Audio
Dr. James P. Geiger
Transcript
Conklin: [00:00] The date is June 17, 1997. My name is Sara Conklin, and I am interviewing Dr. James P. Geiger, Cardiac Surgeon for Letterman Hospital from 1952 to 1953, and then 1964 to 1969. I can see from the front of a piece of paper he has that he wants to correct the information I have already put on the tape about what his position was in 1952 and 1953 versus 1964. So Dr. Geiger, what is this about?
Dr. Geiger: [00:39] Well, when I first came to Letterman was in June of 1952 as an intern, fresh out of medical school and looking forward to learning and making my world the medical profession.
Conklin: [01:00] Then you came back in 1964 as a full-on doctor. Yes?
Dr. Geiger: [01:06] Actually, I was a doctor in 1952, I had that Medical Doctor Certificate when I finished medical school. The internship is a form of post-graduate training and also an opportunity to get some practical, hands-on experience.
Conklin: [01:26] Let's start the interview with discussing some of your background. Where were you born?
Dr. Geiger: [01:30] In a small town in Pennsylvania in the soft coal mining district in a town called Connellsville, spelled C-O-N-N-E-L-L-S-V-I-L-L-E.
Conklin: [01:44] And when were you born?
Dr. Geiger: [01:46] September 21, 1925.
Conklin: [01:49] Who were your parents?
Dr. Geiger: [01:51] My father was James Luther Geiger. He was an employee of the Baltimore and Ohio Railroad, and my mother was a former schoolteacher, Bertha Naomi Petenbrink Geiger. Both of them were what we would look back on and call Pennsylvania Dutchmen. Both had had farm growth and living before they came to this small town.
Conklin: [02:23] Do you have siblings, and where are you in the birth order?
Dr. Geiger: [02:26] I was the second child. My sister was 3 years older, and she had gone to nursing school. Unfortunately, she died at the age of 60 of lung cancer.
Conklin: [02:42] Were you raised by your parents?
Dr. Geiger: [02:44] Yes, indeed. Except that my father died when I was 5. He had a cancer.
Conklin: [02:50] Did your mother remarry?
Dr. Geiger: [02:51] No, she never did, and she was one tough, but gentle woman.
Conklin: [02:53] Where did you go to school, and what was the highest grade you attained?
Dr. Geiger: [02:56] Well, I went to public school in our town. The town was small enough that we could walk to school, and finished 12 years of public school education. Then started in a private college, Washington and Jefferson College in Washington, Pennsylvania, all male students. I enrolled there 2 weeks after I graduated from high school, had a partial scholarship. It was a fabulous school. It had a reputation of being one of the best pre-medical education programs in the country, the eleventh oldest college in the United States, and one that I hold very dear.
Conklin: [03:46] What year did you graduate?
Dr. Geiger: [03:48] Well, actually, I had an interruption in college by virtue of the Draft in January, 1944, and after 2-1/2 years in the Army as an enlisted man, originally in the Infantry and then as a Corpsman with a combat engineer outfit. I went back to college 2 weeks after I got out of the Army, and graduated officially in August of 1948, then went on into medical school a couple of weeks later.
Conklin: [04:33] So we noted in your questionnaire that you were indeed a Medic in World War II. What was that like, and did that affect your career choice?
Dr. Geiger: [04:45] Not to a major degree, because I was already enrolled as a premedical student. I look back and I think possibly the biggest influence on my choice of medicine as a career was the kindly family doctor who was taking care of my father when I was like 5 years old. I can still remember seeing him coming to the house to see my dad.
Conklin: [05:13] Great. We have notes in your file now about your Army career, so we do not need to reinvent the wheel, but I would like to know what being "adopted" into the 1950 Class of West Point meant and how it might have affected your career.
