As some of you may not know I was referring to recent case that I had and Litchfield and which my wife woke up with a belly ache early on Friday morning and I was convinced that she had an upset stomach intestinal flu or something in that nature and the finally Saturday morning lady brought her to the hospital and had a friend operate on her we discovered. She had a ruptured appendix.Let's came out shortly after I had written an article on appendicitis from a calls. Actually, I've had I've had a lot of trouble in the last few years. I have I mentioned this a recent visit to the Carson Show and I have my son with two years ago. I was playing football and the he was a quarterback for the sophomore team and he was I thought he played quite well in the first-half the second half we didn't play very well. And after the game I asked him what had happened. He said while my wrist is kind of sore and I examined and so do I will be better tomorrow and the next day he said yes still hurts dad. And I said way out was know where you'll Shake turn off the lights and finally on the third day my wife call one of my partners and had him see my son and of course as you might guess he had a fractured ulna and I'm the only end it wasn't the sort of thing you get into when you take care of your own family, which of course I know. Try very vigorously not to do I would speak a little bit about the problem communication with patients since that is the one field in which I possibly have had a little more experience than the other members of the State Medical Society first briefly a few words on how I got into the writing business. I've been asked in the past that and it's sort of an odd application for a surgeon particularly one who while I'm the chief of surgery and Meeker County and I'm also the only surgeon in Meeker, if you're if you're in if you're in which building you need an operation, it's me or Charlie kubisch and he's a veterinarian. The song I have a captive clientele and in a way that is good. It means that when I leave town the patients that come in with the elective problems, my partners and Associates will save for me. I know that when I go back I'll still have a practice on the other hand. It means when I leave town if there is no board surgeon and even all the Jeep he's out there to a lot of surgery and they don't do the major surgery. However, there are some general surgeons off in Willmar for them and they cover for me so I'm not deserting my printer. I didn't get in a writing very early but like most pre-meds in college. I ain't spent all my time worrying about getting into Medical School you all been through that you're afraid to go down to run around the track or go out for the band for fear. Someone is up in the laboratory to selecting a rabbit and going to get a better Mark than you and Turn into medical school. So I didn't do any writings of the compulsory writing that too. And we all did I got into Medical School fortunately and it was then that I discovered that in the medical profession as well as in the teaching profession. If you want to gain any sort of prominence, you have to publish if you want to go from assistant professor to associate professor professor, you have to increase the length of your bibliography and proportionately, but of course again, I didn't do any writing. I was too busy trying to pass all the compulsory courses. It was until I got to Bellevue that I wrote my first article we operate on a patient on when we made the diagnosis of duodenal ulcer and to our Chagrin we discovered when we are open the abdomen that she had a carcinoma of the duodenum and I looked this up later and found that only Cases have been reported in the world literature. And so I wrote my first article which was called carcinoma of the info papillary portion of the duodenum, which I'm sure you've all read. It was published in surgery in 1955 that time the doctor draft was still in existence and I was called into the army after one year surgical training and I was sent to a place called Igloo South Dakota. It was designated as an isolated Post in the zone of the interior, which was really an understatement that you could really hardly get there in the winter at any rate. It was an interesting experience. I did General practice the officers in 3 and listed man on the post and two thousand civilians and we had a 15 bed hospital and we were assigned the job of providing all the medical care that we could within the limits of our capabilities and equipment. And we did we had a very thriving general practice. I was assigned there was a doctor general practitioner from Litchfield, Minnesota. Dr. Donald dill at any rate when I finish my training, I wrote a couple of other articles out there one was well one was a patient, you know how it is when you're in a young surgeon you had one year of training and there are there is no one in the world who knows more about surgery than a surgeon with one year of experience. You're you're at the point then when you think you can do anything and you don't have the courage to say no when someone asks you can you do this at that actually gave rise to my second article. I was we had a patient come into the hospital six week old child vomiting projectile vomiting. We've made a diagnosis of pyloric stenosis and my general practitioner Associates at all. You can do that operation. Can't you and Chris I never Scene one never mind having done one. But again as I say I said, yes and I operate on this child under local anesthesia, which