During my final month in high school, I faced quite a dilemma trying to decide whether to go into medicine, which I really wanted to do, or engineering, which was a more practical choice. Father was 85 years old at that time. It would take me at least eight years to become a physician: three years of pre-med, four years of medical school, and one year of internship. Given my desire to be a surgeon, it could take even longer. If during this time my father should die, the responsibility would fall on me, the firstborn son, to support the family. I would be required to put my education on hold and go to work fulltime without any specific training. If I went into engineering, however, I would have a degree—and therefore be a better provider—in only four years. Since my father and uncles were all alive and healthy in their eighties, I thought it possible that I still had time to complete my education in medicine. With confidence, conviction, and courage I plowed ahead.

Not only did Father survive this eight-year period but also my two-year surgical residency and the almost three years I spent in the army—a total of thirteen years before he passed away at the age of 97. Shoot for the moon and get there!

My first year in pre-med could not have gone better. Perhaps because my experience with technical mechanical drawings in high school had provided me with an excellent understanding of spatial orientation, I did extremely well in embryology. I read the textbook from cover to cover and understood it so well that the teacher asked me to make a presentation and explain various developing organs, especially the heart. He liked me so much, he made me his laboratory assistant. This allowed me to attend tuition-free for the remaining two years of pre-med.

Other than purchasing essential books, carfare, and food, I spent very little money during my three years of pre-med. I saved up as much as possible.

I can only recall buying two suits as a young man. I must have bought more than just two, because the salesman at Rothschild’s Men’s and Boys’ store was very friendly and solicitous to me, often calling me up to let me know about clearance sales. At one such sale, I bought a presentable green suit requiring multiple alterations for the rock bottom price of only twenty dollars. I am embarrassed to relate that a week later I changed my mind and took the suit back to the store hoping to return it for salvage value. Much to my surprise my salesman friend gave me full credit for it. What excellent customer service!

In my last year of pre-med Paw Paw’s father, my future father-in-law, bought me a much wanted but unaffordable fifty-dollar blue-gray suit at Rothschild’s. I didn’t look too good in my shabby clothing. What a good future in-law.

I entered medical school in 1940. In my freshman year I paid only $300 for books and tuition, and $150 for a microscope.

Shortly after school started I began to hear about “AOA” and soon learned that it was the Alpha Omega Alpha Honorary Medical Society that most students aspired to join. Many studied ten to twelve hours a day in the attempt to reach this goal. Given the fact that I worked in addition to attending school, it was impossible for me to spend this much time studying. My goal at that time was merely to complete my studies and obtain my MD degree.

Freshman year was uneventful. I did quite well in the comprehensive anatomy course, a combination of gross anatomy, embryology, and histology. I had already taken much more detailed histology and embryology courses in pre-med, so I spent most of my time studying gross anatomy.

In that first year, we had weekly or biweekly surprise examinations designed to make sure we studied regularly and were well-prepared at all times. It was impossible to study all of the voluminous materials with equal intensity, so I learned to study selectively, mastering the points I thought were most important (and therefore might be the basis of questions on the surprise examinations), and spending just enough time on others to be familiar with them. This approach helped me to achieve high test scores, and I ultimately received a good grade in the 900 credit hours.

Big things happened during my sophomore year in medical school, both for the country and for me. In addition to being the year when the United States officially joined World War II, that was the year of the greatest challenge of medical school: the terrifying “sophomore comprehensive examinations.” These daunting examinations, which came at the end of the school year, tested every subject covered in freshman and sophomore years and were evaluated on a harsh pass/fail basis. Students who passed were allowed to advance to junior year; students who failed were given the choice of repeating a year or dropping out of school completely. Everyone approached these exams with trepidation. Those two days, and the months leading up to them, were the most grueling of medical school. Thankfully, I passed.

Having achieved tuition-free status only on a one-year basis for each of the first two years, I needed to find a new way to finance the third year of medical school as well. I was fortunately selected to be the anatomy professor’s helper that year, and my tuition-free status was renewed again.

As I progressed through medical school, the war continued, and in an effort to increase the number of physicians in the military, the United States government began ordering medical schools to accelerate their curriculum and steer graduates directly into the military. Thus in early 1943 most students at the U of I College of Medicine, including me, were inducted into the Army Specialized Training Program (ASTP). A lesser number joined the V-12 program of the Navy. Students who did not want to join either specialization program were inducted directly into the service.

Those of us who joined ASTP or V-12 immediately became commissioned officers with pay. Our tuition and books were fully covered by the Army. Summer break was eliminated that year so that we graduated in December 1943, several months earlier than originally scheduled.

Immediately upon graduation, I was promoted to Second Lieutenant of the Army Air Corps. As a graduate in the top 10% of my class, I was also elected into the AOA Honor Society that year. This accomplishment took confidence, conviction, and courage.

As soon as I graduated from medical school, Paw Paw and I were married in the Catholic church near her home where she always went to Mass. Shortly after that, she began working at the department store Goldblatt’s to help pay the bills while I completed my internship and residency. I made only ten dollars a month as an intern and twenty-five as a resident—not even enough to cover our fifty-dollar rent. It was tough but we never complained; we just charged ahead. Paw Paw did a yeoman’s job. I loved her for that.

