Confidently Placing Sutures

Sutured Wound

Sutured Wound

I was recently watching Cathy quickly sew a button on one of my shirts and made the comment, “I guess I should be sewing my own buttons with all the experience I have with needle and thread.” I quickly told her however, she did a much better job which is true. I believe the average seamstress is more gifted in sewing than the most skilled surgeon, and Cathy is far above average. The difference lies in what one is sewing. Accurately placing sutures in wounds with skill and speed are basic to the work of a surgeon. Over the course of forty-five years as a surgeon I placed multiple thousands of sutures in untold types of wounds, and in some respects I miss exercising the skill now that I am retired.

My Dad (Pop) taught me how to place sutures when I was in high school. I would go with him on house calls or accompany him to the emergency room to treat people who had sustained an injury requiring sutures. He would allow me to suture relatively minor wounds while explaining to the patients I was in training under his watch care. I don’t ever remember a patient objecting to my work since Pop was there in the room making certain I did it correctly. This was at a time when malpractice litigation was almost non-existent, and most people were thankful to get medical care even from a non-licensed trainee. By the time I entered medical school I could place sutures more quickly and accurately than the majority of interns.

During my surgical residency at Charity Hospital in New Orleans I spent four years learning all the intricate techniques necessary for a general surgeon. Early in my first year of training when Cathy and I were newly weds I would bring home needle holders, sutures and scissors to practice all forms of suturing. I would sew the neck of socks together to simulate the technique of sewing intestine end to end. I don’t remember how many pair of socks I owned, but at one time or another they all were stitched to each other. I would cut them apart and  sew them back together again. I think Cathy got pretty tired of examining my handy work. I tried my best to convince her that I was able to place some of the most beautiful stitches ever done at the “Big Charity.” I know she thought I was great, but I don’t believe I ever impressed her with my surgical skills. I also practiced sewing in tight places by sewing objects together within a match box. It was certainly better to hone those skills at home with inanimate objects rather than in the operating room on a patient in need of immediate help. I wasn’t able to simulate the stress of the OR in our tiny apartment.

When I began my private surgical practice in El Dorado I was sharing office space with Bubba, even though his practice was family medicine. Initially he assisted me in the operating room until I became familiar with the other surgeons in town and could confidently ask them to assist. I did not do many procedures the first year, but I was sure grateful to have him in the OR. He had assisted Pop for twelve years prior to my arrival, so he was very familiar with good surgical technique. This was when I learned Bubba wanted to become a general surgeon, but by the time he completed his obligation of two years in the US Air Force he and La Nell had two children (Lydia and Andy). They believed they could not afford the huge expense of an additional four years of training at a medical center.

I have previously written about the spiritual conversion Cathy and I experienced when we attended the Bill Gothard seminar in Dallas in August, 1977. We had been married twelve years and had been living in El Dorado for six years. God transformed us and made us new as promised in His Word (II Cor. 5:17). Bubba was one of the first to know about the change, and he began slowly to mentor me not as a doctor who also was a Christian, but as a Christian who also was a surgeon.

One day while assisting me in the OR Bubba asked, “Do you know how a wound is held together and heals following placement of sutures?” He was always very precise in his approach to life and medicine, and I thought he was quizzing me on the exact physiology of wound healing to see if I remembered what we had been taught in medical school. I began by saying  that with the injury there is coagulation of platelets in blood at the wound edges which leads to the formation of fibrin—. He interrupted by saying, “You are giving the scientific explanation, but God gave us the Biblical explanation of wound healing.” I said, ” alright; you have my attention.” He said the wound healing passage is in Colossians, chapter 1, verses 16 and 17. He continued, “It says that the Lord Jesus created all things in heaven and earth, visible and invisible including principalities, powers, kings and queens. It further says all things are under His control and by Him all things consist.” Bubba stopped and asked, “Do you know the definition of the word consist? It means “held together.” Jesus is the One that holds all the universe together and keeps it from falling apart. That includes the edges of this surgical wound you have just caused. Jesus Himself will be holding this wound together! You can put the sutures in place, remove them in seven days and assume all the invisible physiological processes have occurred. If Jesus isn’t holding it together it will break open.”

