I have a new favorite doctor show, “The Knick” on Cinemax, airing on Friday nights. The show stars Clive Owen as the charismatic cocaine-addicted chief of surgery Dr. John Thackery at a fictitious New York City hospital called The Kickerbocker at a time when surgery was one foot out of the barbershop. The tagline is, as they say, priceless: “Modern medicine had to start somewhere.”
On the third episode, last Friday night, Dr. Thackery performs a pedicle skin graft from the upper arm to cover a gaping hole in a woman’s face where her nose used to be, before she got syphilis. Back in those days, this was a marvelous feat. Real progress in what we now know as reconstructive surgery didn’t come until the end of World War I, when Sir Harold Gillies, a New Zealand otolaryngologist later known as the “father of plastic surgery,” established the first hospital ward for the facially wounded in Queen Mary’s Hospital in Kent.
For over fifty years, I have been a bystander to the evolution of plastic surgery. As a teenager I remember the heady early days of microvascular surgery; my father, Dr. Melvin Spira reattaching the scalp of a man whose hair got caught in machinery, then the tales of sewing back severed fingers and ultimately entire limbs with gradually improving functional results. In the 1970s the great French surgeon Dr. Paul Tessier, pioneer in techniques for cranio-facial surgery to correct birth defects came to the United States to teach, and I remember a Saturday morning clinic at my father’s office, where mothers whose children’s facial deformities were so severe that these kids had, literally, never seen the light of day waited in line to be seen by the great surgeon who could give them back a normal appearance, and thus a life.
Plastic surgery, like my own specialty of radiation oncology, has become one of the “lifestyle” specialties to which medical students aspire, particularly those with an artistic bent and good hands, and for good reason. Cosmetic procedures are highly reimbursed, and are done during “regular” working hours. Walking around here in San Diego and Los Angeles, surely two of the plastic surgery capitals of the world, it’s easy to spot who has had “a little work” done. Having one face lift might be a good thing (I wouldn’t know because, as I’ve covered in previous blog pieces, my imagination runs wild with the possibilities of complications and I am far too chicken for elective surgery), but have three and you become one of “our ladies of perpetual surprise”: eyebrows at the hairline. Same goes for breasts; it is not normal for the “girls” to be rigidly immobile as their owner pounds away at the Stairmaster.
Last year, I mentored a medical student who had started his medical education thinking that he wanted to become a plastic surgeon. After a beloved aunt developed breast cancer and needed radiation, he started to think that perhaps he would rather become a radiation oncologist because he enjoyed dealing with cancer patients. He was an outstanding student, and I was quite sure that he would be accepted, and do well in either specialty. I assured him that with his gifts, and his compassion, he could combine his interest in helping cancer patients with his interest in reconstructive and restorative surgery. Residency interviewers for plastic surgery residencies have a difficult job these days: All of the applicants say they want to do reconstructive surgery, but most end up doing cosmetic work.
Apparently my student was convincing when he said he wanted to do plastic surgery to help cancer patients. He started his plastic surgery residency at Stanford last month. Dr. John Thackery of “The Knick” may be fictional, but I hope that my student leads the way in new innovations in reconstructive surgery. My cancer patients may depend on it.
Miranda Fielding is a radiation oncologist who blogs at The Crab Diaries.