LIFE AFTER SURGERY: JOHN GARY MAXWELL

Ed Nelson asked me to write something for his “Life After Surgery” column.

It may be more proper for me to reframe the question “which life?” for I have had many lives, several almost fatal events, and three times retired in the traditional sense.

I was born in Salt Lake City in 1933. I was sitting in front of our Zenith radio on December 7th 1941, when I heard US President Franklin D. Roosevelt call it a ‘day of infamy!’

For most of our nation, 1933 was the middle year of the great depression but in Utah my family was fortunate and able to survive when my father found employment for $25 a month delivering bread to small stores in the Salt Lake Valley. He worked six days a week from 2 am in the morning to 10 pm for the Continental Baking Company. Ten members of the extended family that included my mother’s two sisters lived together in a cramped two bedroom apartment. One of these was my uncle,  Seldon Heaps, who was a talented pianist, but was no longer able to work. When he was a young man, all movies were in black and white, with no sound effects, so he would watch the screen and play whatever music fitted the action, whether it be a love scene, or people dancing, or cowboys chasing the masked bandits who had robbed the stagecoach.

At age fourteen I began working as a check-out clerk and bagger at a local Albertson’s grocery store. By sixteen I was strong enough to empty the hot bread from the metal pans that came out of the Continental’s ovens every 20 seconds, with four loaves in each pan.

Both my father, Grant Verl Maxwell and my mother Phyllis Roberts had to drop out of school after finishing the 8th grade.  I heard repeatedly that education was the only path to a life better than they were able to achieve.

At age sixteen I was fortunate to attend East High School, the dominant public high school in Salt Lake City.  Its dominance was not in athletics but in its reputation for  providing the best preparation for college and specialties of medical school and law school.

East High was a daily treat:  mathematics, science, literature, grammar, even debate and chemistry were part of an exciting and expanding world that was my treasure to explore.  The woman whose name is gone from memory taught algebra and geometry was a demanding tyrant.  She would look over the sea of faces of her students and without warning select one to come to the chalkboard and outline the solution to one of the problems in the previous day’s homework. She made these fields logical and reasonable, even pleasurable.

Mr. Glen Iverson taught us the basics of sentence construction by insisting we diagram each with noun, adjective, verb, adverb, and object. He would end each day’s class by reading out loud some of his favorites pieces of English literature!  It was exciting that a grown man, who today might  be recognized and denigrated as “queer,” would read poetry to high school students and challenge us to write our own treasures! The outcome was my life-long appreciation of poetry, and books of all kind, whether history, philosophy, or fiction.

Also graduating with me from East High were my two best friends, Eugene England and Gary Brant Christiansen.  Perhaps it was false pride or being subconsciously convinced we could carry out almost anything when we foolishly decided to climb the 9,000 foot face of Mount Olympus in Holladay. Without ropes, pitons, climbing experience, guides or maps we started up what appeared to be three different slits in the mountain’s rock face with no equipment save for our fingernails and tennis shoes. We were climbing carefully without hesitation.  Nearing the top, I looked down to see there was a free-fall of several hundred feet, and when looking up, I was not able to find a new hand hold.  I was physically exhausted and nearly panicked that falling would be fatal. It was Gene who saved me by calmly directing me to a secure hand hold which enabled me to lift myself  to the next level.

Gene graduated from the University of Utah, and received a PhD from Wallace Stegner’s Creative Writing Program at Stanford University.  Chris entered the United States Naval Academy in Maryland and then moved to Oxford for a PhD in international economics.    

When I entered the University of Utah’s Medical School in 1951, the dean cautioned me that he had been told that the Korean War or the smoldering unrest in Vietnam would soon lead to federal legislation requiring all medical school graduates to serve as officers in some branch of the military.  Forewarned, I signed up with the 328th General Hospital of Utah’s National Guard, so that I could serve in a medical unit rather than being drafted as a ‘grunt’ and end up in an infantry unit or a MASH hospital near an active war zone.  I received an officer’s salary and each summer was obliged to attend a one month camp in Oregon or California where the 328th medical personnel would teach classes. practice their skills, and care for any man or woman who became ill or injured.

