One of the biggest problems for any resident is getting everything done each day. There are people to see, things to read (to make sure that you were on top of patient care), and then there was the busy work, including the dictating of charts. It is the administrative work that would come back to haunt you. If you didn’t accomplish the paper work in a
timely fashion (like immediately) most hospitals, at least once a month,
printed a delinquency list for every one to see. Normally our posture was to
wait on this list and then, after having procrastinated as long as we could, be
forced to go down and complete them.
Smith called me in the office one day and said, “JR, I want you to do me a favor. I want you to go down to the record room and find out who’s responsible for the list of residents with delinquent charts. I want you to have him call you two days before he makes the list. And
then, those two days before the list comes out, I want you to go down to the
medical records office and dictate those charts.” I never appeared on that list
again. Smith’s point was this: learn to use the system, don’t let the system
One of the best things about training at Michigan was the camaraderie between the residents. The four of us virtually did everything together. We arrived at the hospital around 5:30 and we spent the whole day together until we left at 7:30 or 8 pm that night. We got to know each other very well. It was comforting to know that it wasn’t all just
happening to you.
One of the moments of clarity for me occurred when Dan #1, who was really from the year before, talked about his family. Dan, Ed, and Dan #2 were married. I was not. Personally I think that was a prerequisite to get into the plastic surgery program at the University of
Michigan and I somehow fell through the cracks. A married resident was a
committed resident without the distraction of nurses and female residents.
Dan#1 commented on how hard we were working. It was brutal to go through the day, having people who had certainly more knowledge and expertise than you pound on you for what you did not know. In a sense he was correct. No one ever seemed to support you for what you did know. The cup was always half empty.
All Dan#1 talked about during the day was his two small girls, approximately three and four years old. What he said was this, “No matter how bad his day was, when he got home, there were two little girls who thought he was the greatest thing in the world. No matter how down he was, when he hit that door he was a happier person because of them.” He
offered that he felt bad for those of us, meaning me, who didn’t have that
experience: those of us who got home at the end of the day and merely had to
confront that somehow that day you hadn’t measured up. You didn’t know all the
answers. You didn’t solve all the problems. And more than likely, you didn’t get
everything done that you wished you had gotten done.
That all changed when the next year of residents arrived. Noel Tenebaum was from New York, he was single; Steve Gitt was from Phoenix, he was single (though considering marriage) and then there was Jeff, Jeff Wagner, who was
married andwho you could characterize as nothing more (or less) than Smith
cloned. It was clear that Jeff was going to be very successful as an academic
Noel and I hit it off immediately. In a sense, he became my family. Most of our time away from the hospital was spent together. We talked about life, we’d complain about the
workload, and we’d date nurses from the same nursing unit. That friendship has
lasted to this day, and even now I consider him family, more than just a
My second year of residency in plastic surgery at the University of Michigan began with one of the most frightening experiences I had had as a physician. A cute little six-year-old
boy, blond hair, blue eyes, and helpless, was brought into Mott’s Children’s
Hospital with meningitis. He had been an awesome hockey player but now he was
fighting for his young life. He arrived the day my chief residency year began
July 1, 1991. Dr. Smith assigned him to me, and it began a journey for both of
us that would change our lives forever.
Meningitis, an infection, either bacterial or viral, affects the membranes that cover the brain and spinal cord. Patients can present with headaches, stupor, and confusion, but it also can result in loss of integrity of the blood flow to different areas of the body,
particularly the extremities. We watched helplessly as the process progressed. Our
only recourse was to treat him expectantly chasing every complication that
resulted from his disease. I cried (along with his parents) as he began to lose
toes, his foot, and then his lower legs. Every day I needed to change his
bandages. It was difficult knowing that every day I was putting this kid
through excruciating pain. I felt so bad for his mother and father having to
watch this happen. Day in and day out, I’d round in the intensive care unit and
work on this kid for about an hour.
He did eventually get better and he did survive it, but the cost was the loss of his lower extremities. On the day that I finished my residency training at the University of Michigan, he was discharged home. His mother thanked me; we all hugged as they wheeled him to
the car. She made me a promise that we would stay in touch, to let me know from
time to time how he was doing. And she did.
A year later, after he had gone through extensive physical therapy, a company in San Diego had fashioned him some prostheses, above the knee leg attachments, to allow him to walk (and skate) once again. The Detroit Red Wings had heard of his fate and had adopted
him as their “mascot”. It was a wonderful thing to do.
I got a call from his mother. She needed a “favor”. During intermission at a Detroit Red Wings-Los Angeles Kings game, he was going to demonstrate his new legs by skating to center ice, a treat for any kid, but a triumph for him. She wanted to know if I could attend,
but more importantly, she wanted me waiting at center ice. I cried like a baby
in front of 20,000 screaming fans as he made his way toward me. I don’t think
I’ve ever been that happy. I still cry today every time I think of him, not so
much for his loss, but for his spirit and his willingness to fight on.
Michigan also provided me with one of the biggest non medical joys of my training career. My uncle, Terrell Burton, who had coached football at Michigan with Bo Schembechler for 20 years, was still affiliated with the team. Growing up I hadn’t been able to spend a
lot of time with him because they lived so far away, but my Aunt Sue and my
mother would speak all the time. Sue and Terrell were great and all about encouragement.
Sue always had a smile and the best thing you can say about Terrell was that he
was “a coach”. No matter when I got to see them, they were always loving and
always giving – well that is, except one weekend a year. Once a year, the
University of Michigan played Ohio State University in football. Terrell, who
knew I loved Ohio State football, would ride me for the whole week. I’d get
calls at the hospital, where he’d say, “Watch out for this play. We’re going to
do this to you on Saturday.”
But what Terrell did that was awesome was that he invited me and the entire plastic surgery division to the training facility where the University of Michigan football team prepared for games each week. There were lecture halls, with motivational slogans on the
walls, and indoor football fields. Let’s just say that this group of doctors
and nerds were literally in heaven. You could feel the history. You could feel
the excitement that went along with University of Michigan football. It was
simply great. We walked around the facility like a group of kids on a field
trip. I think Smith and Riley Reese enjoyed it more than the residents. Smith
summed it up by saying to Terrell, “My only hope is to build a plastic surgery
program the football team can be proud of”. I think he accomplished his goal,
but I don’t think any of us had as much fun in two years as we had that day.
My training career was winding down quickly. Two years had passed and I had yet to leave the hospital. Noel and I were now inseperable and had grown to be brothers and confidents. I knew that was a friendship that would last a lifetime and it has through children, living at different ends of the country, and divorces.