on September 21, 2003
I wanted to be a doctor; more I wanted to be a surgeon. In 1960's Houston, however, boys from public schools and working class families did not get ANY encouragement. One day, purely by accident (literally a draw from a hat) I was assigned to read The Making of a Surgeon. When I closed the book, I knew that I would someday make it. Why?
The central lesson of the book was that the best surgery residents were those that got up at night and actually saw patients. Dr. Nolen made it clear that surgery residency was primarily a matter of attention, compassion, and work. Not brilliance, not political connections, not a long family history in medicine. A real revelation for a small town Texas boy. I mean, I could work!
Some of the procedures are technically dated, and some diseases are hardly seen now, but the face of surgery residency in New Orleans in 1988 was remarkably similar to that in the New York of Dr. Nolen's book. The style is conversational and engaging. The only real regret is that Dr. Nolen will not be writing any more.
Should be required for every child that thinks they can't possibly be a surgeon.
on February 3, 2001
I thought this was one of the best medical books I've read. The book was somewhat outdated though in its reference to surgical procedures and residency, but that also makes you appreciate the advancement of surgery over the last 30 years. I didn't really pay attention to how old the book was though, as the main point was Dr. Nolen's maturation from a clueless intern into a competent surgeon. He describes many different facets of surgical training from the first appendectomy to life outside of the hospital. I believe Dr. Nolen wrote an excellent book and meticulously gives a full perspective into the life a surgical resident. I enjoyed his writing style, which was very clear and straight forward. I think this book is a must read for anyone considering a surgical career.
on February 22, 2012
I've noted that many of the people who have thus far reviewed this work are involved in the medical profession. While Nolen's book is, no doubt, a great read for the professional, I believe it is just as interesting for the typical man on the street, or if you will, the potential patient.
I picked up the book almost by accident. Needing a book to read on a long flight, I almost thoughtlessly picked up an old copy off a friend's shelf. Once I started it, however, I found that it was every bit as engaging as the best page-turner. Dr. Nolen was apparently not only a brilliant surgeon, but a gifted writer. There are so many interesting facets to this book, I hardly know where to start.
As is the case with anyone who watched the old television show "ER" knows, doctors go through a number of years of practical training beyond the four years they spend in college and the four years they attend medical school. This in itself is amazing to me, as a typical residency is around four years also, most doctors will be 30 years old before they are able to start their individual careers. I believe Dr. Nolen spent five years in his surgical residency. This book focuses on that time period. As many of us are aware, the residency period is an incredible marathon. Nolen well-conveys the level of stamina the resident must possess, to the point where the up-and-coming resident must virtually give up all vestiges of a private life.
He also highlights the great divide between the internist and the surgeon. While I was aware of the technical differences in the way internists and surgeons approach treatment of the ill and injured, I had little idea of the great psychological divide between the two. In a way, the surgeon approximates the personality of a test pilot. The well-trained surgeon is a virtual tower of self-confidence. Given the incredible stakes at risk in even small operations, it is no wonder that these men and women are frequently accused of "playing God." They are, after all, holding the lives of each patient in their well-trained hands. It is no wonder to me, after reading this book, that most surgeons wish to be identified as such--not simply as "doctors."
What truly stood out for me as I read this book in early 2012 was the tremendous gains that have been made in medicine over the last 50 or so years. Nolen's residency was at New York's Belleview Hospital in the mid-1950's. The hospital he describes and some of the treatments he and his fellow surgeons deal out bring to mind a butcher shop. Belleview is a dirty, chaotic, inefficient dump and it is a wonder in my eyes that anyone ever recovered coming out of this place. The description of the wards--30 patients in a single room with absolutely no privacy--particularly affected me. Tests which are now typically done daily on hospitalized patients by technicians were then done only intermittently by the doctors (usually interns) themselves. Likewise, the doctors often did much of the blood work and "scut jobs," including cleaning up the place, themselves. Staffing was so poor that patients often suffered in agony for hours, waiting for a single nurse to cover the ward and eventually give them a shot of morphine. The primitive conditions under which these doctors labored would be extraordinarily scandalous by today's standards. Supplies as simple as syringes and scissors were frequently lost or stolen and thus unavailable. Thank God conditions have improved markedly in the last half-century.