For our honeymoon we went to New York, where we stayed at the Roosevelt Hotel and saw a show. Even after such an extravagant vacation, we still had about $800 left when we came home. I had saved up quite a bit of money working over the years at Won Kow.

I started my internship under the accelerated “9-9-9 program.” This program and its counterpart, the V-12 program of the Navy, were implemented to keep up the supply of physicians and specialists available for the war.

The 9-9-9 program began with nine months of internship. When the internship was complete, if you were selected to become a resident, you would stay for a nine-month residency; if not, into the service you went with general medical knowledge. After the residency, if fortunate enough to be selected again for advancement, you would complete training in a specialty and enter the service in your specialty.

All of my training during this time was at Cook County Hospital, where most training was passed on from the residents with very little supervision from the attending men. I was often left to fend for myself. I found this to be very important in the development of independence.

On January 1, 1944, my first day as an intern, I was in the pediatric surgical ward. I vividly remember a nurse calling out for help.

“Doctor, come here! This child is in acute respiratory distress!” she yelled.

I looked around to see whom she was addressing, not realizing at first that I was the doctor she was calling for. Because it was New Year’s Day, the resident had left without properly briefing me on the acutely ill patients. Somewhat flustered, I quietly read the chart and decided that the child had an acute empyema—fluid in the chest pressing on his lung. On my own, without any previous experience, I drained the chest. I had no choice. The patient did well.

I made it through the whole 27 months of the program. Following my nine months as an intern, I spent three months in internal medicine and fifteen months in the fracture service. I finished my residency in fractures. Residents in fractures—independent of orthopedics—were only trained in Chicago and Boston.

Many of the residents were appointed based on politics rather than chosen by the merits of their performance. I recall during my last month of medical school trying to determine what hospital I should apply to for my internship. I knew that a private hospital was not adequate for good training and County Hospital had the reputation of turning out some poor doctors. As my internship proceeded I soon learned that the poor doctors were the ones who didn’t care about the welfare of their patients. They were just there to obtain experience—especially in surgery—and to hone their skills. Doctors who had compassion and sympathy for the less fortunate, however, did well. They looked to see that patients were well cared for and procedures were done properly. When these virtues were carried out, very good doctors became better. They developed greater skill and confidence.

My attending man in fractures did not impart any confidence in me and barely spoke to me, so I usually did not consult him. I only presented complicated cases to him for his information. I endeavored to learn as much as I could on my own, though. I read the two volumes on fractures by Watson Jones from cover to cover and practiced it to perfection. My attending man would wonder about me to my supervising resident.

”How does Moy do this?”

Usually there was no answer. I was not addressed directly.

Using my training in mechanical drawing, I developed a new method to calculate how to wedge a cast to correct a misaligned tibia fracture. At that time, although cast wedging was widely performed, it was usually something of a “guessing game” for the physician involved. My method enabled me to wedge a cast with precision, ensuring superior alignment of the patient’s tibia. I showed the attending physician and he shot me down. He stated that the method was not acceptable for publishing. His son, who later became an orthopedist, took my work and published it in an orthopedic journal.

In spite of such negative attitudes, one can learn a lot and develop great confidence from being forced to fend for oneself. When one comes out of such a residency one feels that if it can be done, it will be done. Confidence, conviction, and courage are required to make it through such a challenge.

During my internship, I roomed on the seventh floor of the main hospital. I enjoyed my living situation immensely. My buddies and I were known as the two Jews, one Nazi, and the crazy Chinaman.* To celebrate interns and residents leaving after completing their services, we often had raucous parties with beer flowing freely and the piano pounding throughout the late evening. In spite of the noise we never received any complaints. After all, we interns and residents ran the hospital. If one of us got so drunk that he could hardly stand up, we would just place him on a gurney and roll him to his quarters.

One dark and rainy night we were traveling from one building to another through an underground tunnel. As I opened the door to the tunnel I was slapped in the face by a meaty object hanging from the doorframe. Much to my horror, I realized that it was an amputated penis from a dead body.

During my days at County we did anything and everything with impunity. What pleasure it was to be an intern back then.

Upon completing the 9-9-9 program, I was made Chief of Orthopedics at Keesler as I replaced an orthopod (an orthopedic specialist) who had just returned from overseas. As you can imagine, the airfield, which was used for training, produced many fractures for me to treat. In severe cases, after initial treatment the patients were transferred to General Hospital in Atlanta, Georgia. I usually accompanied them to Atlanta.

I remember one severely fractured tibia, which I reduced and casted. After the reduction, there was a misalignment of the tibia, which I corrected using the cast wedging technique I had pioneered. Then I reinforced the wedged area with a large amount of plaster, giving the cast a grotesque appearance.

