CURRENT BOOKS: What Doesn’t Kill You Makes You Stronger

Peter Bretan, MD, FACS

The Year THEY Tried To Kill Me, by Salvatore Iaquinta, MD, 352 pages, Purely Chaotic Publishing.

According to Dr. Salvatore Iaquinta, “Internship is the first year of residency. The surgical internship is the basis for the urban legends about doctors working 48 hours straight without sleep and then doing a ten-hour case on your mother.”

In his book The Year THEY Tried To Kill Me, Iaquinta--who is now an otolaryngologist at Kaiser Permanente San Rafael--chronicles his surgical internship at Highland Hospital in Oakland from 2000 to 2001. His orientation begins with a pep talk from one of the chief residents: “If a surgeon tries to break you, don’t. Remember that They are trying to break you. Let their insults roll off you like a bead of water. If you snap back once, it will haunt you. Nobody here forgets anything.”

Iaquinta’s book helped me relive my own surgical residency from 30 years ago, but this time I could laugh and smile about it because of the humorous self-deprecation he eloquently injects into the raw reality of universally intense, serious episodes of real-life surgical events. One need not be a physician or surgeon to enjoy his book. In fact, everyone can be thoroughly entertained by his true-life diary, in which he shares his experiences with circumspection and sensitivity, not typical of the public’s perception of surgeons.

Many previous depictions of the surgical life--such as The Making of a Surgeon, The House of God, MASH and ER--are humorous as well, but this book demystifies surgeons and portrays them as human being with emotions and frailties, just like their patients. Iaquinta shares his angst, anxiety, love, loneliness and eventual triumph, all against the backdrop of life and death in a busy county hospital which, as he typically understates, “can be a thankless place.” I am particularly grateful for his dispelling of the typecast that all surgeons are cold steel, insensitive, callous, highly prepped technicians as a result of their grueling training.

Iaquinta answers the age-old question of why anyone would choose to endure such an intensely abusive year, followed by a career of taking on high-risk patients who suddenly require life-threatening operations and are often in need of vast emotional support. He answers simply, “I really want to cut people. In a legal, organized fashion, which is mutually beneficial to the cutter and the cuttee. Seriously. I’d die of boredom if I couldn’t work with my hands.” His answer is pure and from the heart. A surgical career is motivated by the individual satisfaction of expressing talent, training and art. The wonders of being able to perform life-saving surgeries are a reward unto themselves.

Iaquinta was born, raised and educated in Wisconsin. He devotes a chapter to the reasons for his cross-country odyssey to Highland Hospital, which was unlike anything he had ever done previously. The move was a stressor for him and his college girlfriend Rachel. Unfortunately, their long-distance relationship, which sustains him through his internship, also ends with it.

The most compelling chapter describes how Iaquinta uses his personal experience with the death of his father to empathize with a dying and comatose patient’s family members and prepare them for her inevitable death. His sensitive interaction with the surviving family represents common aspects of the practice of surgery seldom known or appreciated by the public.

I called Iaquinta recently and asked him to describe the process of writing his book. He said it started with an email to a friend describing the first day of orientation. His friend replied, “Don’t stop writing, it’s priceless.” He didn’t. By the end of his “near fatal” internship, the diary was about twice as long as the final book. He spent several years honing the manuscript and emerged with a must-read for anyone who wishes to share one of the most intense years of training in any profession.

The book’s characters are real, but most names are changed. One notable exception is Dr. Organ (now deceased), Highland Hospital’s pioneering chief of surgery, renowned not just in the Bay Area, but throughout the world. Organ questions Iaquinta’s decision to specialize in otolaryngology by asking, “Are you sure you want to be a nose picker the rest of your life?” Another memorable character is Corey, a chief surgical resident who is even-keeled and fair. Iaquinta reflects that, “Dr. Organ can be King of the Hospital for the rest of his life, but it will be Corey that I respect for throwing that extra stitch into the dude with the perforated ulcer.”

In an epilogue, Iaquinta writes, “Despite being a big, smart doctor, I still can’t believe people let me cut them, even if it is in a mutually beneficial manner.” His book has received high acclaim since its release late last year. I thank him for his percipient record keeping of the special lessons of his surgical internship, as they are special for all of us. His work helps honor and elucidate the art of surgery.

 

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Dr. Bretan, a past president of MMS, is a urologist and transplant surgeon with offices in Novato and Sebastopol.

Email: bretanp@msn.com