I’ll tell you the story of Pancho, my friend who was faithful and strong and achieved a good end. His last name was Martinez and he hailed from Jalisco, Mexico. He had never caught good break until he met Interplast, in the person of social worker Dr. Amy Laden.
According to his culture, Pancho was born as a human, but not of the human race. Subsequently, this practice was made legal by his lack of a birth certificate. That lack of identity was also definitely related to his inability to speak clearly. He communicated poorly, saying, “oh, ah, oh, aah” when attempting to pronounce “coca-cola”. He had a severe bilateral cleft lip and palate with significant nasal deformity, as we say with the jargon of our particular field of Plastic and Reconstructive Surgery. Ever since he mustered his first breath, he didn’t achieve the stature of a human until he applied the strength of his back and deftness of his hands in the lemon picking line of work in Santa Paula, Ventura County, California. He worked dexterously and happily for eight years, but felt he needed more in life.
He somehow appeared in my office with his friend Magdeleno, who was my garbage man and, then of course, my patient – I had performed a full thickness skin graft to the palmar surface of Magdeleno’s fingers at no cost to him. He was a relatively well off, and “rich,” guy possessing the health insurance of the powerful “Hygiene Worker’s” union of Redwood City. He had also emigrated from the Mexican province of Jalisco way before Pancho and had worked very hard to become a union member. They arrived in a big American Dodge van; complete with swivel seats, a stove, fridge, A/C, hi-fi, curtains, air horn, and extra gasoline tanks, appurtenances that he paid for with money he earned himself. As a garbage man, he commanded a huge sum per hour – at that time $8, which I suppose now would be about $45 per hour. Magdeleno became a rich man, through the American union system that had fought long and hard for fair wages many years prior to the migration from Mexico and Latin America. In owning the big van, Magdalena said that he had “driven a full house.” He had brought this house down to his hometown, bringing his family to show off his new American way of life. Now dear reader, here was a Mexican garbage man with the trappings of the rich. He did have a huge impression, I’m sure, among his old friends. Indeed, Pancho also emigrated.
I did not have to ask Pancho why he came in to see me, although I probably should have – asking the patient his unwritten and unspoken agenda in life is something we must never forget to do in order to avoid performing surgery on the wrong part of the body. Dr. Berner had taught, “Always ask; I once had someone on the operating table and had done a rhinoplasty, when the patient said, ‘It’s my nose Doctor.’ From then on, I always asked a standard operating procedure because big mistakes can be made.” Dr. Berner previously had never asked, “What do you want?” He always said, “When should we operate?” He assumed it might be the “Dumbo” ears, but the patient had actually come in for a body-image concern with his nose, which was a major part of his life.
He bravely produced his will and his bank account, signifying that he was prepared to die on the operating table and not cause others a financial burden for his burial. I received it with dignity and then selected the highly prepared Eric Bachelor as his lead surgeon to work with me.
We operated together on Pancho with a certain amount of Richard Siegel-ian joy and enthusiasm for what we knew we could do for him. The surgery went well and Pancho the invisible became the real Pancho. He was much more self-confident, although still afraid around crowds. For a while he had his pre- and post-op care taken care of by Magdeleno, who lived in Redwood City and brought him punctually to clinic.
I brought our patient Pancho over to our property one day to stroll around. He looked at the weeds and irrigation pipes, the blossoms on the kiwi vines, the creek. I asked him his occupation. He said, “Agricultura.” I said, “Can you use a shovel and un azadón hoe? He said, “Con mucho gusto,” and he was immediately hired as my Special Man Friday. He worked admirably, and thus was able to further my agricultural aspirations to raise kiwi fruit. He drove the green truck, of course, the 1972 Dodge. All told, he and I and Judy and my son, D-2, went for 52 loads of compost at the Campbell’s Soup mushroom factory south of Pescadero and near the Pigeon Point Lighthouse, with the truck’s sideboards loaded high to the sky, pulling a trailer with sideboards. Of course the occasional adventures, and one terror, occurred, with tire blowouts, mechanical failures of the trailer hitch, and the unforeseen, all of which had to be dealt with, despite needing to be back at Stanford at 7:00 A.M. for the first case of the day. We all fixed irrigation, pulled weeds, sprayed a bit, pruned and espaliered 118 kiwi vines. We did what was necessary to improve the adobe clay and to give the vines a chance.