Dr. Geiger: [05:34] When I was assigned as Chief of Surgery at the Hospital at West Point, this was a choice assignment, and I chose it as a place to go after I finished my general surgical training. A large number of the men who were teaching at the Military Academy were just a shade younger than I, but most of them were graduates of the Class of 1950 from West Point. And some 3 or 4 different families lived in the building where we lived. We became friends and unless you were a total jerk, most of the time, someone got interested in you and would adopt you into the class and include you in their social events, and you became one of them. It was a wonderful experience. We got to know some of these people very closely, and one of them later became the Dean of the Academy, and one of them followed me out here. I have even had him as a patient twice, once in Korea and once here. So, those were things that influenced my military career and actions significantly. I cherish having been adopted, and later the one man was instrumental in getting me an honorary appointment into the West Point Society Chapter that is here in the Bay Area.
Conklin: [07:28] My guess is that would be nothing but helpful in a military situation. West Point people are very well respected. Did the West Point patina sort of bless your efforts?
Dr. Geiger: [07:45] I do not know whether it particularly did or not. I think that my efforts were probably blessed the first few months I was in my surgical rotation of my internship, when I had the privilege of working with a surgeon who was also the Commander of the Hospital, Leonard D. Heaton. One day, at the time of surgery, we were finishing a procedure, and he asked me what I intended to do when I finished my internship. I said, "Well, I'll probably get out of the Army and wind up finding a surgical residency some place, because that is what I want to do." And he said, "When we finish here, we will go upstairs to Personnel, and you tell them I have told you, even though a lot of people do not know it, I am going to Washington to man Walter Reed Hospital, and I will see to it that you have a residency there if you want it." So, that was a real stroke of good fortune.
Conklin: [09:00] How did you feel when you heard that?
Dr. Geiger: [09:01 Elated. First of all, to be chosen by a man who was so highly respected and secondly, to have been literally handed the opportunity to get what I wanted most to do.
Conklin: [09:15] That was wonderful. This is a very awkward and weird question, but are you a really good surgeon? You probably know that, right?
Dr. Geiger: [09:24] Well, I think that I am. . .
Conklin: [09:25] Did you impress him, I mean that is a very impressive thing to say.
Dr. Geiger: [09:29] Well, I worked hard, and I had a sense of responsibility, and I'm sure that my relationship with my mother in the depression years instilled in me the work ethic. I worked parttime as a kid from the time I was in second grade.
Conklin: [09:52] I'm thinking it is just more than being a hard worker. Is there any particular . . . I mean you have to work in a very small area, you have to be very precise. There are some skills there that seem beyond just a good hard worker.
Dr. Geiger: [10:09] Well, there are skills that are developed, and that was part of the training program. Actually, when I was a Corpsman during World War II, we were taught some basic skills, including how to sew or suture, how to give shots and things of this sort. I was very proud of the fact that there was something else that I learned and that is what I throw into the category of the art of medicine. Even as a Corpsman, a lot of the guys or GI's would call me "Doc," knowing full well that I wasn't. It was a good feeling.
Conklin: [10:54] The "art of medicine" - what is that?
Dr. Geiger: [10:58 ] Well, I think that is the difference between a scientist and a technician. It is somebody who has a feeling for the patients, a feeling to give them a little bit more than say what the book says you should be giving them. It is to make them comfortable with the understanding of their problem and what you feel you can do to help them and if you cannot really help them, to soften the impact of the problem.
Conklin: [11:35] In 1952, you came to Letterman from 13 months in Korea as Chief of Surgery. What was your position, and how would you characterize your job when you first got here.
Dr. Geiger: [11:49] Well, I have to change the date, because it was actually '64, and the Army had four hospitals - had two MASH hospitals, one General Hospital at Pusan, and then the biggest 400-bed EVAC hospital, the 121.
Conklin: [11:50] These were all Korean?
Dr. Geiger: [11:50] Yes. We were the referral point for any of the complex problems, and at that time, I was fully trained both in General Surgery and in Cardiothoracic Surgery. It was natural that I would be the Chief of the Surgery Department and also the Chief of Professional Services. It was a well-knit, well-running organization whenever I got there. I can take no credit for building, I just tried to build upon it. One thing that was unique about the place was that it was old quonset huts with almost exposed wiring on porcelain insulators and concrete floors, and yet we turned out some phenomenal work. I took the Hospital through an accreditation for the American College of Surgeons accreditation. We had the same accreditation as one of the major hospitals does here in the States and had a phenomenal record as far as a low incidence of infection and the quality of work that was turned out. And again, I was just one of many who helped to synchronize the work and function of others.
