Perspective

miChael g. lamB mD

Carl Groth was a key person in the development of liver transplantation. Dr. Thomas Starzl wrote about Groth in his autobiography, “The Puzzle People”. He described him thus, “large by any ethnic standards … his features were strong and primitive. He towered over most adults.” Starzl then reflected on Groth’s childhood in Finland when the Russian army besieged Helsinki in the winter of 1939 and “the resolute Finnish Resistance held the vast Soviet forces at bay”. “Whether these facts are relevant”, Starzl continues “may be debatable but when describing steel, it pays to know what fires have tempered it”. There were many back in 1967 who did not believe liver transplantation was possible. But these two “men of steel” were believers. Their adversary was death. Starzl comments further on Groth, “Once the battle was joined, I wondered more than once whether anyone else saw the symbolism of his constant vigil. Sometimes, the vision was of the sentinel always alert to the circling wolves just beyond the flickering campfire. Or he was a soldier in white, interposed between the invader and his native Finland. No man’s land was the ICU on the third floor of the hospital”. Starzl was no slouch either. He had competed on a very successful football team in high school and had played basketball in high school and college. He served in the U.S. Navy. He was a hiker, a mountain climber, skied down the Swiss Alps, and he toured across France on a bicycle averaging 100 miles per day. He was a man’s man, as was Groth. This was the stuff that medical pioneers were made of. They were directly or indirectly responsible for saving and improving thousands of lives. But today they would be viewed by some as classic examples of toxic masculinity.

Starzl’s model of the doctor as a soldier in battle with disease and death is now seen as an anachronism by at least a few academics. Some have written that the model needs to be discarded because the patient gets ignored when the focus is on the battle with death and disease. That is hardly the case in my experience and it certainly wasn’t in Starzl’s. He knew all his patients by name and remembered them for decades. Starzl and Groth were intensely focused on getting patients well again. That’s what the war on death and disease was all about and it demanded total commitment to each and every patient in the battle.

The current mantra that is being bantered about in some corners of academia is that way back in the bad old days (prior to about 1990) medicine was dominated by white males. With these white guys came this outdated model of doctors as fighter pilots in a death struggle with the bad guys (various diseases). That’s not entirely true since they also were fighting for better access to health care. They were fighting for patient’s rights and against insurance companies, big government, and hospital conglomerates that were trying to deny necessary care and discharge patients too early. Ashley Andreou, while a medical student, wrote on this topic and is among those who see the battlefield model as just another example of toxic masculinity in medicine. Toxic masculinity includes (according to Ashley) male dominance, grueling work demands, having to wake up once or multiple times in the middle of the night, 28 hour shifts, and superiors that champion “mental and emotional toughness”. In other words, things that are just hard. Remember that Ashley is part of that generation where for the sake of fairness “everyone gets a trophy”. I wonder what former UPMC Montefiore

In the Battle

Lieutenant Roberto Hero’s

Al Drash as a fullback at

Vanderbilt Hank Bahnson as a tackle at Davidson

Surgical Chief Mark Ravitch thought about mental and emotional toughness after he operated for 36 straight hours during the Battle of the Bulge. Ashley also somehow links this toxic masculinity in medicine to the killing of George Floyd. There are others with views similar to Ashley’s who believe that real progress will only occur in medicine when such examples of toxic masculinity are put to rest. But is the model that Dr. Ravitch, Dr. Starzl, and Dr. Groth worked under really something that should be described as toxic? Would not a better term be heroic?

In looking at this, let’s first accept that the increased diversity we see in medicine these days is a good thing. But should we totally cast aside a model that has produced some of the finest physicians of the modern era just because it strikes people as being too masculine. In my own medical career, the people who had the greatest impact on modern medicine, the trend setters, were people who some would describe as embedded with toxic masculinity. I prefer to call it heroic medicine and I see these medical innovators as iconic medical champions. What follows are just a few examples.