was a horrendous experiences any of you who have operated on showing that age might guess much to my chagrin after I finally with a lot of work managed to close the abdomen of the child in the postoperative. Continue to throw up and after another week. I did something that I even Amaze in retrospect to think that I didn't have those Arie operated on that child and found a course of the I hadn't adequately spread the muscle and the fortunately the child made a good recovery. That was the basis for my second article, which was called inadequate operation for pyloric stenosis. I was published in The Archives of surgery went back to Bellevue. And for the next three years. I didn't do any writing the reason being that at that time. We had a chief of surgery who felt that if you didn't have anything worth saying there was no point writing an article about it that really limits your output. I mean we've all been through training. We realize that there is a lot of material that gets into the medical-surgical literature that it really doesn't blind the great books of the Western World certainly and we could all survive without it. But we had a resin and I can remember he used to say when the new journals with a ride that there really should be a journal every month just for the doctor just want their names and print as you would put their names in the car, but you wouldn't put anything in the journal and he had a point. Well, of course I've contributed to that flood myself and I realize it's a very difficult problem in there more than one point of view. I don't even I didn't do any riding. Finally when I finish my training. I went out to Litchfield Minnesota to practice the reason being as any of you surgeons may know that there is not a great demand in many of the metropolitan areas for another general surgeon. There are quite a few general surgeons in Boston. There are quite a few in Chicago. There are a lot of general surgeons and some of the nice New England towns that we visited and they were less than ecstatic about the idea of my joining their ranks. And so I came out to Litchfield where I knew there was no general surgeon and much to my surprise. When I arrive there. I wasn't as busy as I thought I would be I really did and all my naivety you think that people will be banging on the door saying thank heavens you're here you can take out my gallbladder and I'm so delighted you've arrived I've had these varicose veins for years and now you can get rid of them. None of that happened. The car is the general practitioners did a lot of surgery and for the major cases, they brought somebody out from Minneapolis and they've been doing that for years and it worked quite well. I saw was a consequence I spent the first few months acting as an assistant as a Practitioners did their cases and then occasionally getting a major case to do but of course it again is most surgeons know you don't survive on the stomachs you the bread and butter of surgery if you'll excuse the phrase of the hernias in the veins and the hemorrhoids and at that time President Kennedy was alive and he'd written I would send one of his speech is paraphrasing a Greek philosopher that happiness was the opportunity to utilize your talents in a life of 14 scope and I thought well here I am with all this talent and here's this life with tremendous scope and I'm not very happy. So I wrote an article called surgery in the pursuit of happiness and I sent it to ask gno. Well, the editors of SG in Olalla most of them were very successful surgeons send it back. They said that they didn't think this was true, but they did say that it might reflect the point of view of the younger surgeons and practice and saw if I could shorten it. They would run it as an editorial and I did shorten it and it appeared as an editorial and SG and now you can't go any higher in the field of writing an editorial in sgno unless you want to get paid for what you write. And so that of course was the next step and the First Market that I tried was one with which were all acquainted medical ikan onyx. For those few don't know what it is. It's it's the magazine that tells doctors what to do to hold on to some of their money doctors in my experience personal experience are probably the poorest Economist in the world. If you find a bowling alley, which is in exactly the wrong place in town. The chances are a doctor owns part of it. If I were a stock sales Gold Mine stock that I wanted to unload I would get out the AMA directory and if I hadn't sold it all by the time I got to the bees I would know I was in the wrong profession. And so medical economics has a reason for being and that is to tell doctors something about the economics of their practice and I wrote for them for several years. I wrote sort of for the horror section of the magazine. I would write articles about what it happened to me recently in the world of finance and they would publish it and say don't let this happen to you. At the same time that I was writing for medical economics. I was trying to sell to the mass circulation magazines and I wrote poetry for the look and I wrote a short stories from the New Yorker political essays for the New York Times magazine. I even wrote for a while ago for Playboy and Saga and even wrote a piece for True Confessions soul. I got so I knew the round trip time from my from Litchfield to the New Yorker and vacuum and it was two weeks to get an article out and get it back and forth five years. I collected rejection slips until