Conklin: [13:55] Was it a particularly frenetic atmosphere?
Dr. Geiger: [13:57] Periodically it could be because we had a couple of other missions. One was not just to support the MASH Hospitals that were up along the demilitarized zone but we would get casualties or injuries from, as they called it, the result of U.N. action, and some of them could be motor vehicle accidents. Many of them were from shell explosions because the Koreans would be trying to salvage the metal from some of the shells that had not exploded. A lot of eye injuries, a lot of general body injuries, and the first case of case of gas gangrene I ever saw was at that Hospital.
Conklin: [14:49] Gas gangrene?
Dr. Geiger: [14:50] One of the major hazards of warfare in previous history in World War I and the Civil War, and others, was because they had no effective way of treating it, and a major amputation was the only way they could treat it. Sometimes, you are not able to amputate the part that gets infected, but it's a form of a family of bacteria, Clostridia, and it's related to tetanus, only it is infinitely worse.
Conklin: [15:26] So, you get to San Francisco, you are fresh out of Korea, what was your position, and how would you characterize your first level of responsibility here on Post?
Dr. Geiger: [15:38] Well, I was Assistant Chief of the Cardiothoracic Surgery Service, and was given a lot of responsibility and a lot of opportunity to develop some special techniques in congenital heart surgery. Fortunately, the man I was working with, Colonel Elmar Aronstan, he was at times a crotchety old devil but he was a very likable person, and he became a friend. He worked in much the same fashion as I like to work. He worked long hours, he worked hard, and he would get involved with the patient and their families, and it was a very rewarding experience. The opportunity to care for these kids . . . about 30% of what we were seeing in the way of heart cases, a number were retired, some were active-duty GI's and members of their family, obviously, and then probably '65-'66, we were seeing more of the patients who were returning from Vietnam, the casualties coming out of the War there, and that presented a different set of problems, one of them being what I called high-velocity lung injuries. We worked out a way to handle some of these problems, and it was reported at one of the major conventions and published some information that had never previously seen print.
Conklin: [17:48] What are the kinds of wounds that are specific to the Vietnam War versus the Korean War. Are there any major differences?
Dr. Geiger: [18:03] Well, there were some. Originally they had rather primitive weapons in Vietnam, but a lot of bacterial infections were present, but then they would. . . . well, I guess they were Russian and Chinese weapons, the Russian AK-47 was a higher-velocity rifle, and also some of the munitions, the mines and artillery rounds would, because of the velocity of the missile that caused the injury, it would create a greater degree of tissue damage, and we were seeing things that many of us thought were unique. My previous experience had been both in World War II and in Korea, so they were different.
Conklin: [19:14] Being a lay person and not a surgeon, I am guessing that there is more tissue loss and you were stuck with larger holes to fill, or what?
Dr. Geiger: [19:27] That's part of it, or damage of, or larger involvement of adjacent structures - nerves, arteries, veins. Yes, these things did exist previously, but they just literally blow away tissue. I remember one man who literally lost 15 pounds off his backside. We saw a lot of lung problems, seeing an entity at that time that was called "shockla." They were reporting that so many of these men didn't make it back to the States. It had a mortality rate of over 90%.
Conklin: [20:22] What was "shockla?"
Dr. Geiger: [20:24] The lungs would literally get . . . it was the end organ of major infection, major trauma, and the lung would fill up with bloody fluid, and they would literally suffocate, they could not get enough oxygen into their body.
Conklin: [20:41] And you could not stop the leakage?
