Going to Germany was an experience in itself, I was to fly from Indianapolis via TWA into Kennedy in NYC and connect with Lufthansa for 7:00PM departure to Frankfort. My TWA flight was late leaving Indy and on reaching Kennedy I had to get a limousine for $50 to go to the International terminal which was literally 100 yards across the road. As I rushed to the check in, the clerk said the boarding for my flight was closed. I panicked. Here I was on the hospital’s dime and had missed my flight and I had to be in Kiel the next day. I asked her what options did I have and she nicely said “I can put you on a flight that leaves in an hour to Hamburg from there you can get a train to Kiel”. That was a relief plus it gave me time to exchange some currency which I hadn’t had a chance to do. So I finally boarded and wondered what was ahead. I almost suffocated on the flight because the German passengers bought cigarettes duty free and tried to smoke them all on the flight.
Arriving the next morning, I cabbed to the train station which was huge and my not being able to read or speak any German manage to find the ticket window and purchased a ticket to Kiel. Instinctively, I listened for the train to be called and since I had no idea about what car to board I decided to get in the one closest to the engine, which was a smart move on my part; because the train as it went north dropped off cars from the rear that were switched to other destinations. Luckily I didn’t take the car towards the end of the train or I would have ended up I don’t know where.
The train trip was through some beautiful scenic country side and I knew I was safe to arrive at my destination since Kiel was the end of the line.
As soon as I checked into the hotel which was about 3PM, I crashed with the time zone change and slept until about 10PM. Since dining is done late in Europe I ate and decided to scout my surroundings for tomorrows adventure at the University Hospital. Arriving back at the hotel I found the hotel bar and immediately connected with the bartender and a keyboardist that played in the bar until the wee hours. Now that I knew I was situated, I felt relieved.
The course started the next morning and as I trudged up an inclined path to the Hospital, wondering what was in store for me. I hadn’t met anyone that was an attendee until I entered the auditorium.
We were greeted by Dr Jordan Phillips an internationally known laparoscopist who had established a society called the American Association of Gynecologic Laparoscopist and had coordinated this course and introduced with Dr Semm.
Herr Proffesor Semm began by describing how he envisioned being able to do operaterations via laparoscopy and what innovations he had developed to achieve that goal.Having a degree in engineering helped bring his technology to fruition.
The goal that he had was to be able to do most of the common gynecological operations through the laparoscope using multiple puncture sites in the abdomen to access the organs and develop a technique for cutting, clamping, suturig and removing pathology. He than proceeded to describe what he had invented or designed to achieve this.
First, was an automatic insufflator that pumped gas on demand to distend the abdomen for visualization. Second, were special trocars (spikes) to insert into the abdomen where tubes could be inserted to allow instruments for manipulating tissue as you would in an open case. The insufflator kept up with any gas that leaked around the gaskets in the cannulas (tubes), Third, he
developed a series of instruments (grasper,clamps,needles, scissors and needle holders). Fourth, he invented a unit that could coagulated tissue without burning any adjacent structures. Fifth, he created an irrigation suction system to keep the operative field clear of blood and debri. Six, he designed a morcellator that chewed up tissue for removal. And lastly,
he perfected a technique of suturing that gave the surgeon the reassurance of securing bleeding from large blood vessels. All of these inventions and techniques were compiled in a syllabus that was handed out for future reference. This was definitely needed since most of the lecturers spoke English but some things were lost in translation.
Listening to the introduction to the course and having practiced on their trainer model to become facile in manipulating tissue and tying knots, I felt more comfortable than I had been in Miami a year ago.
There were 24 attendees and we were divided into twelve groups of two and assigned to a trainer with one of his fellows. My fellow was from India and we struck it off right away. He had us go through a series of exercises to see what our dexterity was and satisfied with that put us through a series of steps that replicated surgical procedures (ie. taking out a cyst, removing a tumor, tying a blood vessel with both kinds of knots). The knot tying (intracorporeal and extracorporeal) was emphasized since Semm believed this was the key to completing the surgery without having to convert the case to a laparotomy (opening the abdomen).
After practicing our trainer exercises all morning, I asked my instuctor if I could show him a maneuver that I had come up with for tying that was simpler than what Semm did and proceeded to demonstrate it to him. He was impressed! So I ask him if he could show it to Dr Semm. His reply “NO, I could never show Herr Professor anything”. I asked if I could show it to Semm’s Associate Professor Tennenbaum and he again said “NO WAY”. That’s when I got the feeling that Semm was not likely to take suggestions or take fools lightly (me). So I kept my mouth shut on this point. But found later that my technique was easier and having shown some of the attendees they returned home with Robinson’s knot tying method.
With the basics over we were told that Semm had 6 cases scheduled the next day to demonstrate Pelviscopy on actual patients.
That night we had a reception to welcome us to Germany and to sample the food and customs where we were bussed to a medieval castle. This was really an interesting event and we were plied with food and toasted with drink far into the night, making the early wake up call a little hard to accept.
The next day was the part of the technology I had come to see. Looking at video tapes and working on trainers was great but I wanted to see what Semm could do in real time on real pathology in real patients.
We were split in to 6 groups of 4 so one group could come into the operating room while the others were able to observe on close circuit in an adjoining room.
This was where something happened that produced a seminal moment in my thoughts about Pelviscopy.
When our group was in the operating room we saw that Semm sat on a special stool and had arm rest (like an ether scree) to brace his elbows over the patient and the laparoscope was held by his assistant who looked into a side port to observe what Semm was doing. And periodically they would attach a crude camera to the scope and feed a signal to a TV monitor back to the conference room where the we could see what he was doing. All this was fascinating and quite impressive as Semm provided a running commentary of what he was doing. As I recall they took out a cyst, removed a fibroid tumor and separated some adhesions along with removing the appendix.
