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Invited Critique
February 2001

The BKOOTORBBE Club—Invited Critique

Arch Surg. 2001;136(2):238. doi:10.1001/archsurg.136.2.238

The principal duties of a director of a surgical residency training program are to prepare his or her pupils to be safe practicing surgeons and to instill the discipline required for such practice. With an occasional resident, the latter is more difficult than the former.

Dr Rainer applied for a residency while still in his army uniform, having emerged a few days previously from active duty in Korea as a battalion surgeon in the third Infantry Division. His referral "center" was the mobile army surgical hospital (MASH) subsequently made famous on television. With such a background, he clearly required rehabilitation.

I accepted him largely because he and his wife Lois sat through the interview holding hands in my office.

It soon became obvious that Dr Rainer was disruptive by his constant insistence that the Confederates deserved to win the Civil War, despite my frequent factual corrections. For the sake of peace, it became necessary for me to create separate blue and gray services.

A sampling of other episodes requiring my fatherly intervention during his residency involved the following:

Arranging for an infamous Denver danseuse to come as the date of an unmarried resident to the insufferably stuffy Christmas party, where faculty wives predominated. At the appointed hour Marvena livened the party by going into her act. I believe this was the last such scheduled hospital holiday party.

Placing an eye patch over a patient whom he wanted to avoid presenting to me as a complication, with the explanation, "Just another post-op eye patient."

Creating a hypothetical patient and an increasingly large hospital record filled with complications on the service of an attending physician who was well known for making chart rounds in lieu of seeing the patients on the service. I learned of this hoax when Dr Rainer was scheduled to rotate off service, and he explained that it would be up to me to choose whether the chart should be closed on this nonexistent patient by having him jump out of the fourth floor window or suddenly expire from a bleeding stress ulcer.

Infusing radio opaque dye into the left main coronary artery via a spinal needle inserted supraclavicularly into the base of the aortic arch while we were developing a technique for visualizing the base of the aorta. Performed on the awake patient under fluoroscopic guidance, this predated coronary arteriography and I was certain it would result in lethal fibrillation. As I recall, I, in hushed tones, indicated to Dr Rainer the gravity of what he had done.

In summary, I question not why I threw Dr Rainer out of the operating room, but why I limited it to this occasion.

I suggest the editor of this journal will open Pandora's box by inviting rebuttals from still-living surgeons targeted for surgical reminiscences. Foibles of previous residents who subsequently achieved professional prominence and dignity after recounting reminiscences of their chief is an unmined source of salacious anecdotes having unimagined implications.

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