#calledtobeasurgeon

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EVOLUTION OF MEDICAL EDUCATION: Ultrasound and the Fetus

There is a question to which the answer is still not adequately explained. This question regards the potential for ultrasound to have any effect on the development of a maturing organism. This problem has a very real relevancy at this time because of the prevalence of this procedure. The average pregnant woman in this country, at this time, has at least one sonogram performed on her. Often, she has several performed during the course of her pregnancy. This raises the question, do these examinations have any potential dangers and do these examinations all have real medical significance? A sonogram entails bouncing sound waves off of an object and analyzing the reflection. Does the object off which the sound is bounce sustain any effects from the bombardment? The answer is that it most certainly does. Depending on the intensity of the waves the effect can be dramatic, even to fracturing stones. But this does not mean that less intensity has no effect. Even very low intensity has some effect though this may not be apparent grossly. The sonogram which is commonly performed on pregnant women has no noticeable effect on the patient or the fetus, but this does not prove that it does not have any effect. The word noticeable is vital in that sentence. In biological situations it is well known that many effects do not become apparent at once. Consider how long it was before the dangers of      X-Rays were understood. The fetus is a very active organism which is continually developing with cells actively dividing and connecting to each other. The mechanisms controlling these processes are not fully understood but we do know that they can be affected rather easily, either physically or chemically. It is not unreasonable to infer that a sound wave hitting a cell in active division or connection, at a crucial time, could disrupt the normal pattern of development. While this might have no apparent effect at that time, it might become manifest much later. This raises the possibility that the ultrasound bouncing off the fetus could affect various developing connections of neurons in the brain. If this is so, the effects of sonograms could have far reaching significance and deserve much more careful study. For instance; could this be associate with the incidence of autism and other neurological abnormalities, such as attention deficit disorders. There are two obvious ways to study the question. One is to correlate the number and timing of the sonograms performed on pregnant women with the future development of their offspring. A statistical analysis which would require a very large sampling and considerable effort to input the various significant data. The other method could be an animal experimental study whereby pregnant laboratory animals were subjected to sonograms at various stages and the effect on the offspring noted. Until the potential of ill effects of sonograms are more fully understood, it would be wise to limit the number of sonograms performed on pregnant women to those that have important medical significance. Too often they are performed to satisfy simple curiosity. If doctors and patients realized that there might be a potential danger associated with this simple and painless procedure, many less should be ordered.   EVOLUTION OF MEDICAL EDUCATION Called to be a Surgeon, Not for Bread Alone Author: Dr. Neville K. Connolly Ultrasound and the Fetus Read the full article

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Called to Serve: A Healer’s Calling