One of the more memorable faculty during my pre-clinical years was Horace W. Davenport, who came from Oxford as a Rhodes Scholar with a PhD in physiology.  On his first day he made it clear he was not pleased that he was assigned to teach the stupid and uneducated adolescents of Utah’s intellectual waste land. To emphasize his distain, he mounted a small cannon on a desk of the classroom, and would fire it each time he said something profound that his students would otherwise miss because of their stupidity!  Far more instructive were the  four hour laboratory experiments such as measuring the effect of strenuous exercise on urine output were.

More to my liking were the men of Surgery, Dr. Ralph C. Richards and Dr. Phillip C. Price, and Dr. Thomas Creighton King who emphasized kindness and gentleness, both at the patient’s bedside, in the clinic and in the operating room. They asked questions that the patient could easily understand and avoided medical terms that were confusing. They did not rush the patient to answer quickly.

Unsure of my path I applied for a mixed Medicine/Surgery internship at the Salt Lake County General Hospital, which with  two Veterans Administration hospitals, were the only teaching hospitals in Salt Lake City and County.

At this time the drug Penicillin had just been released for clinical use.  House officers collected all the urine from each patient treated and this was sent to the hospital laboratory for recovery and re-use for patients needing this expensive and  lifesaving new drug.

Interns were required to perform such basic lab tests as hematocrit, WBC, and Grams’ stains on any wound drainage or urine sediment to help in deciding treatment options.

The hospital pharmacy did not provide pre-calculated chemotherapy treatment for patients with malignancies but it was the house officer’s responsibility to do so.  An exhausted intern PGY2 could mistakenly give a dose that was off by a factor of one or ten giving the patient too little or too much.

In one of the six months on Medicine Service I cared for at least fifteen patients who had contracted poliomyelitis and could not breathe.  They were placed in a box-like “iron lung” that alternated positive and negative pressure with the hope that some nerve function would gradually return allowing them to survive out of their chamber.  Any nurse or doctor caring for them was at risk as Jonas Salk’s vaccine was not yet available in the quantity for those afflicted or for caregivers.

During the Medicine rotation, there was competition for a limited number of PGY2 and PGY3 positions. Those who were to present a patient to Prof. Maxwell M. Wintrobe read every available article that might possibly come up.  Coming to Utah from McGill University in Canada, Wintrobe was a world renowned expert in diseases and malignancies of the hematopoietic system. What I found most useful was Wintrobe’s mental discipline of examining all evidence for and against every possible diagnosis.

I never presented a patient to him but years later Wintrobe, to my surprise, asked me to be his surgeon for an indirect inguinal hernia repair.  When I told him that I would do a complete and thorough presurgical physical examination, including a rectal exam, he responded, “I knew you would, that is the reason that I asked you.”

Near the end of my internship I learned from the leaders of the 328th General Hospital Corps that the hospital would not be called, not as a single entity, but its officers could choose among options for fulfilling the obligation for military service as a medical doctor.  I was given three choices:

1. To attend jump school for six months and as a para-medic, to parachute from airplanes into any war zone.
2. To serve two years in the demilitarized zone between North and South Korea, hoping that open warfare would not erupt.
3. To serve at least two years at the Coco Solo Hospital in the city of Cristobal, on the Atlantic side of the Panama Canal Zone as a Captain in the U.S. Army Reserves of the United States Army.  Weekdays I would work in the outpatient clinic of Coco Solo Hospital caring for Panamanian citizens who worked for docks of the Canal.  I would have access to the Post Exchange for purchases at much reduced prices, and to the Officers Club’s restaurant where we could have a complete evening meal for $3.

I was promised a three bedroom house for my family that now consisted of a wife and three children, and there would be a school bus to take the two older children to Canal Company School five days a week.

What doctor would not choose the third option?

What I was not told, however, were the details of my days and nights as a general practice doctor.

Weekdays from 10 am to 5 pm, I saw a large number of outpatients, almost all women, who came complaining of “tired blood,” wanting a vitamin B12 shot, and of their exhausted husbands who came home too tired to eat. At first I had a nurse to translate from Spanish but this became tiresome so l learned to understand and speak Spanish.