When we got to Atlanta, the receiving doctor took one look at the cast and wanted to remove it. He was about to do so when I interceded to ask that he take a look at the X-rays before removing the cast. He did, and was astonished and embarrassed when he saw the perfect result. He apologized for jumping to conclusions about the quality of my work based on the appearance of the cast and the fact that it came out of a small regional station hospital.

Look before you jump.

When I arrived home around 5:00 one evening, Paw Paw told me that the toilet was plugged and there was discharge on the bathroom floor. Having just returned all sweaty from bowling, I really wanted to shower. I asked her why she didn’t call housing maintenance to have someone take care of the problem. She said that she had called a number of times, starting around 3:00, and still no one had come.

I picked up the phone immediately and called housing again. An enlisted man answered the phone and explained that since it was now after 5:00, everyone was gone for the evening and he would need to call Washington to approve an overtime order to have the problem fixed that night. Fuming, I hung up, picked up the phone again, and called the General directly. This was a violation of the chain of command, but I was not concerned. “General, this is Captain Moy,” I said. “I have a plugged toilet and it’s not good for my newborn.” The General instructed me to call Major Frank and said he would take care of the problem. I called the Major and said that General Anderson told me to call him to take care of the toilet problem. I could barely hear him over the phone, as there were a number of children climbing and yelling over his shoulders, and he could also barely hear me.

“The general wants me to fix your toilet?” he asked.

“No sir,” I replied, “I believe he wants you to send somebody over to take care of it,” and hung up the phone.

Within ten minutes a crew of three arrived to take care of the problem. Before they left they completely cleaned and sanitized the bathroom floor. From then on I only needed to pick up the phone and call. Word spread like wildfire over the base about the “crazy captain” who didn’t follow chain of command and just called to get the job done. I am sure there were more insulting appellations used as well.

If you have aces in your hand, use them.

One year prior to my anticipated discharge from the service I decided that it was time to look for a surgical residency. My first choice was to return to Cook County, but I decided it would not be possible because I lacked the proper connections to land such an appointment. My next choice would have been to go to the University of Illinois Research Hospital. The scuttlebutt, however, was that if you had not interned at Research you didn’t have a chance at securing a residency there—especially if you spent your time at Cook County. (I found later that this was not true.) So I returned to my medical school and sought the advice of Mr. George Moon, the Registrar. “Grant,” Mr. Moon said, “go to the Mayo Clinic. Our school will send them a letter of recommendation.” The Mayo Clinic was—and still is—a world-renowned research institution.

I went to Mayo for an interview and then returned to school to eagerly await their decision. Much to my disappointment, I was rejected. I was the only applicant recommended by our school that Mayo had ever rejected. They rejected me not because of my résumé or skills, but because I was Chinese. The rejection from Mayo guided my decision to go to Edward Hines Veterans Hospital, where most of the consultants and attending men were staff from our university.

As it turned out, the rejection from Mayo was a blessing in disguise. At Hines I received far better training in surgery than I would have received at Mayo. I did not realize this until late into my residency.

Coming out of service I was able to obtain priority on a brand new black two-door Chevy Aerosedan for a total of $600, including all fees. It was beautiful.

One Saturday, a week after I got the car, I parked it outside my house. About fifteen minutes later I came back to retrieve some packages from the car, but it wasn’t where I thought I left it. I scratched my head and figured I must have parked it somewhere else by mistake. I began to walk around the building complex, looking everywhere. I went into my locked garage, came out again, and circled back to the front of the house where I thought I left the car in the first place. No car! Hell, I realized, it’s stolen!

I had no choice: I was forced to accept this turn of events. I was fortunately able to buy a replacement quickly.

I heard nothing else about my missing set of wheels for a long time. But one day, over three years later, two federal agents accosted me.

“Dr. Moy, have you ever owned a two-door black Chevy Aerosedan?” they asked.

I replied in surprise, “Yes, why?”

They explained that they had been investigating a ring of car thieves working out of Chicago. The thieves would use an accomplice working at a car dealership to obtain the VIN of a new car, which they would then stamp transfer to a stolen car. The thief had claimed that my car was unattended with the keys in place. Of course I could verify that was false! It had taken the feds three years to finally trace the vehicle to me. They said it was an enormous ring of thieves they had finally broken.

I have known many people who died, but usually I only saw them after the fact. I was only present at the exact moment of death for the passing of my father. I remember it vividly.

It happened during the last of the two nights that I was off call from the night rotation at Hines. I returned home for the final care of my father, who was nearing his end. It is our culture that if at all possible, all of the family should be present upon the demise of any family member. In my second night sleeping in his room, at about 3:00 AM I noticed his breath had become erratic. I thought that the time was near as his conscious periods waxed and waned. He looked about the room and saw that I was the only one present. Thereafter his respiration gradually improved, he grew mentally clearer, and I thought it had been a false alarm. This episode recurred at about 9:00 AM and still no one was around. All had gone to work except me. I had taken the day off because of his condition. This second episode lasted for about a half hour, then ended as the first one did.
 