About the Author: I would like to introduce this unique and special surgeon to you. I met Dr. Connolly when my three-year-old son, Rickey, was referred to him for a painful lump on his thigh that turned out to be rhabdomyosarcoma. Neville had just become a citizen of the US and was just starting his private practice in Washington, D.C. as a general and pediatric surgeon. Neville operated and removed the tumor which gave Rickey relief from his pain. He explained the diagnosis to me and said he would be happy to care for him as I asked him to do. Rickey trusted and adored him. He felt that Neville could fix whatever went wrong, which he did for the year he was sick. Neville tried everything that was available to cure him and Rickey did very well for the first six months. Rickey’s father was a hopeless drunk, years before Rickey got sick, and was never there for him. Neville provided Rickey with the security of a father figure that he lacked from his own father. I had Rickey baptized at home by a Priest from St. Alban’s Episcopal Church and Neville became his God Father. Neville had two little girls and Rickey said he was the only little boy Dr. Connolly had. When the cancer metastasized and I could no longer take Rickey to Dr. Connolly’s office, he came from Washington, D.C. to our house in the Virginia suburbs to care for him. Since he had just started his practice, he was not too busy to work it into his schedule. He brought Rickey children’s bible story books about Jesus and the lamb and other stories that Rickey treasured. When Neville went on Vacation with his family he would send Rickey post cards to encourage him. When ever anything bothered Rickey, he would say call Dr. Connolly, he will fix it, and he did. He was available for Rickey any time, any day. When Rickey didn’t feel well, he would pat my arm and say, don’t worry mommy, God is looking out after me. He also told me that if you have faith even as small as a grain of mustard seed, you can do anything. I don’t know how he knew all the things he did at three years old, but he said them with authority. He loved classical music that he was introduced to, by the record of music and the story of Disney’s Sleeping Beauty. I asked him how he liked the story.  I liked it a lot, he said, but you know I felt sorry for Maleficent, the evil fairy, maybe she wouldn’t have been so bad if they had only invited her to the party. There was something very special about Rickey. I always thought I felt that way because he was my son, but everyone who knew him thought he was very special too. Neville said he tried not to get too close to his patients, because it hurt so bad if they died, but he couldn’t help himself with Rickey. The night Rickey died, Neville came to the house to take care of arrangements. The first thing he did, after he comforted me, was to go into the bedroom and get down on his knees at Rickey’s bed and asked God to forgive him for his inadequacies and prayed for Rickey. I was overwhelmed by emotion in realizing the depth of character of this humble and pious healer. His abilities in healing and caring were extradentary. His faith in God and his response to God’s calling was without bounds. Now I know why Neville and Rickey were so drawn to one another, they are kindred spirits. Rickey’s funeral was held at St. Alban’s Episcopal Church in Washington, D.C. and Neville was one of the pall bearers. Neville and I remained friends and he became my doctor for life. After Rickey died my marriage ended in divorce. My ex-husband remarried and later died of alcoholism. I started a new life and got a job at Georgetown Hospital. and moved to Washington D.C.   I became friends with Agnes, Neville’s wife, and we all served together on committees of our Church at St. Alban’s. Many years later, as Agnes started to fail, I was able to help Neville care for her. About thirty-five years after I first met Neville, Agnes died. Neville and I were both getting close to retirement. Neville told me he realized that he was in love with me and asked me to marry him.  I realized that like Rickey, Neville and I were kindred spirits and I was in love with him. We have been married for twenty-three wonderful years. Though there have been many changes in the delivery of  medicine during his practice, Neville will always believe it to be a “calling”. Read the full article

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God’s Will: Serving Patients – Excerpts of Caring from Called to be a Surgeon, Not for Bread Alone Dr. Neville K. Connolly, MA, MD, FRCS, FACS, FAAP

