When I first read the news this month that Thomas Starzl, MD, had died, I immediately remembered the stirring description Bud Shaw, MD, wrote about training with the trailblazing transplant surgeon in the 80s.
I’ve read quite a few books by doctors and am particularly fond of memoirs. In that genre, Shaw’s book, “Last Night in the OR: A Transplant Surgeon’s Odyssey,” stands out as one of the best. And I’ve never forgotten Shaw’s description of Starzl’s intense personality.
Shaw, who went on to become a notable transplant surgeon in his own right, cut his teeth alongside Starzl at a time when liver transplants were still controversial and the physicians were on the front lines of groundbreaking and highly risky operations.
Shaw chose to open his memoir with a story from his early days training with Starzl and describes a transplant operation the team was attempting on a patient with a failing liver. In Shaw’s recounting of the events, he casts himself as a rookie fumbling clumsily through the operation while Starzl barks orders and doesn’t hold back on his critiques as Shaw shows he isn’t yet up to snuff.
It’s clear from Shaw’s description that Starzl was a force in the OR who said and did whatever it took to get the operation right. Here’s an excerpt from the first chapter of the book where Shaw, Starzl and the rest of the team are working furiously to stop the patient’s bleeding:
“Shit,” Starzl said and threw another stitch where I’d broken mine. This time I pulled too hard and the silk pulled out of the tissue and a blood torrent erupted. Carlos [Fernandez-Bueno] grabbed a sponge and pressed down, then got out of the way just as Starzl threw another stitch and tied it himself. He threw two more in the same spot, Carlos tied one and Shun [Iwatsuki] the other, and finally the bleeding stopped. Shun frowned at me and vaguely shook his head.
I decided I could cut the ends of the stitches after they tied them. It was a job we gave to medical students. I was a trained surgeon, and a good one by all accounts...So I grabbed a pair of scissors and cut the suture.
“Too short, goddammit,” Starzl said. “That’ll come loose and he’ll bleed to death. Is that what you want?”
He laid down another stitch and Shun tied it, four throws, and I cut it.
“That’s too long,” Starzl whined. “Come one, now, Shun. Help me. He doesn’t know what he’s doing.”
At the end of the first chapter Shaw circles back to that night in the OR with Starzl. Despite Starzl’s terse language and insulting jabs, Shaw’s reverence for his mentor was high. It’s clear that Shaw took the opportunity of recalling his early struggles in the OR to illustrate how out of his league he was — and to highlight how much of his training and career he owed to Starzl.
The end of the chapter reads:
Sometimes I’d try to help and lean in just a little and I’d bump Starzl’s arm or his shoulder and he’d give me a hip check or an elbow to the chest. I didn’t think it was intentional. Protecting his space was instinctual.
That first night, I couldn’t yet see the pattern in anything we did. Often, Starzl just grabbed whatever hand was close by and shoved it where he wanted it, with no apparent regard for whose hand it was or what else it ought to do. “Shitfuckgoddamn,” he’d hiss. “I can’t see.” “Don’t hinder me, help me,” he’d say when someone tried to help and failed. That was my initiation to the operating room of Dr. Thomas Starzl, and although I didn’t know it at the time, these were but a few of the phrases I would learn to hate and mock and, in the distance of time and place, yearn to hear again.