I have never forgotten Bubba’s explanation of this particular passage. Every time I counseled with a surgical patient before their procedure I could confidently say I would be placing the sutures, but it would be Jesus who would be holding it together and heling it. As my preacher friend, Luther Price would say after explaining a particularly difficult Bible passage, “My, what a God!”

Dr. John

Lighting the Orange Bowl Stadium

Orange Bowl Stadium

Orange Bowl Stadium – Miami, Florida

A number of exciting things happened in my life, in Cathy’s life and the lives of our children in 1977. The most life-changing event happened for Cathy and me in August in Dallas when we were saved and born into the Kingdom of God. I have recounted the  story of our conversion in A Shopping Trip To Dallas. Everything in us was transformed when Christ entered our lives. II Cor. 5:17

Another exciting thing happened the same year when the Arkansas Razorback football team coached by Lou Holtz was invited to play in the Orange Bowl against the Oklahoma Sooners. Because the Orange Bowl is played in Miami it was a great opportunity for us to visit Cathy’s family for the Christmas season in Fort Lauderdale. The game was to be played on January 2. I called Cathy’s brother, George to try to get us tickets to the game, because he had good connections through his college. He was the Dean of Students at Broward Community College in Fort Lauderdale and knew the right people to get good seats. He was able to purchase a ticket for son, John Aaron, for himself and for me.

Our flight to Fort Lauderdale was memorable, and I have written about my encounter with Rabbi Norman on the flight from Atlanta to Fort Lauderdale. (Sharing Jesus With Rabbi Norman). As a result of our meeting he sent me a signed copy of his book, Patrick J. Magillicuddy and The Rabbi.

The Orange Bowl is one of the premier bowl games every year, and this was the first time the Razorbacks had ever been invited to play in it. No one in the sports world apart from ardent Arkansas fans gave the Hogs even the slightest chance against the mighty Sooners from Oklahoma. They were ranked number two in the nation in all the polls with the undefeated Texas Longhorns ranked number 1.

George, John and I were excited (especially me) as we drove the 30 plus miles from Cathy’s parent’s home in Fort Lauderdale to the stadium in Miami. The game was played at night so the closer we got to our destination, the better we could see the bright lights of the stadium in the clear, crisp evening. We also saw many cars of OU fans with their signs and streamers proclaiming their Sooners as national champions. Notre Dame had defeated the Texas Longhorns in the Cotton Bowl earlier in the day, so all Oklahoma had to do was defeat the lowly Razorbacks and claim their national prize. As we walked into the stadium with our red shirts and hats, several O.U. fans told us we had wasted our time driving such a distance to witness an ugly slaughter!

At the gate each of us was handed a tiny flashlight in the form of a candle and were told to leave the light off until the half-time show at which time we would be instructed what to do with it. Disney Productions was in charge of the half-time show, and it had been promoted as a typical Disney extravaganza. I noticed one fan after another turning their candle on with many of the children leaving theirs on as they took their seats. Although our seats were good with an excellent view of the field we were seated high in the lower deck. There were many more OU fans present than Arkansas fans, and seated directly in front of us was a family of a husband, his wife and two children with O.U. shirts, hats and pom poms. They were very animated and vocal prior to kick-off, so we remained pretty subdued.

George had given John his battery-powered fog horn which he normally used on his boat. He told John to use it sparingly because it was very loud. (Wrong thing to tell a 10-year-old!) The Razorbacks jumped to an early lead in the game, and our nearby O.U. fans became more subdued. As the margin of our lead increased our cheering with the fog horn emphasis also increased. The folks in front of us particularly cringed when John blew the horn, which he did every time our team made a first down.

Something happened at half-time which I have never forgotten. When the Disney people took charge of the program we were all reminded to turn off our candles if we hadn’t already done so. We were told when it was the appropriate time we would be instructed to turn on the light. The announcer of the program then said very loudly, “Let’s begin the show,” and all the stadium lights were turned off.

I was struck by the extreme darkness which enveloped the stadium. As I looked around I noted I would have had difficulty leaving my seat and walking down the long flight of stairs if we had an emergency requiring an immediate exit. It was impossible to see much beyond one or two rows ahead in the darkness. Then something happened which impressed me greatly. Across the stadium in about row twenty-five one person turned on their light long before the announcer instructed us to do so. It was a young man whom I estimated to be a teenager. I could almost see his face clearly even though moments before I could not see anything farther away than 8 to10 feet.