When the surgery was complete we had a “snack” that was really a feast at about 11 O’clock between the next 3 cases in which they served sparkling drinks, cold meats, cheeses, black breads, pastries, fruit and the like which they told us was an everyday operating room ritual in Germany. (I was ready to definitely adopt this and bring back to the US).
When done we adjourned to the conference room for a question and answer
session. Dr Semm took the podium and was peppered with detailed questions about this and that from the audience.
I had this thought and when he recognized me I asked “ Herr Professor, why don’t you watch the TV monitor to operate so everyone can see what is going on rather than look through the scope”. He replied, to my embarrassment, “Dumbkoff don’t you anything about light, every time you connect a link to the light source (source to cable to scope to lens vs camera) you lose 50% of the light” and went on to answer other questions. I slid down in my seat and said to myself, I need shut up and learn something about light!
The next days in Germany consisted of more cases and some side trips to see some sites and then my return home.
On the flight back I reviewed the material I had received about the procedures, the equipment and the copious notes I had taken all leaving me with the burning question……would doctors in the US accept this tedious method of doing surgery no matter how elegant. And as I fell asleep high above the Atlantic, I surmised NOT!
Sunday, September 23, 2007
My Story of Pelviscopy
In my life time and more specifically in the 50 years that I have been a physician some monumental events have affected the course of medicine worldwide; antibiotics, blood replacement, the cure for malaria, the Salk polio vaccine, cure for tuberculosis and more recently the DNA key to disease. The story I’m about to relate is my part in a technology that I believe shaped a new surgical approach in medicine to the magnitude of these events. The technical details of this story are necessary for me to relate so the reader can appreciate the magnitude of what followed.
This story starts in 1986 with a trip to Miami where Dr. Tom Benson the director of the OB/GYN residency at Methodist and I the associate director attended the first course held in the United States offered by Dr Kurt Semm from Kiel Germany. It involved teaching a technology he developed that was foreign to American gynecologists. We in the US had embraced laparoscopy for diagnostic purposes since the mid 1950’s. But because of certain limitations in equipment and with the only meaningful surgical procedure being tubal sterilizations, it was not seen as a truly operative procedure. And serious complications began to occur with alarming frequency that made a large number of gynecologists abandon it world wide ……electrocautery bowel injuries. These were produced because the electrocautery used monopolar current which cause burns if a structure was touched between the source and the object (i.e. tubes) due to a short circuit in electrical energy. These burns led to bowel perforation and in some cases death: making the procedure fall into disrepute and abandoned in the USA. In the 1970’s Dr. Richard Kleppinger invented a bipolar forcep that eliminated the danger of bowel injury due to their design. To understand the physics of this development is to understand how electrical current (energy) behaves. Monopolar current travels from the electrode (devise tip) through the body and exits to ground. Whereas, bipolar current is transmitted from one tip of a grasper to the other tip without any chance of shorting the circuit and causing an electrical burn.
The procedure Semm developed he coined the term Pelviscopy to differentiate it from the stigma that Laparoscopy had attached to it.
What Semm proposed was to be able to operate intraabdominally using a scope for visualization and insert multiple operating cannulas in the abdomen whereby instruments could be inserted to perform the tasks of grasping, coagulating, cutting and sewing that mimicked what was done in an open abdominal case (laparotomy). With that capability, he felt that he would not only eliminated the need for a large incision, recovery would be reduced as would post op pain.
His first task, which was his real contribution, was to design the equipment and instruments to achieve his operative goal.
The first thing he invented was an Automatic insufflator that would pump gas on demand to keep the abdomen inflated so multiple puncture sites for instruments could be used. The second thing was what he called an endocoagulator, an instrument that used heat to coagulate instead of electrical current. Thus, sealing off bleeding for hemastasis. Thirdly he constructed a series of instruments that could be inserted through the abdominal wall called cannulas (tubes) to grasp, cut and sew tissue. And lastly, and most importantly he developed a technique of ligating blood vessels ( intracorporeal and extracorporeal knotting) so diseased tissue could be removed. All these steps went to produce an elegant surgical innovation.
You don’t have to be a doctor to see that if this approach to surgery was feasible the impact it would have would be mind boggling. You could literally operate through a key hole and with some refined instruments remove diseased tissue the same way.
The course I attended in Miami was my introduction to this fascinating new approach to what was to be the surgery of the future.
I have always been fascinated by technology and when Benson, my boss, asked me if I saw any value in this in our hospital and residency, I said let me work on how hard it is for me to learn this and teach the basics and go from there as to it’s adaptation. But first I needed to have one of his practice units called a “pelvic trainer” and a few of the basic instruments so I could gain skill in doing the surgical maneuvers on an inanimate model.
He approved my request to purchase the needed equipment and I went to work honing my skill. I also had a group of lower level residents who were required to learn the skill in my lab to the point that we had a good feel for our ability to perform an operation but not on any patient yet.
About 6 months had gone by and I still wanted to feel more secure in doing this on a patient when I was invited to Germany to take a hands on course where I and 24 other doctors from around the world would get to see Semm actually perform Pelviscopy. Since Benson knew I was cautious and wanted to be as knowledgeable as possible he requested the hospital send me to the course.
Going to Germany was a learning experience that led me to developing Pelviscopy at Methodist Hospital and expanding it to the general surgeons, who reluctantly finally embraced it. Today that surgery is called minimally invasive surgery and spans practically every surgical specialty (ie. Hysterectomy, Cholecystectomy, colectomy, nephrectomy, pulmonary, heart, ortho, etc, etc). The story of the learning curve follows.
