Chronology of Residency Program of Otolaryngology Residency
at the University of Kansas Medical Center at Kansas City, Kansas 1955 to 1958
Author: Roger Wehrs
My three-year residency in Otorhinolaryngology at the University of Kansas Medical Center was not only first class in medical and surgical training but socially and academically rewarding as well. Dr. Proud was not only an excellent clinician and teacher but he had an excellent sense of humor. He and the residents formed a cliche of work and comradery like a well-knit family. We all had our faults and shortcomings but were accepted and tolerated by the other members with love and compassion.
First let me describe and analyze each resident as well as professor Proud. This is necessary in order for one to understand the kidding and comradery among the staff, and to interpret the caricatures drawn by Yogi Williams.
Gunner Proud M.D. was 43 years old when I first met him. He was of average build and tall, around six feet. He possessed a very high balding forehead and thin greying hair. He was always in a hurry and although he was kind and understanding he was very short on patience.
Russell Bridwell, the chief resident, in 1955, was blonde, even tempered and efficient.
Roger Wehrs, was a first year resident, in 1955, and is of very short stature and this was a source of much fan fare, joking and kidding by the other residents as to his height, but always in a jovial mood and never vile or demeaning.
Oscar Pinsker was also a first year resident, in 1955. He had two years of surgical residency elsewhere which counted as a year of his Otolaryngology residency. He therefore completed his residency in two years and finished in July of 1957.
Gene (Yogi) Williams began his residency service in July of 1956. Yogi was a frustrated artist of great talent. He had lived and worked in Taos, NM as well as New York City. Although he was a very talented artist, he had found it difficult to make a living in that field and decided to become an ENT specialist. Another influencing factor in this decision was that his brother Wade, who was also a talented artist had died of Hodgkins lymphoma a year earlier. Dr. Williams main love and focus was art. Medicine was more of a hobby. Physically, Yogi was large boned with a dark complexion and had a head of coarse black hair. Although clean shaven, he nevertheless always looked like he needed a shave. He had a swarthy complexion and thick lips. He always had a pen and paper in his hands and was continually drawing caricatures of those around him. His favorite subjects were the other residents and staff. He had knacks of always bringing out the most prominent physical features of his subjects. His caricatures were not portraits of the person but there was no doubt as to whom it referred.
Ferdinand Kirchner who began his residency in 1957, was born, raised and educated in Mexico City. He was darkly skinned and of average height and weight. Although he was fluent in English, he had a marked Spanish accent and this combined with rapid speech made him difficult to understand.
Then there were several individuals who would come and go for short periods of time, I will call them axillary residents. Rollo Lange, who had just finished his residency, but who remained for a couple of months to finish off some sort of obligation. He was thin and very tall with a good natured and care free attitude. Richard Draemel was undergoing his training at Kansas City General Hospital in Kansas City, Missouri. He was loosely associated with our residency program and attended our Clinical Pathological Conferences and occasionally helped out in surgery. Physically he was very average except for an unusually large nose. This feature and his Catholic faith were used in the caricatures by Yogi.
Then there was Yokeim Boren, who was a German exchange resident, amd spent about nine months with us. He was stout and of good German stock, with a pleasant accent and a mild complying personality. He took a lot of kidding for he could not comprehend many of the innuendos and jokes due to the language barrier.
CLINICAL PROTOCOLS AND PROCEDURES
The training protocols in the Otorhinolaryngology residency under Dr. Gunner Proud at the University of Kansas Medical Center in the 1950's was divided into three main but not equal categories. Surgery, Outpatient Clinics and Research
Surgery occupied, Monday, Wednesday and Friday mornings. Outpatient Clinics were from 1PM till 4:30 PM Monday thru Friday. Research time was unscheduled and carried out whenever the resident had free time. This was often Tuesday or Thursday mornings as well as other mornings when the resident was not assigned to surgery.