Later I thought of the spiritual significance of one single light in a totally dark stadium of sixty thousand people. In Matthew’s gospel Jesus commanded us when He said, “You are the light of the world. Let your light shine before men that they may see your good works and glorify your Father who is in heaven.

I have wondered what my meager light could possibly accomplish in a very dark and sinful world. Now I am reminded of the half-time show at the Orange Bowl in 1978, and the teen-aged boy who failed to follow instructions. He taught me one tiny and seemingly insignificant light can light-up a dark place when it is empowered by the Father of Lights! (Matthew 5:14-16)

Dr. John

PS: For those who don’t remember the Razorbacks trounced the Sooners 31-6 that night at the Orange Bowl. After the game we couldn’t find any of those Oklahoma fans who questioned our intelligence for even attending.

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Never Look At Your Food Through A Microscope

 

 

"Sausage Bacteria"

“Sausage Bacteria”

Charity Hospital in New Orleans was a phenomenal hospital in which to be trained as a surgeon. From earliest remembrance Pop told me stories of his 2 years of medical and surgical training at “Big Charity” during the mid-1930’s, and I never failed to enjoy hearing his stories no matter how many times I had heard them. When I completed medical school at the University of Arkansas in Little Rock, I was certain I wanted to receive my surgical training at Charity Hospital. In those days I had the option of doing a 1 year internship first, and I chose to train that year at Grady Memorial Hospital in Atlanta, Georgia. I am so thankful I did because it was in Atlanta in September, 1964 I met and began dating Cathy Young from Fort Lauderdale, Florida. We were married on August 7, 1965, the month after I began my surgical residency program in New Orleans.

As a first year resident I was paid the enormous sum of $225 per month. For those who were able to physically and financially survive that first year, the salary for the 2nd through 4th years was raised to an unheard of sum of $500 per month. Cathy and I were able to live reasonably comfortable because she was teaching in one of the Orleans Parish elementary schools, and her salary combined with mine made us feel wealthy! The salary deficiency for the residents at Charity Hospital was offset somewhat by the free room and board the hospital provided. Cathy and I did not live in the hospital because we had a very nice apartment on the west bank (Mississippi River) near her school. I used my room as an on-call room in which I could rest when I had the chance. I was on call every third night and had to spend that entire 24 hours in the hospital caring for in-patients and doing emergency surgical procedures.

The Doctor’s Dining Room was a special treat and benefit for the staff. It was located in the basement of that massive 20 story hospital and served wonderful meals 4 times daily to the 350 interns and residents. All the tables were covered with tablecloths and there were servers employed by the state of Louisiana to serve us. One of the servers especially loved by most was named Maisey, and she had worked in the dining room for more than 25 years. One knew he had arrived and had some status when Maisey could call you by your first name and remember your favorite dish and meal. With the annual turnover of doctors in such a large hospital, it was an amazing memory feat on her part.

Breakfast was a special treat because we could individually order our meal. We could special order pancakes, waffles, omelets and eggs cooked to suit our tastes. Biscuits were made and available 2 or 3 times weekly. I always looked forward to a full hot breakfast after doing emergency operations throughout the night when I was on-call.

Early one morning when 3 or 4 of us were seated together enjoying one of those delicious breakfasts, one of the doctors made a comment on how much he enjoyed the patty sausage they always prepared. A pathology resident looked over and asked him; “Have you ever looked at sausage under the microscope?” The surgeon looked back quizzically and said, “I never have nor have I even thought about it.” Another listener said he never had but would like to; which was the only encouragement the pathologist needed. “Come on, let’s go look!” Four of us left the dining room and made our way to the Pathology Department which was on the 6th floor.

The pathologist had brought a piece of the sausage from one of our plates, and he froze a tiny portion to make a slide that is known in the profession as a “frozen section.” He placed the slide under the microscope and the 4 of us took a look. There were comments like, “I had no idea what we were eating,” to “At least the high temperature killed all (or most) of these creatures.” When I looked through the scope none of the creatures I saw seemed to be moving , but a few of them appeared to be looking back at me!

