Thanks ever so much for your letter. It was also grand to talk to you and to hear the cheery "who stole the till"
in the background. We are all very glad here that you're having a fine time there.
Bob Watman is coming here to look over the situation on Tuesday. If he doesn't take it, I don't know what we'll
do; perhaps I will suggest Adrian Kantrowitz. He is very interested, having asked about the job.
I wrote to Phil Crastnopol about his paper, and got a letter back indicating that he thought it should be published and inferring
that he would go ahead without mentioning the Department. He excused this on the basis of the fact that the illustrations
he had of the technique are the best that he has seen. So he said he would write it as a technical paper rather than as a
report of results. I think I'll just let it go at that.
The business in the Emergency and Admitting room is still being tossed around. At the Executive Committee meeting on Tuesday,
it was finally decided that the only way we could accomplish anything is for me to go ahead independently and get what I can
out of Gollance, mustering the support from whoever will give it. I am sure that Eichna, Harmel, and Mellins will scream with
me to Gollance to at least test him and see what he intends to do. Eichna is very much interested in getting this straightened
out. He is intent on establishing the principle that we want to keep patients out of Kings County Hospital except those that
really need hospitalization. He is fighting to change the admitting policy so that there will be no administrative admissions
whatever. Eichna is very busily engaged in a campaign to get everyone to concentrate their efforts on Kings County and not
spend energy working for programs in the affiliated hospitals. The question came up of accepting residents here from affiliated
hospitals for part of their training, and he objected unless it very definitely benefited our program. He apparently is interested
in developing a strong, full-time, Kings County oriented staff and does not want to have divided loyalties. This sounds good.
He has set a target date in the Executive Committee of April 1, 1961, for establishment of a combined record system. He says
he is going to see this through, and the way it sounds Gollance will have to put up an awful lot of resistance to stop him.
The recovery room situation in the E building is such that we have decided to use the day room on the 7th floor for this,
and use part of one end of the day room along with one of the private rooms for the vascular laboratory. The plans for this
are now being begun by Bob Renck, and the question of where we will get the money to put in the partitions and the necessary
facilities will come up next. I hope that we can get some of this from the hospital. I've been under the impression that
any money for these construction purposes comes out of the State budget out of our supply allotment. Is this correct? Anyway,
Wes is working on this and we're making noise about it.
I haven't heard much about the special cardiac diagnostic laboratory except that things have been running kind of haphazardly
there because the equipment doesn't always function properly. I get the impression that Lynfield is doing most of the
work there, but what the politics of it are I haven't inquired about. Wes and the vascular people are doing their work
in the E building now.
Your impression about the Overholt (that is, the Foregger) low volume bubble oxygenator is correct. At a flow of 1500 cc.
per minute it generated a significant number of bubbles in the bottle and a dog perfused with it and tested for breakdown
of the blood brain barrier showed four-plus brain. It wasn't tested at higher flows than this because it seemed as though
the evidence was sufficient.
After considerable thought, I decided to hire a man for the laboratory on that teaching assistant line, and Joe Hill tells
me it's perfectly alright to do this. So I've asked Jack Stuckey to find somebody with the idea that we would use
this person to take care of and run the pumps, both in the laboratory and hospital. That is, if we can find the kind of person
we want. So far it has been impossible to get a person who will stay here who is also capable of this. If we could find somebody,
it might be well worthwhile.
The medical people and pediatricians have not been very productive of cases for open-heart surgery. We have one scheduled
for next week which is an interatrial septal defect with bilateral congenital stenoses of the main right and left pulmonary
arteries. We plan to resect these pulmonary artery coarctations and fix the I-A defect. They had another interatrial septal
defect who refused operation. I understand there are cases lying around, and I suppose they will get them worked up gradually.
The medical students and house staff are very cognizant of the difference in caliber of our attendings on our wards, depending
on whether they come from the old A or B service. Because the teaching on rounds was so deficient on these (NA) wards, I have
asked some of our men who are preceptors to the students that are assigned to these wards to make rounds along with the attendings
and house staff weekly for the so-called grand rounds. I have an idea this is going to result in many attendings on the A
side not coming, but I think that we're going to have to accept this. The fact that we have our house staff as well as
medical students on these wards, it seems to me, makes it mandatory that we have adequate teaching. I just hope that some
of these people don't resign entirely and make our O.R. coverage difficult. The definite weakness of these people is going
to continue to be a problem, I'm afraid.
The rotating interns on our service are still complaining to Marty Metz, he tells me. On the basis of this, we have established
another set of rounds for the interns alone with one of the attendings each week on each ward. This, together with increased
emphasis on teaching by the residents, we hope to help this situation. I have tried to bolster the teaching in the OPD by
assigning attendings so that a specific man goes there each day, and I have asked Harold Fishbone to teach there continually
as he used to do. I hope that this will help to solve our weakness in that area.
We have some excellent applicants for residency for next year. I almost have a hard time deciding which of the good men to
take, I hope we won't be fooled and take the wrong ones, but some of them are certainly well worth betting on. We will
be able to take on about nine new people, the way it sounds, and we may put at least one of these in a level of about senior
assistant resident, Our numerical strength at this level next year will be less than optimum. I continually hear complaints
concerning Dignan and Minkowitz. Apparently they are rather weak. I am making every effort to get a plastic surgery residency
for Minkowitz as soon as she's finished her third year here. Dr. O'Brien is rather reluctant to take her on because
he says the Board is complaining that the women he has been training have not done very well and amounted to anything in plastic
surgery. So with this resistance, she is looking elsewhere. It may be difficult for her to find a job since it seems as though
these jobs go to select folks years ahead.
The final proofs for our Chapter for Pack's book have been sent back. They wondered about the reference from which some
of the illustrations are taken concerning the paper in Surgery that we marked down that is "in press". I reassured
them and indicated it would be alright for them to put this down as a reference because you were writing the paper and would
have no trouble getting it published in a journal where you were editor. This seemed to satisfy them. So I suppose the book
will be out in about a year now.
Dr. Seldin of the dentists has been after me to change some of the ground rules upon which his oral surgeons cooperate with
the plastic surgeons. He wants me to authorize him to sign out the charts on the fractured jaws that they fix. Apparently
they have a fairly good working relationship in that they alternate these cases. However, they are on the plastic surgery
service and have to be there because they need a medical man's supervision. I am more than sort of hesitant to let his
name go on the chart as attending and have him sign the charts on this basis. He wants to do it because he says his residents
will have to have this as indication this have taken care of the patients for Board credit and also because he wants to send
out bills for his education fund. I still am not convinced and am putting him off on the basis of the fact that I am supposedly
collecting information about how other places are run. Some of O'Brien's people are doing this and Seldin is too.
All in all, it seems as though it would be rather difficult to have Dr. Seldin as the responsible attending on cases that
need medical supervision on our service. I'd like to know your reaction, but with some support from you we might put off
making any kind of final decision on this until you come back.
These are some of the things that come to me as I sit here with my feet up. You can see that things haven't really changed
much, but we are trying to keep the ship from sinking so that when we get back you will have something to pilot. We are all
in good health and are enjoying the lovely fall days with their golden hues, Our best to you, Ellie, and the kids.