This story starts in 1986 with a trip to Miami where Dr. Tom Benson the director of the OB/GYN residency at Methodist and I the associate director attended the first course held in the United States offered by Dr Kurt Semm from Kiel Germany. It involved teaching a technology he developed that was foreign to American gynecologists. We in the US had embraced laparoscopy for diagnostic purposes since the mid 1950’s. But because of certain limitations in equipment and with the only meaningful surgical procedure being tubal sterilizations, it was not seen as a truly operative procedure. And serious complications began to occur with alarming frequency that made a large number of gynecologists abandon it world wide ……electrocautery bowel injuries. These were produced because the electrocautery used monopolar current which cause burns if a structure was touched between the source and the object (i.e. tubes) due to a short circuit in electrical energy. These burns led to bowel perforation and in some cases death: making the procedure fall into disrepute and abandoned in the USA. In the 1970’s Dr. Richard Kleppinger invented a bipolar forcep that eliminated the danger of bowel injury due to their design. To understand the physics of this development is to understand how electrical current (energy) behaves. Monopolar current travels from the electrode (devise tip) through the body and exits to ground. Whereas, bipolar current is transmitted from one tip of a grasper to the other tip without any chance of shorting the circuit and causing an electrical burn.
The procedure Semm developed he coined the term Pelviscopy to differentiate it from the stigma that Laparoscopy had attached to it.
What Semm proposed was to be able to operate intraabdominally using a scope for visualization and insert multiple operating cannulas in the abdomen whereby instruments could be inserted to perform the tasks of grasping, coagulating, cutting and sewing that mimicked what was done in an open abdominal case (laparotomy). With that capability, he felt that he would not only eliminated the need for a large incision, recovery would be reduced as would post op pain.
His first task, which was his real contribution, was to design the equipment and instruments to achieve his operative goal.
The first thing he invented was an Automatic insufflator that would pump gas on demand to keep the abdomen inflated so multiple puncture sites for instruments could be used. The second thing was what he called an endocoagulator, an instrument that used heat to coagulate instead of electrical current. Thus, sealing off bleeding for hemastasis. Thirdly he constructed a series of instruments that could be inserted through the abdominal wall called cannulas (tubes) to grasp, cut and sew tissue. And lastly, and most importantly he developed a technique of ligating blood vessels ( intracorporeal and extracorporeal knotting) so diseased tissue could be removed. All these steps went to produce an elegant surgical innovation.
You don’t have to be a doctor to see that if this approach to surgery was feasible the impact it would have would be mind boggling. You could literally operate through a key hole and with some refined instruments remove diseased tissue the same way.
The course I attended in Miami was my introduction to this fascinating new approach to what was to be the surgery of the future.
I have always been fascinated by technology and when Benson, my boss, asked me if I saw any value in this in our hospital and residency, I said let me work on how hard it is for me to learn this and teach the basics and go from there as to it’s adaptation. But first I needed to have one of his practice units called a “pelvic trainer” and a few of the basic instruments so I could gain skill in doing the surgical maneuvers on an inanimate model.
He approved my request to purchase the needed equipment and I went to work honing my skill. I also had a group of lower level residents who were required to learn the skill in my lab to the point that we had a good feel for our ability to perform an operation but not on any patient yet.
About 6 months had gone by and I still wanted to feel more secure in doing this on a patient when I was invited to Germany to take a hands on course where I and 24 other doctors from around the world would get to see Semm actually perform Pelviscopy. Since Benson knew I was cautious and wanted to be as knowledgeable as possible he requested the hospital send me to the course.
Going to Germany was a learning experience that led me to developing Pelviscopy at Methodist Hospital and expanding it to the general surgeons, who reluctantly finally embraced it. Today that surgery is called minimally invasive surgery and spans practically every surgical specialty (ie. Hysterectomy, Cholecystectomy, colectomy, nephrectomy, pulmonary, heart, ortho, etc, etc). The story of the learning curve follows.
Reds
Two friends of mine a while back bought a liquor licenses and a place called Reed’s that had been a neighborhood bar for years. They decided to name it Red’s the reason for the name change is lost since they are both dead now.
It became the “it” place to go. It was on one of the most traveled streets in the black part of town and right at an interstate exit. If anyone came to town and was looking for someone they would go to Red’s or someone there would know where they were.
I was a good friend of the owners and the manager Jack and knew all the barmaids: Loretta, Wanda, Anna, Lilly, Paulette, Jeannie, Dee, Millie, Nancy, Rene’ and Brenda.
Jack was a real character, a guy with a heart of gold, who would run a tab for the winos and pour a free drink for the bar for any reason what so ever just so he could knock back a “shooter”. He was a great cook and would fix huge pots of chili, white beans, chitlins, chicken wings, beef stew or neck bones on Saturdays and everyone would be eating drinking and getting down. Marvin Gaye’s “ What’s goin on “ or Al Greene’s “Lets stay together” would be blastin and before there was an “electric slide” or “stepping” we would be forming a line dance of our own and dancing the night away. I closed the place a thousand times. It was my nostrum
Red’s had a character of it’s own and anyone from out of town I took there always said they wished there was a Red’s in there town. I’ve been around and in many bars and joints but Red’s was something else.
The characters that came thru Red’s would have been a perfect cast for Damon Runyon story. Like “Capt Bob” who was a stone wino who could recite any dirty poem or story for a bottle of “hooker” ( Wild Irish Rose) or “Junior” who passed out and fell in the middle of the street out front. And it was summer and the doors were all open and the crowd said Doc “ give Junior mouth to mouth” and I replied “NOT ME, I’ll direct traffic around him until the paramedic come”. Jimmy the owner abhorred cursing and every other word was usually MF this and MF that and when he wasn’t around we would play card or shoot dice in the back room.