The Ear surgery training of the freshman resident was very interesting and followed along this pattern. For the first few visits to the operating room, the new resident scrubbed in with Dr. Proud. This was an orientation and observation session and the resident only observed and assisted the Chief. This was a valuable experience as Dr proud was a master surgeon. Also he kept up a monolog not only about the case at hand but general operating technique, complications, and his experience with similar cases. After a few weeks of observing the Chief, the neophyte surgeon scrubbed in with the chief resident and here is where the real hands on training began. It was the chief resident's job to explain and demonstrate every step of the procedure from the initial prepping of the operative site to closure of the incision. Good teaching was important, for in a few weeks the junior resident would be doing the operation and the chief resident would be sitting beside him being responsible for any mistakes or short comings, encountered by the junior resident. The neophyte would begin with the incision and the preliminary part of the procedure, then when the senior felt he had reached the extent of his ability, the teaching resident would take over and finish the operation except for the closing which again reverted to the junior. In this way the trainee gradually progressed until he could complete the entire procedure unaided. At this stage the senior resident would often not even scrub but was in the room for consultation or advice. If the mistake was more than routine it was the responsibility of the senior resident to take over and correct the deficiency. Good teaching was important to prevent errors and to have a responsible student. If a major problem arose the senior resident would call Dr Proud who would either give advice or scrub in to solve the problem. This seldom occurred due to the structured teaching protocol. There was also another interesting aspect to this teaching pattern this resided in the person of our black scrub technician, Mable. Mable had been employed by the University Hospital for many years and always served as the scrub tech for the ENT Dept. Therefore she was very familiar with the instruments and routines, having seen and followed the training of many residents. We who worked with Mable always had a word of advice for the new resident, "If you do not know the name or which instrument you need next, just hold out your hand and Mable will give you the correct one."
With this setup most of the teaching was done by the residents, yet sometimes Dr Proud would have the resident in training scrub with him. As stated previously the chief was an excellent operator and teacher but he was short on patience. He was a skilled and rapid surgeon and was always in a hurry. He found it difficult to sit still while the neophyte resident struggled to do a good job yet do no harm. Therefore after a half hour or so of fidgeting and pacing Dr. Proud would exit the room and leave the supporting role to the senior resident. .I say senior for often it would not be the chief resident who was the instructor but only a first or second year individual who was senior to the trainee.
We all gladly accepted this double role of teacher and student for in teaching you always learn more.
The outpatient clinics associated with the ENT residency program at KU provided excellent preparation for office practice in the future. The patients came mainly from the indigent population of both Kansas Cities as well as the surrounding suburbs. A second cadre of patients were referred in by physicians through out the state of Kansas. These patients were not all indigent but consisted of complicated and difficult cases that could not be handled by the private physicians. Dr. Proud also saw his private patients during hours that the clinic was not in session. Many of these also became interesting teaching cases. The residents would examine these patients with Dr Proud and he made it plain to the patients that the residents would be assisting him with the surgery.
An excellent audiology department was also associated with the clinic. It was staffed by a Phd. audiologist who evaluated all our preoperative and post operative patients. This was valuable as well as essential to keep us honest in evaluating the effectiveness of our ear surgery for hearing improvement.
During clinic hours all residents except those who might be in surgery or Research were present. Also the clinics were staffed by Dr. Proud or one of the private attending staff members. Physically the clinic consisted of numerous cubicles, each equipped with office instruments as well as suction and air pressure. Spray bottles of neosynephrine, xylocaine and cocain were in each cubicle. Dilute cocain was used openly and in large quantities It was an excellent anesthetic as well as vasoconstriction agent. Only one time did we have reason to believe it was being used illegally. An orderly whose job it was to keep all the spray bottles full was taking a small amount from each spray unit and replacing it with water. As we had the cocain solution colored light blue we noticed that the vials were becoming less blue each day and the culprit was soon caught in the act and fired.
Another exciting aspect of the clinic was the presence of Yogi Williams. He always had a prescription pad in his hand and was sketching some incident that had occurred or he imagined could occur. He loved drawing the residents in some medieval costume or situation. Often these caricatures were only of the head or upper body. Occasionally he would sketch an interesting patient but it was more often Dr Proud or one of the residents. Although there were several female staff members present he never drew caricatures of them. When we asked him "Why" He replied that the women could never see the humor of caricatures of themselves and he had gotten into some ugly situations in the past, so the only woman he would sketch was his wife. Evidently she understood him! I regret that we did not save any of these quick sketches, because there were so many of them we did not attach much value to them and we knew that the next day there would be more. I believe that many of these ideas were later incorporated into some of his larger drawings he made of the department such as his series representing the history of tonsillectomy.