Late that afternoon, Father completely evacuated himself of feces and urine and would take no more food or water thereafter. This was in preparation for his death. We Chinese firmly believe that we should not leave any spoilage upon leaving this earth. Father certainly adhered to all of his beliefs.

At 7:00 that evening Father again started breathing erratically. This time, almost everyone was home. As each member of the family stepped into the room he would turn his head toward the door and cock his ear toward the sound of the footstep, apparently identifying the individual. As the hour almost passed my eldest sister, Helen, called and stated that she had some car problem and probably would not have a chance to see father. I relayed the message to father but he still continued to listen intently for footsteps. My sister finally arrived and when she stepped into the room my father turned his ears toward the sound and one tear dropped from each of his eyes onto his cheeks.

“I can’t bear to go,” he said.

With that, he closed his eyes and just stopped breathing. It was as quick and definitive as turning off a water faucet. I have never witnessed anything else like it.

I truly believe that there must be something more to life than just live and die.

Before long, I was selected to be the junior resident on the most sought-after service: that of Dr. Puestow, the Chief of Surgery. Dr. Puestow’s senior resident had the duty and privilege to see all surgical consultations and select the most interesting and difficult cases for Dr. Puestow himself to operate on and use to teach. Hospital policy was that no one could spend more than six months on his service because he was in such high demand. That meant a resident could only be on Dr. Puestow’s service once. The selection of a resident for this position was not by the usual system.

All senior residents were given the responsibility of total surgical care of the hospital from 6:00 PM until 7:00 the following morning. Grade points were submitted by one’s mentor (attending man) after the completion of the rotation on his service.

I was an eager beaver, always enthusiastic about my work. Sometimes I got so excited that I leaned in far enough to block Dr. Puestow’s field of vision. “Grant, can you see alright?” he would ask when he could no longer see. That was my signal to back off.

As I mentioned earlier, I think being rejected from Mayo was a blessing in disguise. I received excellent training at Hines and was given a lot of independence and responsibility. In contrast, Mayo fellows in their training were generally not given the chance to make decisions on their own or assume full responsibility, and therefore missed one of the key components in the development of a good surgeon. Years later I saw the ill effects of this poor training. In one case, while doing a gastric resection for a scarred duodenal ulcer, one surgeon was so inept and so rough that he tugged on the stomach and tore away the distal end of it. Another surgeon was so indecisive as to whether or not to repeat a blood count on a patient, I closed the door to the patient’s room so that he would not be able to pass judgment on whether or not the patient should have surgery. Both of those individuals were certified general surgeons, Mayo trained.

Dr. Puestow was also Mayo trained. In spite of this, he became a great surgeon on his own after he left Mayo. He developed his operating skill while working with the residents at the Illinois Research Hospital and doing some of their cases and also while in private practice.

Three months prior to my last six-month rotation, when I would be a senior resident in general surgery, I was in the Assistant Chief of Surgery’s office, where he was looking at his recently received diploma from the American Board of Surgery.

“George, what is the size of that diploma?” I asked him.

“8 x 11,” he said. “Why do you ask?”

“I am making frames for all of my diplomas,” I said. “I might just as well make one for that.”

He exploded. “You conceited son-of-a-b**ch!” he said.

“No George,” I responded. “I will get it, even if it takes me ten years.” Confidence and conviction!

He paused. “Who are you requesting as your senior service mentor?” he asked.
“Puestow,” I replied facetiously.

He laughed in disbelief. “You are crazy,” he said. “You already had him once.”

“But George, you asked me what I want. That is what I want,” I said.

A month later a bulletin came out announcing a new policy. The senior resident with the highest grades would be allowed to choose any service he wished. I had the highest grades, so I chose Puestow’s service and became his senior resident. This set a new precedent. I glowed knowing that he had changed his rule for me.

My confidence, enthusiasm for learning, and reputation as a crackerjack made me something of a legend in the hospital.

Work hard and the impossible may happen. Remember and remind yourself that even under the worst circumstances the best results may emerge. Be upbeat and optimistic and the sun will shine!! Don’t despair!!

Back when I was an intern at Cook County, I had often gone to the morgue and sought out Dr. Loeffler, an old pathologist who had come to America from Vienna as a Jewish refugee. I would go to him with questions, and he was always willing to spend time explaining the correlation between physical findings and pathology specimens. He loved to teach, and I made an eager pupil. I lost track of him when I left the County Hospital.

During my last six months at Hines as a senior resident, I was given a final cadaver to dissect. My job in this dissection was to focus on the abdomen, chest, and neck as these areas were where we did most of our surgery. I had just finished working on the chest and was exposing the head and neck when I noticed the face. It had a familiar hawkish nose, strikingly similar in appearance to Dr. Loeffler. I looked at the nametag and I almost cried. It was Dr. Loeffler. I dropped everything and walked away with a heavy heart. I couldn’t finish. I was heartbroken, feeling as though I had mutilated my friend.

He dedicated his body to teaching, in which he truly believed.

Although I worked hard at Won Kow, the money I made there was insufficient to pay university tuition. Determined to pursue my goal, I looked for another way to finance my education. I decided that I must find a scholarship.

