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So She Is Dead?

So She Is Dead? Dr John Kirklin was a master educator throughout his entire remarkable career—we can attest to this characteristic firsthand. He challenged, pushed, embarrassed, and most importantly stimulated us to develop everlasting traits in our surgical careers. He stimulated medical students, general surgery residents, cardiothoracic fellows, and colleagues to ever deepen their knowledge. We vividly recall him regularly presiding over surgical grand rounds both at the Mayo Clinic in Rochester at the University of Alabama in Birmingham. Grand rounds was a general surgery conference taking place each Saturday morning and always represented a specific disease entity. During the presentation, Dr Kirklin would call randomly on people in the audience to answer specific questions regarding diagnosis and management. His questioning was vigorous, intense, and in depth. It was clear that if the individual did not have good knowledge of the subject, this was vividly exposed. After questioning a member of the audience, he would then call on an “anonymous” individual in the audience who had prepared a formal presentation to address one aspect of the subject. Dr Kirklin then would proceed with additional aspects until the entire subject was completely covered in detail. On Monday morning, he would often call colleagues who had been absent at grand rounds on Saturday; “Jim, I noticed you were not at grand rounds on Saturday—are you all right?” Point made! In the operating room, which ran like a choreographed symphony, he was an extraordinarily patient teacher of residents. He patiently and quietly led them through each and every step of the procedure, beginning with the insertion of monitoring devices, preparation of the patient, making the incision, the details of cannulation and cardiopulmonary bypass, and then the details and steps of the operation. He was a master at providing graded operative responsibility to challenge and stimulate. This was equally true for a cardiac procedure or the repair of an inguinal hernia. As a faculty member, he would call me (A.D.P.) almost every Sunday evening to discuss some topic for clinical research to be developed for publication or presentation. His motivation for developing new knowledge was intense and never wavering, and he always wanted to share this with other practitioners in the field. The proof of this was his extensive list of presentations locally, nationally, and internationally, as well as his enormous bibliography. The following anecdote perhaps exemplifies his unique educational skills better than words convey. My (J. A. vH.) initial contact with this unique surgeon was as a very junior (and very ignorant) surgical resident rotating for 3 months on his busy cardiac surgical service. These were the early days of transposition of the great vessels and tetralogy of Fallot repair; during this rotation, we witnessed the first aortic valve homograft replacement—pioneering cardiac surgery indeed. Dr Kirklin's team consistently performed 4 cardiac bypasses each operating day. In the Mayo system of putting surgeons in the operating room every other day, this meant 8 cardiac bypasses one week and 12 the next; occasionally a bypass case was replaced by a repair of an abdominal aortic aneurysm as a “fun case” or, on truly special days, repair of an inguinal hernia (an operation he loved). Postoperative rounds with Dr Kirklin rarely were completed before 10 PM. The indefatigable educator started the cycle again with teaching coffee sessions in the cafeteria promptly at 7 AM the next morning. So much for the 80-hour work week in current vogue! On the nonoperative days (consulting days), which included Saturdays and Sundays, a phone call to Dr Kirklin at exactly 9 PM regarding the status of all patients was part of the educational ritual. For the first 2 months, this call was made by the senior resident (of course, the call was expected to be made from the cardiac intensive care unit—Dr Kirklin made sure of that!), while the junior resident assumed this responsibility (with the senior resident close at hand) for the final month of the rotation. A marvelous example of graduated educational responsibility. During one of the early such calls by me (J.vH.) (which were stressful to the ninth degree), I was asked about Mrs Jones. “What is her current PO2?” asked Dr Kirklin. “Thirty-five,” was the confident reply. Without the slightest waver in his voice he further inquired, “And her PCO2 is what, Jon?” “Ninety-six,” came the dumb response. A moment of deathly quiet followed by an audible sigh, “So she is dead then?” “No sir, we just saw her a few moments ago,” said I. With my hand over the mouthpiece, I whispered with wide eyes to the senior resident (Billy Hightower of Alabama fame), “He says, she is dead!” “Let me speak to Billy, Jon,” Dr Kirklin said. The faux pas got resolved by Billy promptly. When he ended the call, Billy informed me that Dr Kirklin wanted me to give a talk the next morning on the interpretation of blood gasses in the cardiac patient! A remarkable man he was indeed. We, as his students, are in his debt. Correspondence: Dr van Heerden, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 (vanheerden.jon@mayo.edu). http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

So She Is Dead?

