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Surgical Reminiscence
November 2001

Joe

Arch Surg. 2001;136(11):1323. doi:10.1001/archsurg.136.11.1323

IN 1969, during my last year of residency in the United States, I was chief resident in surgery at St Luke's Hospital (Bethlehem, Pa). One night, a 37-year-old man arrived in a critical state at the emergency department with multiple bullet wounds. This man, whom we will call Joe, had worked for a number of years at the Bethlehem Post Office but had to leave the job because of a severe mental disorder that made him act strangely on occasion.

One Sunday afternoon, Joe arrived at the post office carrying a .12 caliber rifle and asking for the head of the post office because he wanted to kill him. Fortunately, the boss was not there, and Joe left in a rage to find him. The workers called the police. I was having lunch on the third floor of 555 Springer St with my wife when we heard the police sirens close to our house, followed by gunshots. A few moments later, a call came from the hospital asking me to hurry back. When the police found Joe, who was out looking for his ex-boss to kill him, they cornered him in an alley. Police cars surrounded him. He got out of his car with rifle in hand, and the officers started negotiating with him. Apparently he agreed to turn himself in, and one of the police officers, convinced, put away his gun and walked toward Joe to take him in. Suddenly, Joe lifted his rifle and shot the officer at close range, killing him instantly. The other officers immediately fired back, shooting Joe several times in the forearms, thorax, and abdomen.

Joe was taken to St Luke's and rushed to emergency surgery, where pulmonary and intestinal injuries were repaired, as were broken bones in the upper extremities. Postoperative recovery was favorable. He had a 24-hour police guard in his room, and he was almost always cuffed to the bed. I was the physician in charge. One day, Joe asked to speak to me without the presence of the police. He told me that the police wanted to kill him: during the day they constantly shook his bed to keep him awake, and during the night they took off his blankets and opened the window to the cold winter wind and administered the intravenous solutions quickly so that he would die. This was hard to prove, especially since he was getting better each day. I spoke to Paul Kiel, MD, chief of surgery, and arranged for the police to stay out of his room at night and for surveillance immediately outside the door. Time passed, Joe's wounds healed, and he was transferred to the state prison to start his trial for killing the police officer.

I finished my training, and in January 1970 I started my practice as a general surgeon in Mexico City. Two or 3 years later at the Annual Meeting of the American College of Surgeons (which I have attended each year since I left the United States), I met my former boss, Dr Kiel. After reminiscing about old times, I mentioned to him that I would like to return soon to Bethlehem to remember the happy years I had spent there. The first year of my training was spent in the Graduate Hospital of the University of Pennsylvania, and I had been sent to rotate at St Luke's with the idea that if I liked it I could finish my training there. This I did, which provided many things, among them the opportunity to tell you this story. Dr Kiel, in a very grave tone of voice, said that I could not return soon to Bethlehem. "Why not?" I asked, worried.

It turns out that our old friend Joe had decided to take up his own defense in prison, and one of the first things he did to obtain funds for his defense was to sue Dr Kiel and me for $100 million each for attempted murder. We did not know whether to laugh, cry, or feel offended. After all, we had done all that was in our hands to save him. What is most important in our life as physicians is to always offer our best knowledge and resources to the patient who has faith in us, without caring that once in a while a "Joe" will show up, someone who does not recognize or value the effort we put into our work, and who even impedes us for a moment from returning to a well-loved place. Fortunately for us, that lawsuit did not prosper, and the court's decision was not favorable for Joe.

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