IamA 93 Year Old Retired Surgeon, US Marine Corps Battalion Surgeon late in the Korean War, Playwright, and Author. I just finished my third novel; it's about the crazy early days of transplant surgery. Ask me Anything! AMA!

What was the scariest unknown in the early days of organ transplants?

With kidneys, a failure of the new organ was a disappointment. But with a heart, a failure was a death. Scary? You sew in an ice-cold paralyzed heart from a dead person, warm it up in its new home, and wait: will it beat? You bring up a page of my book - The Transplant Web. bluewaterpress.com/web

Ok...I have a question. With the current rise of antibiotic resistance, can you suggest non antibiotic treatments for surgical sites? Surely there has to be something. Perhaps very strong salt water? Thanks

Oh that's a good question. In a clean fresh wound, there's no need for antibiotics at all. What is needed is to clean the wound by irrigation, and removal of foreign material, and dead tissue. If the wound is new enough, it can be closed by suture. But after several hours, it should be left open. Then, after a day or two, if the wound is clean and healthy, it can then be closed. Antibiotics don't treat the wound. Anything like strong salt water actually injures the tissues in the wound and does more harm than good.

To piggy tale on this, I've read that doctors are using thin tissues made of Manuka honey on burn victims to prevent infections. Is this really a thing?

Burn wounds are an entirely different situation because of the depth of the injury, and continuing risk for infection. I haven't heard of Manuka honey, but the woods are full of people who plaster stuff on burns!

As a fan of MASH the tv show, how close did the producers make it like what you were familiar with?

Did you ever patch up North Koreans?

What is your biggest take away of war?

MASH was a hollywood version. The Marines are smaller, tighter, closer to the troops. Take away the cocktail hour and the foolishness of MASH, tho and it's pretty close. My biggest take-away? War is hell, yes; also standing proof that "there's got to be a better way". North Koreans are humans. We treated them if they came to us. Women, sometimes.

Didn't expect your answer about serving the North Koreans "if they came to us". I grew up with a grandpa that was a WW2 vet and he hated the Japanese. Good on you for raising above such things. Thank you for your service and dedication.

i hope the world gets better as it bumbles along!

What are your feelings on the head transplant that is supposed to take place late next year?

Is that something you thought would happen in your lifetime?

i am skeptical about a head transplant. Face? sure. Carotid arteries? sure, fix 'em. But nervous system? spinal cord? we can't make that regenerate or heal even in the lower spine. But what a field head transplants could be for science fiction! Draculoids, anyone?

How do you become a 93 year old, a surgeon and write 3 novels? I mean where do you get this energy and motivation from? Please describe your daily routine and life motto. I'm a 24 year old looking for serious grandfather advise here.

I've been lucky. but also devoted to interests. Good genes. Good ordinary health maintenance. No cigarettes. No coffee. Ordinary exercise. Boil it down: have a good, serious goal to believe in, and work to it. That's the key, I think: a set of values bigger than I, to conform to and to work for. Those values are not the whole story of life—just the backbone. You've heard details from everyone. My theme: find something bigger than yourself or your future to believe in, to serve, to be guided by. For me it was medicine, the demands of surgery, and finally in later years, faith in the power of love to make things whole.

just the backbone for life

First of all: Im facinated by all the work you have done during a rapidly changing timeframe. What was your biggest "oops" moment?

I was an intern, boggled out, courting my lady, driving back to the hospital on a bridge over the Mississippi, and fell asleep. Glad for good rails! (I loved her then and for 70 years more).

What was your role in the war? (What did you do as a surgeon at war?) And how did you do it?

I treated acute injuries brought in by helicopter or stretcher to the battalion aid station, and patched them up or sent them to the hospital company. The hospital company was miles closer than an Army MASH unit (you know them from the TV program) which allowed us to use them more effectively. So we patched em up and stopped the bleeding, then shipped them back to the fight (less serious injuries) or to the hospital (more serious injuries).

Thank you for your service! What did you have for breakfast?

