The Journey for the New Doctor

by James S. Ogsbury, MD.

Dr. James Ogsbury's memoir "About Not Losing" recounts his experiences as a neurosurgeon, highlighting a malpractice trial from the late 1980s in Denver. It also details his military career, emphasizing his transfer to various Air Force bases and the challenges of practicing medicine under military supervision. Ogsbury shares insights into surgery, teamwork, and patient care.

The book comes in hardback, paperback and e-book.

The Military

After I completed an internship and first-year residency at the New York Hospital, Cornell, I joined the military through the Berry plan (a plan that allowed physicians to join the military as physicians and not as soldiers). In September 1969, I began my military career. I was first assigned to the Sheppard Air Force Base, Texas, for two weeks of basic training. While basic training is serious for regular recruits, for physician recruits, the main goal is to prevent the naïve doctors from getting hurt. For example, when we had to complete the exercise of crawling on our bellies under barbed wire, blanks were used in the guns to be sure that some stupid doctor did not raise his head. After two weeks of basic training, I was sent to my first base, the Altus Air Force Base in Altus. Oklahoma.

Altus is in a rather desolate portion of Oklahoma, and the joke is that it was chosen as a site such that if the base was bombed in a war, then no civilians would get hurt. As I was an officer, my wife,. Kathy and I were given a small house on the base, and I immediately noted how beautifully manicured the housing area, and, indeed, the whole base appeared. I was told that there is an obligation to maintain the grass at each house on Air Force Base, and the Altus Air Force Base had won an award for this. The irony was that there was then a drought in that region, and farm animals were dying from lack of water as the meager water that was available was diverted to the military base.

Most of the time, in Altus, it was rather benign. I was there to assist the general surgeon, Dr. Jim Burns, in the hospital. Interestingly, Dr. Burns was Cornell-trained and a quite good surgeon. However, because of him, I quickly learned the military way. Dr. Burns had a strange habit of mowing his lawn in military uniform, clearly against the rules. Fortunately, we had a wonderful hospital commander, Col. Martinez, who was a Puerto Rican Air Force officer destined to be the first Puerto Rican General in the Air Force Medical corps. In a sense, he had more security than the Wing Commander or Base Commander on the base, particularly since he had taken care of the wives of both the Wing Commander and the Base Commander. So, if someone complained about Dr. Burns, Col. Martinez would gently advise Dr. Burns that it would probably be wise if he would choose to use his regular clothes while mowing the lawn.

Unfortunately, Col. Martinez was transferred to another base (probably an upward move), and the new Hospital Commander was definitely a rule-oriented military-style medical director. Within a month, Dr. Burns was in severe trouble and even at the risk of ending up with a general discharge (which can threaten his ability to obtain a license in some states). His case was referred to the supervisor of the new Hospital Commander, a military man who was not a physician. The supervisor supported the Hospital Commander and wrote ten specific criticisms of Dr. Burns’. medical practice. I remember only two, but all ten were easily answered. The first of the two most memorable criticisms was that Dr. Burns had no support of any of the other physicians in the hospital – at which point, of course, every hospital physician wrote a letter of support. The second was that Dr. Burns was performing malpractice since he sent his pediatric hernia patients home as early as the third postoperative day, at a time when many modern surgeons were doing their pediatric hernia procedures as outpatients. Fortunately, as the answers were all addressed, the responses were sent to a further-level administrator who had no choice but to find Dr. Burns, and Dr. Burns was able to complete his military career.

Because of that episode, I had quickly learned that, while military medicine is enticing, in that the financial side of medicine is eliminated from medical care, the fact that one’s career depends on supervisors who are non-medical and clearly biased, a totally intolerable situation. Thus, while at one point I considered a career in military medicine, after that experience, a military career became a non-choice.

After eight months at Altus, I found I was being transferred to the Korat Royal Thai Air Force Base hospital in Korat, Thailand. At first, I challenged the move, thinking that I might be being sent to a true war zone situation as some punishment and that the transfer was unfair. I discovered that the actual reason for the transfer was that there was a need to fill a position in the hospital at Korat. My position as a partially trained surgeon at Altus Air Force Base was considered to be the least important and, therefore, the least necessary, surgical job in the entire Air Force Medical Corps, making me the ideal candidate to be sent overseas.

