The Journey to Medicine and Neurosurgery

Dr. James Ogsbury is the author of the new book, “About Not Losing”, which is a memoir of a controversial malpractice trial in the late 1980s and early 1990s in Denver, Colorado. As a neurosurgeon, Dr. Ogsbury lived an exciting life of which the book is only a part. In this series of articles from Dr. Ogsbury we learn more about his life before and after the trial that is written about in his new book. 

You can buy “About Not Losing” here. It’s available in hardback, paperback, and e-book! 

THE DECISION TO PURSUE MEDICINE

When I was a young boy, my family was very close to my father’s sister’s family, particularly my aunt and my cousins, one of whom was my age. I did not know my uncle as well as the others, but obviously met him on occasion. However, at some point, he developed cancer, from which he died. I remember wondering why nothing could be done to prevent his untimely death. 

Obviously, that unfortunate episode planted the seeds for me to consider medicine as a career. Then, subsequently, my parents moved to Andover, Massachusetts, so that they could afford to send me to Phillips Academy Andover as a day student. Initially, my energy was focused on the intensive educational programs and participation in interscholastic football, skiing, and baseball. In addition, my parents were interested in music and thought I had talent (probably not true). They supported my limited ability to write music and to sing. 

Thus, during the first few years at Andover,  I made records, usually with a female partner. One song (Have Some Popcorn by Janet and Jay) was a talking parody of two kids in a drive-in movie.  Hanover Records sold 50,000 copies (which interestingly is still available on YouTube), causing our act to be bought out by a more major company, Kapp Records. Kapp invested a lot of money in us, which, unfortunately, led to no success. Therefore, during my initial years at Andover, my time was filled with academics, athletics, and even trips to New York to make records, and I had no time to think of the future. However, as time went on, and I realized my strength lay in the scientific field, I began to think of my future. I quickly realized that I could not intellectually compete with some of the brilliant students in the sciences at Andover, students who were already looking forward to careers in research and teaching. I then concluded that medicine was a reasonable alternative, though I was not encouraged to follow that career as my advisor thought medicine to be a menial job inappropriate for Andover students. However, by my third and fourth years, I had decided that medicine would likely be my career.

 I then made a tactical error by deciding to go to the small university that my father attended  (Denison University in Granville, Ohio) rather than following the usual Ivy League track taken by most Andover students. The problem with that decision was that, while the quality of education at Denison was probably equal to that of the Ivy League schools, the ability to then get back to the Ivy League for medical school was most difficult.

 I enjoyed my time at Denison. The academics were good, and l loved playing varsity baseball. Because baseball was a minor sport relative to lacrosse at Denison, we had a single baseball coach who was a football coach with a unique philosophy – that is all football players are good athletes, and all it takes to play baseball is being a good athlete. So, if we had played any other baseball team in football, we would have killed them. The problem was we had to play them in baseball, and we were terrible. I lettered for four years as a starting pitcher and gave all my winning baseball game balls to my then girlfriend, now my wife – she insists there were only two, although I thought there were three. In addition to baseball, I joined two other guys and formed a rock and roll band, which played two or three times a week for four years (this provided necessary spending money). With all of that going on, I am not sure I would have continued the path to medicine had I not been accepted to the medical school I wished to attend.  

Fortunately, I was one of the top two students in the Denison science department, was admitted to Cornell University Medical College, and moved to New York City with Kathy, my soon-to-be wife. At Cornell, the learning was expectedly demanding but also enjoyable, given the noncompetitive philosophy there. In addition, Kathy worked for the Dean of Students (she knew my grades, but I did not) so we were directly involved in student and University affairs. All in all, the experience at Cornell was extraordinary, and the only important decision thereafter was e which field of medicine to enter.

THE DECISION TO BECOME A NEUROSURGEON

The first two years of medical school were difficult, as expected. One quickly learns that the skill it took to get into medical school (primarily intellect and the desire to proceed to a medical career) has little relevance to surviving the first two years (which involved primarily massive memorization of medical material.). Fortunately, toward the end of the second year, we had short clinical rotations, which at least gave a student a taste of actual clinical medicine. After the second year of medical school, I applied for a listed summer job in pulmonary (lung) medicine. Stupidly, I inadvertently walked into an office several doors down from the pulmonary office. This office happened to be the office of the world-famous neurologist Dr. Fred Plum. I confidently walked in and announced to the secretary that I was there to apply for the summer job.