One thing Jimmy did not tolerate was disrespect to women and that’s what let to his untimely violent death. Jack had a way with people, even drunks and could get them out the door before anything happened. One night before Jack came to work a guy insulted a woman and Jimmy grabbed him to put him out and the guy pulled his gun and shot Jimmy point blank. He died before the medic arrived. After the funeral his cortège drove by Red’s and the customers stood on the front porch and held their glasses high in a last salute to him. Red’s was never the same after that.
It became the “it” place to go. It was on one of the most traveled streets in the black part of town and right at an interstate exit. If anyone came to town and was looking for someone they would go to Red’s or someone there would know where they were.
I was a good friend of the owners and the manager Jack and knew all the barmaids: Loretta, Wanda, Anna, Lilly, Paulette, Jeannie, Dee, Millie, Nancy, Rene’ and Brenda.
Jack was a real character, a guy with a heart of gold, who would run a tab for the winos and pour a free drink for the bar for any reason what so ever just so he could knock back a “shooter”. He was a great cook and would fix huge pots of chili, white beans, chitlins, chicken wings, beef stew or neck bones on Saturdays and everyone would be eating drinking and getting down. Marvin Gaye’s “ What’s goin on “ or Al Greene’s “Lets stay together” would be blastin and before there was an “electric slide” or “stepping” we would be forming a line dance of our own and dancing the night away. I closed the place a thousand times. It was my nostrum
Red’s had a character of it’s own and anyone from out of town I took there always said they wished there was a Red’s in there town. I’ve been around and in many bars and joints but Red’s was something else.
The characters that came thru Red’s would have been a perfect cast for Damon Runyon story. Like “Capt Bob” who was a stone wino who could recite any dirty poem or story for a bottle of “hooker” ( Wild Irish Rose) or “Junior” who passed out and fell in the middle of the street out front. And it was summer and the doors were all open and the crowd said Doc “ give Junior mouth to mouth” and I replied “NOT ME, I’ll direct traffic around him until the paramedic come”. Jimmy the owner abhorred cursing and every other word was usually MF this and MF that and when he wasn’t around we would play card or shoot dice in the back room.
One thing Jimmy did not tolerate was disrespect to women and that’s what let to his untimely violent death. Jack had a way with people, even drunks and could get them out the door before anything happened. One night before Jack came to work a guy insulted a woman and Jimmy grabbed him to put him out and the guy pulled his gun and shot Jimmy point blank. He died before the medic arrived. After the funeral his cortège drove by Red’s and the customers stood on the front porch and held their glasses high in a last salute to him. Red’s was never the same after that.
The Rough Years 3
Now that I was in the recently completed house, things were a mixture of sadness and confusion. It was difficult living with a new wife and baby, my aunt and a teen ager, and trying to work with the fear that someone may be stalking me. I spent many a sleepless night hearing noises and seeing shadows in the woods around my house. Plus my aunt talked constantly about how my mother and she had planned something in the house and I was doing it all wrong. I had hired a nanny to care for Becky and my aunt had miffed her by assuming she was a housekeeper so I ended up paying her to keep Becky and her house. This did free Rena up but it did nothing to give me any space. I tried taking up golf as a distraction, but golf is a game that does not do well by being distracted and many a peaceful day was interrupted by a call about a perceived problem at home.
All this led to more frustration on my part and tension with Rena and my aunt. I finally persuaded my aunt to get an apartment right around the corner from where we lived to salvage our sanity and relationship. Right after that Rena decided she wanted to move back to Atlanta to pursue a “career”.
Now, only 4 years into the marriage and trying to deal with numerous financial and personal problems, I was essentially left to deal with all this alone. It was really a separation that allowed Rena to have space an no problems and me problems and no space. My spiral was tightening as I felt lower and lower emotionally.
The clinic was only doing fair now that there was more abortion protests and I was burnt out by medicine in general. I had nothing that stimulated me, surgery was to say the least easy for me and basically something I could do by rote. So all I did was go to the clinic, go to the office, go to surgery and to Red’s. and drink day after day after day. On this endless merry-go- round, I could not catch up……..debt increased and back taxes accrued with all the penalties and interest the government could apply. I saw no way out of this hole that I could not stop digging.
Then to my surprise Rena wanted Becky to come back to Indy and stay with me. To this day I have not be able to understand what she was searching for or why she wanted her to go back with me but I said yes and she brought Becky home and she and I set out to care for ourselves, something we have continued to do until this very day.
I was in deep tax debt and I chose to pay my alimony, child support and college obligation rather than the IRS….so as was expected the IRS forced me to sell the house for a portion of the back taxes.
My taxes were never going to get current because I was never able to pay my quarterly tax estimates. This not only incurred a penalty but an interest that accrued monthly each being 18% a year. I was drowning in a whirlpool of debt with no life preserver.
During all of these problems, I was badgered by my ex-wife about timely support payments. I was mentally exhausted and to top it all off the IRS forced me to sell the house.
Now, I had to find a place for Becky and I to live when Rena decided to return to Indy. We found a condo that only held about 1/3 of our things and put the rest in storage and started to regroup our lives. This I hoped would be a restart personally though I had no clue to how I would get right financially.
As the saying goes “ when it rains it pours” the landlord for my clinic lease which also housed my office cancelled renewing it which essentially put me in a situation where I had to lease another place under unfavorable terms ( a five year lease ). I was screwed but I fought thru that and after a year when I thought things could not get worse my landlord informed me that he was selling the condo he was leasing me and I had 1 month to leave. What else could happen? I still don’t know how I managed to survive all these reversals in my life……but I did survive. I found another place that looking back was what I really felt was ideal. It was a condo in a converted old factory building and it had exposed brick walls with floor to ceiling windows and hewn wood overhead beams. What I really liked was it had an underground garage and my unit was on the fifth floor with a view of downtown Indianapolis. All this was only 6 minutes from the hospital and 15 minutes from my office.