I was transferred to the Royal Thai Air Force Base Corot Thailand. Kathy decided to follow me, although this was an isolated tour, and she had to go as a civilian. Soon after arriving at Korat, I was transferred to the U-Tapao Air Force Base Hospital to be the assistant to the general surgeon there. Kathy followed me to U-Tapao, and we found a place to live in Pattaya Beach on the Gulf of Siam. This was initially a nice job; work was good, and the base was beautiful and near Pattaya, so time off could be spent on the beautiful beaches there. Unfortunately, soon after my arrival, my fully trained general surgeon went back to the States to take his surgical boards, leaving me, a partially trained surgeon who had never performed any significant general surgical procedures, as the only surgeon for 50,000 American troops.

Most of the time, the care was rather mundane, and difficult cases were sent off to the big hospital at the Clark Air Force Base in the Philippines. However, one day I was told that ” shrapnel wounds were coming.” I did not like the sound of that, first because it sounded like this was more warlike than I had been led to believe, and second because I had no idea how to treat shrapnel wounds. I called the main hospital in Vietnam at the Tan Son Nhut military base, asking what to do about this unique problem. Whoever answered the phone quickly realized he had a surgical rookie on the line and decided to pull my chain by saying that shrapnel was likely made of magnesium, which would flare once in the air, and that I should take the shrapnel out of the wounds under water. I then heard laughter, at which point the line went blank. I then found out the nature of the problem I was to be facing. An airplane, actually from Korat, came in on fire with its hydraulics not working and unable to jettison its bombs. The pilot and copilot were able to land and safely get out of the plane, but then the fire marshal failed to “time the ordinance” (that is check on the time it takes for a plane on fire to have its bombs explode and, if the fire is not out, have everyone quickly exit the area once that time is reached).

Unfortunately, an explosion did occur, seriously injuring a few of the airmen who were sent to the Clark Air Force Base Hospital. Two patients with superficial shrapnel wounds were sent for my care. I found out that one airman, who had been close to the plane, had been struck by shrapnel but knew to hit the deck if he survived the first explosion such that any subsequent explosions would go over his body. The second explosion did indeed cause no further injury, and he was suffering from superficial shrapnel wounds over much of the front of his body. The second, who happened to be the Vice Wing Commander from my base in Korat, was struck in the front by the first explosion, had turned and run after the first explosion, and was struck by the second explosion by shrapnel into his back. He, therefore, had 360° of superficial shrapnel in his body. Unfortunately, no one had told me that shrapnel is sterile and that the only necessary treatment is to remove the small piece of metal from the superficial wound and allow the wound to heal. So, I carefully debrided and closed the wounds for eight hours on the airman and for 16 hours on the Wing Commander. Obviously, both did well, but what took me 24 hours would have taken a good trauma surgeon probably 45 minutes to accomplish. Other than that, our stay at U-Tapao was non-eventful. From my very brief stay at Korat, I did remember that the base was not authorized to have a physical therapist, and so, while at U-Tapao, Kathy took a three-day OJT course in basic physical therapy. After about three weeks at U-Tapao, Kathy and I returned to Korat.

Our life in Korat turned out to be a wonderful experience. My predecessor had left word that if I wished to take on the services of his house girl, I could use the house he had used. We did just that and came to love Chan, our house girl. Before we arrived, Chan buried all of the utensils that my predecessor had obtained, such that Papa San (the owner of the house) would not steal them, and she then dug them up and cleaned them for our use. She was there for us for the rest of our tour.