I had to make emergency house calls in daytime or at night to the off-base homes of the Panama Canal employes – Black and Hispanic, or to the families of officers who lived on the base.  One night I was called to an officer’s home to find his wife, four months pregnant, awakened by severe abdominal pain and vaginal bleeding.  Her blood pressure was 80/45, and her pulse 130 per minute! I made the bedside diagnosis of a ruptured tubal pregnancy and called for an ambulance from Coco Solo Hospital, and she was quickly transported there.  My diagnosis was correct!  She survived when the surgeon rushed her to the operating room and removed the ruptured tubal pregnancy.

I also had to be ready at a moment’s notice to respond to the request from a ship’s captain to see a seaman who was injured or complaining of abdominal or chest pain and might need hospital care. (The ships were almost always cargo vessels from around the world with a motley crew that was usually unable to speak English.)  I would board a ‘Tugboat’ that would come alongside the cargo vessel from which a twenty foot Jacob’s ladder was dropped. I had to climb up the ladder onto the deck carrying a small medical bag with a blood pressure cuff, a stethoscope, and thermometer.  I was always forewarned by the tugboat’s Captain, “Don’t look down, ‘Doc’ for if you fall you will be crushed like a tiny bug!”

Back from the Canal Zone in the summer of 1961 I was promoted to Major, U.S. Army Reserve remaining with the 328th General Hospital Corps at Fort Douglas, Utah. I  returned to the Salt Lake County General Hospital as a general surgery resident.

As I progressed from PGY1, PGY2, PGY3 I took part or directed the care of patients admitted to Dr. Walter J. Burdette, Dr. Philip Price, Dr. Ralph C. Richards, Dr. Thomas Creighton King. and Dr. Petter Lindstrom, a neurosurgeon and husband of recently divorced movie star, Ingrid Bergman.

In 1964 Lindstrom was the Chief of Neurosurgery at the Veterans Administration near the University of Utah campus.  A a handsome man, he was often featured in the tabloids and caught the attention of many of the nurses and house staff. They  paid little attention to the fact that he did not perform any of the standard neurosurgical procedures when at the ‘County.’ From across the nation and even from foreign countries, patients came to him as a ‘last resort’ with intractable severe pain, obsessive-compulsive disorders, severe anxiety and depression, and certain types of epilepsy to have the function of both frontal lobes of the brain disrupted by high intensity ultrasound.

For some reason Lindstrom always selected me as his assistant in these procedures.  He did not scrub but stood at my back, touching my shoulder,  directing me to use a circular saw to remove a one inch bone plug lateral and superior to each eye, exposing the epidural layer.  Then I would place the head of a  high intensity ultrasound device against the dura for three to five minutes. Then the bone plug would be returned to its place and the skin was closed.  This was repeated on the other side, resulting in bilateral frontal lobotomies. The patient was usually discharged the next day. I often wondered if we had improved or lessened their quality of life. If and when they returned for follow up they were seen only by Lindstrom in his office. Even as I write this I have an uneasiness that I had lobotomized  dozens of people.

While the records are no longer available I am sure this was done after proper patient safeguards were in place and that the study was published in peer-reviewed journals.

Sometime in the summer of 2020 Dr. Edward Nelson came to our small house on 1200 East Street in Salt Lake City just south of the University of Utah campus. My wife Cheryl and I purchased this home because it enabled me to spend time with some of my children in the city. I was also able to search the public libraries and those of the Church of Jesus Christ of Latter-Day Saints, to search for information about my family’s roots in Ireland and Scotland and their journey to Utah.

Nelson’s visit was to discuss what might be done about the frustrating lack of records of any kind that would document the beginning and the accomplishments of the University of Utah’s Department of Surgery in renal transplantation. This was soon discussed with Dr. John M. Holman, Dr. Glenn D. Warden, and Lawrence E. Stevens who agreed that each would contribute what records they had or could find.

Information was also needed from the nephrologists about patients on hemo-dialysis and peritoneal dialysis, and the numbers of patients they sent for kidney transplants, the anti-rection drugs used, and the survival rates on dialysis and after renal transplants. It immediately became clear that a support staff would be needed to organize the data, make graphs, charts, and photographs in anticipation of a publication.