OJ and a sweet roll. It's a lot better than the Marine Corps canned eggs!

Sounds like an interesting book. I am not a native speaker but will check it out. And I have a question - how would you compare medical care in USA and Europe ? Is there a big difference for example in regard of surgical procedures, availability to general public, quality etc ? Thank you.

I'm sure medical science is of modern quality around the world at this point. Availability is a local situation...

Sir, Semper Fi! Can you elucidate a bit more about your experience in Korea? Where did you serve and with what unit? What were your experiences as a BN Surgeon? What kind of access did patients have as far as emergency CASEVAC/MEDIVAC? Today we're taught about the golden hour in which we try to stabilize with self/buddy/corpsman aid, get a ground or air CASEVAC with the goal of getting back to the first level care in an hour. Did y'all have similar goals/ TTP's? Thanks again for your service and willingness to share in this forum.

I lucked out; I missed the vicious back and forth high casualty months of the early war; I was with the 1st MARDIV stationed in Kimpo.

The whole history of military medical care has taught over and over again the urgency of getting casualties to definitive care. You are right-on about the importance of transport.

My own experience as a battalion surgeon was limited to stabilizing wounds, control of bleeding, and urgent transfer to the hospital company. (Most injuries were due to shrapnel.)

Thank you for your service, Semper Fi!

I should add, the corpsman are the real heroes. Collecting the injured under extremely difficult and hazardous circumstances. They're the first link in retrieving injured fighters.

Thank you for the reply. Have you been back there post-war? If so, I'd be curious to hear your experience and thoughts about that. I had the honor of being promoted on the bridge of no return in 2013; it was a humbling experience to stand surrounded by history there. Thanks again sir.

I have not been back to Korea. It has changed to a modern, smart country in the part of it that is free. I have a grandson from Korea, a fine young man, who stood on that bridge of no return, and was speechless.

Thanks for being here! What advance in medical science have you seen during your lifetime do you consider the most amazing/unthinkable?

A series of wonders! I remember measuring penicillin in hundreds of units, and recovering it from the patients' urine! It was that new and rare. And it's gone on from there. Dialysis. Heart by-pass. Vascular surgery. Control of immune reactions. The genome, and manipulation of genes. Can't keep up and we ain't done yet!

I remember my grandpa telling stories of recycling penicillin - crazy!

"Stay strong Mr. Smith, we're just waiting for the patient on 4A to take a piss."

give him another glass of water!

Without getting too detailed, what is your take on the current political tensions in the peninsula?

i know no more than you do about it, but itlooks like the same-old-same-old to me.

If you can remember , what was your rank in school?

I was #2 in my high school class. #1 became a judge.

Or did you mean in the Marine Corps?

I'll ask, what was it in Marine Corps?

Thanks.

The Navy supplies corpsman and medical officers. I was in the Navy, attached to the Marine Corps, as a Lt.JG

Thanks for doing this AMA! My family is full of big believers in organ donation - my aunt had kidney disease and received a kidney from my mom, and 10 years later when that one failed, from her daughter. She gained a good 15 years of life not hooked up to dialysis machines, which she hated.

I'm curious about the match process. Have there been advances to ensure a better match between donors and recipients? Are there any innovations in the pipeline that you're aware of that could reduce a recipients need for anti-rejection drugs? I know those kinds of drugs were hard on my aunt overall.

Again, thanks for doing this, and for your service!

Your fine tale touches on so much. The transplant story started with kidneys. Retired and ancient, I am not involved in the rejection picture. But I salute your experience! I'm sure you have added your voice to support organ donation, and to get people to talk about advance decisions, signed donor cards on driver licenses etc. My novel The Transplant Web makes vivid the constant need for donor organs.

Do you suffer from PTSD at all? Thank you for your service and this AMA!

I do not. But I never knew TS either: no trauma and little stress. My concern in Korea was about my boots, not about the ground they walked on.

What is your favorite novel?