In those days, scholarships were awarded based on applicants’ performance on an examination. Setting my sights high, I first attempted the scholarship examination at the prestigious University of Chicago. But having not attended a college preparatory high school, I found I was totally unprepared for the University of Chicago’s demanding examination. I realized this immediately upon opening the examination booklet. Without writing a word, I quietly closed it and left.

Since my sister Helen had recently graduated from the Lewis Institute, I decided to try my fortune there. The Lewis Institute’s scholarship examination was much more general. Shortly after I sat for it, I was awarded a one-year scholarship.

When I enrolled at the Lewis Institute, I did not know how good the school’s reputation was. I later found out that the registrar at the University of Illinois College of Medicine, who was not a doctor, was taking pre-med courses at the Lewis Institute with the goal of eventually attending medical school himself. This validated the quality of the Lewis Institute’s teaching.

During the late 1930s, when I was in pre-med, China was at war with Japan. Chinese citizens who were here in the U.S. were very active in war fundraising so they could send money back home to support the war.

On June 17, 1938, the United Council for Civilian Relief in China hosted a “Bowl of Rice” fundraiser dinner and dance at the Sherman Hotel. It was there that I first met my future wife, whom you know as “Paw Paw.” She was wearing a gardenia in her hair, and she was the most beautiful girl at the party.

I was twenty years old when we met, but Paw Paw was only sixteen and still a student at Hyde Park High School. Together we often rode the “L,” Chicago’s elevated train system, to her high school dances. On many of our dates, she would climb up and sit on the handlebars of my Ranger bicycle and we would travel the streets of Chicago together.

When Paw Paw graduated from high school, I gave her a gardenia corsage. She continued on to college at Mount Mary College in Milwaukee.

As I approached the end of pre-med, I began surveying my medical school options. I knew right away that Northwestern was out of the question because it had a quota of one oriental per year and had already accepted my cousin, who had attended Northwestern as an undergraduate. Besides, I could not have afforded it. Loyola was also too expensive.

I decided that the University of Illinois was my best choice. As a state school it had the lowest tuition, and as the largest school it had the greatest number of available seats for entering students.

Unbeknownst to me, admissions at the University of Illinois College of Medicine were highly competitive for applicants from Chicago. As a state school, U of I was obligated to set aside a portion of seats in each entering class for students from each county in the state. Cook County, where Chicago is located, was allotted the most seats per class; however, as the county with the largest population, Cook also had the greatest number of highly qualified applicants. Admission was strictly judged based on applicants’ scholastic achievements. Out of 600 applicants only 60 were selected for my class.

I consider myself quite lucky to have secured a seat in medical school. But as with most luck, I likely had a hand in making my own luck. I had worked hard to receive excellent grades in pre-med, and that hard work paid off.

Before I started medical school I was deeply concerned as to how I was going to handle dead bodies, especially given my longstanding fear of the dead. The moment of truth came during freshman year, when each student is required to dissect a human body in order to successfully complete the anatomy course.

At the beginning of a dissection the entire body is wrapped in a heavy cloth. Dissection begins on the arms. After that, the lower extremities are done. The abdomen is next, then the chest, and finally the head. As the process progresses steadily from limbs to head, one’s emotions regarding the dead disappear gradually. I completed the dissection with flying colors.

My second opportunity to dissect a body came during summer following freshman year, when a student who had flunked anatomy asked me to help him do his dissection over again. I was all for it. As I worked on that second dissection, I became completely comfortable with the dead. Often tired in the early afternoon, I grew accustomed to pushing the body over and taking naps on the table next to it.

Because I received such high marks in my freshman year, I was selected to be one of six prosectors of anatomy in the following year. As a prosector, I was tasked with carefully dissecting a human body in advance of its use in a classroom demonstration. The school would compensate me for this gruesome job by giving me a tuition-free second year.

Although I started medical school with a fear of the dead, I ended up dissecting more bodies in the first two years than any other student in my class. Every student dissected at least one body. Prosectors typically did two. I was the only student who dissected three bodies. What a conquest of mind over matter!

“I spent only $450 for my entire medical education,” I tell people.

“I don’t believe you,” they often say. “It must be a figment of your imagination. How could that be all you spent on your medical education? Show me.”

Except for the $450 I spent in my first year of medicine, I did not spend a cent during my three years of pre-med and the remaining three-and-a-half years of medical school.

The first year of pre-med was tuition free for me because I was awarded a competitive scholarship. I received the remaining two years tuition free in lieu of payment for my teaching duties.

In the first year of medical school I spent only $150 for a microscope and $300 for tuition and books. I remember very vividly that there were very few books to be purchased. The anatomy professor had incorporated embryology, histology, neurology, and gross anatomy in their entirety all into one book, thus eliminating the need to have separate books for each subject. This comprehensive course was credited for 900 hours.

I was invited to attend the second year tuition free as compensation for my work as a prosector—one of six sophomore students chosen to dissect a cadaver for demonstration for the incoming freshmen. This has always been part of the teaching.