I was asked, one day, to see a patient with acute abdominal pain. A simple physical examination convinced me that he had acute appendicitis and I recommended immediate surgery. He refused and went home. I was very worried and could not get him out of my mind. That evening, though it was pouring with rain, I drove out to his house to see him again. I found that he was no better, perhaps a little worse. This time he acceded to my demands that he be operated on. I put him in my car and drove him to the hospital where I removed an appendix which was about to rupture. He and his wife were very grateful and I got to know him quite well while he was recovering. I found out that he worked for a radio company and was an expert on such things as amplifiers and radio receivers. By this time, we had moved into our house in Washington and I had set up my ‘Hi-fi’ system. I had this made for me by a friend in England before transistors had replaced vacuum tubes. Also, it used 240-volts rather than the 120-volt current used in American houses. Someone had told me that houses in America had two incoming electric lines and an earth line. If one connected the input of the two incoming power lines, one got 240-volts. I had done this, connecting the input of my machine with one terminal to each of the incoming lines in the main box. It had worked quite satisfactorily for some time but now it had died. I was at a loss to find someone who could repair it. I asked my recovering patient if he would be able to help me out, since he was an expert in that field. Perhaps out of a sense of gratitude, he agreed to come to my house to see what he could do. When he arrived and saw how I had managed to get an input of 240-volts into the machine I thought that he would have a heart attack. After rapidly disconnecting my brilliant solution, he explained that I needed a transformer to adapt my machine to work on 120-volts and that he could get one for me. I had never really understood much about electricity and always felt lucky that I had learned, rather parrot-wise, enough physics to get into medical school. I am still not quite sure why electricity does not run all over the floor when you pull a plug out of a wall socket. I accept the fact that it does not do so as a merciful act of God. Apparently, God was on my side when I did the original wiring as there was no explosion and the house did not burn down. My patient kindly sorted out the whole mess and got my Hi-fi working again. Other than the cost of the transformer he would not charge me. He said that my unexpected zeal in coming to his house that night had saved his life and he felt this small service scarcely repaid me. I wonder if he realized just how significant a service he had rendered to me.   I became involved in a situation which was very revealing and, to me, rather unhappy.  One of the senior pediatricians asked me to see a small child with intractable constipation. I examined the child, found that I needed to evacuate the impacted stool from high in the intestine and did so with the aid of an anesthetic. My examination convinced me that the child had Hirschsprung’s disease. This is a condition where the nerves in the lowest part of the intestine have not developed properly. As a result, the contents of the intestine are propelled only so far. They cannot be pushed through the area which has the deficient nerve supply. Though the condition had been known for many years, its true cause was only discovered in the late 1940's by the group at Boston Children’s hospital. At Great Ormond Street in London we had learned about their work and copied them. The cure was to remove the malfunctioning part of the distal bowel and connect the remainder to the anal canal. This is a somewhat tricky operation but pediatric surgeons were performing it with great success. Having seen this particular child, I wrote a note on the chart suggesting the diagnosis and recommending an X-ray which would confirm my opinion. I also called the referring physician. Most apologetically he informed me that he had only seen the child because the child’s own pediatrician was out of town. This pediatrician had returned and did not wish me to see the patient any more. He had his own surgeon. This surgeon did not believe in Hirschsprung’s disease. He had the child transferred to another hospital where he performed several misguided operations without improving the situation. I was very frustrated but did not see what I could do. A couple of years later a baby was admitted to the ‘staff’ service and was seen by Dr. Hawfield. He called me and said that he had a baby that he would like me to see with him. I went to the ward with him. Before he could tell me anything about the problem I noticed the name of the baby. It was the same last name as the child mentioned above. I said; “Are you suspecting Hirschsprung’s?” He said he was but how did I know. I told him the sad story of the other child who turned out to be the older sister of the current patient. It turned out that the older sister was still in trouble. The parents had spent all their money on the medical expenses of the older child and had to send the second child to the hospital for free care. We confirmed the diagnosis on the baby and Harold asked me to operate as he was not familiar with the procedure. I made the necessary plans and arranged for one of the anesthesiologists with whom I had developed a very satisfactory relationship to give the anesthetic. The night before the operation I went to the hospital to check that everything I would need would be ready. There I met the Chief of Anesthesia. He said to me; “Why are you going to kill that baby tomorrow?” I spent a miserable night appreciating how much depended on the next day. Besides the life of the baby, my whole reputation hung in the balance. I went ahead and performed the operation as I had done before under the tutelage of Denis Browne. Actually, the baby was only 3 months old and the standard recommendation was to wait until the baby was at least 6 months of age. The procedure went very smoothly and the baby had a normal bowel movement on the way to the recovery room. She never looked back and was discharged within a week. This is not the end of the story. The parents, who were very grateful to me, were working for an embassy in Washington at that time. They were subsequently transferred to New York. A couple of years later they called me up from New York to tell me that their older daughter was still suffering from her original problem. Since their younger daughter was now completely healthy, they asked if they could bring the older one down for me to cure. I told them that should not be necessary because there were excellent pediatric surgeons in New York. I would contact the one I knew on their behalf. I rang up Dr. Santulli and explained the situation to him. He agreed to take on the child which he did. He found that she was nearly moribund but he revived her and then cured her. I went over the hospital records of this child when I had first seen her. To my amazement and utter disgust, I found that my notes, consultation and recommendations had been removed in total. This made clear to me the difficulty I would have in establishing a purely pediatric surgical practice in Washington at that time. Perhaps I could sow the seed for others to follow. This was my thinking at that time but, with hindsight I realize that I might have done much more if I had pursued the issue of the original ignorant mistreatment of the older daughter or I had brought up the deletions to her chart when I discovered them. I was too acutely conscious of my foreign back ground and surgical training to face the repercussions that almost certainly would have ensued. Maybe if I had done so at that time the upgrading of the surgical care of children in Washington would not have had to await the arrival of Judson Randolph as the full time surgical chief. Read the full article