Right now it's The Transplant Web, my own novel about organ transplants and the lives that weave together to make them happen. A transformative novel for me, years ago, was Chaim Potok's "The Chosen." I admire the novels of Wendell Berry - a true conservationist.

In the early days of transplant surgery, were there ever attempts to transplant things that we now know can't be transplanted?

More to the truth - things were NOT transplanted that now we know CAN be transplanted. Hands, for example. Always remembering that the suppression of immune response carries a risk for cancer.

My mother was an ER nurse in Vietnam and she's fascinated by medical history and advances. I however went a complete different route and went to college to eventually become a playwright. So from my mother and I both: thank you for your service. She is going to try to read your book. From me: can you speak more about the playwriting?

To me, playwriting is for me. The labor of writing, and rewriting, and re-rewriting is repaid in the scrutiny of other playwrights, in round-table criticisms, in staged readings. Production, equity performers, ticket sales? dream on! But I like the trying. A New York director said my play was "well crafted." Made me smile. Maybe you are on a faster track? or better one? good for you!

Since your retirement, other than writing, what have you found pleasure in doing with your spare time?

I quit golf. When you pass 90, you don't need to "do" much. Treadmill. Letters to editor. Ice cream.

Ever hooked up with Hot Lips O'Houlihan?

I'm laughing! No. But your Q. emphasizes the difference between an army MASH and a USMC hospital company. The Marines h.c. sets up close to the troops in very close support. In those days at least, no women were in that area.

How has changing technology changed surgery in your life?

good question. A big challenge for every doctor, even surgeons, is to keep up with the new developments, know which are the good ones, and quit when they get ahead. Doing surgery through buttonholes was what put me off. So I retired and write stories!

How much do you think MASH despite being a comedy accurately reflected the war?

10%. The war (never declared as a war, and still today unfinished) mixed nations and people of those nations in a vast un-system of supplies and transports and peoples and hungers and hurts and disappointments. MASH was aa good a look as you can get through a keyhole.

What was the most exciting or interesting thing that you took part in as a surgeon? What was the first surgery you did that you were in charge of rather than helping?

I came out of a surgical program where I always assisted master surgeons. In the navy, first time out, gastric resection: no prob. Been there, done that.

I've just had a small bowel resection due to perforation. Thank God for keyhole, I feel for patients before the advancements in surgery, can't imagine less effective anaesthesia, ketamine, wound pain and post operative ilues all mixed together.

there is no fun for the patient, not anywhere.

As always, thank you for your service sir. Been in the Army for 3 years and only 21. Love every minute of it. How did you not get burnt out working with civilians? I'm currently in a medical unit and love working with soldiers but civilians are a bit more frustrating. Thank you in advance for the reply!

Good for you! You are a lucky guy! Soldiers and sailors belong to something. Civilians are individuals and think any old way they want to think.

How do you feel about the practice of selling organs like in Iran?

Different strokes for different folks. I respect individual life and the rights of individuals. I like our system here in the US of A.

My mother works in cardiac and has talked about the difficulties in double transplants like heart/lung. Was this type of ambitious surgery ever even considered as being possible during the early days?

Also what is day to day life like as a 92 year old?

never considered, but surely dreamed about. life at 90+? same as 20+: it's worth what you make of it.

Mike is brought into your field hospital with two gunshot wounds, a fractured skull and shrapnel from a fragmentation device, he's lost a lot of blood, is unconscious and has a swollen abdomen, what do you do?

Treat the hell out of him. Stop bleeding. Be sure he's breathing, give oxygen, put in some blood volume (blood, plasma, fluids) and then attend to the wounds. A swollen abdomen suggests what lawyers call a "hypothetical".

How do you have a meaningful discussion about organ donation with people who worry their organs will be used to save someone who "doesn't deserve it"? Or other concerns of not being able to select a recipient.

I would hope, after discussion of the procedures and safeguards and urgencies and protections and priorities involved, that such questions as control of the donation will be forgotten. The issues are so real, so urgent, and so regulated, that lost control becomes a given.