The residents would examine the patients on a rotary basis. When an interesting or difficult case was encountered, the examining resident would consult with the chief resident. If he could not solve the problem, they would consult with Dr. Proud or the attending staff. The clinic was our main source of surgical patients. Most cases were picked up by residents during routine examinations, some however were referred in specifically for surgery. In this way our surgical schedule was booked several weeks in advance with varied and interesting cases which provided excellent teaching for the residents. This was especially true for Otologic cases as a huge backlog had accumulated due to the fact that the speciality had been out of favor and neglected for several years.. Also new types of surgery were being developed to treat patients with hearing impairments who for years had been pushed aside as there was no known surgery that was effective.
Suddenly there was a relatively simple and effective operation for patients with deafness due to fixation of the stapes footplate caused by Otosclerosis. These cases came in great numbers as there was a large reservoir of these cases who for years had been told that there was no medical or surgical treatment that would help them. Now there was a simple, painless operation that gave them a dramatic increase in hearing often to a normal level, with only an overnight stay in the hospital. Nothing like it had been seen before or since. By word of mouth the news spread rapidly. At KU we had 12 cases scheduled for a stapes procedure each operating day. At that time, 1956, the operation was new and constantly changing. At first we were doing stapes mobilization, which consisted of using a curved pick to break the frozen stapes footplate loose so it would again move the fluid of the inner ear and restore the hearing. Unfortunately only about 20 to 30 percent of these cases could be mobilized, and of those that could be, 2 out of 3 would refix in a few weeks. These patients often had a dramatic increase in hearing while still on the operating table. As a matter of fact we did them all under local anesthesia so we could whisper in their ear after mobilization and roughly test the effectiveness of the surgery. Due to failure to mobilize, fracture of the crua, or refixation, many surgical revisions were necessary. But when the surgery was successful, the results were dramatic and the patients grateful, Therefore they were willing to undergo the procedure numerous times. As time past, our operative techniques evolved though removal of the crua, prostheses and finally stapedectomy which was successful 90+ percent of the time. This was an exciting and fruitful time to be involved in the reborn speciality of Otology. Unfortunately there was also a lot of disappointment as the patients with nerve deafness also filled the clinic seeking a quick cure, and they were devastated when told they were not surgical candidates.
We also saw many cases of draining ears with chronic mastoid infections. Most of these were due to cholesteatoma which being due to squamous epithelial ingrowth did not respond to antibiotics and could only be cured with surgery. Of course these cases were always secondarily infected and the antibiotic therapy made them better candidates for surgery. At the early stages of my residency we were doing only radical or modified radical mastoidectomies. The radical mastoidectomy effectively removed the disease and gave the patient a safe ear. That is the patient was no longer in danger of a severe oltologic complication such as a brain abscess or lateral sinus thrombosis. Unfortunately the surgery did not improve the hearing and usually made it worse. This radical procedure removed what was left of the eardrum and the ossicles. The modified procedure was supposed to preserve the hearing but seldom did. Therefore, this treatment was very frustrating for the surgeon and often devastating for the patient. I vividly remember a 16 year old girl who I examined in our clinic. She had bilateral mastoid disease with huge cholesteatomas and secondary infection. Her hearing was somewhat diminished but was still serviceable and she had no difficulty in communicating. She was scheduled for surgery and due to the extensive disease it was necessary that I perform bilateral radical mastoidectomies on her. Following this surgery she did well with no more drainage or infection, however she was extremely deaf and one could only communicate with her by shouting. She was devastated by this development as was I. She could not wear a conventual hearing aid due to the bilateral mastoid cavities. We did fit her with a bone conduction hearing aid which helped her but was not very satisfactory. As her surgeon I was also disappointed and although I tried to console myself that now she had "safe" ears, but I wondered if I had done her a favor. I told myself there must be a better way to treat such patients.
An answer to my prayers came when Dr Proud returned from a medical meeting in Toronto and excitingly told us of new surgery called tympanoplasty developed by German surgeons . The goal of these new procedures was not only to remove the disease from the ear but preserve and improve the hearing.. The underlying principles were simple, after removal of the choleseatoma and disease, skin grafting and prostheses were employed to aerate the middle ear and restore it's function. We immediately incorporated these principles to our surgery and I seldom again performed a radical mastoidectomy.