 To this day I remember the surprise on her face – no one had ever done that before – but she politely said that she would talk to the doctor (without saying Dr. Plum’s name). She left for a time, returned, and said that the doctor felt he could find a place for me. Interestingly, Dr. Plum was studying the neurophysiology of the pulmonary system, and it was a full three weeks before I realized I was not working in the very good, but not world-famous, Department of Pulmonary Medicine, but in a department surrounded by world-famous neurologists. 

I was assigned to work with Dr. Fletcher McDowell, one of the scientists who discovered the use of L-dopa for Parkinson’s disease. It was so early in the L-dopa studies that there were no machines making the capsules, so Kathy and I actually made some spending money by forming the capsules by hand. The only problem with our capsule making work is that L-dopa is a precursor of the pigment melanin, and soon our bathroom, where we did the work (because of the exhaust fan) turned an ominous shade of black. The time spent working with Dr. McDowell was wonderful, scientifically and socially. He even invited us to come out to his family home. We were astonished to find out that he was married to Electra Vanderbilt, and they lived on what was left of the Vanderbilt estate. 

Thereafter one of my jobs was to play tennis at the Vanderbilt estate indoor tennis courts with Dr. McDowell’s friends. Also Kathy and I I were honored to be invited to have dinner with them in their beautiful 18th-century home.  To  my amazement Mrs. Vanderbilt McDowell did all the cooking herself. 

I subsequently had rotations with Dr. Plum and Dr. Jerome Posner and realized that a book that was used in most medical schools around the country (The Diagnosis of Stupor and Coma) was authored by Drs. Plum and Posner. I quickly realized that while Dr. Plum was a great neurologist who deferred to almost no one, he did defer to Dr. Posner who was a brilliant clinician and person. Indeed, I experienced Dr. Posner’s extraordinary memory when, many years later, he somehow recognized and greeted me when he happened to walk by me at a meeting here in Denver. However, despite the brilliance of the professors, one episode on the neurology service indicated that clinical neurology was not a good choice for me. I was on the Neurology service when Dr. Plum was away, and there was a patient on the Neurology floor who had been kept in the hospital pending Dr. Plum’s return (one could do that in those days). After his return, Dr. Plum went on rounds and asked all of the appropriate questions that no one else had asked. The diagnosis became clear, and we walked on to the next bed. I naïvely asked the resident what we were going to do for that unfortunate lady,. He said there was nothing we could do for her; we just now had a name for her illness. That ended any thoughts of my attempting to become a clinical neurologist, particularly since my personality seemed more attuned to the surgical specialties.

Some months later, since I continued to maintain an interest in neuroscience, I managed to obtain a rotation with the Department of Neurosurgery which was under the direction of the famous Dr. Bronson Ray. Dr. Ray was the final resident of Dr. Harvey Cushing, the father of neurosurgery, and Dr. Ray was of sufficient import that whenever he performed a craniotomy (brain operation), other neurosurgeons from around the country would stand around the operative field to watch his surgery. As a medical student, I was the second assistant at some of his cases. Dr. Ray rarely spoke in the operating room. His surgical nurse knew exactly what instrument to hand him by the order of the case and by the way he extended his hand, so there was rarely any discourse between them. He rarely spoke to the resident’s first assistant and never to me. However, the second assistant was allowed to close the skin, and one time, I used what I thought was a clever one-handed surgical knot. Dr. Ray tore out my closure and said that if one is sloppy with the skin, then he would be sloppy in the brain. Of course, I was mortified.

Other than that, the experience with the neurosurgery team was glorious. It was unbelievable to be surrounded by Dr. Ray, as well as two other world-famous neurosurgeons, Dr. Russell Patterson and Dr Richard Berglund, as well as highly skilled residents carefully chosen out of the many applicants for the program, and even extraordinary nurses who had been on the neurosurgery service for quite some time. The level of skill and dedication was beyond belief. Because of this, we had many unusual patients which often led to unusual circumstances. Probably the most memorable of patients were those from the Mafia. 