During my stay here I started exploring the possibility of relocating my practice to Atlanta, but since I was in so much debt it made no sense to move to another city in which I had no professional contacts.
Rena and I were going through some serious changes since I had made so many concessions and felt I was doing all that I could to provide a decent life.
She decided to move back to Atlanta, which was really an impulsive thing and I was glad to have some peace by being alone. She decided that Becky should go with her and I agreed. This impulsive move lasted less than a year and she was back again unhappy as ever. None of these moves helped any of the problems we were dealing with and only caused us more tension in our marriage.
I knew that the only way out of my situation was to try to get a job where I was salaried and my taxes were withheld at least this would allow me pay my current taxes in a timely manner and not pay estimates on income that I didn’t have.
I ran my dilemma by my friend Benson who was the Director of the OB/GYN residency at Methodist Hospital. And he said he might be able to hire me part time to staff the GYN clinic. He was able to do this and for about 4 months I worked not as a full time employee but at least I had my foot in the door.
The interaction with the medical students, interns and residents revived my love for teaching and I asked Benson how was the chances for full time employment and he said the OB/GYN education committee would have to approve the need and Dr Frank Lloyd the CEO of the hospital would have to approve the position. I told him I was really desperate and needed a job.
Then something occurred that changed my whole life. A seminar was being held in Miami where a new surgical technology was being taught by a leading pioneer from Germany. He, Benson, arranged for the two of us to attend this first course in what was called Pelviscopy. On the flight back to Indy, he asked me did I see this revolutionary approach having any validity and being integrated into our institution and patients. I said I saw some potential but would like to work with the teaching model trainers we used in the course to get a feel for how difficult the technique was to learn and teach. He gave me the go ahead and found some funds to buy the teaching model to practice on.
The path ahead is really one of the major achievements and contributions I have made in my medical career. The story of Pelviscopy and what was spun off from it follows. HospitalHo
All this led to more frustration on my part and tension with Rena and my aunt. I finally persuaded my aunt to get an apartment right around the corner from where we lived to salvage our sanity and relationship. Right after that Rena decided she wanted to move back to Atlanta to pursue a “career”.
Now, only 4 years into the marriage and trying to deal with numerous financial and personal problems, I was essentially left to deal with all this alone. It was really a separation that allowed Rena to have space an no problems and me problems and no space. My spiral was tightening as I felt lower and lower emotionally.
The clinic was only doing fair now that there was more abortion protests and I was burnt out by medicine in general. I had nothing that stimulated me, surgery was to say the least easy for me and basically something I could do by rote. So all I did was go to the clinic, go to the office, go to surgery and to Red’s. and drink day after day after day. On this endless merry-go- round, I could not catch up……..debt increased and back taxes accrued with all the penalties and interest the government could apply. I saw no way out of this hole that I could not stop digging.
Then to my surprise Rena wanted Becky to come back to Indy and stay with me. To this day I have not be able to understand what she was searching for or why she wanted her to go back with me but I said yes and she brought Becky home and she and I set out to care for ourselves, something we have continued to do until this very day.
I was in deep tax debt and I chose to pay my alimony, child support and college obligation rather than the IRS….so as was expected the IRS forced me to sell the house for a portion of the back taxes.
My taxes were never going to get current because I was never able to pay my quarterly tax estimates. This not only incurred a penalty but an interest that accrued monthly each being 18% a year. I was drowning in a whirlpool of debt with no life preserver.
During all of these problems, I was badgered by my ex-wife about timely support payments. I was mentally exhausted and to top it all off the IRS forced me to sell the house.
Now, I had to find a place for Becky and I to live when Rena decided to return to Indy. We found a condo that only held about 1/3 of our things and put the rest in storage and started to regroup our lives. This I hoped would be a restart personally though I had no clue to how I would get right financially.
As the saying goes “ when it rains it pours” the landlord for my clinic lease which also housed my office cancelled renewing it which essentially put me in a situation where I had to lease another place under unfavorable terms ( a five year lease ). I was screwed but I fought thru that and after a year when I thought things could not get worse my landlord informed me that he was selling the condo he was leasing me and I had 1 month to leave. What else could happen? I still don’t know how I managed to survive all these reversals in my life……but I did survive. I found another place that looking back was what I really felt was ideal. It was a condo in a converted old factory building and it had exposed brick walls with floor to ceiling windows and hewn wood overhead beams. What I really liked was it had an underground garage and my unit was on the fifth floor with a view of downtown Indianapolis. All this was only 6 minutes from the hospital and 15 minutes from my office.
During my stay here I started exploring the possibility of relocating my practice to Atlanta, but since I was in so much debt it made no sense to move to another city in which I had no professional contacts.
Rena and I were going through some serious changes since I had made so many concessions and felt I was doing all that I could to provide a decent life.
She decided to move back to Atlanta, which was really an impulsive thing and I was glad to have some peace by being alone. She decided that Becky should go with her and I agreed. This impulsive move lasted less than a year and she was back again unhappy as ever. None of these moves helped any of the problems we were dealing with and only caused us more tension in our marriage.
I knew that the only way out of my situation was to try to get a job where I was salaried and my taxes were withheld at least this would allow me pay my current taxes in a timely manner and not pay estimates on income that I didn’t have.
I ran my dilemma by my friend Benson who was the Director of the OB/GYN residency at Methodist Hospital. And he said he might be able to hire me part time to staff the GYN clinic. He was able to do this and for about 4 months I worked not as a full time employee but at least I had my foot in the door.
The interaction with the medical students, interns and residents revived my love for teaching and I asked Benson how was the chances for full time employment and he said the OB/GYN education committee would have to approve the need and Dr Frank Lloyd the CEO of the hospital would have to approve the position. I told him I was really desperate and needed a job.
