Category Archives: Medical


A package of unfiltered Luckies

The Lucky Strike package design when Dave started smoking in 1957

It hadn’t occurred to me to smoke when I was in high school; both parents smoked unfiltered cigarettes, but among kids my age, only the thugs, greasers and delinquents did. None of the college bound kids smoked.

It all changed when I got there myself. I was 18 and devoid of social skills when I arrived at Middlebury College in the fall of 1957. Unable to make friends, I sought refuge in the college radio station, WRMC, where I hoped to sharpen my electronics skills and gain some degree of social acceptance. Maybe, I thought, the shared activity might generate some companionship. Besides, there were a couple of girls who worked at the station and maybe I could gather the courage to ask one of them out.

Most people on the radio station smoked. In fact, the American Tobacco Company paid for our United Press teletype service; all we had to do was play their Lucky Strike® commercials on the air. And it gave out little sample packs of five cigarettes each on campuses nationwide, including Middlebury.

In the dorm and at the radio station, the people who smoked seemed relaxed and at ease with each other. They didn’t have problems making friends or asking girls out. I picked up a sample pack of Lucky Strikes and smoked one. Of course, it tasted terrible, but I knew I had to stick with it if I wanted the social benefit that I saw in smoking. After I few days I got used to the taste and told my mother on the phone that I had started. “I’m sorry to hear that,” she said, “but of course Joe and I have smoked for years. I guess everyone does.”

Later that fall Middlebury’s fraternities held their annual “rush,” in which they looked over the male members of the freshmen class for potential members. Each of the ten fraternities hosted events called smokers on Friday and Saturday evenings which we attended in groups over a period of several weeks. I felt no less awkward and embarrassed at these gatherings than I had before, even with a cigarette in my hand or sticking out of my mouth. And none of the fraternities selected me; instead I wound up in an independent mens club.

I kept smoking unfiltered Luckies throughout college and succeeded in making a few friends; some smoked and some didn’t. Two of them had pipes which required constant reaming and scraping with a special tool they carried. When I tried one it tasted terrible in spite of the pleasant aroma.

Lucky Strike Ad

An ad for Lucky Strikes from the early 1940s

In my first year of graduate school at the University of Vermont in 1961, I met a young woman, a non-smoker, who became my fiancé. Her name was Helene and after our engagement two years later she produced a very funny hand-drawn cartoon showing what I looked like as a smoker. There were spikes of fur coming out of my eyeballs and mouth, ugly spots on my face and hair sticking out in all directions. The inspiration for her sketch had come from the Surgeon General’s first report on the health hazards of smoking issued in January, 1964.

By that time, I had transferred to Princeton to complete my doctorate and very few of the people in the lab where I worked smoked. After six years of what I called real cigarettes—those without filters, I quit cold turkey. I had no trouble, but I joked that if I ever had another cigarette, I would inhale so deeply and with such satisfaction that the smoke would pour out the eyelets where I laced up my shoes.

Helene and I married in 1965 and moved back to Middlebury where I had a teaching job. Our daughter Hanna was born three years later. A year after that, in 1969, we moved to St. Louis, where I took a research appointment, but Helene was not happy. We separated in August 1970 and divorced in May 1971.

Filtered Kents

Kent Golden Lights – Dave’s last cigarettes when he quit on February 28, 1986

The stress was too much; I powered myself through the initial months with Librium and attempted to cover my anxiety and grief with a return to cigarettes. This time I chose filters as less risky than what I had consumed before. I smoked Kent Golden Lights® for 16 years.

In 1985 I took two smoking cessation classes, and in the second one acquired some samples of Nicorette®, the nicotine chewing gum. I worked then for McDonnell Douglas and carried the Nicorette in my brief case every day until February 28, 1986 when the boss decreed that smokers would have to move to a separate part of the office. I dropped my cigarettes into the wastebasket and took out the nicotine gum. I haven’t smoked since. It wasn’t until 1996, 38 years after I started smoking and 10 years after I quit, that second hand smoke began to irritate my eyes.

Nose Job

When I began my job in the Department of Otolaryngology at Washington University Medical School in St. Louis, in 1969, I kept my ears open and picked up all sorts of medical information. Sometimes it came from the grand rounds I attended every week, where cases and scientific papers were discussed or simply from chatting with the residents that I taught in class or who worked in my lab. After I had been there a few years, I had a question for one these physicians, a guy who had some expertise in respiratory dynamics.

