Don Laub and I were talking today about how I connected with Interplast. In the early 1970s when I was working as an engineer, one of the mission controllers was also a flight instructor. I’m not sure how we got together, but I hired him to help me get my private pilot’s license, which I achieved in one of the summers that I was working back in Houston. At the time I was in a graduate engineering program at Stanford, and having learned how to fly, when I returned to my graduate program I also joined a flying club. I was actually much more drawn to flying than I was to the academic work of engineering.
So I ended up dropping from full-time to part-time, from part-time to no-time, and working with Lockheed and Sylvania and other employers. But after a period of years, while I enjoyed the problem-solving parts of engineering, I really missed the “people” aspect of life. We were dealing with missiles, projectories, orbits, and ballistic missile programs. That involved a number of things, one of which included my stopping at Arby’s roast beef, somewhere on El Camino one day and sitting down next to Bob Bell. Because career change was on my mind, Bob and I talked about career change. It turned out that Bob had been a pilot for Flying Tiger Airlines, but was currently working in the health care field. He was, I believe, selling some form of health care equipment.
Through the conversation I asked him if he missed flying. He said no, because he continued to fly. He went on to explain that he was the chief pilot for an organization that does international plastic surgery, and he worked with volunteer pilots and with a DC-3 that the foundation, Interplast, had purchased to transport surgery teams into Mexico and Central America. At some point he said that he was looking for a co-pilot to volunteer on the DC-3. I asked him what it required to become that co-pilot. He said it required an instrument rating, a multi-engine rating, and he reminded me that he had some minimum number of hours.
So I applied. I told him that I was really interested in the job. And he arranged for me to come out and do a check-ride in the DC-3. It certainly helped that my first landing at San Francisco International was in a DC-3… [a good anecdote may be missing here]
I started to explore the various ways of getting a medical education. The more medical schools I visited, the more I was discouraged. There just didn’t seem to be any way a guy embarking on middle age with B-average undergraduate and graduate work was going to get into medical school in the 1970s.
At about this time I spent many weekends up in Lake Tahoe. I would drive up for the weekend and ski, or in the autumn before ski season I would cut wood for a shared ski cabin. On my way home from Tahoe I picked up a young man who was hitchhiking. I gave him a ride to down near Sacramento and dropped him off at his parents’ house. He and I shared our ambitions of wanting to get a medical education. He told me that he had enrolled in medical school in Morelia, Michoacán. He also said his father was in touch with a school in Cuernavaca and that his dad would be happy to put me in touch with that medical school. I went in, met his father, got an address, and wrote a letter. And I was soon enrolled to start medical school in September 1975. This was after I had taken a year out to take organic chemistry and some biology courses so I would have some prerequisites.
But I’m getting way ahead of the story because back in the early 70s with Bob Bell, I started to serve as a pilot with Interplast. Actually, as soon as anyone started work with Interplast, they seemed to get inspired and carried away by the spirit of the organization and the people. So fine—we just became part of the job. As soon as the wheels touched down in Calexico or the Yucatán or wherever, we pilots got involved in loading stuff, carrying stuff, finding stuff, and those of us who could speak a modicum of Spanish became translators, most of us well over our heads.
I can remember the clinic days that would precede operative days in Mexicali. I may have it wrong, but I think we would fly in on a Thursday night and see patients in a “clinic” on one day, then would operate on two days, but again, that might not be accurate. But what I remember very clearly is the rapidly paced pandemonium of surgeons evaluating patients, making operative plans or other plans.
We got involved in many other aspects of the project as well, not to mention the wild and wonderful parties that went on, with mariachis and dancing and eating more than you could imagine, after long days of work at the hospital. And we helped by giving the families instructions as to where to come when on the day of surgery, instructions about diet for the preoperative child, and at the end of the day, wrapping it up with everyone at least looking—and certainly my feeling—exhausted.
After surgeries were done, and rounds were made on the kids and postop, and the nurses were comfortable, we would slowly trickle back to Phil Collins’s house to relax for a little bit and start the social whirlwind of the evening. Just being a part of that reinforced my notion that I needed to have the kind of skills that I could lend to this sort of enterprise.
After getting back to Phil’s house in time to freshen up and start the festivities of the evening, I remember food that seemed to be cooked by an army of neighborhood women, and sitting around Phil’s kitchen/diningroom table with all that activity, laughing and telling stories, strategizing, all at the same table. Then having everybody—seemed like it must have been half the neighborhood and all the surgery team and pilots and recovery nurses and anesthesiologists—chowing down, and then having that blend into some form of party. There would invariably be mariachis.