Then something occurred that changed my whole life. A seminar was being held in Miami where a new surgical technology was being taught by a leading pioneer from Germany. He, Benson, arranged for the two of us to attend this first course in what was called Pelviscopy. On the flight back to Indy, he asked me did I see this revolutionary approach having any validity and being integrated into our institution and patients. I said I saw some potential but would like to work with the teaching model trainers we used in the course to get a feel for how difficult the technique was to learn and teach. He gave me the go ahead and found some funds to buy the teaching model to practice on.
The path ahead is really one of the major achievements and contributions I have made in my medical career. The story of Pelviscopy and what was spun off from it follows. HospitalHo
The Rough Years 2
The murder of my parent not only put me into a spiral of depression, the investigation was unsuccessful in ever solving the crime
When I was released from the hospital I felt really guilt ridden for not being able to attend the funeral and on top of that I had to find strength to return to work since my responsibilities had not stopped. ( alimony, child support and taking care of my aunt and family).
The police sent detectives to interview my aunt and later me about the murder. I was even asked to take a lie detector test which they said was routine to clear me of any suspicion. And for weeks a team of detectives poured over details with my aunt and I trying to find a motive or what had occurred………to no avail.
Because I had no clue as to why they were murdered, I felt fearful for my family and myself since I may have been the target because of my involvement in the abortion clinic and they were the victim of some crazys by mistake. This fear had me looking over my shoulder and losing sleep for several years. It definitely had an affect on my health in general and though I had stopped smoking the alcohol use continued. ( I was not into any sedatives or antidepressants).
I set about the project of completing the house they had started with all the headaches and financial burden that it entailed. Once that got started it at least gave my Aunt Mad and Rena something to distract them by the job of getting that job done.
One of the problems of a new building project was what I had experienced with my previous ones…….a poor general contractor. I ended up firing him and getting someone to finish the job but at an increased cost. ( my continuing luck).
Once the house was completed we moved Aunt Mad in with us because it had been my parents plan for her to live with them. This proved to be a disruptive situation in that I had a 1yr old, a 14 yr old and a 70 yr old and a recent marriage. I wouldn’t wish this on anyone especially recovering from the trauma that we had all experienced. So it was probably to be expected I had another arrhythmia attack 6 months later. Now my physician had me on a potpourri of medicines that made me constantly fatigued. I was mentally and physically exhausted and on a spinning wheel that wouldn’t stop.
Then I received a call that my favorite cousin Bill had been murdered in Chicago……..would all this never end!
We had hired a nanny to care for Becky and a very good friend invited us to visit him in my favorite city San Francisco. This was a needed relief and I was able to relax and recharge my body and spirit. We shopped, ate crab by the bay and generally had a good time. When I returned home unfortunately
It was back to the usual.
I was trying to find some sort of outlet to release my tension, I had always loved to read but it was not getting it done. So I took up golf and really loved the game but I never could concentrate because Rena was always interrupting me on the course with some trivial problem, So I ended up just hanging out in my spare time a bar run by a friend called Red’s. And because bars are for drinking, I drank and drank. Luckily I was able to function and avoid anything like a DUI, but I knew it was not the healthiest behavior in the world. But it was an escape to go into a dark cool bar and BS with friends about nothing, sipping on a favorite libation mixed by a favorite barmaid. This was my hangout and my friend Jimmy, the owner, was himself murdered by an irate customer one night over nothing some years later. Bad things seemed to be circling me like a vulture circles a carcass.
What more could happen? Plenty, just read on.
When I was released from the hospital I felt really guilt ridden for not being able to attend the funeral and on top of that I had to find strength to return to work since my responsibilities had not stopped. ( alimony, child support and taking care of my aunt and family).
The police sent detectives to interview my aunt and later me about the murder. I was even asked to take a lie detector test which they said was routine to clear me of any suspicion. And for weeks a team of detectives poured over details with my aunt and I trying to find a motive or what had occurred………to no avail.
Because I had no clue as to why they were murdered, I felt fearful for my family and myself since I may have been the target because of my involvement in the abortion clinic and they were the victim of some crazys by mistake. This fear had me looking over my shoulder and losing sleep for several years. It definitely had an affect on my health in general and though I had stopped smoking the alcohol use continued. ( I was not into any sedatives or antidepressants).
I set about the project of completing the house they had started with all the headaches and financial burden that it entailed. Once that got started it at least gave my Aunt Mad and Rena something to distract them by the job of getting that job done.
One of the problems of a new building project was what I had experienced with my previous ones…….a poor general contractor. I ended up firing him and getting someone to finish the job but at an increased cost. ( my continuing luck).
Once the house was completed we moved Aunt Mad in with us because it had been my parents plan for her to live with them. This proved to be a disruptive situation in that I had a 1yr old, a 14 yr old and a 70 yr old and a recent marriage. I wouldn’t wish this on anyone especially recovering from the trauma that we had all experienced. So it was probably to be expected I had another arrhythmia attack 6 months later. Now my physician had me on a potpourri of medicines that made me constantly fatigued. I was mentally and physically exhausted and on a spinning wheel that wouldn’t stop.
Then I received a call that my favorite cousin Bill had been murdered in Chicago……..would all this never end!
We had hired a nanny to care for Becky and a very good friend invited us to visit him in my favorite city San Francisco. This was a needed relief and I was able to relax and recharge my body and spirit. We shopped, ate crab by the bay and generally had a good time. When I returned home unfortunately
It was back to the usual.