Dr. Geiger: [20:43] It was poorly understood, and even to this day, it was a problem in civilian medicine. It has been renamed to Respiratory Distress Syndrome, but when I went to Vietnam, that was one of my goals to try and come up with a program that would allow us to treat and correct some of this problem. My concept was based on some experience and research that we were doing with some of our patients at Letterman at the time, clinical research, not so much laboratory, but clinical. We were seeing various cardiovascular problems, and they would have some secondary lung changes, and well, I put it in the category of serendipity. If you are receptive to a solution to a problem, you are quite likely to find it.
Conklin: [21:56] Is this, not that we need to go into all of the ins and outs of this, but in case someone is listening to this tape and wants to find out more about this lung situation, it was written up . . . where would they find this information?
Dr. Geiger: [22:12] There have been several books written about it. I think that some of the texts that have been written overlook a few of the obvious facts, what I think are obvious. I had the opportunity to present this at the Western Surgical Association meeting, and it was published in the medical journal, "Chest" in April '71.
Conklin: [22:50] Great. You mentioned bacterial infections. Was that ever a problem for the Hospital? Did people bring things back from Vietnam or Korea, let's say, that became a biohazard where you had to have quarantine situations?
Dr. Geiger: [23:13] The biohazard was predominantly to the patient. There was an entity, a bacteria called Pseudomonas pseudomallei. This literally is a bacteria that grows in dead tissue, or in a very low oxygen environment, and it is carried much like the Clostridia infection. It was a normal flora in the intestinal tract of the water buffalo in Vietnam. So the rice paddies got contaminated, and if a GI got injured and this stuff got in the tissue, then it was a major hazard to try and treat it.
Conklin: [24:25] Were you successful in getting it treated?
Dr. Geiger: [24:29] We had some remarkable successes once we were able to identify what the thing was.
Conklin: [24:34] Great. Let's see, you lived on Post, at 512B Washington Boulevard, with your wife and your new son. What was the social climate on Post as compared to other duty stations
Dr. Geiger: [24:50] Comparison is possible only in retrospect, because that was my first assignment as a military officer, and we had some nice, close neighbors. Most were very affable and friendly, and once in a while, you would find that some little kid down the block would get in a squabble and you would wind up with, "Hey, what are you doing throwing rocks at my window?"-type thing, as in any housing environment, but it was extremely rare to have any of these things. The kids were pretty much disciplined. Their family knew discipline, and the kids consequently learned discipline.
Conklin: [25:42] Did you ever find the social situations on Post coming into the work place at all or were they totally separate? If your wife made the General's wife mad, would you hear about it later?
Dr. Geiger: [26:58] I don't know if she ever made the General's wife mad, but I think that there were certain, well, I guess, social climbing situations that arose, and a few petty jealousies from one wife to another, perhaps, and one's appearance, one's furnishings, one's car - sometimes became a subject of conversation.
Conklin: [26:29] If it was a little under snuff, would you basically get the word that you were to make it better and put on a better show?
Dr. Geiger: [26:40] I know that that has happened, but I never experienced any of it. There was one funny story, if I can interject it, that occurred when I was at the hospital the West Point some years later. This one doctor was walking across the parade ground carrying an umbrella. It was raining. Under ordinary circumstances, that would be considered a very appropriate thing to do, but an officer did not carry an umbrella when he was in uniform.
Conklin: [27:15] Just supposed to get wet, huh?
Dr. Geiger: [27:17] You were supposed to wear a raincoat and cap cover, and one of the senior West Point officers saw this man, and was infuriated that he would violate the custom as it existed. He called the Hospital and said, "I want that man to see the psychiatrist." I said, "Sir, he is the psychiatrist." (Laughter)
Conklin: [27:43] That's a great story. We're getting down to the end of this tape. I am a little worried to ask you something that will be big and so maybe we ought to just turn the tape over.
SIDE B
Conklin: [00:06] You brought up the fact that the Presidio, maybe because of the presence of the Sixth Army, was a pretty formal place to be, but you felt outside of that realm in your Hospital world. Can you go into that a little bit.
