the faculty of Department of Surgery at Columbia University
College of Physicians &
Surgeons (P&S) realized that they weren't getting many residency
applications from academically oriented graduating medical students.
Since they felt that their mission was to train academic surgeons, they asked
around and learned that one of the most exciting areas of academic
surgery was organ transplantation, which in that era meant kidney
transplantation. However, the Chairman of Medicine at P & S, Dr.
Stanley Bradley, did not accept the use of dialysis, and since a
kidney transplantation program requires a population of dialysis patients,
P & S could not start such a program. Dr. George Humphreys, the Chairman
of Surgery, was unable to persuade Dr. Bradley to change his mind, so he
decided to start a dialysis program within the Surgery Department.
Frederic Herter, the Director of Surgery at Francis Delafield
Hospital, agreed to place
the dialysis program at that hospital and appointed Dr. Joseph Buda to direct
it. They bought a Travenol machine, installed
it at Delafield, and hired a nurse who had done some dialysis work.
In September 1968 they started looking for patients and found AW, a 35-year-old
man who had lost his kidneys from hypertension and could not get into one of
the scarce dialysis slots elsewhere. Dr. Buda admitted him to
Delafield, placed a Scribner shunt in his arm and then realized that AW
needed ongoing medical care. The medicine residents and attendings were not allowed to be involved with dialysis
patients, so he was immediately turned over to the senior medical student who
was just starting a surgical subinternship at
Delafield--me! I walked onto the surgical ward in my whites and was told,
"Congratulations! You're going to take care of our first hemodialysis patient!"
I had no
idea what to do for this man. There were no books on dialysis in the
library. There was a book on uremia but it didn't mention dialysis.
I did find a few articles in Index Medicus, all of
which were experimental (there were no computers and no Medlines). Twice a week I wheeled AW down the
hall and watched the nurse hook him up to the machine. I prayed that
nothing bad would happen; fortunately it didn't.
later, I received a second uremic patient, a woman with severe lupus whose
kidney function had failed despite medical therapy at the private Harkness Pavilion. Since patients with systemic
diseases such as lupus were excluded from the few dialysis programs available,
she was clearly going to die without this treatment. Transfer to
Delafield was seen as a last-ditch effort to keep her alive.
Unfortunately, she also had severe thrombocytopenia, and attempts to place a
working Scribner shunt led to copious bleeding, so she never received dialysis.
She was eventually transferred back to Harkness.
I felt as
though I was flying blind. The surgical attendings
and residents were sympathetic, but they couldn't teach me much about
either dialysis or uremia. I remember saying to myself, "If I get
out of this without a major disaster, I'll never have anything to do with
dialysis again." It just goes to show one should never say never.