Our experience on the base was quite special. Indeed, it probably was the most fun in medicine that I have experienced in my life. First, Kathy and I quickly became an integral part of the base. On many isolated tour bases, there are mostly airmen who have four-year commitments in contrast to the physicians with two-year commitments. Under the rules, the airman could not bring over their families and maintain their credit for the isolated tour, whereas the physicians had no such limitations. Therefore, on many similar isolated tour bases, there is a strong resentment toward the physicians by the airmen. Not so at Korat. The fact that my blonde wife (the only blonde on base) was known to work full-time in the hospital because we took care of the Thai wives of the airmen and because we developed some programs that proved to be very popular with the airmen, the hospital and its physicians happily worked closely with the non-medical staff at Korat.In addition, while in most overseas small hospitals, the staff can take care of only the most basic of problems, the medical life is boring, to say the least. But, because of a unique circumstance at Korat, we were able to find a way to address many issues that are generally not available in a hospital such as ours. In Korat, I quickly found that the night Corpsmen were the most powerful brokers of influence on the base. That was because when an officer came into the hospital at night with a social (generally venereal) disease, the night Corpsmen would give the officer penicillin and Benemid for his “strep throat,” as it was listed in the chart. Then, the officer owed the Corpsman a favor. These favors were very carefully nurtured and maintained and judicially utilized. If there was anything we needed to obtain and something that could not be obtained through regular channels, our corpsman could almost always find a way to obtain whatever was needed.. I remember we received a culture machine that way when our old machine stopped functioning.

The best example, however, occurred when I had a patient who had acute appendicitis. The U-Tapao general surgeon was only an hour away by air, and transferring him there clearly was a better option than trying to perform an appendectomy at Korat. I found through channels that an airplane was available, but then I received a call from a general who was an important commander in the Pacific theater. He told me that he understood my concern and even realized that my patient might die. However, it was the rule that the last plane must always be available to the troops and that the mission must come first. I was impressed, first, that he took the time to call him me, but second, that he had to triage many lives where I had only one at stake. However, the lack of that plane was not a problem because I called my “Radar” (we always had a” Radar”) and told him my problem. He asked for me to give him a few minutes. Literally about 10 minutes later, a helicopter arrived, my patient was taken down to U-Tapao, underwent the necessary operation, and returned cured about three days later. I never asked what my “Radar” had to barter for that helicopter – as I did not want to know – but the system worked as it often did.

Soon after arriving at Korat, I found there was a strong bond between the physicians and corpsmen. One time, early in my tour, my “Radar” made a small medical error overnight, I happened to have been in the hospital that night and reported at the morning briefing that I had made the mistake. There was certainly not in any risk to me – what were they going to do to me, send me home? But more importantly, because the corpsmen took care of us, we needed to take care of them. And after that, the needs of the physicians were paramount to the corpsmen. Partnering for necessary equipment was common and it was wonderful to operate in that environment.

One of the important things while living in Korat was to learn the local rules. First, it was not necessarily considered bad for a Thai criminal to rob (though it was bad to kill), so we frequently carried two sets of money when we traveled in town, one to use if we were accosted, the second to protect. The criminals knew just what we were doing, but as long as we gave them a significant amount of money, that was all they wished. The second was that all it took was 100 baht (I believe about $2.50 at that time) to take out a contract to have someone killed – so one still had to be careful. Indeed, if a contract was taken out on an American (as happened to one of the physicians who promised to marry a Thai woman and then brought over his wife and was surrounded by the Thai woman’s relatives), that person was grabbed by several large American servicemen, taken to the base, kept overnight in an American jail with American guards and flown back to the US the next morning. Third was that the Thais had a very strong sense of friendship. If you were felt to be a good foreigner, you were quite safe. Kathy wished to travel to a village in central Thailand where beautiful silk fabrics were made and sold. But that was also a place where there was a mild communist insurrection (not a big problem), but further, the town was the local center for heroin distribution in central Thailand (a big problem because, if you became involved with that process in any way, they needed you dead, nothing personal). However, we found that, because we took care of the local Thais, it was safe for Kathy to travel to that village with a Thai friend, the wife of corpsmen who had called ahead to inform the villagers of her arrival. To the dismay of the special forces at the base (they said they could not rescue her), off she went in a Thai bus, evidently the heroin disappeared, the silk came out, and Kathy bought a few pieces and, after she left, obviously the heroin came back out – all perfectly safe.