Dr. Geiger: [00:20] Well, we relished or cherished the relationship with the Post, and would frequently go to the Retirement Parades, and the pomp and ceremony were indeed part of military life, but the formalities existed in the front office at the Hospital. For example, when I first reported as a First Lieutenant, I went into the Adjutant's office and snapped to attention, gave a salute and presented my orders. At that time, military courtesy and discipline were expected, but some of the things which I know exist in the Infantry Post which this was, we did not experience to nearly the same extent, although the Commander's Office was a place where informality did not really apply. The flag was there, you did not go in without an appointment or an invitation, and if you passed the Commander, why you paid the proper respects. But as far as the medicine and the practice itself was concerned, I felt that there wasn't any better.
Conklin: [02:01] Was there a special esprit de corps, a special feeling, you knew you were all doing really important things?
Dr. Geiger: [02:07] To say the esprit de corps was high is an understatement. It was a large Hospital but it was still a small Hospital. Everybody tried to accommodate. If you thought there was an urgent thing that had come up, you could expect that this would be accommodated. You would be helped to resolve this in as early and expeditious fashion as possible. I compare it with, say, the Hospital at Ft. Sam Houston where I had served. It was a pleasant place, and there was a certain amount of this, but I think Letterman was unique, and everybody who had ever heard anything about Letterman wanted to come here to serve on this Post. It was more like a family, a happy family.
Conklin: [03:18] That's great. I hadn't heard that it really had national standing in the Army hierarchy of Hospitals. . . .
Dr. Geiger: [03:28] Very definitely . . .
Conklin: [03:29] This was better than Walter Reed?
Dr. Geiger: [03:31] I don't know that I would say better, it was enough different - the locale, the people, and the way it worked out, it was a premier assignment.
Conklin: [03:44] This comes to mind - was it kind of like a younger and a more risk-taking, not scary risks, but willing to go the extra . . . .
Dr. Geiger: [03:56] Well, to go the extra mile was standard. You know the old joke about to do the impossible takes just a little longer . . . but, no, I don't know that it was necessarily risk-taking as such, but we certainly were in the forefront of a number of things in our department. There might have been a little professional jealousy from one department to another, but I don't know that I ever saw anything significant out of it.
Conklin: [04:37] We are going to be talking about the cardiac surgery in a few minutes. Let's go now to the polio epidemic. You were there for one of the last polio epidemics. What effect did that have on procedures and services at Letterman?
Dr. Geiger: [04:52] Well, it was a very scary time on the Post as it was in the City because, although they knew that this was a virus, you didn't know really how to protect yourself against it. If somebody had a cold, you could sort of avoid them, but if somebody was incubating polio, you had no way of knowing it. For example, seven people from the Post, came down with polio in that fall of 1952. I was particularly concerned because my wife was pregnant at the time, ready to deliver, and I was working on the Contagious Disease Ward. I would come home, change clothes in the basement, shower, and then I would see her. There were special isolation techniques that were instituted. Swimming pools were closed, you know, all sorts of measures were taken to try and prevent the spread of the polio. One of the Chiefs of Neurosurgery - he didn't come down with polio but his wife did with a terrible degree of paralysis.
Conklin: [06:20] What were iron lungs? You see them on . . .
Dr. Geiger: [06:24] That was the only form of respiratory support that we had at the time.
Conklin: [06:29] These people's lungs were involved?
Dr. Geiger: [06:31] No, it wasn't just the lungs, the muscles were paralyzed. You see, it was paralytic polio, and it wasn't just extremities, but the respiratory muscles were paralyzed. If they were not put into one of these iron lungs, they would die. I remember when I was in medical school, one of my classmates came down with polio and missed a whole year. One of the other fellow interns in '52 came down with bulbar polio and fortunately, it was transient, but I mean this was something that hit very close to home.
Conklin: [07:22] Was it the total topic of conversation?
Dr. Geiger: [07:25] It certainly was for quite a few months. Then, as the winter came on, why it became less of a hazard.
Conklin: [07:33 So what months and what year are we talking here?