“Irv,” I began, “I think I have a deviated septum and I have trouble breathing though my right nostril. Should I do anything about it?” “Well, you might think about it,” he said. “It can lead to trouble later in sleeping or even in your bronchial tubes, sinuses or lungs.” We both knew that surgery was the only option – something called a “submucosal resection” done under local anesthesia. What Irv didn’t have to say was that smoking cigarettes, which I did at two packs a day, was a far greater risk to my respiration than any deviation of my septum could be.   But Irv wasn’t my physician, and the residents knew not to give unsolicited medical advice to their colleagues and friends.

CAT scan picture of a deviated septum in the nose

An image from a CT scan showing a deviated nasal septum

It took another year of stuffiness and obstruction to convince me to get it done. I wasn’t getting any air at all on the right side when I asked Irv to suggest a surgeon. “Don Sessions is pretty good with noses,” he replied. “You’ll be in and out in less than a half hour.” A couple of days later in his office, Don took a look and said, “Yup. It sure is. Let’s get you scheduled.”

I checked into Barnes about a week later in the early fall of 1977, a couple of months short of my fortieth birthday. My girlfriend Nancy had driven me and stayed with me in the room for an hour or so. When I said that I was frightened she reminded me how minor the surgery really was. I calmed down, and after she left, a resident came in to give me a pre-op physical. “Hey, chief, aren’t you the guy who taught us about cochlear microphonics and all that auditory stuff? “Yeah, that was me,” I replied as he checked me over. When I woke up the next morning I wanted to reassure myself with my usual morning routine of shaving and showering—and smoking a couple of cigarettes which was allowed then in hospital rooms.

After I rode a gurney to the OR, a nurse pinned me to the table with a sheet and started an IV. I was still scared, and it must have shown. “Would you like a little Valium to settle you down?” she asked. I nodded. “Yeah,” she said, “here it comes.”

Then Don Sessions came in along with a couple of residents whose voices I recognized from behind their surgical masks. The nurse scrubbed my face with Betadyne and placed a drape over my eyes and a second one over my lower jaw.

“OK, here goes,” Don said as he jabbed me with a long needle, right above my upper lip, directing it from left to right. It hurt like hell. “Scream, curse, do whatever you need to,” he said as he emptied half the syringe into me. Then another shot in the same place, this time from right to left, followed by two more directed upward along the outside of my nose. My face was starting to feel numb. After two more shots inside my nose, Don said, “Here’s a little nose candy,” and placed some powdered cocaine up inside each nostril.

After that there was a lot of scraping, crunching and chiseling. Maybe it was the Valium and cocaine but I didn’t mind. I’d had a lot of dental work done under local anesthesia, and this didn’t seem much worse. But then from under the drape I saw a long chisel headed toward me. “Now just give it a hard tap,” Don told the resident who was holding small mallet. My head shook with the impact. “No, you’ve got to belt it lot harder,” Don said. Now I was scared. Was this the resident’s first try? Would the chisel go too far this time and plunge into my eye or my brain?” There was another sharp jolt and my head shook again. “OK, there it is.” And he held up a triangular piece of bone for me to see.

“We’ll stitch you up now. We’re due at Stan Musial and Biggie’s for lunch, and we have to get moving.” I felt a twinge of disappointment; had I not been pinned down to the operating table, I could have been joining them at the restaurant. He installed a plastic splint inside my nose on both sides and pinned it in place with a heavy suture that he drove through from one side to another with a straight needle. Then he stuffed what seemed like several yards of gauze packing into my nose. Of course I will still very numb.

Back in my room, the nurse put an oxygen mask on my face since now I could breathe only through my mouth. I reached for the phone to call my parents in Marblehead and spoke with my father assuring him that I come through the operation OK. Then I dozed off until the resident came in to check up on me. After he left, I wondered if I could smoke with only my mouth to breathe through. I went in to the little bathroom and lit a cigarette. I took a puff inhaling the smoke. Then I blew it out—no problem.

I went home the next morning and stayed there for a week. I was sore and there was a little bruising around the bridge of my nose, but I could sleep OK. I got used to breathing though my mouth. Of course the packing was uncomfortable; it looked terrible and it dripped. At the end of the week I went back for my check up. Don was out of town, so another staff physician took out the splint and all packing and cleaned me up. I could breathe again.

