“Good grief,” Dr. Rodriguez said. “He was against anesthesia?”
“Yes, as crazy as it sounds today. He believed that the pain that patients experienced was God’s work and shouldn’t be interfered with, or something weird like that. Anyway, for a while here at Bellevue there was a ‘pro-anesthesia’ faction and one that was against, led by Homer Fuller. Luckily pro-anesthesia won out, for obvious reasons, yet as I understand it, Homer kept doing his lightning-fast surgery without anesthesia long after it was generally accepted by most everyone else.”
“Homer Fuller kept doing surgery without anesthesia?” Mitt questioned incredulously. He’d never heard anything along those lines, or even close. All he’d ever heard about his medical ancestors was unadulterated praise. It was a source of significant familial pride.
“Yes, it seems so,” Dr. Harington said. “That’s what I read, and I have a reference to an obscure, unpublished article that talks about this, if you’re ever interested to learn more. In the 1970s, an NYU bioethicist named Robert Pendleton, who was as fascinated by Bellevue Hospital history as I am, somehow came across some revealing primary sources. Unfortunately, his untimely death from a heart attack intervened and his work was never published. As great as the Fuller surgeons clearly were in terms of operative skill, they did seem to have a penchant for being on the wrong side of what we now know were major medical advances.”
“What do you mean?” Mitt asked, taken aback.
“Another Fuller named Dr. Otto Fuller was responsible for a number of important technical surgical advances and was also, strangely enough, on the wrong side of another major advance that was as important in many ways as the introduction of anesthesia. It was the antiseptic movement, which, at the time, was being championed by none other than Dr. William Halsted. I’m assuming you are also related to Dr. Otto Fuller?”
“Yes,” Mitt admitted. “He was my great-great-great-grandfather, born in 1835.” He’d heard so much about his Bellevue relatives, Mitt had all their associated dates committed to memory.
“My gosh, such fascinating history,” Dr. Harington said with an appreciative shake of her head. “Back then, before the Joseph Lister antiseptic crusade took over the world’s surgical centers, around half the surgical patients died of sepsis, including here at Bellevue. Since we’re so accustomed to strictly adhering to aseptic technique nowadays and take bacteriology for granted, it’s difficult for us to realize there was a long time before it was accepted. Back then, surgeons didn’t even wash their hands or their instruments or change their clothes before doing surgery, and sometimes they went from doing autopsies directly to the operating room or the delivery room without any preparation in terms of cleanliness whatsoever. It truly boggles the mind.
“What about Dr. Benjamin Fuller and Dr. Clarence Fuller?” Dr. Harington questioned after a short pause. “Are they also direct ancestors?”
“Yes,” Mitt answered. He was almost reluctant to admit it after hearing what she’d said about Homer and Otto.
“Two more high-powered Bellevue physicians,” Dr. Harington said. “Dr. Benjamin Fuller was the second surgeon in the world to perform a mitral valve fracture in 1925, the same valve we’re going to replace today, which they couldn’t do back then. Were you aware of that?”
“I was,” Mitt said, feeling a bit of relief to be reminded of something positive.
“He was a pioneer, for sure,” Dr. Harington said. “And extremely technically talented. But, like his two forebearers, he had his downside. He was a rabid opponent of the concept of informed consent, which was becoming a significant issue at the time. He felt strongly that charity patients, which is what Bellevue has always handled as a public hospital — and still does — had a moral or religious obligation to offer their bodies for medical research as their side of the bargain. From his perspective, since they got free care, he felt they were obligated to contribute, even had a moral responsibility to do so. The trouble was back then there was no limitation to what a surgeon could try, even on a whim, and a few of them tried rather strange therapies, like injecting tobacco juice.”
“Tobacco juice?” Dr. Rodriguez questioned with astonishment. “Why tobacco juice?”
“Heaven only knows,” Dr. Harington said. “It’s part of the reason Bellevue history is so fascinating. Of course, I’m talking about a long time ago, back when bleeding and purging were the primary treatment options.”
“I had never heard anything about Dr. Benjamin Fuller being against informed consent,” Mitt said when Dr. Harington paused.
“I don’t imagine you would have,” she said. “Especially because he had so many positive attributes. What about Dr. Clarence Fuller? I imagine he’s held in high regard in your family, with his contributions of putting Bellevue Hospital psychiatry on the world map.”
“I heard a lot of positive things about Clarence when I was growing up,” Mitt said. “I’ve even read a number of his papers predating behavioral therapy,” he added. He was tempted to say he’d briefly thought of psychiatry as a potential specialty but held himself in check.
“Yes, he certainly contributed early on to behavioral therapy,” Dr. Harington said. “As well as to psychotherapy. But he had a downside, too. He had been a strong, early advocate of lobotomies and was responsible for many of those done here at Bellevue before the procedure totally fell out of favor and he tried to distance himself from it. As I learned also from Robert Pendleton’s papers, he even did a huge number on children because at the time he was competing for the top job as division chief. His main competitor was Dr. Lauretta Bender, a big advocate of electroconvulsive therapy, which was getting her a lot of press. He even advocated lobotomies for behavioral problems of childhood, insisting it was far more effective than ECT, which often had to be repeated up to twenty times to get a lasting effect.”
“Okay, ready to commence bypass!” the perfusionist suddenly called out, breaking into Dr. Harington’s monologue. “Sorry to keep you all waiting. We’re good to go.”
“All right!” Dr. Harington said, and clapped her gloved hands excitedly. “Okay! Let’s get this show on the road!” She leaned over toward the anesthesiologist, asking if the patient was adequately heparinized.
“She is indeed,” the anesthesiologist replied, flashing a thumbs-up.
Mitt took a deep breath and changed his posture, moving most of his weight from one leg to the other. He was shocked to hear that his illustrious surgical forebearers had been on the wrong side of history in relation to anesthesia, antisepsis, and even informed consent. Up until then, he’d only heard how great they’d been, without having any idea their greatness was restricted to technical ability. As for Dr. Clarence Fuller, Mitt had never heard of his supposed support of lobotomy.
“I assume you know what we are doing here,” Dr. Harington said to Mitt as she got ready to implant the cannulas, which had already been prepared. The closed-circuit tubing had been severed and the appropriate tips connected.
“Generally, yes,” Mitt responded, trying to deal with the disconcerting revelations about his ancestors as well as his exhaustion. He’d read about open-heart surgery as a medical student and had a reasonable understanding of the basics but had never actually seen it done.
As the case proceeded, Mitt became progressively more enthralled. To his delight, Dr. Harington explained step by step how the patient’s blood was rerouted away from the heart, how the heart was then cooled to four degrees centigrade by the cardioplegia solution introduced through the coronary arteries, and finally how the patient herself was cooled but to a much lesser degree by the heart-lung machine to lower her metabolic demands.