Dr. Geiger: [07:36] I obviously remember October/November of 1952 most vividly. Our son was born in November of 1952, and working on the Contagious Disease Ward, I was quite anxious for my wife and the baby.
Conklin: [08:02] Because of specific personal relationships, Letterman was closely tied to efforts at Stanford Medical Center and the University of California, San Francisco. What were these relationships and these ties?
Dr. Geiger: [08:16] It was more Stanford than the University of California because they were both very close, but several of the people at the Stanford Hospital were consultants - consulting physicians and surgeons - at Letterman, and I have a booklet on some of the history of Letterman which I will share with you, and it outlines it a little more closely. But one of the strongest relationships was with Dr. Carlton Mathieson, he was Chairman of the Surgery Department at Stanford. He came to Letterman every Tuesday night, I think it was Tuesday, and we had Grand Rounds, teaching rounds. He also was instrumental . . .the Army initially did not have a lot of so-called Board-Certified Specialists, General Heaton included, initially was not Board-Certified, and working with Dr. Mathieson, General Heaton not only became certified as a superb surgeon but they set up a program of surgical residencies. This was the beginning of the major specialty training programs in the Army.
Conklin: [10:14] It started here?
Dr. Geiger: [10:15] It did.
Conklin: [10:15] Great.
Dr. Geiger: [10:18] Through that relationship.
Conklin: [10:19] What was the personal part of the relationship?
Dr. Geiger: [10:21] It struck me as being much closer than say, what I saw in my professors when I was in school. We would sit around a big table, they would ask questions, and if you didn't know, they would feed you the answer. Even as an intern, I was not only allowed to participate, but expected to be present and participate.
Conklin: [10:48] It sounds like a fabulous teaching . . .
Dr. Geiger: [10:50] It was a remarkable opportunity.
Conklin: [10:52] It happened because of two men that were specifically friends?
Dr. Geiger: [10:55] Yes.
Conklin: [10:57] Great. When we started talking, you corrected a date for me which has thrown me off a little here. Let's go back to when you were an intern at Letterman. Now that was '52 to '53?
Dr. Geiger: [11:13] Yes.
Conklin: [11:14] Okay, and then you came back in '64 and were here until '69.
Dr. Geiger: [11:19] Correct.
Conklin: [11:21] In '64, you returned to Letterman as Assistant to the Chief of Cardiovascular and Thoracic Surgery, and in '68, then you became the Chief.
Dr. Geiger: [11:32] Yes.
Conklin: [11:33] How did that important change of responsibility play out in your work and in your psyche?
Dr. Geiger: [11:40] Well, fortunately, working with Colonel Aronstan, I had been given a lot of responsibility and opportunity. It wasn't quite as frightening as it might have been otherwise, but the impact of "the buck stops here" was quite obvious and a very strong feeling. It was not that you couldn't talk with somebody else to help talk a problem through, but the final decision professionally, I was stuck with it.
Conklin: [12:20] What was your scariest decision?
Dr. Geiger: [12:22] Oh boy . . .
Conklin: [12:24] The one that really kept you awake at 3 o'clock in the morning.
Dr. Geiger: [12:29] There were enough wakeful times that I don't know that I can pinpoint one, but . . . .
Conklin: [12:34] Does anything come to mind?
Dr. Geiger: [12:36] There were . . . you know, if you couldn't come up with an answer to a problem that was confronting you, it was scary. We had a training program. There were interns and General Surgery residents who came through the Service, and it was our responsibility to share with them the development of their surgical skills, and there was a tendency to sort of rank the seriousness of certain operative procedures. Appendectomy is sort of routine, and there is one very basic, simple type of open-heart repair where you just close a hole in the upper part of the heart, a so-called atrial-septal repair. That was the first procedure that a thoracic or cardiac surgical resident would do, had a lot of practice using the other techniques of open-heart surgery prior to that, but this was the first case he would do. I remember one of the residents saying one day, "Well we have so and so on the schedule tomorrow, it's a simple ASD." I said, "None of these are simple. Every one of them is fraught with the potential for disaster, so don't ever assume that it is simple." You know, the irony of the thing is that this man had a complication related to the use of the heart-lung machine.