THE CARE OF THE MAFIA

The Department of Neurosurgery took care of both main branches of the Mafia. One branch was cared for at another Cornell hospital where the agreement was that if an important member of the Mafia was being cared for, the Mafia would take the entire floor, with only selected nurses allowed to cross the barrier in and out of the floor. Dr. Ray would not stand for such an arrangement because the neurosurgery floor was his personal sanctuary. At Cornell, the arrangement was that if an important member of the Mafia was admitted, Dr. Ray allowed a Mafia member with a gun to stand guard in the patient’s room. I quickly became accustomed to that arrangement. Indeed, I found that the members of the Mafia were my favorite patients. They understood hierarchy and the delegation of authority, and when one of them had a question, they assumed that whoever was present at that point was there with the agreement of Dr. Ray. Therefore, never did they request that you call Dr. Ray if they have a question and you are the only one present. 

I will never forget one memorable moment when a young Mafia man named Joe, handsome and articulate (in my mind, like a lieutenant in the military), had undergone a back operation. Standing at the door was a tough-looking older man with a gun (in my mind, like a master sergeant). I was present on the floor at about 4 a.m. finishing charts, when the tough looking man I came up to me and said in his usual gruff way: “Hey Doc, Joe, he’s doing good, no?” I answered politely with whatever “doctor speak” that I could muster.  He repeated his question, “Joe, he’s doing good, no?” I pulled out the last little “doctor speak” I knew.  He then turned to me and said, “Well?” Puzzled, I said, “Sir, what do you need?” He again said, “Well?” I answered, “Sir, I am not sure what you wish?” He then said, I think with a sly smile, “Well, can Joe have a girl?” I was immediately terrified. I was not worried about what the Mafia could do to me, but at that very moment, I knew that my career was now on the line. I could not call Dr. Ray at 4 o’clock in the morning and ask if Joe could have a girl. I paused for a moment and answered, “I believe Dr. Ray would not mind at this point for Joe to have a girl, as long as Joe does not move too much.” He turned to me and said with a smile, “I understand perfectly.” About one hour later, a beautiful young woman came to the floor dressed in a mink coat, and probably little else, and entered Joe’s room. After about an hour, she left. I did not participate in Dr. Ray’s rounds with the chief resident that morning, but I was later told that Joe was evidently very pleased with his care, and Dr. Ray had said to complement me for my innovative answer. Obviously, a nurse had witnessed the incident, but my terror at the precipice of my career left no memory of anyone else being present). 

OTHER NEUROSURGERY MEMORIES

There were many other memorable moments spent working with the neurosurgery team. One time, a young float nurse made the error of connecting the IV tubing to the ventricular drain site and the ventricular drain tubing to the IV tubing. Obviously, the patient became ill very quickly from the increased pressure of the IV fluid being poured into her brain, and the nurse called me. I recognized the problem, corrected the tubing placements, and the patient promptly woke up fully. Other nurses happened to come in just as I was reconnecting the tubing, but I did not say a word to them. I am not sure whether they reported the issue to their supervisor or they just talked to the mortified young nurse and respected that I took care of the problem and kept my mouth shut. I certainly had the support of the nursing staff thereafter. On another memorable occasion, a general surgery resident, temporarily on the floor, evidently disagreed with the decision by Dr. Ray to proceed with a particular operation, and, in the discharge summary, his feelings were made very clear. As of the next morning, that resident was no longer anywhere to be seen.

 However, the most memorable moment, perhaps of my career, occurred one night when Dr. Ray had to take a patient back to the operating room with an obvious postoperative hemorrhage. There was no resident readily available to help him, and, in that circumstance, he usually insisted that some resident race in for the surgery. However, to my surprise, he indicated that it would be satisfactory for me to assist him as a first assistant (I learned later that a medical student had never before assisted Dr. Ray directly). Then, once the operation started, he quickly reopened the skin, removed the bone plate, and opened the dura (the covering of the brain). Blood immediately welled to the surface – I seem to remember seeing several little geysers of arterial blood. However, to my astonishment, Dr. Ray briefly put his instruments down, turned to me, and, with a twinkle in his eyes, said, “Are you sure you want to become a neurosurgeon, doc?” My answer was, of course, “yes sir”, and, at that moment, my career in neurosurgery was clear.