Henry T. Bahnson M.D., Professor and Chairman of Surgery at UPMC, seldom walked up the steps in the hospital stair wells. His entourage of medical students and surgical residents gently jogged up those steps to the 3rd, 7th, 12th or whatever floor they were going to. Elevators were off limits for Bahnson and his team. He was a hiker and mountain climber who had scaled some of the most challenging peaks in the Alps and the Himalayas. He also played 4 years of Division One Football at the then all-male Davidson College where he was an All State tackle (playing against the likes of Duke, the Citadel, N.C.State, North Carolina, V.M.I., Wake Forest, and South Carolina). He graduated suma cum laude and was “man of the year” for the class of 1941. Bahnson was a pioneer in the resection of aortic aneurysms and in the surgical correction of cyanotic congenital heart disease. He performed the first heart transplant in Pennsylvania in 1968 and initiated a full scale transplantation program in Pittsburgh with Dr. Thomas Starzl in 1981. That alliance led to UPMC becoming the leading transplant center in the world. Twice he was Pittsburgh’s Man of the Year (1968 and 1983). He was very fit and had both a demanding and an inspiring presence. He calmly asked hard challenging questions on rounds but he also won the Golden Apple Award for excellence in teaching. Toxic masculinity? Medical School Dean Arthur S. Levine called him “The very soul of our institution”. Allan Drash,M.D. revolutionized the care of children with diabetes, in fact he wrote a book on it. He described Dennys-Drash syndrome and was the consummate academic pediatrician. His work led to the development of Children’s Hospital and the University of Pittsburgh as the premier center for the study of Type I Diabetes. The team approach for the care of diabetes in children began with Drash. He put in long hours of work and had incredible commitment and energy. His loving wife of many years once said “his whole life was built around trying to help children with diabetes and to reassure parents.” A well-built muscular man who enjoyed weight lifting, Allan once worked as a lumberjack. He had been an Alabama All State high school running back and received a scholarship to play at Vanderbilt in a backfield that had All American, Billy Wade. He served two years in the U.S. Airforce. Drash once wrote to his daughter, “There is nothing more important than to be consumed by a sense of dedication and responsibility to a profession, a calling, that takes one out of one’s own self and into the service of others. It is not the job of medicine that is demanding, but that we are demanding of ourselves.” Toxic masculinity? A former patient of Allan’s put it this way speaking of being diagnosed as a child with diabetes: “It’s this overwhelming shadow of darkness. But we never had that, we had Dr. Drash. In the battle against diabetes, Al Drash was on our side”.

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Then there was Peter Jannetta, M.D., the Chief of Neurosurgery at UPMC and later AGH. Dr. Jannetta was a tall handsome athletic looking man who seemed tireless. He was self-assured without being cocky. He too was a “tough guy”. He had played on the football and lacrosse teams at the University of Pennsylvania. He was also on the Penn swimming team and continued to have an avocation for swimming for many years. When he discovered what is now called the Jannetta procedure for the treatment of trigeminal neuralgia, other surgeons scoffed at him. But Jannetta had the drive, determination, confidence and mental toughness to persist. The Jannetta microvascular decompression procedure is now a standard treatment for several neurovascular compression syndromes. He also served as the Secretary of Health for the Commonwealth of Pennsylvania and while at UPMC, he built what was arguably the best neurosurgery department in the country. It was also a collection of folks that Ashley Andreou and others would likely label as classic examples of toxic masculinity. If so, it may have been the most potent collection of toxic masculinity ever assembled in one department, that’s how incredibly masculine and successful it was.