For reasons unknown to me, I was selected to be the laboratory assistant to the anatomy professor in my third year and thus earned another tuition-free year.

The last six months of my senior year were paid for by the government under the Army Specialized Training Program. This program, which I entered at that time, was formed to keep the fighting forces supplied with physicians during the war.

I have spent many wee hours pondering this. In 1940, the year I started Medical School, tuition at both Loyola Medical School and Northwestern Medical School was $600. This daunting figure stood out against the $300 yearly tuition at Illinois. As of the writing of this book, 2012, in-state tuition at Illinois is now $25,000 yearly; out-of-state tuition is $50,000. No wonder my declaration has been challenged repeatedly—it was unbelievable. My total expenses were $450; my total tuition was only $300.

You can call it a dream, only possible in America.

“You must be damn lucky. This I still don’t believe,” people say.

“Doctor, I need your help!” the man exclaimed. “For the past two weeks, my twelve-year-old son has been awakening, screaming with pain. He gets out of bed, holding his head and walking around, and then shortly the pain disappears. He has seen many doctors and the only finding was that both tonsils were severely infected and enlarged, almost completely obstructing the back of his throat. He’s been on medication for the past three weeks. Everything was found to be normal. My brother is one of your patients and says you are a pretty good doctor. I thought you might help me.”

I examined the man’s son and found nothing new. I moved his head in various directions and noticed that on forward flexion (bending) of his head there was some laxity. I took X-rays of his neck in forward and straight upright positions and found an abnormal increased spacing between the atlas of the first vertebra and the odontoid of the second vertebra. I believed this abnormality was the cause of his complaint. To clinch the diagnosis, I carefully flexed his head forward until the boy felt pain, and then reversed the movement and his pain was completely relieved.

To fully understand what I just said I need to describe the anatomical relationship between the atlas and the odontoid. The odontoid process is a tooth-like projection on the axis of the #2 vertebra. This projection articulates with the atlas of the vertebra above it, the #1 vertebra. A thick strong band of ligament arches across the ring of the atlas and holds the odontoid in place. The tonsils are located just in front of this attachment band.

In this boy’s case, a severe prolonged infection of his tonsils had caused a severe inflammatory reaction, bringing much blood to this area. The swelling resulted in a loosening of the ligamentous band, causing backward pressure on the odontoid and spinal cord with forward movement of the boy’s head. When his head was straightened to an upright position, the pressure was released and the pain relieved.

I told the boy’s father that his son would need to have his head and shoulders in a cast for a period of six weeks. Once the cast was removed, he’d have to wear a cervical collar for a prolonged period of time.

This was a very unusual case as the infection had gone unchecked for a long time. Today, such an incident would be highly unlikely given the easy availability of antibiotics and treatment of infections. I have yet to see or hear of another similar case. 

The diagnosis of this problem was not unique. Why the diagnosis had not been made previously is of no surprise, as there is always a cause and effect. My equation is 1 + 2 = 3. #1 is the complaint, #2 is the cause, and #3 is the effect. The attention given to the numbers depends upon the emphasis placed on each component. The greater the importance, the larger the influence. If none, the number is eliminated. Therefore it is essential to place the most attention on the important factors for each step.

Evidently, the other physicians who saw this boy before me did not consider the seriousness of #1 (the complaint), #3 (the effect: pain), or both. Therefore very little or no effort was made to determine the cause and diagnosis since the only finding for #2 (the cause) was a normal examination. 

The success of the equation depends upon the astuteness and diligence of placing the correct value on each step in the equation in order to make a proper evaluation. Thus 1 + 2 must equal 3.

It is cause and effect always.

While I was working at County Hospital there were many opportunities to learn from some very skilled surgeons. I remember in particular one demonstration of the gall bladder operating technique, performed by a professor at Northwestern Medical School for a post-graduate training class. The demonstration was going forward as planned when someone called out a question from the audience.

“Doctor, how do you repair an injury to a common duct?” the trainee inquired.

“Oops!” the surgeon called out in response. “I just slipped and cut the duct!”

My jaw dropped. That patient could have been anyone. There but for the grace of God go I, I thought.

That day I lost my respect for that man as a surgeon and as a person. In his arrogance, he committed the poor soul on the operating table to what could be many years of repeated surgical operations and difficulties. Being a good surgeon takes more than just operating skill—you also must have compassion, morality, and a commitment to do no harm. This instructor was just a skilled operator, not a human being. An incident like this explained why this hospital had a bad reputation. I have never forgotten that episode.

Some people don’t believe what they read. The Keesler Army Airfield was located along the Mississippi River, where there was good swimming and diving during the hot and humid summers. But although it was safe to dive during high tide, there were many signs warning swimmers not to dive during low tide, when the water is shallower and diving is dangerous.

One day a stupid flyboy disregarded all the signs and dived during low tide, breaking his neck. I was called to the scene, where I stabilized the fracture and had him transported back to the hospital.