That winter, I remember my nephew Jimmy Laub, who was 6’4”, young and strapping, came to help me on the farm with Jay Lang, another member of the family (my sister’s son) – not an insignificant personage, as he played nose guard with the Menominee Falls High School football team in Wisconsin. He was really tough, and I could not budge him in arm wrestling. We were beset with rain and basement flooding, provoking a decision to dig a French drain circumferentially around the house and then down to the creek 250 feet away, 4 feet deep and 18 inches wide, back-filling it with 1 inch drain rock, drainage pipe, and tarpaper, in order to solve the problem. Digging by hand, Jimmy, Jay, and I set out, and we knew how to work, I must add. But Pancho, who started working alone in a different place near the basement, consistently outstripped the three of us in speed, dexterity, and neatness; he dug the vertical walls perfectly straight.
By the way, a helpful note here is that Dr. Jack Simon, my neighbor, asked Pancho to dig some holes for the 4×4 inch wooden posts he needed to make a fence. That evening, after Pancho’s first day, Dr. Simon asked how he got the machine into that narrow space. But there was not any machine – Pancho had dug all these by hand. Not only that, but he had dug square holes exactly 5×5 inches and 24 inches deep to exactly match the 4×4’s. This is all to say he was an exceptional worker.
In his post-operative condition, he becoming a card-carrying member of the human race, and of course, desired more and more things as all of us do; his aspiration was to achieve the comforts of the American life. In his value system, these parts of life were the wife, the truck, the house, the child, and the admiration of his peers. His first goal was to obtain a wife. He corresponded with women of his hometown who all knew him in his unrepaired cleft state, interviewing them by mail, and then selected one, the only one who seemed willing. Her name was Rita. She had one short leg and one long leg, but was “very beautiful” and very nice. He then fit out the green truck with a camper top, put a mattress in there, and fixed it all up nicely for his triumphant trip to his home town to pick up the new bride and bring her back. He left as if he were General Patton off to conquer a new land.
He didn’t return so quickly. In fact, for over four weeks, we could not find him. Rita had had second thoughts about Pancho and turned him down flat. Uh oh, trouble… Pancho had found a new definition for “disappointment.”
On his return to the U.S. he stopped by Tijuana, washing his sorrow away with Ecstasy, which caused him to be unconscious for a week and to lose all of the hair on his head. Somehow God awarded a recovery to Pancho. He showed up on the job later, much the worse for wear. He then took to drinking beer a little and he became intoxicated easily post ecstasy coma. One night he ran the green truck off Fremont Road near Concepcion Road. And in order to ensure “public safety” he strung one of my heavy ropes straight across the road, completely blocking traffic. He then disappeared from us, and I later learned that he had landed in jail. We had a lot of trouble locating him, but eventually did, and found that he had gained weight in jail, because they fed him plenty of Velveeta and ham sandwiches.
Once he was home he brightened up with some hard work and then designed a new plan for fulfillment of his human instincts, his DNA instructions. His new plan was each weekend to visit the San Jose dance halls where many Latina women were easily befriended.
Soon he approached my wife, Judy, asking her to please meet her proposed new employee, Ester, who, according to his cultural rules, would clean her house and do any jobs Judy would assign. She was to be Pancho’s new significant other and he, according to the cultural protocol, was to bring her to meet Judy formally, to make a sort of business deal. Judy called me at work, in a distressed state of emotion. Judy did not want to go through with that proposed plan. But she did acquiesce to my rationale and interviewed Ester, who was an interesting person to say the least. She appeared to be 80 years old, a tiny bent-over old woman with deep lines on her face. Her youngest child was 41 years old, and was at that time dying of AIDS in Kaiser Redwood City Hospital. There were seven other children. The proposal was to buy a small trailer, in which Pancho and Ester would live, under the massive oak tree between rows one and two of the kiwi vines on our north slope on Fremont Road and Arastradero Avenue in Los Altos Hills. All this required discussion and back-and-forth give-and-take, but it was accomplished. Ester was brought to our house by one of her fully-grown children. With broad beaming smiles they moved into the trailer, knowing full what cohabitation involved. She brought Pancho breakfast, morning snack, lunch, two snacks during the afternoon, and dinner. He gained weight rapidly and his smile never stopped. There were many afternoon soirees in the trailer and we all envisioned what was taking place as the trailer gently swayed.
Soon Pancho announced to Judy that she should withhold his salary. He wanted it to go into the bank because he would need it soon: Ester was to have a baby! Upset, Judy called me again to come home immediately and straighten this goddamn thing out. So I did, sitting down to interview Ester. I asked her how she knew she was pregnant. This might be a silly question to ask a person who has had eight children, but she said, “I can tell by the movement.” I didn’t have to ask her if her menstrual periods had stopped. I of course thought, “Well, okay then. You should know.”