Nelson and Homan’s request for help and equipment needed was sent to the department level and even to the Dean of the Spencer Fox Eccles School of Medicine.

Denied at every level we decided to self-publish at our own expense the The First 50 Years of Renal Transplantation the University of Utah.  One hundred copies were printed by the Golden Leaf Press of Wilmington, North Carolina in 2021.

Fifty copies went to Dr. Nelson, and I received 50 copies.

What was important was that factual evidence survived and the results of these early efforts were commendable for the time.  Establishing an organ bank is the best example.

The Intermountain Organ Bank was begun at the University of Utah in June 1969 by Dr. Larry Stevens, with Ms. Georgia Gerrant who initially functioned in many capacities as secretary, receptionist, kidney procurement technician, and public relations person. They were soon joined by Mr. Walter U. Petermann, a surgical technician from the Division of General Surgery, and Ms. Janet MacCalman, RN. The IOB was the University of Utah’s first and only non-profit, “in house funded and operated” model of a transplant center-based organization.

Early procurement efforts began with retrieval of only kidneys, but soon corneas, skin, and bones were added to the organs needed.  A transplant surgeon, usually accompanied by a senior surgery resident, the transplant nurse, and the technician would drive to a nearby hospital, or fly by helicopter or fixed wing aircraft, to a distant hospital. The University of Utah Health Sciences Air-Med Flights began in 1978 but organ bank personnel were using helicopters from private vendors and the Utah National Guard several years earlier.

From July 1, 1969 to September 30, 1971, permission for organ donation was requested 169 times from the deceased’s next of kin and was given 112 times.

Six kidneys were received from other transplant centers  and a total of 64 kidneys involving the Intermountain Organ Bank were transplanted.

When testing for human lymphocyte antigens became available it opened the way for renal transplantation from living related donors.  From January 1965 to 1971, 128 transplants were done with kidneys given by living donors, from a parent, sibling, son or daughter, an aunt or uncle.  Not only did this give the advantage of kidneys without any significant time without blood flow, but also lessened was the frequency and severity of the recipient’s attempt at rejection.   

In September 1978 I was invited by the Rotary Club of La Paz, Bolivia via Dr. Kolff and the Division of Artificial Organs to be a guest instructor in the surgical skills needed to put patients on dialysis machines which he had given them. When we arrived at the airport serving La Paz, I felt very light headed and was breathing rapidly. I was concerned until I noticed the sign telling passengers in various languages that the altitude at the airport of over 13,000 feet high!

Using local anesthesia I demonstrated on volunteer renal failure patients the construction of arterio-venous connections where the radial artery was sutured to an adjacent vein in the forearm. Within a few weeks the flow through this connection increased  rapidly, sufficient that two 18 gauge needles could be placed in the vein and the flow rate was sufficient for blood to flow to the dialysis machine and return to the patient.  Note:  In this forearm photo the elbow is to the left and the hand to the right. The vein is the size of a male adult’s thumb!

The doctors of the La Paz Rotary were well-to-do and made it clear that they did not live in city, but in outlying areas that were guarded and needed an identification card for entry. One evening they invited me to be their guest at a very up-scale restaurant. They made sport of ordering all sorts of food for me that no one else was eating. After they had many after dinner cocktails, they told many jokes in Spanish. I finally realized they had arranged that my main course to be two large testicles, but the animal from which they came was not revealed.

In the spring of 1985 my life in surgery and my personal life suddenly changed! In an apparent “sub-rosa’ back-room deal, the Intermountain Organ Bank and the transplantation fellowship position − that had taken me fifteen years to build – were moved to the cross-town Latter-day Saints Hospital’s competing transplantation program. I immediately considered and visited several academic positions on the west coast and across the nation. Several were available if I wished to continue with organ transplantation, but instead I searched for teaching hospitals where I could continue my career in general surgery.

In the fall of 1985 I was offered and accepted a position as tenured Professor of Surgery at the University of North Carolina at Chapel Hill, and as the second Program Director of  New Hanover County’s Regional Medical Center and its small, but growing, General Surgery Residency Program in Wilmington, North Carolina.

For fifteen years I performed ‘general’ abdominal surgery, thyroid and parathyroid surgery, gastrointestinal malignancies and breast surgery, while also taking a major role in caring for the victims of trauma, crashes, falls, personal violence, knife attacks, and gunshot wounds.