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The Path of Medical Practitioners

The Path of Medical Practitioners Called to be a Surgeon, Not for Bread Alone – Neville K. Connolly, MA, MD, FRCS, FACS, FAAP When Neville emigrated from England to Washington, DC, he joined Dr. John Lyons’ practice to assist him for 3 years and to become acquainted with the American medical system. As soon as he reported to Dr. Lyons’ office he met Dr. Harold Hawfield who was Dr. Lyons’ associate for the previous three years and whose duties and privileges Neville was to take over. Harold was leaving to merge his practice as a partner with another distinguished surgeon. Harold had agreed to stay on for a couple of months to help Neville settle in. He proved to be a tireless tutor, showing Neville around, introducing him to the many people that he would be working with and sparing Neville from making any mistakes. Harold introduced Neville to the hospital where Dr. Lyons admitted all his adult patients. This was a rather venerable hospital known as Emergency Hospital and was situated a couple of blocks from the White House. Though the hospital was old, the most striking feature was the atmosphere. There seemed to be a friendly and cooperative sprint throughout the whole staff. It did not take long for Neville to trace this to the influence of Dr. Lyons, who seemed to know everyone by name, as well as their families, and spoke to everyone. By being Dr. Lyons’ assistant, Neville was put on the staff of the hospital right away. This meant that he had to take a turn at supervising the residents who took care of the non-paying patients from the wards and the emergencies. Neville would be called at night by the senior surgical resident when a patient needing surgery was being admitted. After listening to the patient’s story, Neville could give the OK for surgery or suggest other possibilities. At first Neville did not realize how relatively inexperienced the senior resident was. When Neville was a senior resident (registrar, as it is called in England) he had nine years’ post graduate training. He did not realize that these senior residents were only three to four years out of medical school, but Neville learned quickly when he had to rush to the hospital one night to get the resident out of a surgical problem. Luckily, he sorted it out and no harm was done. Besides Neville’s duties at the hospital he was given the use of Dr. Lyons’ office to see any patients he might have. One night while Neville was doing rounds for Dr. Lyons’ patients, he entered the room of one patient and found himself fascinated. The patient seemed to be incredibly informed about everything and seemed to know everyone of any significance in the political world. She had just had major surgery but did not seem slowed up at all. The political parties were about to have their conventions to choose a candidate for the next President and she was concerned she may not be able to attend both the Democrat and Republican conventions. Neville sat on the radiator in her room for an hour or more most nights listening to her. He knew nothing about her, but she was very knowledgeable and interestingly opinionated. The next day, when Neville was walking to the garage with Dr. Lyons, he said to him that the lady he had just seen for him on hospital rounds was a most fascinating character. Dr. Lyons: “Don’t you know who she is? Mrs. Longworth?” Neville said he did not. Dr. Lyons explained that she was Teddy Roosevelt’s daughter, who was brought up in the White House and had been married to the Speaker of the House. No wonder she was so interesting! Perhaps the greatest compliment to her was that Neville found her so interesting even though he had no idea who she was. Many years later, after Dr. Lyons had died, she became Neville’s patient. By that time, she was in her 80's but still as sharp as a tack. Neville had to perform a second mastectomy on her and she continued to be a fascinating patient, and flabbergasted Neville with some of her antics.   Neville found he had spare time on his hands and talked to Georgetown Hospital about doing some undergraduate surgical training for the medical school. The Professor of Surgery at Georgetown Hospital was very pleased to have him come on the staff and to do some teaching. After Neville has been working for Georgetown for a while he was asked to take on the responsibility of their home service program. This was a charitable program to care for patients that were dying from their disease at home. They were taken medicine and their families given help and advice about taking care of them. The care team consisted of a nurse, a social worker and a doctor who went by once a week. Controlling the pain became Neville’s chief responsibility. Instructing the family how to give injections of narcotics was not a very reliable solution. Neville remembered that a hospital in London had formulated a mixture of narcotics that could be taken by mouth and was very effective. Neville managed to get hold of the formula known as Brompton Cocktail. The Pharmacist of Georgetown Hospital managed to make up a very similar mixture that was most effective. Read the full article