Conklin: [14:40] So it WAS dicey?
Dr. Geiger: [14:41] It was very dicey. I think that was just one example, but probably the one that hit me hardest was a little girl who had what they called heart block. The electrical circuitry within her heart was blocked in that her heart rate would either be extremely slow or sometimes it would stop, and we did not have a good permanent pacemaker. It was frightening to be faced with this dilemma. Medicine helped a little bit, but the concern is best described, I think, by the fact that even though she healed and her medication appeared to be effective, when she went home, shortly thereafter she died. Today, that would not occur because we have this electromechanical device called a pacemaker.
Conklin: [16:03] Did you have, as part of the Army system, the kind of leading-edge technology that the private sector had?
Dr. Geiger: [16:10] Absolutely. If we needed it, we could get it.
Conklin: [16:23] Okay. Let's see. In 1969, the Vascular Surgery Service split off from the Cardiothoracic program. How did this change in administration . . . how did this affect your work?
Dr. Geiger: [16:39] I'm not positive about that date, it might have been as early as '68, but at any rate, there were newer techniques in blood vessel surgery, which was vascular surgery, and more patients were coming in for surgical diagnosis and repair. At the same time, we were doing more open-heart surgery, and we had more of the casualties from Vietnam, and quite honestly, we were relieved, that the workload posed by the Vascular Surgery had been shifted to somebody else. Some of it we enjoyed doing very much, but there is a physical limit to how much you can do in any given day.
Conklin: [17:35] So did a large hunk of the staff leave and go over to this other area or did you hire new people?
Dr. Geiger: [17:44] No. I didn't hire them, the Surgeon General's Office transferred in a specialist in Vascular Surgery. He had been in Washington, and he was transferred out to Letterman to take the position as Chief of the Vascular Surgery Service.
Conklin: [18:05] And so, he . . .
Dr. Geiger: [18:08] Excuse me for interrupting, but incidentally he had received some of his training, well, a year ahead me at Walter Reed, and he had some experience working with two Army surgeons, Dr. Carl Hughes, and Dr. Ed Jahnke, both of whom had done some of the very first blood vessel repairs in Korea during the Korean War, I guess it was '51-'52.
Conklin: [18:50] Blood vessel repairs meaning taking tissue from some other source and sewing it onto to blood vessels?
Dr. Geiger: [19:02] Sometimes. Well sometimes, it was a matter as simple as sewing the edges of an artery back together, much like you would repair a seam in a dress. Occasionally they would borrow a vein from some place else in the body, much like they do now in coronary artery surgery.
Conklin: [19:30] Letterman was part of the Army's pioneering efforts in open-heart surgery in the late 1960s. What was your role, and can you comment on your work with children?
Dr. Geiger: [19:48] Letterman was not the first cardiac surgical program in the Army, but it was one of the earliest, and they had naturally to develop or acquire a heart-lung machine. Some techniques were done using a technique with hypothermia, where you would cool the patient and then you would have enough time that you could do a simple repair. I guess it was 1963, they started doing some valve repairs with some older equipment and then Colonel Aronstan came, and he had had some experience with the first Army program at Fitzsimmons Hospital. He started doing some of these repairs, some of the children. He was the first Army surgeon to do a total correction of what they call a transposition, where the blood vessels are like a mirror image, they were coming off the wrong place. But this was a major accomplishment. It was not the first one in the world, but I think it was the first one in the Army. Then he and I worked together on quite a few things, some other techniques that hadn't been done at Letterman before. We learned by going to meetings and being associated with a few other surgeons from major civilian universities. There is one thing about surgeons in particular, I think, and physicians, professional jealousies are very few. They are anxious to share what they have. For example, if we do some work and we report it in a journal, you pay to have it put there. You don't get paid to do this. And that has been true . . . . I finished a research project that I had to go to France and work with this man because I couldn't finish it here, and I did this at my own expense.