I guess this is adressed in your book, but I'm gonna ask it anyway: How did the idea for transplanting organs come from? Did blood transfusions help accept organ transplants as a possibility? Where there superstitions in play on the first transplants? Are there any practices on the transplant protocol that were used but now is known to do more harm than good? Thx.

Old as I am, I wasn't there. Surgical technic for transplants won the Nobel prize for Alexis Carrel in 1912! The transplant world depends on control of the immune reaction which destroys the grafted organ. That control broke through with cyclosporine in the 1980's.

Did blood transfusions help accept organ transplants as a possibility?

Not OP, but one of the funniest (not so funny at the time) things about old medicine was that they bled your ass for everything. Cold? They'll bleed ya. Head trauma? Bring out the leeches. Severe blood loss? Not enough blood loss, was the mantra.

Another funny thing was that some of the earliest transfusion experiments included injecting people with milk. Because they thought that was what your blood had. Like they'd grab blood and notice some white stuff (your white cells), and so they thought, okay let's try putting some more in. So they'd inject your ass with milk and people would get the crazy eyes and shit like that. Eventually phased out because saline was introduced.

The cherry on top was that there wasn't any sort of ethics board. You'd just have to find someone poor and crazy enough and off to the races they went.

This doc is old as fuck. i'd love to hear more about the stupid shit we used to do. i'd love to hear answers to your questions

golly, i don't know! In medical history lots of things got tried, in ignorance and out of desperation. Everybody knows the answer today to yesterday's crossword puzzle.

What was the most difficult/stressful surgery you performed?

Most stressful was often not even difficult, like a cancer that couldn't be removed. Or most difficult might be straightforward and go well, and not stressful. Never the same.

Most importantly: how did you figure out how to use Reddit when my parents can't even figure out how to use 2 remotes together?

Maybe they need YOUR kids to show them! I am tutored here by my very savvy grandson. I think electronics are here to stay

What are your thoughts reguarding the changes in battle field medicine? Korean War vs OEF/OIF practices?

What advice would you give to today's combat medics?

I drink frequently, smoke a pack a day, consume a atleast one energy drink a day, and have poor dietary habits. That being said I am strong and work out/run every day, and suffer no chronic health issues. I have no major past medical or surgixal history.

I do have a organ donor thingy on my drivers license. Will they be able to use my organs? If so, which ones?

if you are (were!) in good health, they can ignore your habits and use your organs -- heart, liver, eyes, pancreas, skin, intestine, kidneys, who knows? parathyroids, maybe.

good for you with the thingy. a fine first step! may it never be useful.

The critical thing in battlefield medicine is: t i m e. Quick aid, fast evac. Proven in every war.

I salute you for your organ donor thingy. If you are healthy, your organs can be used. Liver, kidneys, heart, lung, pancreas, intestine, eyes, skin, tendons. The list could extend to dozens of grateful recipients. Get your friends to do it, too.

Another question inspired but not related to MASH. Were you there willingly, or drafted like depicted in the show? Were the others who weren't there willingly?

Thank you, BTW.

I was there, willingly, indebted to a nation at war from 1941 that kept me in school through premed and med, and allowed me to train in surgery before "paying back" for two years active duty.

Dr Maxeiner

I'm a 3rd year resident heading into the Air Force after finishing residency. Any tips?

Not about the Air Force! Tip no.one: know your worth, keep it prime, and stay with it. The mickey mouse part comes easier if you know who you are.

What was the nastiest procedure you had to perform, and did the person you were operating on survive?

I never saw anything as nasty, tho often unsettling, unpretty, unhappy.

Green side Corpsman here. From your time as a Battalion Surgeon, I'm curious what kind of care Marines received on the battlefield then opposed to now, has medicine on the battlefield progressed greatly or does it appear to be the same? I've always wondered if the corpsman before me were of a better quality than what we have now. I have always assumed they were more resourceful. Also, thank you for your service!

