurance companies and the politicians, and to some extent the pharmaceutical companies are limiting factors for optimal health. Despite that innovation is a strong driver in optimizing health care.

I read that at 16 years of age, your dream was to become a surgeon—and you did that, along with so many other impressive accomplishments.  Your life’s work seems to vary widely, from pediatric surgery to surgical oncology and clinical nutrition.

What was your motivation for studying and working not only in surgical specialties, but also in human nutrition and even behavioral neuroscience?

            Innovations in medicine happen at the bedside, in the lab and at the bench.  If I hoped to make a difference, I had to do the research that would help us to understand conditions. My primary interest was anorexia with illness. In cancer patients the operation was generally a success but both pre- and post-operatively comprehensive nutrition was lacking. To understand the function of nutrition to the body I attended Human Nutrition courses at MIT. In the mornings I was a graduate student at MIT in Cambridge. In the afternoon I was a professor of surgery operating at Boston City Hospital, while in the evening I operated on emergencies.

            I had a research lab funded by NIH for twenty-five years. To understand anorexia, I had to enter the realm of neuroscience. I worked with bright young surgical, internal medicine residents and PhD fellows from all over the world. Each fellow in my lab performed studies to further the field of nutrition’s place in illness. This work is still being cited 30 years later.  It’s exciting for me to see that happen—that we developed work that is the foundation of research being done today.

Is there something that connects them all for you?

            It’s the story of a young man called LeRoy.  I wrote up his story for the Columbia Medical Review.  LeRoy came into the OR as a healthy muscular eighteen-year-old man. He had fallen off a third-floor ledge. His profound hypotension and an abdominal tap in the ER were in keeping with major injuries to his internal organs. When I performed an emergency laparotomy, to my surprise all the organs were intact and revealed no internal bleeding. He had also sustained a fractured femur which the orthopedic team fixed. I was dismayed to discover that thirty days later LeRoy had died. Reviewing his records showed that he had not received adequate nutrition during his hospitalization. It was a failure of the system, an unnecessary death.  If we don’t put nutrition into the equation of recovery deaths like this will continue to happen. 

I’m sure many of our clinician users on Doximity, including medical students and residents, can relate to having to deal with a traumatic upbringing and other personal struggles while pursuing a very stressful career.

Do you have any advice for medical students, residents, or trainees who are dealing with traumatic childhoods or other experiences similar to yours?

            The “get over it” process is futile. To find peace with yourself and the surrounding world the answer, I think, lies with having compassion for yourself and for your patients. Recovery takes time, introspection and perhaps professional help. 

Has the process of writing and producing the autobiographical podcast helped you find healing or closure in the past?

            Yes, most certainly.  We always carry the scars of our youth.  They don’t go away.  Examining and writing about my past has made me face my own culpability on some issues and heal some of the festering open wounds inflicted by others.

If you had to describe what you want listeners to take away from your story in a sentence or two, what would that be? 

            Remember everyone carries a burden. Forgive and be kind.

Is there anything else you’d really like Doximity clinicians to know about your story or the podcast?

            Here is the Podcast link.

My book Roots & Branches will be available on my website very soon. So check in often.

Thank you for the opportunity to speak with you.


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