At the hospital, I used “Crutchfield tongs” (like the tongs the ice man uses to pick up a block of ice) and applied proper traction to keep the fracture stable. After the patient rested for two weeks, I removed the tongs and instead applied a “Minerva cast” around his head, neck, and shoulders. The cast would keep the fracture stable while allowing the patient to walk around.

A cast around one’s head, neck, and shoulders would be uncomfortable in any weather, but it was a hot Mississippi summer, which made this patient’s discomfort particularly intense. So he complained to his commanding officer, who in turn called my commanding colonel and asked him to have me remove the cast. Shortly thereafter, I was making rounds when the colonel came into the ward.

“Captain Moy, please take off the cast,” he barked.

“Colonel,” I said, “it is not time yet.”
Raising his voice in agitation, the colonel said, “Captain, take off the cast.”

I replied, “Yes, sir. Will you please write the order?”

He didn’t say a word; he just turned around and walked off the ward. He knew that I knew exactly what should not be done, and he didn’t want the responsibility of telling me to do that.

Know your position, hold your ground and stand firmly.

While I was still stationed at Keesler Airfield I received repeated calls from my sister Helen regarding her husband Steven’s persistent nasal bleeding. At the onset Helen thought that it was just a minor problem and that it could be adequately cared for by the local town physician.

Steven had taken what appeared to be a menial job for a highly educated engineer with a bachelor’s and a master’s degree from the University of Michigan. The job required him to travel out of town during the weekdays and return home on the weekends. But Steven desired this particular position because it gave him the experience he would need to run and manage his family’s railroad business when he returned home to China.

I was very concerned about the ominous sign of the continued nasal bleeding. I told Helen to contact Dr. Glatt, an ear, nose, and throat specialist. At his first visit, Steven had a biopsy taken. It turned out he had cancer of the nasopharynx. Steven underwent radiation treatment to the affected area, but minor bleeding continued to ooze. Subsequent surgery was done to interrupt the blood supply to the tumor, but in spite of this, the bleeding was still not completely controlled.

When I was discharged from service, I returned home and assisted my sister in the continuous care of Steven. Multiple blood transfusions were administered to treat his constant loss of blood. Increasing doses of narcotics were required for his discomfort. He lost his appetite for food, was unable to drink adequate fluids, and required supplementary intravenous fluids.

As Steven’s weakness progressed, he lost the ability to go to the bathroom by himself, and I had to give him a device known as a “retention catheter.” He became disoriented from all the narcotics he was on for the pain, and at one point he almost fell out of the second floor window. This mandated the attachment of a “cow bell” that would make noise when he moved so we could more easily monitor his movements.

Steven slowly slipped into oblivion. He left us serenely and peacefully. Steven was more than just a brother-in-law; he was like a true brother to us. We loved him dearly and missed him.

Although Steven’s diagnosis was missed for a short period of time, I do not believe that the outcome would have been any different. When the diagnosis was made the disease was already far advanced.

In spite of two ardent suitors for Helen’s hand following Steven’s death, she never considered another marriage, even to help ease the burden of caring for her children. She never lamented what could or should have been. She was steadfast not only in the care of her children but also the welfare of the entire family. In her we had a sister with no equal.

The three-year surgical residency was divided into two six-month periods of general surgery and four six-month periods in subspecialties. I chose anesthesiology, urology, plastic surgery, and vascular surgery as my subspecialties. In addition to the areas I mentioned, Hines also offered orthopedics, neurosurgery, and pathology. We had a total of about 130 residents, of which 100 were in general surgery; the other 30 were in other specialties.

The selection of subspecialties was simple because each of us knew what fields we wanted. The selection of a general surgery mentor, however, was another story. When we first entered the program we had not yet had an opportunity to see or know the work of the mentors, making it quite difficult to choose.

To gain enough information to select a good general surgery mentor, I chose anesthesiology as my first subspecialty service. Working in the anesthesia service would allow me to see and evaluate all of the operating surgeons before it came time to be matched with a mentor.

I started well in anesthesiology because I was already able to insert a spinal needle rapidly. I had mastered the technique as an intern at Cook County, where I performed diagnostic spinal taps on a number of psychotic patients.

One morning we had just finished operating on a patient who had extensive carcinoma of the left neck with metastasis. The case was done under general anesthesia. When the surgery was over, I removed the patient’s breathing tube. He started to turn blue! I quickly reintubated him and restored his color and respiration. Then I used a technique called “percussing” his chest—tapping it and listening to the sound it made—to try to find out what was wrong. I determined that he had bilateral pneumothorax; pockets of air inside his chest were pushing down on both his lungs, making it difficult for him to breathe.

I called out to the supervising anesthesiologist, “Max, we have a bilateral pneumothorax here.”

“You must be crazy!” he responded. “It can’t possibly be bilateral pneumothorax, because we only operated on one side of the neck.”

I ordered a chest X-ray to check it out. Sure enough, the X-ray confirmed my diagnosis. Later I researched the literature and found out that this happened due to a congenital abnormality in which the patient’s two pleural cavities, normally separate, were connected. Word spread like wildfire throughout the hospital that there was a “crackerjack” resident in the anesthesia service.