I consulted Dr. Jim Meier, noted gynecologist for the society women in Atherton Society and also Chief at San Mateo Chope County Hospital. He was consultant obstetrician for difficult cases at Stanford Medical Center. The Pancho-Meier appointment at Chope fortunately included Jim’s nurse, whom I had previously met in Culiacan, Mexico, daughter of the “tomato king” – a beautiful woman who spoke Spanish and English well and was most tender with Ester. Examination of Ester by Jim was packed with drama, with Judy pacing up and down outside in the waiting room like an expectant father. Jim came out with a smirk on his face and said, “It’s gas.” We were relieved to discuss this that evening at dinner, but we were not relieved at the couple’s disappointment; they had been anticipating pregnancy and not flatulence.
Despite the bad news, Ester stayed on in her capacity. And Pancho eventually met Lidia, the sister of his brother’s wife, a good woman who was already a trained mother, housewife, and strawberry picker, having done the latter for several years. Pancho proposed marriage after a short time. “But what about Ester, Pancho? You should devote yourself to only one woman.” “I’ll take care of it,” he said, so I wouldn’t have to worry about the social situation. To this day I’m not sure what happened to little old Ester.
The wedding of Lidia and Pancho was to take place in Santa Paula in Northern California. My wife Judy and I agreed to be the principle sponsors. This was tremendously challenging for Pancho himself, as he was shy and afraid of formal situations and now he had purchase and dress himself in a three-piece suit. My El Dorado was a light blue color and completely decorated with ribbons folded like roses on every square inch of the car, affixed with double-stick tape. The wedding was in church with a formal reception after the ceremony, and we had as much fun as we could under the circumstances.
After Ester, Pancho and Lidia quickly set up shop in row one under the oak tree. Lidia became pregnant and my friend Jim, who came out of the exam room smiling more enthusiastically this time, confirmed this. Lidia’s pregnancy, however, was not easy. She immediately became nauseated with morning sickness to an extreme and could not hold anything down. She vomited all the time. So I set her up with an IV infusion in the trailer. Pancho was to change the IV bottles and care for her. All worked well. She remained in electrolyte balance and gradually the nausea dissipated. This was her second child, and his name was Johnny Juan. He was a robust kid, not small at all. He never cried because he was well fed as an antidote to every possible cause of discontent. He was a great kid and I remember celebrating his second birthday party down at the creek under acacia trees with family and friends.
And of course for that occasion there was a bit of fermented agave to mark the moment in our minds. All went well again.
Pancho was my good friend, loyal to any end. He had few friends, and few breaks in his life. But he played his cards well and few could tell that his life had taken so many bends. When we announced we were moving to Story Hill Lane, again on 6 acres in Los Altos Hills, he was given the 1972 greenish-brown Fleetwood Cadillac. He loaded it from the running boards to the ceiling. Poor Johnny Juan could hardly find a place to sit. Off they went to San Angelo, Texas, where, upon our most recent phone call, I learned they had parlayed his wages into ownership of four apartment buildings.
Now in 2012, many years fast-forwarded, Johnny Juan is an amateur bodybuilder pursuing a Master’s Degree in Kinesiology at the University of North Texas. I needn’t say that Pancho’s family and our family are quite happy with Interplast and America.
Though our long history together may seem to point toward a fated friendship, I met Pancho quite simply by going out of my way to speak with a completely new stranger, in this case his good friend Magdaleno. As I’ve seen time and again throughout my life, the serendipity of interactions with strangers is just unbelievable – you never know when you’re going to meet a new friend for life, and and what great things you will accomplish, and what memorable times you will share together. You and that person may be life long interdependent players in some project!
Always talk to the garbage man; I bribed mine to haul away about 1 ton of material. I had to pay Palo Alto dump about $120 to even accept the damn stuff. And on and on, I continued a part-time agricultural life style. I enriched my family’s life and my life with this adventure. We found more value in hard manual labor. We all produced Johnny Juan, a superb world citizen and contributor.
And students: always talk to the person sitting next to you on the plane, he or she may be an important player to act on your stage in a play later in your life. And students: always smile at every single person on a trip to a foreign land.
Johnny Juan was a favorite of ours, and Judy gave him a $500 U.S. savings bond on his 2nd birthday party, at his “Bautista.” At a moment of Judy’s absence, I added a statement to the bond that we would initiate a trust, such a bond would be given every year: an estimated $15k accumulation in 18-20 years. Pancho, Lidia, and Johnny Juan moved away to Texas shortly after that party. The trust was unattended. Fortunately, Johnny sent me a copy of that birthday Bautista card recently, wondering about the gift. We immediately sent $10,000 to him, to aid him in his pursuit of a Master’s Degree in Kinesiology, at the University of North Texas. Fantastic all around!
