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Ann Thorac Surg 2003;76:S2201-S2202
© 2003 The Society of Thoracic Surgeons
Emeritus Professor of Surgery, McGill University, Montreal, Canada
* Address reprint requests to Dr Dobell, 192 Des Chanterelles, Sainte Agathe des Monts, Quebec, J8C 228 Canada.
e-mail: dobell{at}polyinter.com
Presented at the symposium, "Gibbon & His Heart-Lung Machine: 50 Years & Beyond," Philadelphia, PA, May 2, 2003.
I would like to recall for you Dr Gibbon as I knew him when I was a resident 50 years ago. He was at the height of his renown, president of the American Surgical Association and the American Association for Thoracic Surgery, close friend of the great names in surgery, and clearly already one of the legends himself. I was at the bottom, he was at the top.
I was so fortunate to be one of his residents and particularly to be assigned to the only proven heart-lung machine in the world from July 1953 to June 1954. This was after the legendary operation on May 6, 1953, and my only extremely minor role in that surgery was to baby-sit the patient on her second or third postoperative night.
Doctor Gibbon loved solving clinical problems and this was one of his teaching techniques. In the early clinical years we would attend his weekly sessions in the "pit" as it was called, a teaching performance in a sunken amphitheatre before the senior medical class. The chief resident would select two or three patients unknown to Dr Gibbon; they might be undiagnosed or postoperative or complicated. Whatever the situation he talked at length on any subject and he never hesitated to come to a conclusion and advise appropriate action. I am sure the students profited from these dramatic presentations but we residents unquestionably gained the most. This was still the time when surgeons were expected to know everything in all fields and Dr Gibbon certainly seemed to. He was a perpetual student of surgery.
He was of course a teacher and his teaching of the junior residents was more remote from that of the chief residents who worked closely with him assisting him in operations, communicating with him about his patients, and making rounds with him. All residents met with the entire staff at two weekly sessions which Dr Gibbon chaired and considered of great importance. One session was a morbidity and mortality review in which all procedures of the previous week were listed and their complications were itemized. These were categorized as errors in diagnosis, judgment, surgical technique, or postoperative management and they were discussed openly whether the surgeon was a resident or staff member. They were effective sessions teaching not only surgery but also honesty, responsibility, and teamwork. The premise was that if a complication occurred then a mistake had been made. Of course the atmosphere was not as litigious as it now is. Occasional triumphs were presented to brighten the mood. The other weekly session was a journal club in which an entire journal was reviewed every week and it was assumed that everyone had read the entire journal so that the articles could be discussed in order by residents and staff. What we learned here was to think, to be critical, and to know that knowledge was to be obtained from journals, not from textbooks. Doctor Gibbon was the Editor of the prestigious Annals of Surgery at this time and he had favorite questions such as: "Were the conclusions justified by the evidence presented?" He was fussy about statistics and he was driven to fury by results of a handful of events being expressed as a percentage, insisting that the denominator had to be more than a hundred before the occurrence could be expressed as a percentage.
When I became chief resident, I became aware that perhaps his major interest was in editing The Annals. Sometimes I would be invited into his office before we were to make rounds on his patients and generally he would be dictating decisions about articles submitted. All articles were referred to two reviewers before he was to make his decision and he told me that he occasionally accepted articles the reviewers had rejected. Sometimes the reverse occurred and he rejected articles his reviewers had accepted. He certainly reviewed each article submitted and immediately dictated a decision, which might be brief or lengthy but was always dictated in one continuous flow without erasures, corrections, or pauses. I learned then, and subsequently, that he was a marvelous communicator, a master of the English language, indeed that he was a poet.
Sometimes we were called on to make presentations to groups of visiting surgeons. We each had reviewed series of patients with one condition or another or we had work from the experimental laboratory that we could present. His advice was to know your subject thoroughly, have reliable data, and present the information clearly. He also pointed out that it was much easier to present to an audience of mature surgeons than to medical students because the former were fiercely interested in the subject. A few years later I remember well running into Dr and Mrs Gibbon during an American College meeting. I joined them for a full lunch immediately before he was to give a lecture on pulmonary edema. It was a chatty, happy lunch with no reference whatever to the upcoming lecture, which was beautifully organized and informative and apparently extemporaneous. He was equally a physiologist and a surgeon and this sort of subject permitted the full range of his knowledge and talents.
I must recount one experience that revealed Dr Gibbon's greatness to us. The late Charles Fineberg was chief resident in 1954–1955 and just before Christmas I was assisting him as a woman underwent abdominal exploration. Charles was well aware of the literature on hepatic lobectomy but as very few had then been done in the world he had never seen or done one himself. A junior surgeon was responsible for the ward service at the time and the decision was made to call Dr Gibbon while Charles continued to explore and determine the feasibility of a right hepatic lobectomy. Doctor Gibbon was happily at home on this particular evening but he appeared promptly in the operating room. Looking over Dr Fineberg's shoulder, Dr Gibbon encouraged him to carry on. Blood loss became a problem and Dr Gibbon did a cutdown to insert a cannula in the patient's saphenous vein at the ankle and spent the next hours pumping in blood and encouraging the surgery. At the conclusion of this successful procedure he looked and felt as triumphant as the rest of us.
There was a bond among us all on his service. Collectively we were termed "The Ribcrackers" but the full title was "The Gib's Ribcrackers" (Fig 1). We convened annually for a dinner that featured Charles Fineberg's marvelous stories.
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He kept young by enjoying the company of his children and of young people. He and his wife were stimulating company and they were close friends to a host of people within and without the medical profession. They were generous in inviting residents to meet prominent surgeons when they entertained visitors at their home. At meetings the Gibbons were surrounded by the elite of surgery but always had time for any acquaintance. After I had left Jefferson and attended surgical meetings I had several opportunities to make up a fourth when a tennis game had been arranged; I can recall games with the Gibbons and an executive from Lippincott, which published The Annals of Surgery.
One of Dr Gibbon's close surgical acquaintances was Clarence Crafoord from Sweden who visited several times. When he came to the laboratory he would sit on a stool, tell us to do whatever we were going to do as if he wasn't there, and then he'd take out a notebook and write in it as long as he stayed. Doctor Gibbon told me that he phoned Dr Crafoord after Cecelia's operation. He may have called others as well but I had the impression that this was the only call he made. One may wonder what time the call was received in Sweden. Probably neither of them cared.
Doctor Churchill, Dr Gibbon's mentor and friend, has been termed a humanist. So were the Gibbons. They loved people, were devoted to human welfare, and treated everyone with equal courtesy. They were stimulating and energetic and exceedingly bright. They were interested in everything (Fig 2). It was a marvelous treat for me to be a minor acquaintance of both of them.
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