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How Medical Technologies Affected Medical Practices

Called to be a Surgeon, Not for Bread Alone Author: Dr. Neville K. Connolly   Many changes have occurred over the last 50 years. The most significant is the ability of the medical profession to diagnose and effectively treat so many more of the ills that affect mankind. The knowledge of the physiology and the pathology of the human being have grown exponentially. This has led to the increased knowledge of the causes of some diseases and expanded the ability to prevent or treat them. The use of radiology with its computerization of images and of ultrasound imaging has led to the development of new specialties and modified the use of others. These developments have meant that that is not possible for any doctor to know all that is necessary to treat all the problems that may present themselves. As a result, the general practitioner often has to call on many ancillary services to make the correct diagnosis to treat the patient. This has had two significant side effects. There has been a serious increase in the cost of the diagnosis and treatment of disease. The other is the apparent diminution of the importance of the general practitioner, even though someone needs to guide the patient in deciding how and when all these new innovations should be used to the best advantage. This can only be the patient’s own personal physician. Without such input the patient navigates helplessly in uncharted waters. The importance of the personal physician cannot be overemphasized, though for a time it tended to be disregarded, now there is a move to try to rectify this deficiency. When a patient is sent for further testing and opinion, the specialty physician should report their findings to the referring personal physician to discuss the results of the tests and give him his recommendation for treatment. The personal physician is the only one who if familiar with the patient’s overall health and is best qualified to advise the patient. Many specialist physicians just send the patient on for additional testing or make recommendations to the patient for treatment without involving the patient’s personal physician There seems to have been a change in the attitude of physicians themselves which cannot be attributed solely to the influence of technical advance, thought this may have made the relationship between the physician and the patient more remote and less personal. Read the full article

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A Surgeon’s Journey in Medicine

Called to be a Surgeon, Not for Bread Alone: Neville K. Connolly, MA, MD. FRCS. FACS. FAAP