In the final analysis, what truly stands out is Nolen's humanity. Although blessed with stamina (and dexterity) most of us can only dream of owning, Nolen is ultimately just another human being, possessed of many of the foibles easily identifiable to most of us. Although he develops a great level of self-confidence over the course of his residency, he still struggles with depression after losing patients, and most of all, the issue of whether he is "playing God."
"The Making of a Surgeon" is not a long book, and I found myself plowing through it in the course of a single day. Part of what makes it so readable is Nolen's sense of humor. He comes up with several real laugh-inducers. "The General Practitioner," he says, "is a guy who knows less and less about more and more, until eventually he knows nothing about everything. The specialist is a guy who knows more and more about less and less, until eventually he knows everything about nothing." I shared this ditty with my doctor, but he didn't find it quite as funny as I did. Wonder why.
By all means, pick up a copy of this classic if you run across one. As I say, it is a quick read, very entertaining, and ultimately, quite educating. Dr. Nolen is no longer with us, but if I had a chance I would have loved to have spoken to him at the end of his career about the changes he saw in his profession over that period. "From the standpoint of an insider," I'd ask him, "just how much did things change over the course of your career?" Perhaps it is just as well that I never got the chance.
on August 17, 2013
Of the thousands of books I have read, this is one has had a lasting impact on me all these years. I recall that I came across it as an excerpt in a magazine or newspaper article. I was intrigued enough to find and read the whole book. Than as now, I am interested in all things related to the function and health of human anatomy. When one of my nieces recently started seriously steering her education interests toward the medical field, the memory of this book solved my answer to the question of what would be an ideal birthday gift for her.
I no longer had my copy, so thanks to the internet the search for the book was easy. I was sad to see that this marvelous doctor had passed away. Nevertheless, I thought it was especially nice that the book now has a forward from his daughter. It is a fast read, insightful on many levels. I ordered it and not being able to help myself, I read it again. (I apologized in my inscription to her on the inside cover, she laughed) I have to say that in re-reading it these many years later I now see even more depth to Dr. Nolen's experience.
The fact that medical science has evolved rapidly since that time; may make some passages appear "dated"; however many other things are the same.
As an example, the way human beings behave. One of the keys to getting along in life IMHO is to be aware of these behaviors, and adjust YOUR response accordingly. The entire book is an excellent example of how to do this. He also takes his lumps with good perspective. Although I did not have the health to pursue a medical career, I did get a formal education in the science of social research. Since then, and due to the fact that more years have passed than I care to admit, I can readily say that I have gained an extensive informal education validating the formal one. It is also interesting to see how the many facets of humanness are affected by the settings--public hospitals, private hospitals, with money or lack of it as the bottom-line under all of it.
Weather you have the privilege, energy and resources to pursue a career in the medical field or not I think that Dr. Nolen's experience can serve you well in many life situations.
on April 13, 2007
An excellent book! My father introduced me to this work, as he knew William Nolen personally, and in fact was a character in the book, Jack Lesperance. Our real last name is Peterson, but it was a pleasure to get some insight into my father's residency at Bellevue Hospital in NYC.
on May 21, 2006
I was looking for something that could be in the same line of House of God, this book.. although a little outdated, presented with the whole picture of surgery, the hardships, the informed judgement, the dealings with patients as well as colleagues, the whole concept of how-to-become-a-good-intern stuff. I really like the way he cares to pinpoint every important aspect about the case, how it went, what might have been diff and off course, what he learned.. and that too in a genuinely funny way. A simply remarkable piece!
on April 23, 2008
It grabbed my attention while I was looking for medical books. Being a medical student, I know the difficulty of getting personal details of the hard times an intern encounters. It's almost impossible to get an anecdote once they finish up and become a specialist (yes I know they may share one or two from time to time, but such numerous examples with details?) Dr. Nolen perfectly shares all his mistakes, his regrets, his experience and etc. A bit dated of course but you should stop to ask yourself, why such an old book like this (where the price of rent in New York were about 300$) is still in the hands of readers? I wished it was lengthier, couldn't put it down, flows smoothly, a good week read.
on November 9, 2006
Surgical training and practice has changed a great deal since Bill Nolan wrote this book, but I find myself thinking about this book almost weekly in my job as an academic general surgeon. I think Dr. Nolan, better than any other author before or since, explained one of the essential tenets of surgical practice "when someone calls you, you need to get out of bed". Even when exhausted, and even when he was on services (including path) where he had no interest and even less aptitude, he did his job to the best of his ability. I would also strongly recommend his two later books, although they may be impossible to find.