Nobody is better than a trained corpsman who learns the rules of his own era, and does his job. I expect the challenges vary from battle to battle, or from morning to night. We take what we get. But you today can be as good as anybody ever was, or better, and I thank you for caring to ask your question.

Putting aside your amazing accomplishments and writings, how the hell can I live my life to be at least 1/2 as sharp and spry as you, in my 90s?

be lucky. care for your health. pick the right parents. and always have something outside of your own skin that you care about and serve.

Previously, you mentioned that those with "less serious injuries" were sent back to the fight. What type of injury would be considered not as serious? Say a broken leg or arm? My grandfather was a Korean War soldier and has told me some very gruesome details from the battlefield, so thank you for your service!

with a broken leg or arm, our guy could not perform. With a gouge out of his back side, he could. Saving life came first; serving the battalion came next.

As a biology major in my undergraduate studies, how important is your undergrad, compared to med school? Do you have any tips for making the transition easier, and are there any major differences between the two (med school and undergrad) that one should watch out for?

Thank you very much.

P.S. Your accomplishments are nothing short of admirable. My goal is to be an author and a surgeon. Not sure about the military yet :)

you are building a tower, and you envision the penthouse. wonderful. but without the foundations of basic science and all the drear stuff that comes first, your M.D.peak won't stand. It's hard work, but meeting the challenge is what makes you. You can probably write that idea better than I just did.

If you could give only one piece of advice to anybody, what would it be?

learn to love.

Have you published your other 2 novels? I'm always looking for more books to read. :)

No; Try my short stories: Wild Asparagus. And thanks for being interested!

What do you think about medical malpractice lawyers?

Patients need redress for medical error. There should be better ways than private warfare.

did/do korean women throw themselves at american servicemen?

huge novelty and all that?

nobody threw nothin' at me!

So how was being a Battalion Surgeon in Korea?

it depended on history's calendar. Sometimes fighting was hot and lines were mobile, the battalions moved fast, often in retreat. There was the landing at Inchon. There was the historic and legendary "attack to the rear" from the Reservoir. My time was the slower, less mobile, hill-to-hill action in 1952. I lucked out for that! I even had dinner one night on white linen at the Fifth Air Force hq in Kimpo, wearing combat boots and waiting for a jeep to go back to "the war".

Former FMF Corpsman here. How was your interaction with the HMs at the aid station? How about the guys out with the grunts?

We had some still days at my aid station, gun sounds far way, and the PX box stripped. Chewing tobacco, cut plug. What do you do with this, I wondered. Here Doc, I'l show you. The corpsman—I still remember his name—cut a chunk, showed me where to tuck it in my cheek, and never let on. The next day I was alive again, but he'd been transferred out. Lucky for him!

Have you ever had to do surgery without anesthetics?

no. but I was good at a neglected art called "local anesthesia". It requires its own discipline, and is about forgotten nowadays.

Ooh Rah, Devil Dog.

What are your opinions on how the Corps functions nowadays? Do the new generation of Marines seem "softer" to you?

i'm not in that game any more. wouldn't even know the rules, today

Did you ever meet your own "Hot Lips Houlihan"? And then watch MAS*H later and think back?

happily. later. 66 years of happy marriage. why mess around for less?

Were you at the Battle of Chosin Reservoir (or the surrounding actions at Yudam-Ni, Hagaru-Ri, etc.) and if so was it as crazy as all the stories say? The Korean War is something people need to learn more about. Thank you for your service.

I doubt I would have survived the "retreat" from the reservoir. Thankfully I came later to the Corps. Those marines fought desperately for two weeks in sub-zero cold against a superior enemy (in numbers). More than crazy. I believe that operation is a proud chapter in the tradition of the corps. It is a story everyone should know!

How close was the tv show/movie MASH to your own experience?

not close. we had thermal boots, a smaller, tighter operation, closer to the fighting, and no cocktail hour.

do you ever play with the organs?

only in the key of C. I can't handle sharps and flats. (: - )