Surgery of the Soul: Reflections on a Curious Career.
By Joseph E. Murray, M.D. Pp. 280. Science History Publications USA, Sagamore Beach, Mass. 2001. Price $35.
“‘Just what kind of a doctor was I anyway’ . . . patients were referred to me for treatments ranging from general surgery to urologic and vascular surgery to plastic surgery. Those who were referred for the surgical correction of cleft lip and palate, protruding ears, or hand and facial trauma were perplexed and wondered if I were a ‘real’ plastic surgeon. Initial consultations with my patients would often begin with [giving] them an explanation of my background, which in a way made our doctor-patient relationship more personal. But to this day, some of my colleagues and patients are still confused about my true surgical identity. Was I a urologist? A vascular surgeon? A plastic surgeon?”
This quote (pp. 125-126) from Joseph Murray’s eminently readable autobiography epitomizes the difficulty in categorizing the professional accomplishments of this remarkable surgeon. For most of us plastic surgery mortals, contributions to our craft come in small subtle refinements of technique, in little facts gleaned from careful research, or from excellence in teaching. A few giants, such as Tessier, Bunke, McCraw, Millard Gerow, and Hartrampf, have contributed major breakthroughs in a limited area—certainly enough for one lifetime. Joe Murray, on the other hand, has contributed many major medical and surgical firsts, the greatest of all deservedly earning him the Nobel prize.
1951 – Primary mandibular reconstruction following resection of an intraoral cancer—while still a resident! When I trained in Pittsburgh 10 years later we were still in “the thinking about it” stage.
1957 – Total orbitectomy for tumor.
1968 – First one-stage correction of a Crouzon deformity in the United States. The procedure was completed and the manuscript was in press before the work of Tessier was known in this country.
1980 – With Joe Upton, primary microsurgical reconstruction of an extended orbitectomy.
The transplant years: Young plastic surgeons may not appreciate that the first publication devoted to the subject of transplantation, Transplantation Bulletin, originated in and was for many years a subsection of Plastic and Reconstructive Surgery. Even today, plastic surgeons continue to be active in transplantation research. Thus it is not so surprising that Joe Murray was selected by Francis Moore to be the surgeon for the first kidney transplant. In those pre–institutional review board days, much of surgical progress was made by swashbuckling surgeons who would boldly try out new ideas on patients first and then go to the laboratory. In contrast, all of Joe Murray’s contributions were a careful journey from clinical observation to laboratory investigation or anatomic dissection, to clinical application. He first became interested in transplantation by observing that homograft skin placed on severely burned patients was rejected much more slowly than that placed on non–metabolically challenged normal patients. Then came laboratory research and finally the skin graft test for immunological compatibility in his identical twin renal transplant candidates. The same careful observation and laboratory trials permitted the leap to allogenic transplantation, and the rest is history. Of course, none of this momentous work was done in a vacuum. It was always a team effort from some of the most brilliant minds in medicine, and all are well acknowledged in the book.
What struck me as much as Dr. Murray’s surgical brilliance was his humanity. All of these successes are described in the context of each patient as a human being. Before the problem is even discussed, we are introduced to each person by name and learn something of his or her life. Thus, aside from all of his surgical and research brilliance, we see Joe Murray as a physician healer first and foremost. As often happens, new science needs new ethics. Joe describes how many surgeons, excited by this new frontier, were prepared to harvest organs even before a donor was dead. As part of a committee assembled by Harvard University, Joe was instrumental in defining “irreversible coma” as a requirement for organ harvest. The final step in this adventure was to create and run the National Kidney Registry. Thus he was instrumental in creating an entirely new medical discipline, from cradle to maturity.
Eventually, Joe’s workload became too great even for him. I consider it a tribute to our specialty that he felt that the greater challenges ahead were in plastic surgery. In 1971 he resigned as chief of transplant surgery to work full time as a “real plastic surgeon.”
Plastic surgery has been defined as the surgery of the skin and its contents. The career of Joseph Murray fulfills that definition in its broadest sense. In a quiet, almost matter-of-fact way, Joseph Murray, plastic surgeon and Nobel laureate, shares with the reader the excitement of his professional accomplishments, his humanity, and his “physicianship” through the medium of some of his landmark cases. He is the plastic surgeon’s plastic surgeon. Reading his autobiography has been a revelation for me.
This is a book that should be read by aspiring plastic surgeons of all ages and at all stages of their careers.