In addition to otologic surgery the residents had excellent training in all aspects of ENT surgery, including sinus, salivary, and laryngology. The only aspect wanting was of maxillofacial trauma. The surgery department at KU had developed a deal with the plastic surgery department that they would get all the nasal trauma cases that came to the emergency room, therefore our training for broken noses was nil. In exchange we were privy to certain cases probably endoscopic in nature. Consequently when I began my private practice I welcomed difficult and complicated ear cases but avoided nasal trauma. This attitude latter influenced my decision to limit my practice to diseases and surgery of the ear.
During his second and third year of training each resident undertook a research project, This could be a surgical or medical project and was supervised by Dr. Proud or one of the attending staff. Clinical work as well as library research was incorporated into the project. This was finally written up as paper for publication in one of the national journals.
The first year was spent in a different type of research. This consisted of learning the anatomy of the head and neck especially the temporal bone. The department had a room in the basement equipped as a temporal bone and dissection laboratory with cadaver material. It was equipped with a drill, burrs. irrigation and suction. Each resident was expected to dissect, drill out and perform mock operations on ten temporal bones before he entered the operating room for ear surgery. This was valuable training and saved experimentation on living patients.
We also did cadaver soft tissue dissections on the larynx, parotid gland, facial nerve etc, to prepare for surgery on these structures.
My first knowledge of the residency program at the University of Kansas Medical Center came in Germany in 1953. I had been drafted into the army as a First Lieutenant Medical Officer. This came following an excellent rotating internship at Alameda County Hospitals in Oakland, California . I had planned to become a general practitioner in CA, however these plans were interrupted by the Korean War doctor draft. My first duty station in Europe was a medical dispensary in Frankfurt, Germany. Here I met Russell Bridwell who was also a medical doctor draftee. Dr. Bridwell had completed one year of residency in Otolaryngology at Kansas Medical center. At this time there was a shortage of ENT physicians in the doctor draft, and he was assigned as the Chief Medical Officer of Otolaryngology at the 98 th General Hospital one of the largest American Army hospitals in Europe. We became good friends and discovered we had many things in common both being from middle America. After a few weeks I was reassigned to a Field Artillery Battalion at Giessen, a city about 40 miles north of Frankfurt. In this assignment my medical training was of no value as I was reduced to practicing medicine out of a foot locker. This was acceptable as I had no speciality training. However I also noted that other doctor draftees, who had completed residencies in internal medicine or surgery and had passed their speciality boards, were also assigned to field units. This was due to the fact that these specialities had a surplus of physicians. This situation was unacceptable to me and I determined that I should get into a speciality that was needed. Therefore the next time I saw my friend, Dr Bridwell, I asked him if there was any chance that I might get into the ENT program at KU. He thought that this was a great idea and said he would contact Dr. Proud as to this possibility. Fortunately there was an opening and Dr. Proud agreed to take me as a first year resident beginning July 1,1955. Again Dr. Proud was accommodating and kept the position open until I could secure my army discharge, and arrive at KU on August 1,1955.
When I think back on my residency it was not only pleasant at the time but influenced the future outlook on my life and the mode of living. Dr. Proud wanted a well rounded residency covering all aspects of Otorhinolaryngology, and overall it was that way, yet his love of Otology kept creeping through. He spent more time with residents doing ear surgery and followed these cases more closely. In his private practice, which was large, he saw far more ear cases than head and neck ones. Also nose trauma or cosmetic surgery were non existent.. His publications were also favorable toward Otology. These feeling could not help but rub off on the residents and this was especially true for me personally. I always tried to see and operate on as many ear cases as possible and tried to steer the head and neck cases to the other residents. As a consequence early on I became quite confident with otologic surgery. I shall never forget an instance when as a second year resident I was operating on a young patient who had developed a lateral sinus thrombosis as a complication of mastoiditis. It so happened that at this time the ENT department was hosting a regional conference. Dr. Proud and all the residents were in the conference hall, but it so happened that I was assigned to this emergency surgery. One of the visiting professors from New Orleans, came and visited me in the surgery suite. Afterward he could not get over the fact that a second year resident was in surgery by himself performing this complicated surgery. I appreciated his looking in on me and of course Dr. Proud checked in with me as well. This kind of experience made me self confident so that I felt comfortable in establishing a solo private practice following the residency.