I was trying to find some sort of outlet to release my tension, I had always loved to read but it was not getting it done. So I took up golf and really loved the game but I never could concentrate because Rena was always interrupting me on the course with some trivial problem, So I ended up just hanging out in my spare time a bar run by a friend called Red’s. And because bars are for drinking, I drank and drank. Luckily I was able to function and avoid anything like a DUI, but I knew it was not the healthiest behavior in the world. But it was an escape to go into a dark cool bar and BS with friends about nothing, sipping on a favorite libation mixed by a favorite barmaid. This was my hangout and my friend Jimmy, the owner, was himself murdered by an irate customer one night over nothing some years later. Bad things seemed to be circling me like a vulture circles a carcass.
What more could happen? Plenty, just read on.
The Rough Years
We moved into our new house and office in 1970 and about that same time
things started to go bad professionally and personally.
One of the problems that physicians encounter is delayed payment from third party payers ( insurance companies). This greatly affects cash flow and with salaries, expenses and taxes being on going it becomes impossible to stay current with debt. I soon was behind in payments on loans and than taxes which provoked an IRS audit. From there things went downhill since even after getting a payment agreement with them, I defaulted the terms.
With this going on it began to affect my marriage and led to a separation and later divorce.
Now I was burdened with maintaining living space for myself, the new house and the new office. My architect partners in the office were having a down turn in business which eventually led to foreclosure on the building. So in the midst of all this, I had to move to a new office.
An opportunity arose that fortuitously got me thru some of the financial hardships. The Supreme Court legalized abortions in January 1973 and I established the first abortion clinic in Indiana in July 1973. This was something that I had felt was necessary since during my residency I saw my share of horribly botched abortions some leading to death and I had no philosophical or religious reluctance to do them.
The clinic was a way for me to give up OB and concentrate on my Gyn office and surgical practice.
I also remarried and we had a new baby girl, Becky who brought a new dimension to my life. Things were looking up! We moved into a town house and were soon joined by my stepson Lenny.
To go back in time a little ways, my father and mother and brother had lived in Evansville for all these years and Evansville was going through a recession that had really crimped my Dad’s practice. He took a job with the VA hospital and they moved to Indianapolis 1965. My favorite Aunt Madeline had retired and moved from DC to join my parents. They had decided to build a new house about the time I moved out of mine. So both of our lives appeared to be on the upswing. As I have learned, life is a series of peaks and valleys and I was about to go through the deepest valley imaginable.
On the morning of August 7, 1975, I was at the hospital and my secretary said my Aunt wanted me to call her right a way. When I called she said she had called my wife Rena to see if she had talked to my mother that morning because my mother was not answering the phone and they talked daily at around 10AM, so she went out to the garage of the apartment building where they lived to see if my Dad’s car was gone, thinking they had gone on a errand. She said the car was in its parking space. I told her to get someone in management to open the apartment and I would be right over. Driving over I had this premonition that something bad had happened. My thoughts were that both of them wouldn’t have had some dire medical problem at the same time so what could have happened.
When I pulled up in front of the apartment building my apprehensions were worsened because there were several police cars at the curb with flashing lights. They lived on the first floor in a garden apartment and as I ran down the hall I saw my aunt slumped against the wall crying and as I approached she said “ Burley, Gwen and Earle are dead. ” At that moment I was paralyzed. A police officer stopped me and said I couldn’t go in the apartment until the crime lab comes. So my aunt and I went to sit in the neighbor’s apartment next door waiting for the investigators to finish. She was trying to tell me what she found when she went in with the maintenance man. As I recall I arrived at about 11AM and it wasn’t until around 2PM that they asked me to come make an identification. I had called my wife and brother who was in school in Bloomington. And now I sat trying to comfort my aunt about something I didn’t even know what.
A detective came and got me and said they had been brutally murdered and was I able to go in and identify them. I indicated that I could and as I climbed the stairs to the 2nd floor hallway I saw a hand sticking through the banister railing and steady myself to go on up. When I looked down the hall the carpet was soaked and the wall splattered with blood and there they lay in their night clothes stabbed innumerable times. The details are imprinted in my brain and I don’t want to describe the horrible picture I will carry to the day I die. I told the detective that they were my parents and staggered back to join my aunt and await my brothers arrival from Bloomington.
I had to get home to my wife and baby and I told my aunt she had to come with me so pack some things and we would go as soon as the police allowed us to. Because I had friends on the police force the murder was made a priority and by the time I arrived home many of my friends were calling or at the house.
I remember having this overwhelming sadness and wanting to cry but couldn’t and I was standing on my patio with one of my best friends and he said let it out and I wept in his grasp like I had never done before. My mother and father had reached a place in their lives where they were getting ready to enjoy the fruits of their labor……two sons raised and seven grandchildren between us; me with six children and Bruce with one and now their lives extinqished by a later to be an unsolved murder.
The stress of all this was not immediately evident and as I tried to take charge of their burial, cooperate with the police investigation and care for my aunt, I noticed that I was having anxiety attacks. At this time in my life I was a heavy smoker so between the cigarettes and the alcohol I was drinking to cool out, I noticed I would have these occasions of rapid heartbeat. This had happened before when I drank too much and I ignored it……too much to do and arrange and I was the only one that could physically and financially handle it all. My aunt was a basket case and my wife was recovering from recent surgery. The funeral was planned for August 11th which was a Monday and because of their disfigurement it was to be a closed casket service.
The morning of the funeral as I was getting dressed, I started feeling weak and dizzy and decided to lay down for a minute in the guest bedroom not wanting to disturb my wife. I asked a doctor friend to take my pulse and it was over 240/min. On the morning of my parents funeral they rushed me to the hospital with a cardiac arrhythmia, me thinking, is this how all this ends.
Until I wrote these words I haven’t recounted any of this to anyone or even gone over it in my mind. I am not a religious person so I cursed no god but I have never felt after their brutal deaths that life had much further meaning to me. I had escaped early death with tuberculosis and now my parents suffer death by murder so what ever becomes of me now is welcomed.