There was Joseph Maroon, M.D., a pioneer in the transphenoidal approach to pituitary surgery, minimally invasive spinal surgery and sports medicine related to the head and neck. Most of the safety measures that are now used to prevent head and neck injuries in football and other sports were triggered by Dr. Maroon’s work. That’s not surprising because he was a star high school athlete who went on to start at halfback for Indiana in the Big Ten Conference. Maroon would become the head of the neurosurgery department at West Virginia University before returning to Pittsburgh. In his sixties, he began running, biking and swimming in “Iron Man” competitions. Maroon compared some of his surgical procedures to a religious experience. The chief neurosurgical resident at that time was Dr. Leland Albright, an incredibly calm, focused and steely eyed perfectionist who became the Chief of Neurosurgery at Children’s Hospital of Pittsburgh where he orchestrated many advances in the field of pediatric neurosurgery. Albright was an All American track and field star at Louisiana State University. In 1964, he was the Southeast Conference Champion in the 880. In 1965, he was the NCAA champion in the 600. Leland Albright never complained about a busy schedule or a heavy workload. He had tremendous endurance and confidence. And then there was Dr. Roberto Heros who pioneered the surgical approach to aneuryms at the base of the brain. Heros had movie star good looks and as a young man was one of the best athletes in Cuba. He had to flee Cuba in 1959 because of his opposition to Castro and the communists. He became a lieutenant in the United States Air Force and parachuted into Cuba during the “Bay of Pigs” invasion. Heros and his squad quickly seized their objectives, but eventually ran out of ammunition and were captured. Roberto was imprisoned by the communists for two years. He returned to the USA after being basically ransomed by the Kennedy administration, went to college on a football scholarship, excelled in his studies and eventually became one of the world’s foremost neurovascular surgeons. Dr Paul Nelson was an upper-level neurosurgery resident in those days. He too was a runner and competed in several grueling Boston Marathons. Mentally tough, always calm, and with great endurance, Paul was yet another neurosurgical trail blazer and a great teacher. He became the chairman of the neurosurgery department at the University of Indiana. Last but not least was 1st year neurosurgical resident, Laligam Sekhar , a brilliant student, came to UPMC from India where he played cricket and tennis. He put in incredibly long hours at the hospital and became one of the world’s wizards of skull base neurosurgery, a department vice-chairman, and a legendary teacher. When he finished his residency at UPMC he took his neurosurgery boards and had the highest score in the country. Basking in all that toxic masculinity obviously helped him. Toxic masculinity? You didn’t hear anything about that when Dr. Jannetta put his big arms around a patient suffering with trigeminal neuralgia and confidently told that person he could fix it or when Roberto Heros clipped an aneurysm and described the moment as “better than an orgasm”.

These men were not just good physicians, they were trail blazers. Every one of them was physically and emotionally a tough guy. Every one excelled in athletic endeavors in which one battles an opponent or the clock. They all made great sacrifices to excel in their fields. Many of them were in the military. They all put in long hours and they all got called in the middle of the night. For them the patient was of paramount importance. I don’t see examples of toxic masculinity in these men. Instead, I see heroic figures practicing heroic medicine, championship medicine. We need more doctors like these icons of the heroic medical model, not less.

Joe Maroon running the ball for Indiana University Leland Albright as a track star at LSU

Henry Bahnson

REFERENCES

Starzl, Thomas E., The Puzzle People , pp. 158-159

Andreou, Ashley, “Unpacking Toxic Masculinity in the Medical Field”, Women’s Media Center October 23, 2020.

Starzl, Thomas E., “ Henry T. Bahnson M.D. 1920-2003”, Annals of Surgery volume 237, no.4, 591-592.

Bahnson MD, Robert, “Remembering Hank”, https://bulletin.facs.org/2014,May Stavesnick, C., “We had Dr. Drash” , Pitt Med Magazine Spring 2020, pages 18-20.

Wuycheck, Diane C., “A Revolution in Neurosurgery: The Jannetta Procedure”, A Tradition of Leadership, Innovation and Caring: A History of Medicine in Pittsburgh and Allegheny County, pp. 75-76, Legacy Publishing Co.

David M.D., FAANS, Carlos A., “Military Faces of Neurosurgery-A Hero so Named”, https://www.neurosurgeryblog. org/2016/04/18/military

The opinion expressed in this column is that of the writer and does not necessarily reflect the opinion of the Editorial Board, the Bulletin, or the Allegheny County Medical Society.