Another benefit of the group residency was the friendly banter and kidding among the staff which often resulted in personal putdowns. This helped my social skills and made me much less sensitive to criticism and bolstered my self esteem.
Therefore I will always be indebted to Dr. Proud and his residency program, not only the excellent medical and surgical training but for making me a more confident and well rounded individual.
AFTER THE RESIDENCY
Russell Bridwell MD
Dr. Bridwell was always close to Dr. Proud and when he returned for his final training after the army it was understood in the ENT department that he would join the faculty and stay on at KU. He had a dilemma as he had more or less promised to enter private practice with Dr. Preston and Dr. Powers, two established Otolaryngololgists in Topeka, when he finished his residency. When the time came he did not want to disappoint his chief and mentor and decided to give the academic route a try and became Associate Professor of Otolaryngology at KU in July of 1957. He was an excellent teacher and was admired by the residents and staff as well as Dr. Proud who had always imagined this association. Dr. Bridwell enjoyed his work and position but his heart was still in Topeka and after two years of academics he moved to Topeka and entered into private practice with the two men who had first encouraged him to seek training in ENT, Doctors Preston and Powers. He had a long and fruitful practice there and Dr. Proud was proud that he had turned out such a dynamic and successful physician.
Oscar Pinsker MD
Dr. Pinsker finished his residency in 1957. He soon established a successful private practice in ENT which he continued for many years. He was a visiting staff physician at KU and continued to instruct and counsel the residents.
Roger Wehrs MD
Upon completion of his residency in July of 1958 he established a successful private practice in Tulsa, Oklahoma. Due to his excellent training in Otology, after a year of general ENT, he limited his practice to this sub speciality. In addition to maintaining a busy private practice he participated in teaching and instruction of residents both in surgery and clinics at the University of Oklahoma Medical Center in Oklahoma City, Oklahoma. Subsequently he became an Assistant Professor in Otology at this institution.
In order to improve the hearing and anatomical results in chronic ear cases, he developed new and innovative techniques of tympanoplasty with homograft ossicles and tympanic membranes. He authored many scientific articles describing these techniques as well as presenting lectures and participating in workshops of his work with homograft material. In the mid 1980's the use of homograft material became questionable due to the Aids epidemic. In conjunction with the Richards Instrument company Dr. Wehrs then developed middle ear prostheses, made of bio compatible hydroxylapatite, which replaced the patient's ossicles that had been destroyed by disease. These man-made ossicles had the same configuration as the prostheses made from homograft ossicles that had been so successful in restoring the hearing of diseased patients. The Hydoxylapatite ossicles successfully replaced the homograft material and yielded similar hearing results. These prostheses underwent several modifications and have yielded consistent, long term results and are still in use today.
Dr. Wehrs also authored chapters in Otological text books. He taught instruction courses at the Annual Meetings of the Academy of Otolaryngology each year from 1964 though 1997.
Gene (Yogi) Williams MD
After completing his residency training in 1959, Dr. Williams joined a group private practice in Phoenix, Arizona. He was successful in this endeavor. However after a few years he became home sick and returned to El Dorado, Kansas. He had grown up there and here his father had been a General Practitioner. Dr. Williams was well liked, had a thriving ENT practice, and continued pursuing his interest of art. In addition to oil painting and sculpturing, one of his projects was to carve out of wood a large medieval chess set. He also drew caricatures, of his family for Christmas and greeting cards. Tragically he was killed in a hot air balloon accident at a 4th of July celebration in El Dorado.
Dr. Williams will always be remembered for his caricatures of Dr. Proud and the residents which he drew during his three years as a resident in the ENT Department of Kansas University. As an undergraduate student at KU he also sketched the first Jayhawk caricature. This has been copied and modified many times and modern versions are still in use.
Ferdinand Kirchner MD
Following completion of his residency at the University of Kansas Medical Center Dr. Kirchner joined Dr. Proud as an Associate Professor at this institution. He continued in this capacity for several years before beginning a practice in Tucson, Arizona.