J.J. recently called regarding an acute shortage of money for the treatment of his significant other’s aunt, who has Stage 4 lymphoma, largely metastasized, and was predicted to die in a matter of weeks. Our 30-minute discussion ranged from always helping another to the best of your ability, to your compassion with an estimated time of survival, so close. And with something like a 1-in-a-100,000 chance of survival, the situation presented itself as a compassionate act of sacrificing money to prolong death, rather than life. In fact, it may be treatment of the haves. “I did everything I could,” rather than really helping the have-nots. The have-nots would be better served with a morphine IV drip at home, than the not-so-pleasant chemotherapy.
After Pancho and his family moved to San Angelo, Texas, our relationship was disconnected for awhile. At first, I was “mad” at him because several small pieces of equipment no longer belonged to me, and I thought that was not right. He made several attempts to contact me, but I did not respond. I called him after a little bit, and to my joy and surprise, I found out that he now owned three apartments. Obviously, he had done well and certainly, he had Factor X.
Pancho was a success in that he enjoyed all of life, which was his original desire when we came together in 1972. As I recall and debrief Pancho’s story, I have a smile on my face and I actually feel warm. And fuzzy. Pancho fulfilled all of the axioms that govern my life, my five ways of life:
1) Living life to the fullest – he certainly did everything that the usual successful American desired and enjoyed.
2) He was a friend of the poor – I don’t know the specifics of how he acted it out, but he certainly displayed that attitude whenever I was with him.
3) All people are equal – as you climb up the ladder of success, you should not step on or harm anyone as you pass them (because these are the same ones that you may pass if you should fall back down). Pancho started less than equal and perhaps felt that a greater power had not given him a full deck of cards. But, he made up for that with an extra dose of Factor X and then got ahead without harming anyone.
4) Factor X – Factor X is the trait of acting as if you had a kerosene rag up in the lower part of your intestinal tract, stimulating you to intensely pursue you own development. Pancho had his fair share.
5) Nothing is impossible – if you concentrate all of your powers 24/7, 365 days per year, for 15 years.
I am thrilled and enchanted with the power of plastic surgery. And Pancho’s story demonstrates the basic reasoning that led me to go into that wonderful fiel:; I had always wanted to use my hands and give the product of my work to people for my livelihood. I had chosen carpentry as the perfect field to obtain that goal. However, the metamorphosis brought me to using both cognitive knowledge and manual skill to help other people in a similar way. In fact, our work seems to be “biological science plus Mother Theresa,” which is the right mix.
 Berner’s mandate: “asking” where and what are essential in cosmetic surgery
 Richard J. Siegel, MD, is a plastic surgeon from New York, University of Pennsylvania Medicine, and Stanford University Plastic and Reconstructive Surgery, and one of the first trainees in the combined General Surgery – Plastic Surgery program at Stanford, an innovation of Dr. Robert A. Chase executed by myself, DRL. In this program, it was RAC’s idea that early surgical experience was a key part of surgery training.
The early psychomotor skills were applied to the training of Siegel who was the right guy to be the first cohort of the training experiment. He excelled. We did many cases together, including the first “Asensio” cleft lip repair done by gringos; he was the first resident in our new rotation to Antigua, Guatemala – and one of the first to rotate to San Pedro Sula, Honduras in hand surgery, he assisted the filet amputation of the lower extremities for untreatable bed sores, etc – he was indeed a well trained plastic surgeon at the end of his first year, and had contributed 3 scientific articles.
He has continued post-residency, after the Interplast decision not to have residents included on their trips, and after his years of practice at Kaiser Hospital to do International Humanitarian Surgery all the time during his wonderful retirement.
He exudes joie de vivre. During his lecture at Stanford, he shook hands with every student, remembered each of their names, and conversed with a wry smile, all of which demonstrates that even though medical professionals can become discouraged over the years (rules of government, difficult hospital work, malpractice fears, defensive medicine, lack of control, transfer of wealth from medical profession to trial lawyer profession), international healthcare has the ability to save medicine.
In all of Siegel’s 50 slides, every person in each and every slide (perhaps 150 medical persons total) are smiling and happy – and Dr. Siegel continues to smile as well. With 70% of U.S. physicians dissatisfied with their job, this is an extraordinary truth about international work.
 Ecstasy, or MDMA, is an empathogenic drug of phenylethylamine and amphetamine class which induces euphoria, intimacy with others, and dimishes anxiety by releasing a flood of neurotransmitters including serotonin, dopamine, and norepinephrine. See more at: http://en.wikipedia.org/wiki/MDMA. MDMA is also used in psychiatric medical practice.
 q.v. – Ray’s philosophy, a separate blog entry to be
 Word of Professor William Hurlbutt, when he was a student in my clinic. This, indeed, has proven to be the right mix