We also learned that since Kathy had to leave Thailand every three months to renew her visa, travel to Laos was a good option. It turned out that the Laotians needed the border between Thailand and Laos to remain open for primarily American tourists because the money from tourism financed their side of the war. We were told it was perfectly safe for us to travel to and into Laos. So, we traveled on a Thai train across Thailand. We were always worried a little bit about robbery along the way, but we arrived safely at the border. There, we were told that it would take us two weeks to complete the paperwork on the Thai side, but, of course, if we paid a small fee, a Thai gentleman could walk us through the process in 30 minutes. It seems like the word for bribery in Thailand translates to something like “fee for expediting business”, a definition quite consistent with our experience. When we advanced to the Laotian table on the Thai side of the Mekong River, a few papers were stamped, and off we went across the river, the only risk being that if the motor in the little boat happened to fail, we would float away from the safety of the border crossing. When we arrived at the Laotian side of the river, we were greeted by a Laotian taxi driver. Clearly, the driver was a Laotian communist, but the rules were that, because the border needed to be open, if an American disappeared from a Laotian taxi, that driver would probably be killed. We were safely driven into the Vientiane, the capital of Laos. It’s a unique city, being the capital of the old French Provincial Empire and an Asian city still with significant French influence. For example, on the outskirts of the city, there was an Arc de Triomphe with a beautiful mother-of-pearl on the underside. However, while we were there, we could hear the war going on 20 or 30 miles away, but the war never came to Vientiane, presumably because all of the diplomats were stationed there. We were told that, interestingly, other than the North Koreans and North Vietnamese, the diplomats of the warring factors went to parties and drank together, obviously thinking that since they couldn’t solve the war, they might as well party together. While in Vietnam, we were able to buy some exquisite gold pieces, wishing that we had brought more money given the low price. Despite the exquisite workmanship, the cost of the pieces was almost entirely due to the price of gold that day. Finally, one day, we somehow arranged a trip in a Lao taxi to go well into the jungle, where the driver showed us a beautiful, unrestored, very old temple. It was very schizophrenic. This driver would kill us in a moment, but since he could not do that, he wished to show us his country. Finally, we reluctantly traveled back to Korat.

Other than practicing basic medicine without any interference from bureaucracy, my most memorable experience occurred one day when I was told I had a phone call. I told my “Radar” that the caller should wait a minute as I was suturing a wound in an airman’s hand. My “Radar” said that the call was coming from a general. I assumed the general was local and told my radar that I had recently seen in a movie that the generals believe that the troops should always come first. But then my “Radar” told me this was a call coming from a four-star general in the Pentagon – so obviously, I took that call. The reason for the call quickly became evident. The call involved my hospital commander, Col. Zimmerman. I had a great rapport with Col. Zimmerman, and we had a wonderful deal. I would take care of the medical side of the hospital, and he would take care of all of the administrative issues such as the drug problem.. However, Col. Zimmerman was an overweight pediatrician, a flight surgeon for the main Air Force group at the base, a squadron of F4 Phantom fighter pilots. By Air Force standards, flight surgeons are supposed to fly with their squadrons so they understand the risks and stresses their pilots face. However, the F4 pilots did not want an overweight pediatrician to be sitting in the backseat of one of their F4’s. So, the squadron actually tried to arrange to have Col. Zimmerman relieved of his command. In the military, a command has a very special role, and it takes a formal investigation to relieve a commander of his command, whether the process involves a high-level commander or one with a lower rank. In support of the hospital and of Col. Zimmerman, and of course, with help from the Jag (legal) officer, I wrote a letter to the Pacific Air Force stating we physicians felt that Col. Zimmerman l was a good doctor and a good man, who supported the war effort, the US Constitution and everything else we could think of – and we just didn’t understand why he was not entitled to the formal investigation involving the loss of command, and then mentioned the page and paragraph in the appropriate manual. Given that this episode was happening at a critical time near the end of the war and the administration did not want any other issues to become involved, the four-star general was calling me to try to get me to retract the letter.

