You Will Do The Surgery
I was walking into the lobby of the UERMM Medical Center when I overheard my name. I turn to the front desk saw this Caucasian guy telling the receptionist he wanted to see me. That was early part of 1971 and I was then a medical intern at the medical center, dressed in my all white uniform. I approached the desk where he was standing, extended my hand and introduced myself as Laurence Gayao.
In turn he shook my hand introduced himself as Dr. Willis Gentry Dick. He said, “I am an American medical missionary and just took on a new position as a director of Mindanao Sanitarium and Hospital in Iligan City (southern Philippines). He looked me straight in the eyes and said I have an opening for a Physician and I think you are the right man for the job.” I was rather taken a back, having never met him before. Then it dawn on me that he must be a brother of my favorite college professor because they had similar facial features. So I answered that I would take him on his offer.
After I finally finished medical internship, I went to visit my folks who were excited that I was to do residency in a hospital not far from where they lived. On July 1, 1971 I when to the hospital and reported to my new boss Dr. Dick who took me around an introduced to all the employees that were working. The mission hospital had about 70 beds and was relatively well equipped compared to other hospitals in that area. I was given room at the hospital for free with free meals at their cafeteria.
Dr. Dick a 1946 Loma Linda University School of Medicine graduate, had an extensive mission experience and was a fellow of the International and American College of surgeons and board certified by the American Academy of physicians. He attracted many patients from other communities around the city. I soon got busy assisting him caring for different cases. Between seeing patients, reading books and journals in Dr. Dick’s library it seemed like I was more busy then than I was in medical school.
Early one evening I was summoned to go to the emergency room stat. As I got there a patient on a gurney was being wheeled in. The individual was holding his abdomen curled up in pain, and another guy was trying to beat him up with his fists. I immediately run to meet the patient and yelled at assaulting fellow in the local vernacular, “You SOB get the hell out of here, right now!” That caught everyone’s attention and the assailant got out or the way immediately.
After a brief history and examination it was obvious he needed to go to surgery to explore for internal injuries. I immediately told them to call Dr. Dick, start an IV, through it give fluids, medication for pain and draw blood for the laboratory studies. When Dr. Dick arrived I gave history and physical findings about the patient. He then proceeded to check on the patient and agreed that he need to go to operating room right away.
Dr. Dick then asked me, “Laurence, are you able to give anesthesia?” The question caught me by surprise and I told him, “No, sir.” He then said, “Well, you will have to do the surgery and I will give the anesthesia.” I said, “Doctor, I have never done anything like this.” He answered “You will be alright if just listen to me and do as I say”
The general anesthesia that we used then was ether inhalation. Ether was safe, easy to use, and remained the standard general anesthetic until the 1960s when the fluorinated hydrocarbons (halothane, enflurane, isofluorane and sevoflurane) came into common use. Ether’s explosive flammability has eliminated its use in most developed nations.
In the operating room after scrubbing and putting on sterile gowns and gloves, I stood in the place of the surgeon after the patient’s abdomen was scrubbed and draped. Externally I appeared composed and in control but in reality I was filled with uncertainty knowing I never had any experience in the surgery to be done. Dr. Dick directed me to make an incision in the abdomen just below the xiphisternum to past below the belly button. With a scalpel layer by layer I cut through the abdominal wall, and using a cautery to stop the bleeders. When the abdominal internal organs were exposed there was no significant amount of bleeding that was visible. “Starting from the top of the stomach going down to the large intestine examine for any lacerations.” Dr. Dick Instructed. In the small intestine I found two lacerations. He then said, “Close those lacerations with chromic cut gut sutures. Close the laceration crosswise and not lengthwise so the diameter of the opening inside of the gut would not be compromised.” Fortunately after examination of the whole length intestinal tract and the rest of the organs there was no other signs of injury. I then put in saline solution into abdominal cavity to rinse it a couple of times. I then proceeded to close the abdominal wall incision. Dr. Dick then announced, “Congratulations surgeon Dr. Gayao.”
I after surgery I took care of the patient making sure there were no complications. Every time we made rounds Dr. Dick referred to the patient as Dr. Gayao’s surgical patient. He was discharge in after a week almost fully back to normal. After a few months I was doing most surgeries on my own and had to call Dr. Dick to bail me out when I was caught in difficult situations which happened a couple of times. One of them was I was doing a straight forward case of appendectomy. I tried seaching for the inflamed appendix but could not fish it out with my finger. I had Dr. Dick called, he after scrubbing and putting his surgical gown and glove got his finger into the incision and in five second had the appendix out and told me to finish surgery. I asked him what did I do wrong? He just laughed and said, “Sometimes that just happens to keep us humble, you will get better as you do more procedures.” It was good that he had an extensive library that I could study before attempting any procedures.
That was a time when there were limited amount of diagnostic studies and limited doctors in different specialties. We did not have any ultra sound, CAT scan, MRI and many of the other studies available today. In our hospital we did orthopedic, ENT and OBGYN surgeries in-spite of the absence of specialist in that field. There was even one time we did neurosurgery on someone who had a depressed skull fracture due being assaulted with hummer in the head. I saw cases that I have never seen in the US such as Tetanus, leprosy, thyroid crises, diphtheria, tuberculosis, amoebiasis and intestinal blockage due intestinal worms infestations.
I have practiced emergency medicine for the most part in the USA since I migrated here 47 years ago and my co-workers ask me how I am able maintain a relaxed composure no matter what happens at work? I tell them I seen worst cases in situations where there where limited resources and specialties to help me out. Here in the US the important rule is know your limitations, how use your resources and where to get help.