Drawing  patients from surrounding counties in North and South Carolina it became clear that a regional trauma center would be needed in Wilmington.  I was able to recruit Dr. Thomas Vincent Clancy from New York who had just completed a fellowship in trauma and critical care where patients came from what he called ‘Fort Apachi’ in the Bronx.

Soon we added an oncologist, Dr. Cyrus A. Kotwall, MD, MSc, FACS, who came having had specialty training in Canada. With our publication of clinical research papers at local, regional, and national levels, the residency began attracting increasing numbers of qualified applicants.

Our faculty salaries were always fixed without any opportunity to add to our income from well insured patients. All insurance money collected went to the hospital.

At the age of seventy and after having been responsible for the medical education some thirty-five or forty young men and women at the University of Utah, and an additional thirty or forty in Wilmington, I retired in 2003 as Program Director of New Hanover Regional Medical Center’s General Surgery Residency and began what can be described as yet another life and career.

In summer of 1996 I learned from my daughter Sue of a group in Utah who were looking for personnel to participate in a two weeks medical mission to the community hospital in the small poverty-stricken city of Quevedo in Ecuador.  The group was equipped to provide all necessary resources for any required general surgical procedures. This included drapes for the operating tables, surgical instruments, and wound retractors that could be sterilized after each use, and 1,000 cc bags of saline or lactated ringers.  We decided to go and to include my fifteen year old son, Bryan, who was in high school but received permission since it was viewed as an unusual opportunity for him to see life and medicine as it was being practiced in Ecuador. (and it might interest him in a career in surgery!)

We landed at the airport in Quito, where at an elevation of 9,300 feet it felt pleasantly cool, but we were warned that in Quevedo on a flat expanse only 250 feet above sea level it would be warm and humid.

After a terrifying four hour bus ride down the sides of the mountains, the City Hospital of Quevedo was a shocking disappointment. It had no glass in the windows, no air conditioning, beds were without sheets, and there was no pharmacy, no laboratory, no X-ray equipment, no pathologist.

There were no nurses for post op care, and we were told that the patients family would be required to give bed side nursing care after surgery. On the first day after arrival, I was asked by a gynecologist to assist him with hysterectomies, for there were dozens of women who needed that  procedure.  Apparently he had been at this hospital before, for he instructed the women to stand in a straight line, and lift their skirt to a level above their knee. There were ten women whose uterus had descended below the knee. Without further questions or examination we filled the quota for the number of abdominal hysterectomies that could be done in our two week stay.

There were no anesthesiologists nor ventilators and all procedures were done by spinal anesthesia. The patient would sit upright on the surgery table and the nurse would palpate the tip of the tenth thoracic spine where she would inject xylocaine,  giving us one to three hours to perform the procedure. With Sue acting as first assistant, Byran’s job was to hand her any instrument needed from the back table and to step forward to wave away flies circling over the surgical site.  Any records that I may have made are long since lost or forgotten, but I recall that we performed inguinal hernia repairs, and a few cholecystectomies.

My son Bryan Maxwell, now forty-three years old, is a Stanford educated anesthesiologist with sub-specialty training in pediatric anesthesia at Johns Hopkins in Baltimore.  He is married to Dr. Jen J. Liu, a specialist in robotic surgery for urogenital malignancies. They have twin children, Cody and Haley, who play in the Portland Youth Symphony.

During the decades that passed after I retired from Surgery in 2003 I decided to become a historian, seeking facts and their interpretation. My ancestors came out of poverty in Ireland, Scotland and Europe but did not find the paradise of land and blessings in Utah Territory that were promised. They found a desert that did not easily yield sustenance and rarely gave abundance.

I knew that whatever I might write might not be published because I was a novice without an advanced degree in history. Perhaps my work would circulate only to a limited circle of family and friends. If so, I could only hope they would be read with charity and respect my attempts to understand the events in Utah in the pre-statehood and the plural marriage era that my ancestors experienced.