The conversation was brief. He said, “Captain Ogsbury, are you the author of this letter?” I answered, “Yes, sir, I am.” He said, “Your actions are ill-advised, and I am displeased.” I said, ” I’m sorry to hear that, sir.”. He said. “What do you have to say for yourself?” I answered. “Sir, as I’m sure you know, I am just a simple doctor and do not know all of the military aspects of things. But I know Col. Zimmerman.” I reiterated all of the complementary things about him in the letter and said I still did not understand why he is not entitled to the specific investigation to which he is apparently entitled.. – and repeated the page and paragraph in the manual.. The general knew I was not to be intimidated and hung up. Soon thereafter, there was an investigation, interestingly run by the wing personnel who had tried to get rid of Col. Zimmerman in the first place. The Wing found no problems with the hospital. That created a problem for the Air Force – this investigation was supposed to support the original action. Then, to no one’s surprise, soon thereafter, three additional officers, two attorneys, and the lead physician at the Tan Son Nhut hospital in Vietnam came in to do an investigation of the. Investigation.

After two days of intensive testimony using two tape recorders (the military was worried that one would die), the three officers left. About a month later my “Radar” raced into I office and threw down a stack of papers. He told me to read just the last page.” On the last page, there was a very short paragraph. That paragraph stated that it was the opinion of the three officers (and the three officers signed their names) that #1. The Korat Royal Thai Air Force Base Hospital is the best small hospital in the Pacific Theater; #2. That many of Colonel. Zimmerman’s brilliant innovations were being suggested for implementation throughout the theater. (The funny thing about that was that we had to instruct Col. Zimmerman on all the things we were doing with which the officers were impressed – such as being available at all times, allowing volunteer civilians to perform necessary non-allocated tasks, but especially having a middle of the night sick call for those airmen on 12-hour shifts) and #3. that the three officers complimented the hospital for its ability to function in the face of the interference from the Wing. That very day, the name of the wing commander, a full Colonel, which was on the top of the list on the officer’s club of officers who had been approved for promotion, had a yellow Magic marker drawn through his name. We found out later that he never thereafter functioned as a one-star general for the rest of his career. I was impressed to learn the basis of military ethics: that is, if you put another at a certain risk, you necessarily put yourself at the same risk. Since Col. Zimmerman had been placed in a position such that if he had lost his command, his career would have been essentially over, the same result needed to be applied to the Wing, and the Wing Commander was responsible for the Wing. Not only was this amazing but I also had learned the important lesson that if one needed to get something done, sometimes one had to go well above the person directly above the person with whom you have a disagreement and then plead your case to a very important person – but you better be right when you do that.

Once that was over, we resumed the normal everyday routine medical care of both the troops and the local population which was so enjoyable. Near the end of our tour, we were concerned to learn that a physician and his wife, a religious Christian couple, took some time to attempt to convert members of the Hmong tribe – and we were reassured to learn they were not successful.

Finally, the overseas year was up, and it was time to go. Of course, we were not afforded the wonderful traditional Air Force ritual that goes with pilots who are completing the last flight of their tour. Often, three F4 pilots would fly together for an entire year and if all safely completed their tour, the three would fly essentially side-by-side slowly low over the flight deck and, at the end of the flight deck, would kick in the F4 afterburners, and fly upward in a triangle, an amazing sight, particularly given the emotional impact of the moment. We, on the other hand, said goodbye to our colleagues and left to go back to the States.

Once returning to the States, rather than the logical decision to send us to the Buckley Air Force Base in Denver, because by then I had been accepted to continue my training in Denver, we were sent for three months to the Mather Air Force Base in Sacramento, California. The high point there was when we met a local sergeant who proved to be a wonderful unknown artist, and many of his exquisite drawings grace our current home in Denver. Also, it was nice for us to occasionally be able to tourist in the Sacramento and Lake Tahoe areas. However, the decision to send us to Mather meant that the Air Force had to pay for the move to Sacramento and then the move from Sacramento to Denver three months later at the end of my military career. The good news was that I did ultimately end up in Denver ready to restart my training.

