John N. Baldwin MD

Address To The UCSF Surgical Society And Annual Course: May 17, 2013
The University of California San Francisco

Thank you, Dr. Eastman. It is indeed a pleasure to be here, and welcome… surgeons and guests in the audience! I hope that I can add to your enjoyment of this morning’s fine program.

Forty-six years ago last month, in 1967, appropriately on April Fool’s Day, I was finishing my sixth year at UCSF, age 34, having become the chief resident in Cardiac surgery, and was in the middle of an aortic valve replacement on bypass, when the famous yellow Western Union telegram came to the door of OR 6. The circulating nurse said, “It’s for you, Dr. Baldwin. Should I open it?” I replied, “You sure can, but I pretty much know what it says.” And I did. “Greetings! You are being inducted into the United States Army. Lyndon B. Johnson, President.”

And so a chapter in my life closed and another opened. It was actually a relief, as I had not decided among three open offers, so this made it all very easy. It verified my father’s famous statement, which has proven true for half a century; “Life is what happens to you while you are making other plans.”

Following my two years in the Army, the last of which (1969) was spent as chief of thoracic and vascular surgery at the 24th Evacuation Hospital in Vietnam, I went back to Monterey, California and began a wonderful, exciting and very fulfilling thirty years of private practice. Those were the days of collegiality, honesty and relative freedom in the practice of surgery, and they remain fresh and happy in my memory. I remember asking my senior partner in July 1969, “I have never billed for anything, ever. What do we charge?” He replied, “New patients are 8 dollars and revisits are either 3 dollars or 4 dollars, depending on difficulty.” “OK”, I said, and went with it. The motto then was: “We make friends in the office and money in the OR.”

My focus today is on the incredible educational experience that was the UCSF surgical program back in the 1960s. We utilized three hospitals: the University, the Veterans Administration at Ft. Miley and… and THE great San Francisco General. There was no question about it, when I hit incoming casualties my first week in Vietnam, it was “The General” all over again, just huge volumes, but no relatives in the waiting room and no attendings hovering over me. The several UCSF guys who went over were ready from day one.

The residency back then, (and now) was Long! Very long. It battered and bruised families and only one of the four chiefs in my year had the same wife four years later. It paid poverty level wages. As a first year surgical resident in 1961 the salary was $130 dollars a month. It was a shame that food stamps had not yet been invented! Professors were emperors, and one old guy never hesitated to smack your knuckles with the Metzenbaum scissors… if he thought you were dozing on the Deaver retractor, or snored standing up.

“Emergency week” at SF General meant that you went there Monday morning of one week and did NOT go home until the following Monday night, with the upcoming week permitting you to sleep at home, but the usual 14-hour days at work. It was amazing that nobody complained, probably because we were all in it together. I guess there were no child labor laws in those days.

As with all of us, and you, in our training, we learned from those who really could operate and from those who could not. (Probably equally!) Dr. Dunphy made it simple: “Look Baldwin, it’s really easy. You watch a surgeon cut a common bile duct and you say, ‘I’m NEVER going to do that.’ And you don’t. You watch a surgeon make a big mistake and you say, ‘I’m not going to do that’, but you do! So you say, ‘OK, don’t ever do that again.’ And you don’t. Then there is the guy who just makes the mistake over and over and over again. Believe me, you don’t want to do that. You get it?”

The residency in my day was non-competitive. If you were a first year resident in general surgery, you could, unless you had fallen asleep over retractors and fell into the field during a brutal 4 hour thyroid operation, expect to finish the program. That created great camaraderie among all levels, a feeling of belonging, a sense of cooperation and a love of each other that persists to this day among my fellows, among whom I include Dr. Eastman and dozens of other incredible surgeons, many of whom are here today: Drs. Al Hall, Bill Blaisdell, Carlos Pelligrini, Frank Lewis, Karen Deveney, and others too numerous to name. It was, despite it all, a lot of fun.

The most important part of the five-year program, in my opinion, started in the first two years, when specialties other than general surgery were part of the rotation. I was fortunate to learn urology from the great Frank Hinman, Jr., orthopedics from the classy Edwin Bovill and neurosurgery from the giants who had trained with Howard Naffziger. At the time, it didn’t register that this incredibly broad experience would enhance my future abilities as a surgeon and as a person; that understanding renal anatomy, hip fracture causation, and early symptoms of brain cancer would all be part of the physician that I was to become, endowing me with a greater understanding than just simply… ”Hey, look at me! Wow… I can fix hernias!”

I would like to close by inviting you to view a DVD that will endorse my last point about the benefits of the multi-field surgical education that our residency provided. This television special employs still and movie footage that I personally took in Vietnam and it was awarded a double Emmy, for CBS-TV and the producer, lovely Tanya Foster.

This will re-enforce another of my father’s oft-quoted remarks: “It pays to be in the right place at the right time.”

Thank you, Brent, for the opportunity to address this great group of surgeons. I hope all of you find The Course and San Francisco everything you had expected, and hopefully more.

Please begin the video.

The video “Images of Bravery” is color and sound and 6:57 minutes long. It describes in action photos videotape and stereo sound, the 199th Infantry division moving into hostile jungle country by helicopter, a young sergeant (in his own words) describing being shot in the head by two AK-47 rounds, being taken to the 24th Evac, and then, in my words, and pictures, his being placed in “expectant behind the curtain” status until I saw him move and took him, as my patient to the OR, as “all the neurosurgeons were busy”.

Follow-up 40 years later shows us in reunion and his being awarded the Vietnam Veterans of America “Images of Bravery” Award in 2008. Dennis Haines of Harrisburg, Pennsylvania.

The lessons learned during my 3 months of neurosurgery saved a life.