Later on, when I was in urology, a patient came in complaining of an inability to void. He was experiencing pain, nausea, and vomiting. These are classic symptoms of acute appendicitis, but the pain was in the wrong place for that. This patient’s pain was low down at the bottom of his abdomen, just to the right of the pubic bone, not in the right lower quadrant where the appendix is. He also had a tender swollen prostate gland.

That afternoon the consultant came in and I gave him the history and physical findings. He did a rectal examination, found the tender swollen prostate gland, and declared, “Grant, this guy’s symptoms are caused by prostatitis. Put him on antibiotics.”

He left and we started the antibiotics. The patient’s pain, however, continued to increase throughout the afternoon. When 6:00 came around, I was the responsible surgeon. I reexamined him a number of times and was thoroughly convinced that he had an unusually low-lying appendix down against the right side of his bladder that was inflamed and pressing against his prostate. Knowing full well that if I operated it would be under my diagnosis and against the diagnosis of the consultant, I took the patient to the operating room and opened him up. Inside I found a gangrenous appendix lying low in the pelvis against the bladder—just as I had envisioned.

I had been so convinced of my diagnosis that I didn’t even realize until later that if I had been wrong there would have been hell to pay. Confidence, conviction, and courage! That incident increased my standing as the hospital crackerjack.

Shortly after I came on the service of Dr. Puestow as his junior resident, I encountered a non-communicative, fidgety patient sitting unobtrusively in the corner. His chart indicated that he had gallbladder disease requiring surgery. I realized he was quite worried about his planned surgery, so I sat and explained to him in detail all aspects of the procedure. He had heard through the grapevine that he was on Dr. Puestow’s ward with the best residents chosen for his service.

The surgery went well and this man made a complete recovery. On his day of discharge he stopped by to say goodbye.

“You are best at what you do,” he began, “and I am best at what I do. Please allow me to make you a couple pairs of slacks to show my appreciation for all your loving care.”

Two weeks later I was presented with two pairs of the most beautiful gabardine slacks. Such sincere appreciation is very rare.

I remember another patient who I cared for as a junior resident for Dr. Puestow. This patient had been on the ward for a long time for the continued care of his chronic infected indolent leg ulcer. It needed daily cleansing with saline solution and debridement. The preparation of the recipient site for grafting was paramount although tedious and time consuming.

One day he approached me and said, “You have cared and done a lot for me. I want you to have this small TV with a five-inch screen. I made it from a kit while waiting for my surgery. This TV is not yet on the market, and I think your children might enjoy watching just as I have enjoyed making it.”    

What sincerity. This man spent hours in making this TV and gave it to me to show his appreciation for my continued care.

All the big surgical cases from the adjacent Midwestern states funneled into Hines Hospital, especially carcinomas of the esophagus. Morbidity rates for this condition were well over 30%, and Dr. Puestow’s pet project was trying to improve the results. He kept very careful documentation of his work in this area. 

Operating on these cases required 6–8 hours of surgical time, with a combined thoracic and abdominal approach. I recall in particular a very difficult case in which I assisted and completed the surgery successfully. But shortly after the patient was admitted to the recovery room, he died suddenly with no apparent cause. 

Dr. Puestow was deeply concerned that his surgical technique may have somehow contributed to the death. Not only was he personally troubled by the mystery, but he would not be able to report the case in his series without information about the cause of death. An examination of the chest tube drainage made it obvious that the chest was not involved. We wanted to evaluate the patient’s intestinal anastomosis to see if it contributed, but we would have to perform an autopsy to do so because the abdomen was completely closed. The family, however, would not grant an autopsy permit. What to do? 

After hours that night I went quietly to the morgue. My heart was pounding, knowing that what I planned to do was against the law. If discovered, I would be charged with assault and battery. I quickly removed the abdominal sutures and checked for visible signs of leakage of intestinal contents and blood but found none. There was no disruption of the intestinal anastomosis. I then closed the abdomen and left as quietly as I had come. 

The following morning I reported to Dr. Puestow that the patient’s sudden death was probably due to his heart. The chest and abdomen, I told him, were normal with no evidence of any leakage. I said nothing about how I got the information and he probably thought that an autopsy had been performed. He did not ask me; I did not lie. A shade of gray?

What a jolt! Over the phone came a solemn voice.

“Grant, your brother has pulmonary tuberculosis.”

I had taken my brother Calvin to Hines Veterans Hospital for the evaluation and treatment of what he suspected was a stomach problem. Upon receiving the terrible news about his preliminary X-ray results, I rushed to the Radiology department and was immediately relieved by what I saw. The X-ray was not of Calvin, but of a larger and taller man who indeed had pulmonary tuberculosis. Somehow the film had been marked incorrectly.

To avoid future problems, the hospital instituted proper identification procedures. We reduced to a minimum problems like this, as well as glitches in blood transfusions and the administration of wrong medication and dosages. It was impossible, though, to entirely eliminate mistakes as the inherent factor of human error still remained.

Fortuitously, Calvin had a benign problem.