Beginning Practice

The first years of clinical practice proved to be an eye-opener. Like, I presume, most residents, I came out of training loaded with the concept that I was ready to take on any problems that I might encounter. I quickly found that the real world of medicine is not at all like that. In training, almost always, a professor is at your side during an operation if you are performing a difficult procedure. He may not tell you exactly what to do, but by his use of instruments, his retraction of the tissues, particularly the brain, and even his demeanor, the professor led you through the difficult operations. Now, there was no one to do that. I had joined a wonderful partner, Dr. Keith Sadler, who was an incredible surgeon (one of only three with whom I have had the privilege to operate – the other two being Dr. Bronson Ray at Cornell and Dr. Kevin Lillehei at the University of Colorado Medical Center) with an incredible sense of space within the brain. I remember one time early in my practice when Dr. Sadler was planning to remove a small tumor deep in the brain, demonstrated on an early model CAT scan. On the test, all I saw was a small, slightly darker area in what was otherwise an almost hard-to-distinguish “urogram.” However, while I’m not sure I would have even known where to make the skin incision, Dr. Sadler confidently went about the operation, opening the skin, removing a flap of bone, and opening the dura (covering of the brain.) He then proceeded to operate slowly but progressively, down a narrow hole deep into the brain. When he abruptly stopped operating, I asked him why he chose to stop. He gave me what I am clear was: “If you have to ask me that, I’m not sure I want you to be my partner.” He said, “Because the tumor is out”. I said, “I know you feel that, but how do you know since the tissue you removed was the same color and consistency as the normal brain tissue. He said, “That’s where the tumor was, and now it’s out”. While I had nothing further to say, I knew that I would have had to try to triangulate the position of the small tumor against many known structures and still likely would not have been able to find it – he simply knew where it was and took it out. The next day, there was a dark spot right in the same place in the middle of the “urogram.” I was astonished, but he was not surprised. Unfortunately, Dr. Sadler had extraordinarily good vision and rarely, if ever, used a microscope, which I had been trained to use for all appropriate procedures. Thus, he was unable to assist on procedures that, to me, required a microscope. That limited the number of procedures that I could perform to quite a degree.

Fortunately, I was later joined in partnership by Dr. Lee Krauth, who was a superlative micro-surgeon, and thereafter, the two of us could perform pretty much any procedure requiring the microscope. It was a good thing for me that Dr. Krauth was an expert in vascular surgery, as I found that vascular procedures were an area of neurosurgery with which I seemed to struggle. After I had a patient who bled during an aneurysm operation and ultimately died (and the fact that the patient’s poor condition prior to surgery made it highly unlikely that she would live even without the hemorrhage was no consolation), I decided to leave the aneurysm surgery to Dr. Krauth. He actually indicated that aneurysm rupture during surgery is not uncommon, and it seemed that the excitement of that circumstance posed a not unhappy challenge for him.

Even before Dr. Krauth arrived, there were mostly good times. I proved that I could easily accomplish most routine procedures, and I developed the reputation of requiring very short hospital stays for my patients. This, of course, made me popular in the work compensation world, and I soon acquired work compensation patients from all over the city. In addition, I developed a friendship with Dr. Kevin Lillehei, the Professor of Neurosurgery at the University of Colorado Health Sciences Center and an extraordinary surgeon. He was willing to come to my hospital when I was facing the need to perform an unusual procedure that I had not performed previously, and I either helped him perform the procedure or, occasionally, he helped me perform the procedure.