All of this further reinforced my notion that a career for me needed to have these elements, particularly the elements of patient contact, patient care. This included being able to talk with and laugh with patients, help kids and their families feel more at ease, watch the planning of something that was going to do them some good, watch the anxiety and the hope on the faces of the parents, seeing the tears both when the children left with the anesthesiologist for surgery, but especially when kids came back and they no longer had a cleft; they had an upper lip. And swollen as it was, it still seemed to look absolutely wonderful to mom and dad and grandma and sis and brother.
So once I finished my pre-med work at Cal State Hayward, I enrolled in a language school in Cuernavaca, gathered everything I could to put in my little Triumph Spitfire, and headed south. I took with me a microscope, a number of medical texts (turned out to be too few), and all kinds of anxieties. Somewhere around August I ended up in Cuernavaca, showed up at the language school, and was assigned to live with a family for the four to six weeks of language school. This was an experience on its own.
The family spoke no English. There were two young boys and two or three young girls who lived there with their mother, a divorcee. There were three students living with the family in a three-bedroom house. The older boy and I shared one bedroom. Next to us were Mom and three to four children in one bedroom. Down the hall was another bedroom with a married couple, who were also students at my language school. I remember coming home from class and trying my newly learned Spanish on the family. They were very nice, correcting me, expanding me, and then carrying the conversation off onto other things so I could learn far more than was laid out at the school. I remember waking up every morning, sitting up in bed, looking out my window, and I don’t know how many miles in the distance it was, but there was this large, snow-covered volcano called Mount Popo (I couldn’t remember it at the time, but it’s an abbreviation of an Aztec word, Popocateptl).
I remember having an experience with the local law enforcement authorities. Turns out there was a road from Cuernavaca to Mexico City called the Cartera, which was a limited access road; in that sense it was a freeway. The road had pavement which I believe was tar under which was rolled gravel. There were two overpasses from Cuernavaca that loaded onto the Cartera in cloverleaf arrangements. I had for some reason decided to go toward Mexico City one night. I was in my little Triumph Spitfire, taking the down ramp to the freeway. I enjoyed this because it was slightly gravelly and I could set up a four-wheel drift as I came down that curve. But coming up that ramp was a federal highway patrol car. We met. In fact, we had a head-on collision. Fortunately we weren’t going too fast, but it was fast enough to take the hood of my Spitfire and push it up onto my windshield so I couldn’t see what was in front of me. I rolled out of my car and got to one of the two officers, who was getting out of the passenger side. Our words were, in unison, “Estas okay?” meaning we were asking each other if we were okay. We reassured each other. Meanwhile, the driver of the patrol car had his head buried in his hands on the roof of the patrol car, saying to himself, “Que pendejo! Que pendejo!” which roughly translates to, “What an idiot I am!” It turned out that they had decided to go up the down ramp because they were chasing a drunk and thought that would be a shortcut.
I thought my days as a student were over, and maybe my days of freedom would be over as well. We went to the police station and filled out the requisite paperwork. Then they revealed a few facts to me. Number one, they had to explain to their superiors what happened to the front of their car. Number two, the insurance I had in Mexico was no-fault. My insurance covered my car; their insurance covered their car. I had a one hundred dollar deductable. Number three was that they were perfectly willing to pay me the hundred-dollar deductible and they handed over a hundred dollars in cash. They asked me if I would be willing to tell a little fib. And they wrote out an account, which I signed. The account said that my car was parked on a hill in Cuernavaca and it appeared to have slipped out of gear, the brake failed, and it rolled into their car, which was also parked, downhill from me. Having done that, they asked my permission to have my car towed to the body shop that they recommended. They gave me a ride home and advised me that if I ever needed anything that I should contact them. That was one of my several introductions into the culture of Mexico, and more particularly into law enforcement in Mexico.
I’m not sure how I got here. I don’t think that has anything to do with Interplast, except I can remember thinking at the time these were some of the kind of interactions that had to go on to get the Interplast program accepted by the government. That’s my story.
During the year I was in Cuernavaca studying I stayed in touch with Interplast. Whenever there was a Mexicali trip, I would take some time off school and fly up to the border and work with the Interplast group. At this point I was able to translate at a little higher level that I had initially when I was volunteering as a pilot. I remember being instructed how to scrub, how to handle the instruments, and I served as scrub tech for surgeries. I was truly stoked about this. I had always watched with fascination the way a special ellipse would go from a clipped lip to a set of lines and points to an indistinguishable set of flaps and from there into a perfectly recognizable upper lip. I had very specific instructions on how to use a skin hook, and how to brace my hand and make sure I did not get the skin hook into the child’s eye. Just being that much a part of the surgery was a huge rush.
