When Brooklyn meets Alabama: a physician story from a 50-year career

I never expected to have a friend from Alabama. My upbringing in Brooklyn, New York, didn’t include anyone from the South, and this was a time in American history when the South was in turmoil. I recall black and white images on our family’s TV showing federally enforced integration of schools and communities, swelling civil rights marches, and disturbing scenes of riots and attack dogs used to intimidate “negros” and prevent them from enjoying the same rights and privileges that I had in America. Several of the prominent surgeons who I worked with at The Queen’s Hospital in Honolulu in 1968 were from the South, my first exposure to people who grew up below the Mason-Dixon line, something I’d heard about only in civil war history. After working shoulder to shoulder with them, I realized that these were great surgeons, and on an individual basis, they did not show prejudice or racism against people of color.

As a surgical resident, one senior doctor stands out in my mind, and that was Dr. Robert Flowers. He was a youthful, attending plastic surgeon who befriended me. I was the only East Coast doctor in the program, which made me the exotic young doctor from New York City. He taught me plastic surgery techniques that were invaluable to me during my surgical career, including stories about his surgical residency, where he was required to watch many surgeries before he was allowed to do any part of the surgery. This was in contrast to my experience in New York City, where the surgeons in training would be eager to cut and explore very early in their careers. In fact, I had thought that early performance of surgical procedures by interns and residents was the key to proficiency.

In the plastic surgery elective I took during my general surgery training, I had many opportunities to watch and assist Dr. Flowers, and he taught me things I had never imagined were important.

One morning I was assisting him on a facelift, and he pointed out that I was gripping the facial tissue too firmly with my forceps. He explained why the gentlest pressure was all that was needed. Otherwise, I might be leaving injured tissue behind which could increase postoperative swelling, redness, and pain, and possibly lead to infection. And sure enough, when I loosened my grip, I noticed that the skin was indented with slight bruising.

After working with Dr. Flowers for a few months and learning so many things, he surprised me one day when he asked if I would like to join his plastic surgery practice. He said I already had acquired many plastic surgical skills, and he was impressed with my overall surgical abilities, keen eyesight, steady hands, and dexterity. I was very flattered at this offer, and he said I wouldn’t need a whole plastic surgery residency, just one more year of general surgery and then I would work with him and in that way, I would earn plastic surgery certification since he was one of the examiners for the board of plastic surgery.

I thanked him again for all he had taught me. But I explained I was very interested in the new field of microsurgery in ENT, and I had already accepted a residency in NYC at The New York Eye and Ear Infirmary, and I would still be able to use my newly acquired plastic surgery skills to do facial plastic surgery for much of my career. (I have lived through plenty of frigid Northeastern winters since I rejected that generous offer from Dr. Flowers, and sometimes I daydream about the life I would have had if I had said yes.)

Flowers and I also had opportunities to talk politics. He said it was past time to get rid of the old segregation habit, the Jim Crow laws in the South, and he was embarrassed at all the attempts to maintain them and the ugly displays of Southern racism portrayed on TV at this time. He was surprised when I told him about the all-white neighborhoods I grew up in when I was raised in Brooklyn in the 1940s and 1950s. He said he guessed the North and South were not as different as he had thought but that the North had certainly advanced more over time than the South.

One day Dr. Flowers came up to me all excited to tell me that we had the worst patient anyone could ever have on our surgical floor. I remember him saying in his southern accent that we had a New Yorker who didn’t think we knew anything about plastic surgery and was continually on the phone with his New York doctors checking every step of the complicated treatment and repair of his ankle injury he got while playing golf. Apparently, his golf cart skidded off the path and scraped the skin off his medial malleolus, which is an area of the ankle very difficult to skin graft successfully.

Obviously, he didn’t know that he had one of the very best plastic surgeons anywhere in the United States helping him. I realize that many people may have thought that Hawaii was just a big vacation resort. How could there be great surgeons outside of New York City or any other big city with large teaching hospitals? Much less, how could such surgeons exist in the remote islands of Hawaii? In fact, this may be the reason that the Queen’s Hospital and the Honolulu integrated surgical residency had a hard time filling their resident positions, and that was why I was the only resident who came from New York City.

Dr. Flowers wanted me to see this cantankerous man. When I first glimpsed him while I was still out of his room, he was propped up on his hospital bed with the phone to his ear, shouting questions about the treatment he was getting to his doctors back in New York City. This was decades before the time of cell phones. But this patient demanded and received a scarce house phone on his night table around the clock.

The nurses were warning me about encountering this patient. They said that he was the worst patient they had ever seen. He was terrible and mean to them with never a kind word or thank you for all the things they did for him.

Initially, I was taken aback by the referral to the term “New York Jew” since I was Jewish. But I quickly saw this patient talking down to his doctors and yelling at the nurses, even throwing things at them as he continuously complained about one thing or another. He even berated the excellent plastic surgeon, Dr. Flowers, who was able to control himself and act professionally at all times.

This truly was the worst patient that I had ever seen up to that time. Even after a 50-year career in medicine, I don’t think I ever saw a more disrespectful and obnoxious patient.