Category Archives: Washington University in St. Louis

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.


A lethal mixture

A tempting Christmas punch!

The large punchbowl looked so inviting on the table in the woman’s apartment at the Town and Country Apartments in St. Louis where I had recently moved in 1970 when I was 31. I had separated from my wife at the end of August and had chosen the Town and Country for its proximity to my work at Washington University Medical School just around the corner. I had met a few of the other inhabitants, mostly med school employees and physicians around my age. One of them, a librarian who worked on the main campus, had invited me to a small Christmas party in her apartment.

I was planning to stop by on my way a larger gathering that Saturday, to be held on the top floor of the Olin Residence, a dorm for medical students not far from my apartment. The party in Olin was put on every year by the residents in the Department of Otolaryngology (Ear, Nose and Throat) in which I held a teaching appointment. Everyone from the department was there: faculty, staff and, of course, the residents, who produced a video skit each year.

The punch at the little party in my apartment building had maraschino cherries, pineapple chucks, tangerine wedges and orange slices floating on the top, along with ice cubes. There were other refreshments, too: Christmas cookies and fudge. I hadn’t eaten supper because I knew there’d be lots to eat.

I’m very nervous in social settings where I don’t know most of the people, and in those years I smoked to cover my unease. Besides, I’m no good at small talk, and at parties I head to the food table when my conversational gambits fall flat.

I didn’t really know what was in the Christmas drink. If I had to guess, I’d say canned Hawaiian Punch with ginger ale, pineapple juice and a little sugar mixed in—nothing more. After failing to start up sustainable conversations with the only two people I knew, I went back for a few more cups. I saw no harm; it just tasted sweet. A little while later, I thanked the hostess and headed to the big party at Olin.

Dave Crowley & Don Sessions

Dave Crowley, Ph.D. and Don Sessions, MD, from faculty photos taken in the early 1970s

When I got off the elevator on the top floor, I needed the restroom—no surprise with all that fluid on board. Inside I heard retching sounds from one of the stalls, and one of the residents I had taught staggered out, shaking his head. “Wow, that’s strong stuff in there,” he said, and bent over the sink to rinse his mouth.

I found the bar, and after what I had witnessed in the mens room, decided on a gin and tonic. “Just a little gin,” I said. I took a sip and turned around. On my left was a row of chairs aligned against the windows, and sitting in them were a few resident’s wives, and several faculty couples. Most of my colleagues were a decade or so older than I was, but one, Don Sessions, was about my age. He and his wife Jan had recently moved to St. Louis from Alaska, where he had fulfilled his military obligation at an Air Force Hospital. They were a relaxed young couple, and before separating, my wife and I had enjoyed chatting with them.

To my right, opposite the chairs was the food table with a large punch bowl, but unlike the one at the party in my apartment building, this bowl didn’t contain punch. Instead it was filled with a special dipping sauce prepared by one of our residents, Dr. Frank Lucente, who had boasted of his culinary skills and had promised a special treat for the annual party. Containing unique ingredients, the sauce was intended to complement various crackers, breads, celery sticks and other crudités that he supplied. It was his pièce de résistance and with artful garnishing around the rim, it seemed so attractive that no one dared take the first scoop, lest an ugly divot mar the glistening surface.

I was debating whether to be first to sample Frank’s work of art when the room began to spin around me. I lurched back and forth a couple times and forced my feet with deliberate effort to convey me back to the mens room where I dove into a stall. Like the resident before me, I staggered to the sink afterward to rinse my mouth and wash my face. Then I felt OK.

Back at the bar, I asked for a ginger ale and took a couple of wary sips. No one had yet sullied the surface of Lucente’s dipping sauce. As I walked past it, the room spun again, this time with greater violence than before. My feet gave way and I stuck out my hand to steady myself, plunging it nearly to the elbow in the bowl of Frank’s culinary creation. I looked with horror and lurched in the opposite direction, landing in Don Session’s lap. Thank God it was Don and not one of the senior guys.

How I made it back to the mens room I don’t remember, but when I got there, there was another resident passed out on the floor. I jumped back into the stall and rinsed my mouth afterwards.   The guy on the floor was groaning. Beside me at the next sink was a young Brazilian physician who worked in my lab. He grinned at me and laughed. I looked at him and said, “Erol, I think I’ve had enough. I’ll see you Monday.”

I stumbled back to my apartment, grateful that I didn’t needed to drive. When I saw my hostess from the small party, I didn’t have to ask her what else had been in her wonderful Christmas punch. I already knew.


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