There was a big boost for me that came from one of those trips. At some point Don had said to someone words to the effect that Bill Wilson will get a medical education. I don’t know if the person who overhead that told me about it on that trip or at a later time, but I do know that over the ensuing years, whenever I felt discouraged by medical school rejections or not doing well on a test, that I would remember that and it would be a little boost to get me over the “down” moments.
Following my first year at Cuernavaca, I concluded that truly learning medicine, as well as learning enough to pass the ECFMG exams, was going to be very difficult for me. Book learning is not my strong suit, and in fact I spent time during that year when I would come up to Stanford and sit in the Medical School library and go over material and slide sets in the audiovisual lab. It finally occurred to me that I had started a graduate engineering program at Stanford and had not received a degree. I was probably still on the rolls as a matriculated student and maybe I could return and take classes.
Having confirmed this, I contacted Dr. Dan Debray, my advisor in the School of Engineering, and asked if I were to take the first two years of medical school and combine that with my units in engineering, could I get a masters in what we would call biomedical engineering? And he agreed. I then talked to Dean Stuart in the Medical School and he said I would be able to take the preclinical classes with medical students as long as there was room in the class.
So at that point I changed my plan, came back to Stanford, enrolled, and took the preclinical sciences with the Stanford Medical School entering class of 1976. I’ve got to say that the students in my class were uniformly generous and seemed to accept me as one of them. We had joint study groups, socialized, helped each other through labs—it was a marvelous experience.
During this time I continued to make applications to medical schools. When I’d get a rejection, I would write back and in a sense reject the rejection, saying that when you sent my rejection letter you had not seen my grades for the current academic quarter, and then I’d remind them that I’m taking a medical school curriculum, etc., and I would provide them with the grades. It never changed anybody’s mind, but it was certainly worth a try in every instance. I had one of the University of California admissions people remind me that no matter how good my grades were in the Stanford Medical School classes, it did not raise my GPA from my prior schooling enough to matter. So the tally that really serves to orient my humility is that over a period of three years and 120 applications, I had three interviews and two acceptances, one into the first year at Northwestern, and the other that really mattered, into the third year at Stanford.
One thing I could not take with Stanford medical students was a hands-on course in physical diagnosis because this involved medical students examining patients. I could not touch a patient under the auspices of Stanford Medical School because I was not matriculated and therefore their malpractice insurance would not cover me. I happened to mention this to Don, I think on another Interplast trip, to which Don calmly said, “Take it with the physician assistants.” Don had started the PA program at Stanford and so it just popped into his mind. He gave me the name of the person to contact, which I did. I paid for what expenses there were, and I took my physical diagnosis course under Don’s PA program. So in the end, I guess one of the things that really matters is that I got a piece of paper. It had my name on it, Stanford’s name on it, and Doctor of Medicine on it.
During my medical schooling I had done a clerkship in anesthesiology. I wanted to do this because I wanted to have some hands-on skills in airway management and manipulating physiology as only anesthesiologists do. John Redpath was on the faculty and he was also an Interplast anesthesiologist.
One of the things I want to say is that while I was in medical school and involved with Interplast I had this wonderful image of surgery training, formed watching the plastic surgeons, the attendings working with residents and fellows, the quality of the interaction, and the depth and detail of the discussion on both sides of the conversation. During medical school, as is just, I took a surgery rotation and was completely turned off by the teaching/learning that went on. There was very little dialog. It was much more like a John Wayne “conversation”: monosyllabic instructions of how to care for patients. It seemed more that students, interns, residents were learning by mimicking (which is certainly a part of learning medicine), without the nuance that comes from a more thoughtful interaction. This dissuaded me from wanting anything to do with surgery.
My time with John Redpath in anesthesiology had just the opposite effect. In fact, I left Stanford already accepted in to the Stanford Anesthesia Residency.
Parenthetically, I also got an invitation to interview at Mass General, but I was unable to convince myself to move back to Boston when Stanford had been such a wonderful experience for me.
I did return to Stanford and was able to get some pediatric anesthesia training. I again joined Interplast on trips, this time in the role of anesthesiologist, which was even more gratifying.