Dr. Neville Connolly’s desire to be a physician started early in his life when he decided he wanted to be able to spend his life helping people. When he started college at Kings College, Cambridge Univ. it was at the start of WW II in England. He felt that being a physician would allow him to be of help to many of the sick and wounded.  After graduating from Cambridge University, he was given a Rockefeller scholarship to go to Harvard Medical School in the USA. Neville went in a convoy of Merchant Marine ships, escorted by destroyers, to New York to attend Harvard. He arrived at Harvard just as the US was attacked at Pearl Harbor and entered the war. While attending Harvard he did training at Johns Hopkins Hospital in Baltimore, Maryland and was assigned to assist some of the great names of Hopkins surgeons. Among them were Blaylock, who developed the “blue baby” operation and was one of the pioneers of cardiac surgery, though he did not confine himself to this field. Firor, who was always a perfect gentleman and a superb, thoughtful surgeon, Reinhoff, nicknamed “Wild Bill”, was fearless but an excellent technician. All this activity was a sharp contrast to the leisurely discussions and seeming inactivity of the Medical Service that he was exposed to in Boston. The results of surgery were swift, and whether successful or not, determinate, it depended on technical skill as well as thoughtful planning. The whole atmosphere was intoxicating for a budding physician. It was here that he changed his mind and decided to become a surgeon. He still liked children and saw the possibilities of combining both his interests by becoming a pediatric surgeon. After graduating from Harvard. he returned to England to get his medical degree from Cambridge. To do this, he had to attend courses at an English Hospital. Since St. Thomas’s Hospital ln London had awarded Neville a scholarship before he accepted the scholarship from Rockefeller to go to Harvard, they allowed him to join their courses. Neville covers in great detail his learning experiences and the differences between the English and American system of training. At the end of his training he passed his exams at Cambridge and got his medical degree. Shortly after that the war ended in Europe, Neville started work at St. Thomas’s as a house officer This was his first year as a doctor, 1945-46. At the end of his six-month appointment he had to apply for another six months as a House surgeon before he could do his National Service in the ARF. He was anxious to get started in the field of his special interest, Pediatric Surgery. Neville’s father knew Sir Stanford Cade, who was the senior Surgical Consultant to the RAF and became Vice President of the Royal College of Surgeons. He was a very influential advocate for the RAF and was able to organize a special burn service at the RAF Hospital. He offered to introduce Neville to the staff of Great Ormond Street Hospital for Sick Children, the premier hospital for children in England. Though Neville was offered another six months at St. Thomas’s He applied at Great Ormond Street and was awarded a House Surgeon appointment to work with Denis Browne who later became Sir Denis Brown, the Queen’s surgeon. Great Ormond Street is a remarkable Hospital. It is the first Hospital in England to care for children exclusively. Neville goes into great detail about how much he learned and how many skills he mastered while working with Denis Brown. After his training at Great Ormand Street Neville started to study for his exams to become a Fellow of the Royal College of Surgeons. During this time, he went into the Royal Air Force to serve his military obligation and was assigned as a surgeon to Ely Hospital, which was one of the main RAF hospitals that had one of the main burn units set up to treat burned pilots, many of them casualties from the battle of Britain. After finishing his service in the RAF, Neville went to St. Thomas’s Hospital as a supernumerary registrar, which was a position provided for ex-service men to get extra training. During that time, he passed his exams and became a Fellow of the Royal College of Surgeons. England had just started the National Health Service and Neville got a position at Norwich Hospital as a middle grade surgical Registrar. He was assigned to two of the four consultant surgeons, Mr. Birt and Mr. Ridley Thomas. This was in the early days of the National Health Service. He found that they were inundated with patients. Once the patient chose the surgeon they wanted, they always saw the same surgeon unless they asked to have a different one. This allowed excellent continuity of care. On a busy day, and most were, they could see as man as 50 patients in a session. At the onset of the National Health Service no one had any concept of the enormity of the health problems lurking in the background. As soon as people realized they could get surgery for their problems without paying for it, they came forward with conditions like hernias, varicose veins and hemorrhoids that they had tolerated for years. The work load was stupendous. After two years at Norwich Hospital Neville returned to Great Ormond Street as a senior Registrar to continue his Pediatric surgical training. After he finished his training at Great Ormond Street he realized that there were few jobs for pediatric surgeon positions in the National Health Service. It was a specialty that was just beginning to be recognized. Neville realized it would be some time before he would possibly be able to get an appointment as a Pediatric surgeon. When he had visited his wife’s family in Washington, DC, he had been introduced to Dr. John Lyons, who was the Senior surgeon at one of the hospitals there. Dr. Lyons had taken care of Agnes, Neville’s wife, when she was very sick as a girl. Dr. Lyon’s told Neville if he ever decided to immigrate to Washington, he would welcome him as his associate. Dr. Lyon’s reputation was outstanding, both as a surgeon and as a man utterly devoted to his patients. Neville saw the move as a chance to make his own career on his own merits rather than chancing it on a selection committee of the Health Service. He decided to make the move to start his private practice in Washington. Read the full article