Conklin: [22:38] Interesting. What was the impact of the closure of the Letterman Animal Research Facility?
Dr. Geiger: [22:41] What I just said was part of that impact, and it occurred as a result, I guess antivivisectionists or animal rights people which I feel strongly is misguided. The one thing, which I think of value that came out of it, was an official program of ensuring that animals were cared for in a humane fashion. That is the one good thing that came out of this particular movement, but when I say it is misguided, I learned basic surgery skills on frogs, guinea pigs, dogs . . . . I couldn't have accomplished 1/1000th of the good that I feel I have done during my career if it had not been for that animal research experience. Was it BASIC research? No, it was skill development research. But some of the things, like treating these complex lung problems were a result of experimenting on animals where you would create the problem and then try to correct it, to figure out what caused it and how to keep it from recurring. One of the things that was done at the Letterman Research Institute was that we developed an advance model of the heart-lung machine, and it was marketed by one of the firms as the Letterman Pump. I can remember using that on many patients because it was versatile, it was reliable, and it just . . . well, permitted us to do a lot of things. . . . The Institute closed. There were several research projects going on, one the orthopedists had in bone growth to try and figure out a way to avoid some of the complications of bone injuries, war injuries, and they were working on retired racetrack greyhounds. Unfortunately, Senator Barbara Boxer got into this thing somehow, and the Secretary of Defense became so pressured that he stopped animal research. This also killed the one project I was doing on high-velocity lung injuries. I struggled to try and complete and acquire the information to the point of going to France and working with a French doctor over there. We were using pigs. We finally have the data, and I hope to be able to get it published this year, but so far it has cost me personally quite a few thousand dollars.
Conklin: [26:29] What was the climate like around the time of the closure? What was the mood of people, what was the talk? It must have been a very significant and very depressing . . .
Dr. Geiger: [26:41] Frustration, depression. How can they do this? How can we teach others how to take care of war wounds if we cannot utilize an animal model? You can't learn this from a computer. It just ISN'T possible. You can develop certain skills and techniques using a computer model and all of the animation, but it is not the same.
Conklin: [27:14] You talked about the family, the Letterman family. How did this closing animal research, how did this affect the family?
Dr. Geiger: [27:23] I don't know that I can comment on that part of it. We were so involved, obviously, in doing the day-to-day work that I guess the full impact of losing the research facility didn't hit us completely immediately.
Conklin: [27:45] Just later?
Dr. Geiger: [27:46] Yeah.
Conklin: [27:47] You mentioned the overwhelming amount of work and then the dedication of the staff. You want to talk about that a little?
Dr. Geiger: [27:56] Well, a lot of us, I think, were . . . I draw the comparison to . . . I’m like a bulldog, if I get my teeth in a problem, I won't let go 'til I get the answer. I remember one night, at 1 or 2 o'clock in the morning, we had been up with this one casualty who was so terribly ill, several of the other staff, the nursing staff, and the guy looked like he was going to die. He had made it back from Vietnam, but he just was in TERRIBLE condition. We sat there, the Chief of Medicine and some of the other staff, and myself, and we took a sheet of paper, drew a line down the center and what we know, what we don't know, what we know, what we don't know. . . . It was so terribly frustrating, and this basically what they now call the problem-oriented record, how you come to a solution. They have been teaching that in the schools now for a number of years, but it was our way of approaching this man's problem and suddenly, we looked at each other and said, "My God, he has Pseudomonas." We started him on one of the newer antibiotics, drained his pus pockets, and a day later, after this stuff had been growing in the laboratory, in the Bacteriology Lab, a little longer, they called all excited, and said, "Hey, you guys have a case of Pseudomonas pseudo mallei" "Thanks a lot."
Conklin: [30:00] We have about a minute left, sorry . . . .
Dr. Geiger: [30:02] I had one more thing about that particular guy. He had been a ranger, a paratrooper. He volunteered and went back to Vietnam.
Description
James P. Geiger discusses being an Intern at letterman hospital between 1952-1953 and then a cardiac surgeon between 1964-1969.
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