My first book, Gettysburg to Great Salt Lake, was published in 2010.  It tells of George R. Maxwell (no relation to me) who was born in 1842 in Grafton, Monroe County, Michigan.  He was attending college in Monroe County when the Civil War began and he immediately volunteered to serve in the Michigan First Cavalry in the Michigan Cavalry Brigade under the command of George Armstrong Custer.  He fought in many battles including the battles of Brandy Station, Cold Harbor, Chancellorsville, Gettysburg, and Yellow Tavern. Wounded eight times over a four year period, his courage earned him the Custer Medal given only to the most deserving officers of the Michigan Brigade.

After the war, Maxwell, with one leg missing and one arm basically useless, was sent to Utah Territory as a Federal Marshall with the charge to bring the Mormons in compliance with federal law.  He was the first to conduct a federal trial in Utah Territory that dealt with the “Mountain Meadows Massacre” of 1857 where men of the Mormon Militia murdered 120 immigrants from Arkansas on their way to California. He served in the arrest and trial of John D. Lee, who was the only Latter Day Saint convicted for complicity in the murders.  Lee was executed by a firing squad on March 23, 1877 at the site of the massacres.

In conducting my research I was immensely fortunate that my wife Cheryl was able to guide me over the battlegrounds around Richmond, Virginia. She was born there and had personally walked the sites of most of the battles around Richmond and north to Washington, DC. Some of her ancestors had fought for the Union and some with the Confederates.

Gettysburg to Great Salt Lake, was published in 2010, Robert Newton Baskin and the Making of Modern Utah, in 2013, The Civil War Years in Utah, the Kingdom of God and the Territory That Did Not Fight, in 2016, and my final book, The Last Called Momon Colonization in 2022.

Here I would like to steal a few words from historian and Pulitzer Prize winner, Wallace Stegner, who in his mind’s eye, took the Latter Day Saints’ measure as they gathered on the bank of the Iowa River at Iowa City in early June, 1856:

“In all its history, the American West never saw a more unlikely band of pioneers than the four hundred-odd who were camped ... Looking for the brown and resolute and weather-seasoned among them, you would have seen instead starved cheeks, pale skin, bad teeth, thin chests, all the stigmata of unhealthy work and inadequate diet ... One in every ten was past fifty, the oldest a woman of seventy-eight; there were widows and widowers with six or seven children. They looked more like the population of the poor farm than pioneers about to cross the plains.  Most of them had never pitched a tent, slept on the ground, cooked outdoors, or built a campfire. They did not have elementary skills that make frontiersmen, but were the casualties from Europe’s industrialization.  Brigham Young’s irresistible  promises of a new start, a better life, and a guaranteed life in the Hereafter, convinced these impoverished, ill-equipped, untried, and untrained Saints that they were not only going to Zion, but they were also going to walk there . . . hauling their belongings on handcarts for more than a thousand miles!”

Among those Stegner described was a widowed women named Elizabeth Donnelly Maxwell, my great, great grandmother. She did not survive but died only fifty miles short of her goal of joining Brigham Young’s Saints in the Utah Territory. Within five years after arrival in Utah Territory, various Maxwell men were “called” to again settle in Utah Territory’s outlying, primitive areas. Over four decades some of my Maxwell family struggled with challenges equally great in the mountain west’s Big Horn Basin of Wyoming.  This was an isolated frontier colonization site, ringed by four formidable Rocky Mountain ranges that encircle the basin’s vastness. The Absaroka Range rises west, the Wind River Mountains stand southwest, the Bear Tooth and the Pryor mountains are on the north, the Big Horn Mountains on the east, and the Owl Creek Mountains on the south.

All of my books were vehicles for a personal pilgrimage to return to view an earlier life, to a different version of myself, to happy times, to difficult times, to an understanding of how my roots have framed me.  My ancestors paid a dear price for me and my descendants to inherit the advantages that only in later life was I able to openly acknowledge and appreciate.

I have endeavored to make these books honest, marked with gratitude and a modicum of pride in my ancestral origins. I now understand what Thomas Wolfe wrote: “you can’t go home again to the old forms and systems which seemed permanent.”

Now it is time for me to stand tall, square my shoulders, and end this opus, as I ended almost every case as a surgeon:

“Primun non nocere”

We are done!

she cried as she waved her wooden leg!