When Giants Walked the Land - J. Pikelman, MD - Forum

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When Giants Walked the Land - J. Pikelman, MD - Ärzteforum

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This new section in the ARCHIVES may be the perfect forum to pass on some
surgical folklore to a generation of politically correct surgical trainees
and young surgeons who may have never known a true character. Such a man
was George Edward Block who died July 17, 1994. In the obituaries that
followed, his multiple accomplishments were outlined and he.was justifiably
lionized as a man above men, a master surgeon, and an individual for whom
the mores of the herd meant little.

George spent most of his professional career at the University of Chicago,
and it is there that he forged his reputation, most memorably captured in
the now-legendary book on the training of surgeons, Forgive and Remember by
Charles Bosk. He published and lectured extensively, most notably in the
fields of inflammatory bowel disease and colorectal carcinoma. When he
spoke, all listened, because everyone knew that this man was speaking not
only from knowledge but also from personal experience. In a debate or
discussion, he could be eloquent or witty and yet in the next sentence
disembowel his antagonist. George could be as profane and crude as a truck
driver or as gentle as a lamb, and the presence of male or female medical
students, nurses, or patients had little bearing on which persona he would
assume. But despite this seeming lack of civility, no physician ever had a
more devoted following of his patients, who all recognized that this
surgeon was willing to confront their worst fears, exorcise them, fight
their surgical battles win or lose, and always return to comfort them and
their loved ones. To accomplish this, he was possessed of great physical
and emotional strength and he passed this on to those who worked with him.
But enough generalities; what about the human side of George Block?

My first serious contact with this force came at Medical Grand Rounds at
the University of Chicago, a well-attended but occasionally esoteric
gathering whose chief purpose some days seemed to be the glorification of
the speaker rather than the transfer of knowledge from the haves to the
have-nots. I was George's very junior resident and accompanied him to this
conference where he had been asked by the gastroenterology division to
speak on inflammatory bowel disease, a subject about which he had published
extensively. I sat next to him as a succession of young, clean-shaven
"experts" in the field pontificated about the relevant literature.
Meanwhile, I noticed he had become tense and obviously aggravated, so that,
when there were but 2 minutes left in the conference and he was called to
the podium with the question, "and Dr Block, do you have anything to add?"
I sat frozen in my seat, sensing something very dreadful was about to
happen. My worst fears were realized when he ascended the podium, grasped
the microphone, placed it in a subgluteal position and magnificently broke
wind into it. He then left the auditorium without saying a single word.

Within the next 2 months, this same man took aside a young Asian refugee
physician who had been awarded a residency position at the University of
Chicago - His Englishlanguage skills were minimal at best and his sole
clothing appeared to be a single white shirt, baggy pants, and open-toed
shoes. After seeing him flail and despair for several weeks, George took
him aside, arranged for English lessons at Berlitz, and then gave him his
Marshall Field's charge card and made out a listing of clothing, including
an overcoat, suits, trousers, shirts, underwear, and shoes. I was present
when he gave the list and his charge card to the resident and told him not
to return until he had purchased everything on the list. He then turned
angrily to me and said that if anyone ever heard about this incident, he
would have me fired on the spot. I truly believe he meant it.

My first chance to repay George came at one of the annual meetings of the
Western Surgical Association. In that year, the meeting was at the Mayo
Clinic and the night before my presentation', my wife and I were
desperately looking for a spot to have a drink, no easy task in Rocliester,
Minn, after 6 pm. We ended up in a bowling alley bar and there nature took
its course, so that by 2 am, I no longer had any anxiety whatsoever about
my talk the following day. Upon arrival back at the Kibler Hotel, my wife
and I agreed we had to do something to repay George. Room service with
delivery of champagne or flowers for his wife Mary were duly considered
before we settled'oil an enema, to be delivered at 5 am that morning by the
hotel nursing staff. Strict instructions were given, describing the
patient's shyness and his anticipated unwillingness to proceed, and the
nurse was encouraged to use all of her strength and poersuasive skills to
consummate the act. In the bleak sobriety ofmorning, what had at the time
seemed like a brilliant idea appeared somehow misguided, as I sat at the
scientific session and awaited George's entrance. He stood behind me,
breathing heavily for perhaps the longest minute of my life. He then sat
down and never again mentioned the incident. Forgive and Remember.
Word of George's tenacity spread far. When he was president o f the
Western Surgical Association in 1993, the presidential suite in a Seattle
hotel was reserved for him; unfortunately, several weeks before the
meeting, the local arrangements host was informed by the hotel that the
suite had been reassigned to the Sultan of Brunei, the world's richest man,
who was going to visit Seattle at that time. George's response was
typical. "Screw him. He's only a Sultan. I'm a President! It's my
g-----d-----room." That promptly ended the crisis and the meeting
proceeded uneventfully.

In his last year, George suffered yet another heart attack and underwent a
redo coronary bypass, unfortunately marred by a succession of septic
sequelae requiring ventilator-assisted support in excess of 1 month. When
he finally returned to his farm, he was extraordinarily weakened and could
barely walk. Recovery was painfully slow and to my eye, accompanied by the
first sign of weakness I had ever seen in the man, a subtle but persistent
depression. Sensing the need for extreme measures and quite in defiance of
his wife, I pirated him some very expensive bourbon, one of his past loves
that had been denied him for many months. Within an hour, his spirits
revived and I felt I could ask him something we had all been wondering,
namely, whether he thought the long pump run and subsequent complications
had affected his mind. He did not hesitate a second, stating that he too
had suspicions, for when he first awoke, his initial thought was that if he
survived he might vote Democratic in the future. He went on to add that
the idea passed quickly, and at that point we all knew he was back.

As 1 of 6 colleagues who cartied George to his grave, I felt I had been
granted a special gift in knowing him. Profane and irreverent he may have
been, but let no man dare say he was uninteresting. There are no
replacement parts for such a man.

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