I also had many interesting cases. On one occasion, I faced a patient with a spinal canal meningioma (a benign tumor) that was long (extended from above C-3 to below C7 with the nerve roots coursing over the top of the tumor). I had the brilliant idea to ask a friend, who was an expert in the use of the laser if we could try the laser to remove a good bit of the tumor between the nerve roots and be able to not stress the nerves as the rest of the tumor was removed. He agreed, and as the operation proceeded, I became convinced that the tumor was regressing in size both lengthwise and horizontally and that the tumor was literally being drawn into the cavity created by the laser. I found this property to be true on several other cases involving the removal of meningiomas. Soon thereafter, I demonstrated this property to Dr. Lillehei during a subsequent operation. He, too, became convinced that this could be a useful property to address certain tumors, particularly tumors adjacent to the spinal cord, but also some tumors deep in the brain. He understood that using the laser might never become popular with neurosurgeons because the use of the laser involves a very slow process that is not consistent with the usual neurosurgical personality. My feeling was that because the use of the laser was a technique that required no traction of the tissues adjacent to a tumor of the spine and/or brain, taking extra time was not a problem. Thereafter, together, we removed a number of spinal canal meningiomas using this technique.

Finally, using that technique, Dr. Lillehei and I performed what still remains my favorite memory of a surgical procedure. We faced a young lady who had a meningioma high in the spinal canal extending from C1 through C3. The tumor lay mostly in front of the spinal cord but did extend a little to the side. Since retracting the spinal cord certainly is not an option at that location (if you injure the spinal cord at C1, the patient will no longer breathe), The only standard way for that procedure would be to try to remove the tumor through the mouth; such a procedure would involve making an incision in the back of the pharynx, removing the vertebral bodies, removing the tumor, and then attempting to reconstruct the spine, all through the mouth, which means a high likelihood of infection. We decided to use the laser and come in through the back side of the spine, where we felt we would be able to see about 20% of the tumor. When we entered the spine, that was exactly what we saw. Then, as we began to lase the tumor, to our delight, the tumor pulled itself out from underneath the cervical spinal cord, and after several hours, all that was left was the attachment to the outside of the spine with which we could easily deal. Because we never touched the spinal cord, the patient recovered uneventfully and went home in two or three days. To this day, I get chills thinking of that procedure.

Also, as well as removing the tumors outside the spinal cord, we found the laser is very good at performing a myelotomy (making a small incision in the spinal cord), probably better than using a knife. On several occasions, we used the laser to enter the spinal cord through a relatively safe area and approached the tumor inside the spinal cord. We used the laser to remove some of the center of the tumor, and then Dr. Lillehei dissected the outside of the tumor with a skill and dexterity that I could not hope to duplicate. Those patients did well as well.

Finally, I happened to encounter a patient with a barely known condition in which the spinal cord actually herniates through a defect (hole) in the dura (covering of the spinal cord) anterior to the spinal cord. This condition produces a characteristic but rarely seen clinical and radiographic syndrome, which I happened to recognize. Dr. Lillehei found several other patients with the same problem, and we successfully repaired the defects in these patients.

During this entire period, I was very lucky to have generally successful outcomes and very few complications. I had one patient who developed a small infection after a neck operation, but the infection was easily treated. My most serious complication involved an unfortunate patient who developed an infection after a back operation but simply refused to come back to the hospital to allow us to treat the infection. Ultimately, the infection spread to his brain, and he died. Of course, I was mortified, but the family was incredibly understanding. They knew I was doing everything I could to get him to come in for treatment, and they were doing the same, all without success. As one of them said, “As long as he was not willing to do what was suggested to him, there was nothing that medicine could do for him,” which is true but still hard to ignore and forget.

Part 3 coming soon.

About The Author

Dr. James Ogsbury is a retired neurosurgeon who lives with his wife Kathy in Denver, Colorado. A graduate of the Cornell University Medical College, who completed his training at the University of Colorado Health Sciences Center, his career in medicine spanned more than 50 years. Originally from New York, he had a brief career in pop music before pursuing medicine, and falling into neurosurgery by simply walking through the wrong door. In addition to private practice, he also was the Director of Surgery at the Lutheran Hospital in the Denver area. His career included the development of a computer-based spine treatment program called the Colorado Low Back Collaborative, and being a physician consultant for two major insurance companies. He still lives in Denver with his wife and enjoys classical music, as well as skiing and biking. “About Not Losing” is his debut memoir about a fractious high-stakes malpractice trial in which he was a defendant in 1989 and 1990.