Dr. Ralph Henderson, Professor of Small Animal Surgery at Auburn University’s College of Veterinary Medicine, was an inspiration to me from the first time I met him.
With Dr. Henderson, everything had to be just so, just right, exact.
As it was with Dr. Johnson.
As it was with Dr. Huddleston.
Are you seeing a pattern?
For example, after we learned “instrument ties,” (tying suture with surgical instruments) he taught us “hand ties.” “Now, a lot of my students have asked me why we have to learn hand ties when we have already learned instrument ties,” he said in class one day. “Many return for Annual Conference to tell me they never use their hand ties in surgery, but they sure are glad they know how to throw a square knot when they fasten a horse, cow or boat.”
At the end of our Soft Tissue Surgery rotation, Dr. Henderson subjected each of us to an oral examination. On the corner of his desk sat a large plastic pumpkin. I’m sure each of us thought the same thing, “Why in the world does he have a pumpkin in his office?”
And, each of us got to find out.
“Here is some suture,” he began. “Inside the pumpkin is a rubber band spread around two posts. Tie the rubber band together with the suture, using any of the hand ties you’ve learned.”
“Together” was the key word.
The purpose of the pumpkin was to simulate a body cavity. Inside was a blood vessel in need of ligation. With both of one’s hands in the “incision” in the top of the pumpkin, there was no way to see inside. Everything had to be done by feel.
If the hand tie is tight, no blood will leak from the artery or vein. If the hand tie is loose, the patient is at risk of fatal bleeding.
In Dr. Henderson’s simulation, if the two sides of the rubber band were snugly against each other, the patient lived.
He was, and still is, good at explaining techniques.
Some years ago I decided that I wanted to learn a wound closure style called “subcuticular closure.” I used it on several patients, but had minor complications I wanted to eliminate. I knew just whom to call. Dr. Henderson outlined the steps from beginning to end, asked me how my technique differed from his, and explained how to eliminate the problem. Expertly, he did it all from 300 miles away, over the phone, before Skype had even been invented.
Today, Dr. Henderson’s special interest is surgical oncology. Long before that passion arose we students got to see him combine expertise with courage in a urinary bladder surgery few would have undertaken.
A patient presented with persistent hematuria, blood in the urine. The common causes: recurrent infection, bladder stones and tumors had been ruled out by other diagnostic measures, so it was time to go in and have a look.
We prepped the patient and Dr. Henderson made the approach. He brought the male dog’s urinary bladder to the exterior, then incised it. The wall of the bladder, which should have been a few millimeters thick, was nearly an inch. Dr. Henderson studied it for a while, then said, “I think this needs to come out.” He found an area inside the thickest part of the bladder and began to peel. Soon, he had in his hand a perfect reproduction of the interior of the bladder wall. “Three-ought PDS, please,” he said, and one of us handed him suture to close and others prepared the tissue to submit for histopathology.
Later, still in shock, I asked him, “Dr. Henderson, if you had it to do over again, would you still take out the interior of that dog’s bladder?”
“It seems to be working so far,” was his reply.
His decision was borne out by the pathologist’s report: “chronic granulation tissue caused by an unknown, long-term irritant.”
Lasting quotes from Dr. Henderson in a few days.
See you tomorrow, Dr. Randolph.