Whatever happens to me I look at as being on borrowed time from that day in August 1975. Much of me died along with them.
I did promise my aunt that as a kind of memorial to them I would finish the dream house they were so eager to build. That is the story that follows.
things started to go bad professionally and personally.
One of the problems that physicians encounter is delayed payment from third party payers ( insurance companies). This greatly affects cash flow and with salaries, expenses and taxes being on going it becomes impossible to stay current with debt. I soon was behind in payments on loans and than taxes which provoked an IRS audit. From there things went downhill since even after getting a payment agreement with them, I defaulted the terms.
With this going on it began to affect my marriage and led to a separation and later divorce.
Now I was burdened with maintaining living space for myself, the new house and the new office. My architect partners in the office were having a down turn in business which eventually led to foreclosure on the building. So in the midst of all this, I had to move to a new office.
An opportunity arose that fortuitously got me thru some of the financial hardships. The Supreme Court legalized abortions in January 1973 and I established the first abortion clinic in Indiana in July 1973. This was something that I had felt was necessary since during my residency I saw my share of horribly botched abortions some leading to death and I had no philosophical or religious reluctance to do them.
The clinic was a way for me to give up OB and concentrate on my Gyn office and surgical practice.
I also remarried and we had a new baby girl, Becky who brought a new dimension to my life. Things were looking up! We moved into a town house and were soon joined by my stepson Lenny.
To go back in time a little ways, my father and mother and brother had lived in Evansville for all these years and Evansville was going through a recession that had really crimped my Dad’s practice. He took a job with the VA hospital and they moved to Indianapolis 1965. My favorite Aunt Madeline had retired and moved from DC to join my parents. They had decided to build a new house about the time I moved out of mine. So both of our lives appeared to be on the upswing. As I have learned, life is a series of peaks and valleys and I was about to go through the deepest valley imaginable.
On the morning of August 7, 1975, I was at the hospital and my secretary said my Aunt wanted me to call her right a way. When I called she said she had called my wife Rena to see if she had talked to my mother that morning because my mother was not answering the phone and they talked daily at around 10AM, so she went out to the garage of the apartment building where they lived to see if my Dad’s car was gone, thinking they had gone on a errand. She said the car was in its parking space. I told her to get someone in management to open the apartment and I would be right over. Driving over I had this premonition that something bad had happened. My thoughts were that both of them wouldn’t have had some dire medical problem at the same time so what could have happened.
When I pulled up in front of the apartment building my apprehensions were worsened because there were several police cars at the curb with flashing lights. They lived on the first floor in a garden apartment and as I ran down the hall I saw my aunt slumped against the wall crying and as I approached she said “ Burley, Gwen and Earle are dead. ” At that moment I was paralyzed. A police officer stopped me and said I couldn’t go in the apartment until the crime lab comes. So my aunt and I went to sit in the neighbor’s apartment next door waiting for the investigators to finish. She was trying to tell me what she found when she went in with the maintenance man. As I recall I arrived at about 11AM and it wasn’t until around 2PM that they asked me to come make an identification. I had called my wife and brother who was in school in Bloomington. And now I sat trying to comfort my aunt about something I didn’t even know what.
A detective came and got me and said they had been brutally murdered and was I able to go in and identify them. I indicated that I could and as I climbed the stairs to the 2nd floor hallway I saw a hand sticking through the banister railing and steady myself to go on up. When I looked down the hall the carpet was soaked and the wall splattered with blood and there they lay in their night clothes stabbed innumerable times. The details are imprinted in my brain and I don’t want to describe the horrible picture I will carry to the day I die. I told the detective that they were my parents and staggered back to join my aunt and await my brothers arrival from Bloomington.
I had to get home to my wife and baby and I told my aunt she had to come with me so pack some things and we would go as soon as the police allowed us to. Because I had friends on the police force the murder was made a priority and by the time I arrived home many of my friends were calling or at the house.
I remember having this overwhelming sadness and wanting to cry but couldn’t and I was standing on my patio with one of my best friends and he said let it out and I wept in his grasp like I had never done before. My mother and father had reached a place in their lives where they were getting ready to enjoy the fruits of their labor……two sons raised and seven grandchildren between us; me with six children and Bruce with one and now their lives extinqished by a later to be an unsolved murder.
The stress of all this was not immediately evident and as I tried to take charge of their burial, cooperate with the police investigation and care for my aunt, I noticed that I was having anxiety attacks. At this time in my life I was a heavy smoker so between the cigarettes and the alcohol I was drinking to cool out, I noticed I would have these occasions of rapid heartbeat. This had happened before when I drank too much and I ignored it……too much to do and arrange and I was the only one that could physically and financially handle it all. My aunt was a basket case and my wife was recovering from recent surgery. The funeral was planned for August 11th which was a Monday and because of their disfigurement it was to be a closed casket service.
The morning of the funeral as I was getting dressed, I started feeling weak and dizzy and decided to lay down for a minute in the guest bedroom not wanting to disturb my wife. I asked a doctor friend to take my pulse and it was over 240/min. On the morning of my parents funeral they rushed me to the hospital with a cardiac arrhythmia, me thinking, is this how all this ends.
Until I wrote these words I haven’t recounted any of this to anyone or even gone over it in my mind. I am not a religious person so I cursed no god but I have never felt after their brutal deaths that life had much further meaning to me. I had escaped early death with tuberculosis and now my parents suffer death by murder so what ever becomes of me now is welcomed.
Whatever happens to me I look at as being on borrowed time from that day in August 1975. Much of me died along with them.
I did promise my aunt that as a kind of memorial to them I would finish the dream house they were so eager to build. That is the story that follows.
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