It was several months before I ordered sausage with my eggs and toast at the Charity Dining Room. After carefully noting the large number of healthy-looking doctors who were enjoying sausage on a regular basis, I abandoned my anti-sausage opinion and began ordering it again. Occasionally when I eat sausage now, I think about what I saw that morning. I have learned it is best not to investigate too thoroughly the things that taste good. Since Cathy is now allergic to pork, and I’m much more concerned about fat grams, I seldom have sausage anymore.  And I definitely have no desire to look at anything else I eat under a microscope!

Dr. John

 

Coach Fischel’s Worst Moment On The Gridiron

Frank Fischel

Frank Fischel

While having lunch recently with a pastor whom I had just met I mentioned to him Cathy and I moved to Branson from Fayetteville, Arkansas, and  I was an Arkansas native. Since I have been an Arkansas Razorback fan for life he asked if I had ever heard of Frank Fischel who was an All Southwest Conference football player at Arkansas in the late 1940’s and early 1950’s. He said Frank had lived for over twenty years in Crane, Missouri where he had known him, and Frank was a great Christian witness and his best deacon at the First Baptist Church of Crane. He wasn’t too surprised I had heard of him, because he was such a great football player at Arkansas, but was shocked when I said I had known him pretty well.

Frank Fischel was an assistant football coach at El Dorado High School when I was a student from 1954 to 1957. He was never my coach since I only played basketball and tennis in high school. One day at a basketball practice, Coach Fischel was watching us scrimmage, and at the end of the practice he asked if I was the younger brother of Berry Moore. When I responded I was, he said he was a little surprised I wasn’t playing football instead of basketball. He could see I was tall and skinny and not even close to the weight of Berry Lee (Bubba) when he was a high school All-American football player at El Dorado. Coach Fischel then told me about the day he first met Bubba on the Razorback practice field when he (Coach) was a freshman and Bubba was a sophomore.

Frank was born and raised in Helena, Arkansas where he was known as a local hero. During the early years of America’s involvement in World War II he wanted to serve his country despite the fact he was under-aged. He convinced the Army recruiter he was seventeen years old and enlisted when in fact he was only fifteen and a half years old. He served in the Pacific Theater flying a torpedo bomber and was involved in the historic battle of Guadalcanal. Upon returning from the war to Helena as a high school student he became a high school All-American football player. He was recruited by many major colleges but chose the University of Arkansas to begin his illustrious Razorback career in 1946.

Coach Fischel said when he arrived in Fayetteville to play football he considered himself to be the strongest, meanest and simply the best football player on the campus. This was before he had seen the other players on the team or taken the first snap of the football. He didn’t say it, but I presume his life-endangering experiences during World War II which few if any other players shared added to his inflated self-image.

On the very first play from scrimmage he was playing defense and lined up opposite the offensive tackle whom he heard was named Berry Moore. Coach remembered, “this guy didn’t look like much of a player, especially since he was wearing plastic-rimmed glasses.” He said I looked over at him and told him, “I’m gona’ run over you and kill you on this play.” When the ball was snapped Coach said he instantly lost consciousness, and the next thing he remembered was having the assistant coaches at his side trying to remove his helmet while mopping the sweat off his brow. When he groggily asked what happened he was told, “Moore caught you with an elbow!” Coach said my brother hit him with his right elbow so fast he never saw it coming, and the force was so great he sustained a concussion. He followed by saying he played football at Arkansas for four years and had a brief stint in the pros and was never again hit with a blow like that. He also said from that point on he gave Berry Moore a “lot of space.”

I discovered Frank Fischel set aside a professional football career to re-enter the military as an Army officer to serve honorably in the Korean War. On returning from that conflict he completed his training to begin working in various coaching positions throughout Arkansas. After he received a Master’s Degree in Administration he moved his family to Missouri to continue his thirty year career in teaching and administration. He finished his journey in Crane where he is remembered as a wonderful man, great teacher and encourager and exemplary husband, father and grandfather. He died in Crane in 2013 having lived eighty-six years.

I wish I had known he was living in Crane since it is so close to Branson. We would have had a wonderful time re-living those times and experiences in El Dorado, and I could have gained so much from his wisdom and Christian fervor. I also wish he could have known Bubba as an adult and an equally fervent believer. They would have instantly bonded again and been inspirations to each other. I feel confident despite Bubba’s quiet and gentle nature Frank would have kept his eye on Bubba’s right elbow!

Dr. John