Back at work I joined my usual lunch companion in the cafeteria: Roy Peterson, a professor of anatomy who supervised the laboratory where the medical students dissected their cadavers. I told him about the little piece of bone they had taken out. “Yeah, that’s the vomer,” Roy said. “If you like we can go upstairs and I show you on one of our cadaver skulls.” I was curious and wanted to see what the bone looked like in its normal position.

Skull from an Egyptian mummy

A cast from an Egyptian mummy showing a right-deviated nasal septum. The numbered pegs aid in reconstruction of the face.

We had to go through the dissection lab to get to the display cases with the skulls, and I was relieved that all the bodies were covered with sheets. I may not seem squeamish, but partially dissected people are too much. At the display case, he pointed out the bony parts of the nasal septum that remained in the skull. “There’s the vomer right at the base of the nasal opening—see, that little triangular piece. You know that septal deviations are very common; you can even see it this skull. It’s usually not bad enough to obstruct breathing, though. They even found deviations in Egyptian mummies.”

I wondered if the ancient Egyptians had the same trouble breathing that I had before the surgery. Probably not I had to admit. They didn’t smoke.


Woody Allen's imagination a work in Hanna and Her Sisters (1986)

Woody Allen’s imagination at work in Hanna and Her Sisters (1986)

In 2006 I went to an ear specialist to check out the mild deafness and stuffiness in my right ear that had persisted for two months. She looked in my ear and at my hearing test. “Let’s get an MRI,” she said. “With the MRI, we can check out muscles of the Eustachian tube and also see if there might be a small benign tumor on the hearing nerve. Why don’t you come back in two weeks.”

I was scared. I knew about acoustic tumors, to which she was referring. Hadn’t I spent five year researching diagnostics tools for them in the 1970s at Washington University Medical School? These rare tumors are benign, but they grow close to your brain and threaten vital functions like breathing. Surgery to remove them involves a long recovery and can destroy your hearing and balance. Few surgeons, I feared, had enough experience with this delicate surgery to minimize complications.

Now I was frightened. What would happen to the class I had just committed to teach in the evening? Could the university cover for me and let me resume after my convalescence , or would they just find someone else? How could my wife and I handle a lengthy disability? My anxiety deepened and the knot in the pit of my stomach grew tighter. I remembered Hanna and her Sisters in which Woody Allen’s hypochondriac Mickey Sachs undergoes in 1986 the tests I was given in twenty years later, for the same type of tumor. My anxious imaginings were no match for the fictional Mickey’s maniacal forebodings, but I could see myself in a wheel chair condemned to life of poverty, pain and immobility.    I prayed that my scans would be clean just as his were.

Woody Allen's Mickey Sachs undergoes a brain scan.

Woody Allen’s Mickey Sachs undergoes a brain scan.

There was hope: Derald Brackmann in Los Angeles specializes in this surgery and has done almost three thousand cases. I knew Derald from my years in research and, I remembered, he trained at Washington University. I even had a group photo showing both of us in our white lab coats in 1972. Perhaps, I thought, the photo would help me persuade my doctor to refer me to Brackmann rather than to someone in St. Louis with less experience.

My fear rose and fell. I kept busy, but stopped for prayer at least every half-hour: “Please God, don’t let this be a brain tumor,” I implored. As an agnostic, I sounded like a hypocrite to myself, praying, but I had to do something to ward off the tumor. Then I thought of death. Why should I die, or not die, at sixty-eight?

Washington University Otolaryngology faculty in 1972. Wally Berkowitz is second from left in the back row. Dave is send from right int he front row

Washington University Otolaryngology faculty in 1972. Wally Berkowitz is second from left in the back row. Dave is second from right in the front row. (Photo courtesy of Barbara Bohne, Ph.D)

One morning in the shower, the name Wally Berkowitz came into my mind, from nowhere. Derald Brackmann didn’t train in St. Louis. The young physician in the 1972 photo was Berkowitz, not Brackmann. My link to the perfect surgeon for my tumor evaporated

On my return appointment, I waited in the examination room. From next door, I heard muffled conversation. Was my doctor reviewing my MRI with a colleague, trying to figure out how to break the bad news to me? As the conversation continued, the words became clearer. She was advising another patient about a sinus condition.  At last she knocked on the door and came in. “How has your hearing been?” she asked. “About the same,” I said, “and my right ear still feels full.” “We’ll she said, your MRI was normal, with just a few insignificant age-related vascular changes. There’s no tumor.”

Next week: The Robot