HEROES AND THE PURSUIT OF HEALING
I hope you won’t consider me disloyal to our great Carnegie heroes if I tell you I do sometimes think about other kinds of heroism – the kind that does not involve saving a human life. In doing this, I take the award standards for the Carnegie Medal and imagine how they might help me evaluate other different, but potentially heroic, behaviors. I’ve written about this in this space over the years, for example, about political leaders who have taken great risks in defense of political ideals. But a tour I took this week sent me in a different direction.
A few days ago, I toured a 600+ bed hospital that is under construction, one that our guide pointed out will replace the historic, but dated hospital where Dr. Thomas Starzl perfected the human liver transplant. Starzl was a man of iron determination. He began his transplantation research at the University of Colorado, then moved to the University of Pittsburgh. Liver transplantation is very complex, and it took him years to work out the details. It wasn’t just a matter of surgery – where to cut and where to sew – but involved the immune system, genetics, and the daunting logistics of organ procurement.
OK, so it was hard, but what made it heroic? It took years and many, many attempts before he could get it all right. He had to endure the death of dozens of his patients and the intense scrutiny of his regulators and peers. But wait, you might ask, wasn’t it the patients who were doing the “enduring” here? Of course, but they were volunteers facing imminent, inevitable death from their liver disease. They were meticulously informed of their chances, and they decided it was best for them to take the risk. But that does not mean that Dr. Starzl didn’t have to endure the emotional burden of what must have seemed like endless death at his hands. Add to that the criticism of his peers – those who worked with him wondered what kind of man it was that could deal with all of that. But Tom Starzl did deal with it, and his techniques are available today to save us, our children, and our grandchildren.
I personally met two Ear, Nose, and Throat (ENT) surgeons who also made major medical progress in the face of withering criticism from professional peers. The problem was tumors in the deep part of the brain at the base of the skull, up against the sinuses. The first surgical attempt involved – believe it or not – carefully removing the patient’s face and going through the skull to deal with the tumor. The face was then replaced. This really did not work, and patients suffered very serious disabilities from the damage to their bodies. As the results became known, the applicable professional society banned further experimentation. Well, our two young surgeons were using microsurgical techniques deep into patients’ sinuses when they realized they had reached the back of the skull … and that they could access the brain from there. They tried it a few times, published their results and were all but banned from their professional society. The society did, by way of censure, remove them from their committee assignments. So, the two surgeons consulted with their elders at the medical school and health system where they worked and the elders saw promise in the work. The medical school and health system agreed to support them to do 300 cases, then publish the results. (If the patient outcomes were bad, of course they would stop early. This would probably ruin them professionally.) They did the 300 cases without announcing interim results. The results were great and, in the end, their publication routed the opposition. They put it all on the line for their patients.
Stories like this are as old as medicine. In 1847, Viennese physician Ignaz Semmelweis introduced antiseptic surgical procedures to deal with an appalling death rate among young mothers who developed infections during childbirth. Semmelweis had the numbers to prove the effectiveness of his new techniques, but the Vienna medical community rejected his findings, got him dismissed from the hospital and eventually forced him to move to Budapest. Ignaz had it right, but it cost him his professional life.
These men were acting to save human life, and while they did not risk death or physical injury, they suffered mightily to see the right thing done. And this is how the bravery of our Carnegie heros benefits society in a larger sense. They demonstrate to each of us that sometimes there is a hard thing to do, sometimes we are the person who must do it, and we must do it even if there is a serious price to pay.