At Stanford, it is obvious that you should, or must, excel. After all, Nobel Laureates eat lunch right across the table from you – the common faculty person. Wow. You look up to these people. That guy right there looking like a regular fellow, appearing as a serious person, mild-mannered, and probably of scholarly bent, they appear to be a bit interesting, not obviously outgoing, not obviously one who has won a claim of the world. I could do the same as him or her. What makes them different from me? I’ll talk to him and find him What makes him tick?
“Hello…What did you say to that guy, sir? Was it about the baseball game? I don’t hear well.”
“No, it was the ball force of gravity theory.”
“Oh, what is that?”
My brother is a physicist working for Warner von Braun, and he talked about that, I think.
After lunch, I said “Thanks for talking,” and now my relationship with this giant person was initiated. Making these friendships was the conscious decision of the five wise men who founded Stanford Hospital, that the lunchtime associations between giants and diminutives would foster logarithmic increase in medical knowledge, and I must say it does work.
I can do that type of work; in fact, I think in many ways I’m better than him and he won the prize!
I will find out more about him.
These meetings linked me up with H. Lee Cronbach, Albert Schalow, Vassiliadis, Honey, “King” Arthur Kornberg, and a couple more impressive men. I know these winners in educational psychology, physics, laser, laser, DNA transcriptors. You see, no one really tells you you should aspire to be a Laureate, it is just in the air and you assume that goal. And so, at Stanford, you have an atmosphere of excellence, of doing something for humanity, something really great. Como (just as) Rochelle, Greatneck, Shorewood. Everyone assumed you should really, really excel. Harley, Davidson, Briggs, Straton, Herbey Kohl, Ewens (Greedy Foundries), AO Smith Foundries Heil, Square D. Now, these were household names and my father’s insurance customers and acquaintances. My grandfather invented the dishwasher. My uncle invented the automatic popcorn popper. Count Gertz, a philanthropist of Austria, political exile from Germany, was my great-grandfather. Joseph Donnersberger decommissioned himself from the Austrian Army, with half his fortune.
You assumed you yourself might do that good if you really were hard-working, if the dice fell right and in your favor. I, for example, always thought I might invent something every person might use – for example, a can opener, the eraser, the rolling suitcase, things like that.
I was looking for my chance to solve and contribute, like everyone else around me here at Stanford.
That is just when only a few patients came to clinic and we were forced to go out to go to the hedgerows to find human pathology – to Salenas, to Imperial, to Eureka. We went lecturing and shaking hands. We went to Rotary meetings and Kiwanis meetings. We joined professional medical societies.
The patients did not really fall out of the sky for us – there was one big deficit at Stanford. Uncle Hippocrates had instructed us to perfect ourselves in a skill and science and apply it to the other person’s medical pathology. This second part was missing. We began to perfect ourselves before teaching others. In fact, the others included first person singular, the new faculty in the Division of Plastic Surgery, the residents, and the students. We did assume an axiom or principle right from the beginning: that your primary responsibility as Chief is to promote the career of each individual under you.
With the huge mountains of skill and knowledge in medicine around you every moment, it was a transformative experience when one of the have-nots of the world came up from Mexicali, Mexico: no money, no education, no friends, no social advancement, inability to communicate to other people with cleft palate speech, and a huge gaping hole right in the upper lip. We had already begun to perfect ourselves before teaching the others by learning skills in excess – microsurgery (Harry Buncke, inventor of the field, San Mateo), craniofacial anomaly surgery (Douglas Ousterhout), aesthetic surgery (Gilbert Greatinger and Robert Berner), transplantation of the kidney by homograft (Roy B. Cohn (RBC) and Sam Koontz), cadaver skin transfer for burns (Gil Eades, University of Washington, and Peking Medical Journal), heart and lung transplant in dogs was being done right next to mine in our – 209 (residents Bill Hurley and Lauer and Chief Norman Shumway), silicone was touted as tissue substitution (Herb Conway and Blair Rodgers, New York City, and Thomas Cronin, Dallas, Texas), abrogation of rejection (Madawar, London), new anatomy was being discovered or delineated in order to transfer tissue from one part of the body to another (Ernie Kaplan and resident from Canada). In a quest to know all of this, the entire field was extant at this time.
