“Some wounds grow worse beneath the surgeon’s hand; better that they were

not touched at all.”

Publius Ovidius Nasa, known as Ovid, Roman poet who lived during the reign of Augustus.

     Waterbury wasn’t the worst place on earth, but over the years I heard many people say that the best thing about Waterbury is that it’s halfway between New York City and Boston.  St. Mary’s Hospital was in the heart of downtown.  The CEO was a nun.  It had been founded many, many years ago by an order of nuns to serve the poor.  The hospital continued to carry out this mission and accepted most of the indigent patients in the area.  There was a private hospital across town that tended to discourage these people from seeking care with them.  They preferred the well-insured, profitable type of patient.  Everyone else ended up on our doorstep, which, as it turns out, is a great thing for a residency program.  The program was an affiliate of Yale University, and we would do some rotations there, as well as a year of research in one of their labs.

     The new interns gathered for orientation bright and early on June twenty-ninth.  We had to be prepared to start our clinical rotations on July first.  Karen, the program coordinator, handed out a massive stack of orientation materials and went over some basic information.   Shortly, Dr. Bernard Kaczanek burst into the room.  He was the Program Director for the residency and was brand new to the hospital.  No one really knew what to expect from him.  Dr. Kaczanek looked us over, and after a long silent pause, started talking.

“Each and every one of you in this room is going to kill someone,” he bluntly stated. 

     He paused for a moment to let that sink in.  I glanced at Jack, the other new intern, who had a perplexed look on his face, as if he might be wondering the same thing I was – is this guy insane? 

     Dr. Kaczanek continued, “Oh, I know you don’t think it’ll ever happen to you.  But I guarantee, each one of you, with something you do with your hands, will kill someone.  I am not saying this to scare you away, or make you think you’re incompetent or incapable of doing surgery.  I say this because each one of you has to have respect for what you are about to learn to do.  Most people, at some point in their lives, will go under the knife.  I’ve had a hernia fixed.  Sanders had his prostate lopped out.  Karen has had her ankle pinned.  Almost everyone goes under the knife, but very few will ever stand above the knife.  You are about to become one of the elite few who stand above the knife, hold the knife, wield its power.  Don’t ever forget the power of what you are about to spend the next six years learning to do.  Don’t ever take for granted that another person is allowing you to cut them open, trusting that you will fix whatever is wrong, close them up, and they will survive.  Not only survive but be better off than they were before they went under your knife.  You have the capacity to cause death or injury with every cut of your scalpel.  No procedure is without risk.  I have seen people die from an IV in the hand – the site gets infected, then they get bacteremic, then septic.  They go into shock.  Next the kidneys fail, then the lungs, then they die.  All because someone started a simple IV.  Everything you do from now on carries risk to the patient, but they will trust you.  And you will end up killing some of them.  You won’t mean to do it, but it will happen.  You can’t be in the business of operating on people, removing organs and repairing organs and rearranging things inside people without occasionally causing harm.  But you also have the capacity to heal and cure, and fortunately, this is what you will do most often.”

     He went on for a while about the art of surgery, and the great responsibility we were being handed, and ended with that same “You are going to kill someone” theme.

“A good surgeon will pick himself back up, learn, and go on.  That’s the key, that’s the difference between a great surgeon and someone who doesn’t belong here.  You will intend to heal.  You may do everything exactly right, but the human body comes with no guarantees.  You can do everything perfectly, and people still die.  Learn, and go on.”

     Dr. Kaczanek had been the Chairman of the Department of Surgery at a big university program out west, where he had run a well-funded lab.  He had held several different offices in the American College of Surgeons and was nationally pretty well known.  Everyone agreed on this much.  The big question everyone had was why was a big-time university-type surgeon willing to give up chairmanship of a huge department of surgery, walk away from a nicely funded lab, and come to little St. Mary’s Hospital and work for the nuns?    There was a swirl of theories floating around, most based on plain old non-verifiable gossip.  No one had much information on his reasons for taking the position at St. Mary’s.  People seldom allow a paucity of facts to stand in the way of forming an opinion.  Numerous ideas circulated as to why Dr. Kaczanek ended up here. 

“Well, I heard he embezzled millions of dollars from his lab.  He used grant money for his own personal use.  Yes, it’s true.  The University didn’t want to look corrupt in public, so they just quietly forced him to leave.”

“He had a long string of complications, and the University couldn’t cover for him anymore.  They wanted to keep him in research, because he brought in so much grant money.  They said he had to stop operating or leave.  So, he left.”

“The other surgeons in the department became jealous of his success – he had published more than the rest of them put together, so they drove him out.”

 “He had to get his family out of the state and give up his research because the drug companies were threatening him and his family.  He was on the verge of uncovering a cure for heart disease, but that would cause the drug companies to lose billions of dollars from cardiac medications.  They didn’t want him to find a cure.”

     If you asked Dr. Kaczanek himself, he simply said he was coming to the end of his career, and he wanted to just operate and teach residents, without all the red tape and extra obligations and headaches that had completely taken over his life for the last thirty years.  Simple, but not nearly as interesting as all those other possibilities.

     The Chairman of the Department of Surgery, Dr. Jim Sanders, spoke next.  He seemed a little ruffled by that intense introduction to surgery that Dr. Kaczanek just threw at us.  Dr. Sanders preferred to keep things pleasant.  He was always very cordial, saying the right things to placate people, but was not known for taking action or implementing change.  At the first opportunity, Shahid, the other new intern, raised his hand to inquire if there was any type of special award given out to the best intern at the end of the year.  Oh my God, I thought, he’s one of those.  One of those irritating types who constantly seeks to make himself look better than everyone else, and tries to make sure they get recognized for every little thing they think they do right.  A brown-noser.  A suck-up.  I saw Jack roll his eyes, grimacing as if this was the most ridiculous question he had heard in a long time.  Jack was a tall, lanky guy with glasses, who was wearing a dress shirt and tie, khaki pants, and some beat-up tennis shoes.  I knew I was going to like him shortly after I met him.  He would become the resident that I could always count on, in every situation, from needing a meal ticket to get some food in the cafeteria, to switching call and covering for me, to finding my husband and getting him to the hospital in time for the birth of our first child. 

     Dr. Sanders politely answered Shahid’s question.   “No, no there’s really no award for being the best intern.  The reward is knowing you’ve done a good job and knowing you’ve made a difference in patients’ lives.  The students do give a resident teaching award at the end of the year, so there is that.”

     Shahid’s face brightened at that.  I could tell he was imagining himself triumphantly receiving that award in a grand ceremony at the end of the year.  I knew I was going to dislike him shortly after I met him.  I had no idea at the time how intense this dislike would grow, how it would blossom into passionate loathing and the overwhelming desire to inflict severe physical harm, an emotion I usually did not harbor towards anyone.   So, these were my co-interns, who I would be inextricably linked to for the next year, for better or for worse.  With a mix of apprehension and excitement I looked forward to what the year would bring.