Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0028-3886.263208
Source of Support: None, Conflict of Interest: None
Author : Nishant S Yagnick
Edition : 1st Edition
Publisher : Amazon (International) and Pothi (Domestic)
Pages : 278
Chapters : 13
Year of publication : 2019
”No great genius has ever existed without some touch of madness”
- Lucius Annaeus Seneca
What is the price of genius? What really differentiates an ordinary life from an extraordinary one? What are the sacrifices needed to rise above the ordinary? Is it talent? Nothing is more common than unsuccessful men with talent. Is it education? If so, why is 'genius' not more commonly prevalent? This book is a homage to a time when surgery stopped being just about removing “lumps and bumps” and started becoming a science. A time when legends who would shape the very careers of generations of surgical aspirants walked the halls of some of the most legendary schools of medicine and surgery. But don't be mistaken. This is not a historical record and has no certainity of accuracy whatsoever. The author, who is himself a neurosurgeon, makes this amply clear in the disclaimer. What it is, is a heady cocktail of conversational set pieces that might have happened between these legends. The book is divided into 13 chapters and traces the life of William Halsted from the time he founded the surgery department at the Johns Hopkins Hospital to his meteoric rise and eventual demise. During this fictional account of his life, we encounter the very birth of Neurological surgery at the hands of Harvey Cushing and his legendary rivalry with his pupil, Walter E Dandy. The chapters are key moments in the history of these individuals and what might have transpired. The aim of the book, as the author says, is to “give the reader a 'feel' for the time, an idea of the achievements of these personalities and the sacrifices they had to make in order to accomplish these achievements.”
The first 3 chapters deal with the initial years of the Johns Hopkins Hospital and the events in Dr. Halsted's life that lead him to join this hallowed school. At a very early stage, it is shown that surgery, at the time, was not the most respected branch of medical education and while others were busy earning a quick buck, Dr. Halsted clamored for something more. He set up a small dog laboratory and used it to perfect his techniques of bowel suturing. What is also worthy of observation is his strict adherence to asepsis to the point of obsession, something which was unknown at that point of time. He is shown to be a maverick, almost foolhardy, by today's standards, practicing procedures on patients repeatedly despite fatal consequences in previous experiments. What is apparent from the description is that Halsted practiced at a time where surgery was very nascent such that the only treatment of breast cancer was to burn it! It was during this time that Halsted tried to bring a scientific nature to the practice and used his knowledge of anatomy and meticulous dissection to further the surgical specialty.
He was not without his flaws. Often portrayed to be careless regarding his students and hospital, he is shown to be a slave to his addictions. While perfecting the technique of cocaine anesthesia, he is shown to be addicted to it to an alarming extent. This often affected his decision-making, and to a broader extent, his life. He was able to, however, keep his addiction in control after seeking help at the Cleveland Clinic, only to later replace it with morphine. Eventually, the opioid tolerance grew and led to gall-bladder stones, a disorder to which he eventually succumbed despite being successfully operated for the same, using his own technique by his trained residents in his operating room!
There is sweetness to the way Dr. Halsted met his future wife, Caroline Hampton and her apparent allergy to carbolic acid, something that led him to start using surgical gloves. There was no real romance in the relationship but a quiet comfort, which comes from a deep understanding of each other's point of view and work. Any surgical residency and practice are demanding and often all-consuming. This occurs even more so in neurosurgery and the spouses often bear the brunt of it. This point is illustrated very beautifully in the complicated and often rocky relationship between Harvey Cushing and his wife Kate Cushing. Dr. Cushing dominates the next four chapters. He is shown to be a very hardworking taskmaster, who despite Halsted's absence, was able to develop his skill and eventually evolve to become the Father of Neurological Surgery.
He has been shown to have persisted in the face of steady disappointments in his initial attempt at Neurological surgery and also has been shown to take risks which others could not have dreamed of in that era. The surgery of General Leonard Wood brought Cushing national fame and he was hailed as the pioneer who started the Department of Neurological Surgery at the Johns Hopkins Hospital before eventually moving to Harvard at Baltimore. His work with Dr. Kocher in Europe, which was eventually named the Cushing's triad, was the result of his incessant doggedness, an urge to prove himself, a trait that would define his life and career. What also comes out is a person who was in competition with everyone, his seniors, his colleagues, and even his students. While Halsted is shown to have taken pride in Cushing's success, the same was not true of Cushing.
We are introduced to Cushing's greatest pupil and eventual nemesis, Dr. Walter E Dandy. They couldn't be more contrasting even if they were painted black and white. While Cushing was shown to be cultured, hardworking and often slow and meticulous, Dandy was painted as being brash. He was fast, and spoke and wrote in an unimpressive manner. But his genius was undeniable. He performed is first independent pituitary surgery at the age of 26 years and was one of the only two persons doing this type of surgery, the other being Cushing himself. But what is shown is the extent that these “legends” went to secure their name in history. Dandy posted his first case in the absence of Cushing, despite the latter's explicit instructions not to do the same. And Cushing was no different. When his time came to leave for Harvard, he did not take Dandy with him. Rather Dandy was left high and dry and it was Halsted who ultimately rescued him and gave him his position back at the Johns Hopkins. Cushing was often dismissive of Dandy's work and did not publically endorse his seminal research on hydrocephalus despite its groundbreaking nature. When Dandy later introduced the air ventriculogram, Cushing was skeptical about it and even forbade his residents to practice it. The Society of Neurological Surgeons also supported the American hero that Cushing was and his word was considered final. This ultimately delayed and even diminished Dandy's status and these incidents were quite reminiscent of the bitter animosity between Babinski and Bouchard. Often careers are destroyed or even fail to take-off not because of lack of talent or hard work but because the right opportunity is denied by a powerful personality. This is not to say that Dandy has been portrayed as an ideal pupil. Even though Dandy eventually contradicted his master on many fundamental issues, it did not affect his devotion towards him. The relationship between the two men can be considered as more than a simple relationship between a teacher and his pupil and may be compared to a father-son relationship, which is a reminder of the original model of Hippocratic teaching.
In the last few chapters, Cushing has been shown to be embroiled in the First World War and the birth of neurotrauma, where the need for rapid and life-saving surgeries has been emphasized. He has been shown to have changed himself from a perfectionist to a fast surgeon who found simple, elegant solutions to life-endangering problems. Eventually, he returns back and is hailed as the national hero though his marriage is in ruins. Life eventually turns to a new chapter with Halsted's death and Cushing and Dandy make their peace with each other at their master's funeral.
The book is entertaining and gripping. I found myself thumbing the entire novel until I read the last page. It holds nothing back in terms of drama and thrill. It glorifies surgeons and advocates the maverick lifestyle. But therein lies the flaw. Medicine colleagues are shown as bumbling, greedy and not particularly intelligent. Thomas Mc Bride, a physician friend of Halsted, is introduced as, “He held her (patient's) hands, as he did for all his rich patients and assured her with a confident look that only good things were coming.” While the intention of the book was never to be historically accurate, the contrast between surgery and medicine could not have been greater. Nonetheless, the accounts are riveting, and it is a look at the probable psyche of a “headstrong” surgeon, who refuses to back down in the face of insurmountable odds, even at the cost of lives. It looks at the changing face of surgery at a time when it was rapidly becoming a dominant branch, and the effect it had on the lives of those who practiced it. Dr. Yagnick's attempt is admirable and shows his ability to hold the attention of his reader even via sensationalism. There are plenty of biographies in the market that are more historically accurate; this is not one of them. In fact, this isn't clearly a biography. It is an entertainer.