Abstract

Dr John Kirklin was a master educator throughout his entire remarkable career—we can attest to this characteristic firsthand. He challenged, pushed, embarrassed, and most importantly stimulated us to develop everlasting traits in our surgical careers. He stimulated medical students, general surgery residents, cardiothoracic fellows, and colleagues to ever deepen their knowledge. We vividly recall him regularly presiding over surgical grand rounds both at the Mayo Clinic in Rochester at...
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Publisher
American Medical Association
Copyright
Copyright © 2006 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.141.7.708
Publisher site
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Abstract

Dr John Kirklin was a master educator throughout his entire remarkable career—we can attest to this characteristic firsthand. He challenged, pushed, embarrassed, and most importantly stimulated us to develop everlasting traits in our surgical careers. He stimulated medical students, general surgery residents, cardiothoracic fellows, and colleagues to ever deepen their knowledge. We vividly recall him regularly presiding over surgical grand rounds both at the Mayo Clinic in Rochester at the University of Alabama in Birmingham. Grand rounds was a general surgery conference taking place each Saturday morning and always represented a specific disease entity. During the presentation, Dr Kirklin would call randomly on people in the audience to answer specific questions regarding diagnosis and management. His questioning was vigorous, intense, and in depth. It was clear that if the individual did not have good knowledge of the subject, this was vividly exposed. After questioning a member of the audience, he would then call on an “anonymous” individual in the audience who had prepared a formal presentation to address one aspect of the subject. Dr Kirklin then would proceed with additional aspects until the entire subject was completely covered in detail. On Monday morning, he would often call colleagues who had been absent at grand rounds on Saturday; “Jim, I noticed you were not at grand rounds on Saturday—are you all right?” Point made! In the operating room, which ran like a choreographed symphony, he was an extraordinarily patient teacher of residents. He patiently and quietly led them through each and every step of the procedure, beginning with the insertion of monitoring devices, preparation of the patient, making the incision, the details of cannulation and cardiopulmonary bypass, and then the details and steps of the operation. He was a master at providing graded operative responsibility to challenge and stimulate. This was equally true for a cardiac procedure or the repair of an inguinal hernia. As a faculty member, he would call me (A.D.P.) almost every Sunday evening to discuss some topic for clinical research to be developed for publication or presentation. His motivation for developing new knowledge was intense and never wavering, and he always wanted to share this with other practitioners in the field. The proof of this was his extensive list of presentations locally, nationally, and internationally, as well as his enormous bibliography. The following anecdote perhaps exemplifies his unique educational skills better than words convey. My (J. A. vH.) initial contact with this unique surgeon was as a very junior (and very ignorant) surgical resident rotating for 3 months on his busy cardiac surgical service. These were the early days of transposition of the great vessels and tetralogy of Fallot repair; during this rotation, we witnessed the first aortic valve homograft replacement—pioneering cardiac surgery indeed. Dr Kirklin's team consistently performed 4 cardiac bypasses each operating day. In the Mayo system of putting surgeons in the operating room every other day, this meant 8 cardiac bypasses one week and 12 the next; occasionally a bypass case was replaced by a repair of an abdominal aortic aneurysm as a “fun case” or, on truly special days, repair of an inguinal hernia (an operation he loved). Postoperative rounds with Dr Kirklin rarely were completed before 10 PM. The indefatigable educator started the cycle again with teaching coffee sessions in the cafeteria promptly at 7 AM the next morning. So much for the 80-hour work week in current vogue! On the nonoperative days (consulting days), which included Saturdays and Sundays, a phone call to Dr Kirklin at exactly 9 PM regarding the status of all patients was part of the educational ritual. For the first 2 months, this call was made by the senior resident (of course, the call was expected to be made from the cardiac intensive care unit—Dr Kirklin made sure of that!), while the junior resident assumed this responsibility (with the senior resident close at hand) for the final month of the rotation. A marvelous example of graduated educational responsibility. During one of the early such calls by me (J.vH.) (which were stressful to the ninth degree), I was asked about Mrs Jones. “What is her current PO2?” asked Dr Kirklin. “Thirty-five,” was the confident reply. Without the slightest waver in his voice he further inquired, “And her PCO2 is what, Jon?” “Ninety-six,” came the dumb response. A moment of deathly quiet followed by an audible sigh, “So she is dead then?” “No sir, we just saw her a few moments ago,” said I. With my hand over the mouthpiece, I whispered with wide eyes to the senior resident (Billy Hightower of Alabama fame), “He says, she is dead!” “Let me speak to Billy, Jon,” Dr Kirklin said. The faux pas got resolved by Billy promptly. When he ended the call, Billy informed me that Dr Kirklin wanted me to give a talk the next morning on the interpretation of blood gasses in the cardiac patient! A remarkable man he was indeed. We, as his students, are in his debt. Correspondence: Dr van Heerden, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 (vanheerden.jon@mayo.edu).

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 2006

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