And so, on one clinic day, BALM asked Chief Resident Dr. David Dibbell to have a sex change. Each Wednesday, clinic day was held in Boswell Building right in front of the beautiful million dollar National Institute of Health (“NIH”) fountains. Even though we had no real basis to speak on that subject, or to make a qualified judgment, we were not astonished because this fit right in with all of the new knowledge that was happening all around us and sort of in the air. We relished a new uncultivated field in surgery, which is being presented to us. In a way, we were instantaneously able to join the elite club of the Stanford Young Turks, who were the grandsons of the five wise men who started Stanford Hospital. (q.v.) We felt that at that time, on that morning, we soon would be able to make significant contributions toward solving and describing a new diagnosis. We would be able to explore and delineate the nature and incidence, and hopefully the social and medical management of that condition. Perhaps what was presenting might become a bonafide part of medicine, and therefore, this coming experience would assist us in doing our job in academic surgery at the great university. Teaching, research, and patient care were coming as a present, somehow.
Chief Resident Dave Dibbell was the first to interview this first patient.
“Don, this is not a good case. This is a great case, a change of sex – go into the room and see for yourself.”
“Dave, I’m a Catholic and I’m from the Midwest, and I don’t want to change what God made; but I would love to do the right thing if this turns out to be right.”
BALM: “Dr. Laub, are you familiar with transsexualism?”
My answer was, “Not fully.”
“Have you read the book on transsexualism? The book was written by Dr. Harry Benjamin. Have you heard of him?”
My answer, “No.”
“He sent me here.”
I examined the beautiful woman patient and discovered generous genitalia, undeniably of the male variety.
Oh my God, was the thought. Here I am, because I know everything in Plastic and Reconstructive Surgery. I know all the operations. I am able to close all of the wounds that can be created, and yet, I don’t know this diagnosis, nor have I ever heard of it, and moreover, I did not know the correct sex of this patient – in fact, I actually made a mistake about who this patient actually is.
“Dave (to Dibbell), what is this going on?”
“Let’s call Dr. Harry Benjamin of New York and San Francisco on the phone during lunchtime.”
H.B.: “Yes, this is a real, legitimate condition: where the brain is separated functionally from the body, in that one is male and the other female, for example, a male body and a female behavior residing in the brain. It occurs right from birth. The cause is not yet clarified but it is real: I can send you some patients.”
“Yes, great, good.”
“I’ll send them on my expense.”
They came during the next month: Faye Annette (the second lawsuit), the daughter of a famous Wild West character, and Diandra Monsuco.
The surgery was on November, 1968, a little bit after sex change history was made in Casablanca, by Dr. François Borou, and at John Hopkins by Dr. Milton Eger. In preparation for that first surgery of ours, we formed a multidisciplinary clinic of behavioral scientist, psychiatry, urology, GYN, plastic surgery, anesthesiology, a theologian, an attorney, a social worker, and the services of a finishing school.
The psychiatrist, incidentally, was Norman Fisk, who would eventually coin the clinical designation of “Gender Dysphoria.” Fisk and I went on a site-visit to every place in the world where gender surgery was being done, except Casablanca, because his down payment was excessive.
Harry Benjamin did come to Stanford and presented at Wednesday afternoon grand rounds, and also lectured at the home of a colleague on Upenuff Drive, near Skyline Drive.
Years later in 1973, we held the first world-wide symposium at Stanford where everyone who was interested in transsexualism presented their work. The informed consent for the surgery was made with a lawyer as the witness to what was explained to the patient and who would be our legal counsel for potential legal troubles.
The surgery is described in detail in another very interesting blog that will be coming soon. It consisted of inversion of the penis, formation of a vaginal space between the rectum and bladder, and use of scrotum, etc., for external genitalia. I was away on an Interplast trip when some bleeding occurred on the ninth day. It was minor in amount and handled competently by John Markley, who also participated in the surgery. The grapevine among the transsexual patients was that you are able to obtain free surgery because when you file a lawsuit, the surgeon stops sending his bill. This was the major incentive on the part of BALM. She could not be reached for any deposition for over 5 years. I was devastated and spent a lot of 3 AM time thinking about the strategy for management of this terrible blow.
The management plan was that I would continue to do the surgery and build up enough experience before the lawsuit came to court; I would be the most qualified expert witness in the world at that time.
[names changed to protect identities]