finally it occurred to me while we had a disaster in the family. I wrote relative choked to death at a banquet and I thought you know, this was really sad. He was a young man you have five children, and I kind of a doctor had been there and I'll possibly Barely, even a surgeon they could have done a tracheotomy on him and saved his life and I looked up the figures in this happens. Not infrequently, a lot of prominent people who died this way. And so I wrote an article called how to do a tracheotomy for the Layman and I sent it off to Esquire and After three weeks that hadn't come back and after 4 weeks. It hadn't come back. Well, finally after five weeks that came back but this time instead of the form rejection slip there was a a long letter saying that they were sure somebody would buy it, but they weren't going to and I knew they'd read it because of the margin we're little comments like how deep do you cut here? Well, you can imagine I never saw that article the reason being that at some banquet someone would get a glass of water down the wrong way in the dining partner would grab a knife and the editors of Esquire and I would have been in jail. But it did wake me to the idea that possibly I should be writing about medical thing since this was a fairly close. Mist and I did I wrote a piece on my first appendectomy, which sold finally to Esquire kind of got me into the writing business from that family idea for the making of a surgeon and at that point. I learned something that I don't have known and that is that it is almost as difficult to sell a book as it is to write 1 as there are about thirty thousand books published in this country every year and most of them you never hear about and so when my editor said would you be willing to devote a couple of weeks to trying to sell the book? I that sure I'll do that and I worked hard on this book and they've published a lot of them and I'll do it one of the first places I went was to, New York. And it was really sort of a combination of the the beginning of this tour and one of the real low spots because I went on a program called to tell the truth and which you were well if you want to feel like a real jackass you stand on a stage with somebody on your left and someone in your right in front of you in the curtain opens and this man says I am dr. William Nolan and you say I am doctor will annoy and somebody else says it I mean it really is The meaning I think it's the word life. I felt as though I really should have had my saxophone or my accordion with me rather than coming out. There's a surgeon but I did it and I found that you had to do this sort of thing. If you wanted to sell books actually the second one of the second places. I think the second place I went to was to Chicago at that time. The AMA hadn't reacted at all to my book. I'm not that I expected much of a reaction, but there hadn't been any reaction and I was going to do one of these late night talk shows in Chicago and the just before I went on they brought a man out and introduce them to me and it turned out to be a doctor Waller born Mayer Who was let you know the president of the AMA and yes, I not well this is where I'm going to get mine. But as it turns out doctor bornemeier hadn't read the book. and Was sort of an interesting experience because as you know, I need late night talk shows every hypochondriac in the city is awake and listening and I eat when you're an author the moderator will always say no. Condolences not answer specific medical questions. He's here to answer questions about his book and dr. Bourne Myers the present the AMA and he can answer questions about medical policy, but not about specific ailments. And of course the collars all want to know about specific ailments and doctor bornemeier and I are on in the very first question that we got was a patient who said that dr. Nolan. I understand there's a new treatment for psoriasis. Can you tell me about that and I put my hand over the microphone and I said Doctor born my I don't know the answer to that to you and he put his hand over his Mike and he said no, I don't know the answer either. So the moderator had to say, I'm sorry neither these doctors know the answer to that question. but but he said the after all they're both surgeons. So the next caller call in and said thank you know and I understand there's a new operation for flat feet. Can you tell me about that? And of course I had to say doctor born my I don't know the answer to that and Doctor bornemeier how to say I don't know either. I'm sure by the time we got off of that program. They thought well, here's a doctor has written a book. He doesn't know anything about Madison and here's the presently AMA and he doesn't know anything either. I don't know how well we represented our conference. Well at any rate in the course of all Lowe's stores. I I learned them trying to get to the point of this talk that After the show first of all, you have all these people look the microphones will as soon as a physician went on at any of these talk shows of one of them either the phone in television show the phone and radio shows all the lights on the switchboard with light up. These were all patients asking questions. You know that my doctor gave me a little pill this morning because my ankles are swollen and I'm wondering if it's all right to take it or dr. Nolan. My mother was operated on last month and the wound is still draining. Should I sue my doctor? I mean just flooded with these questions and then you after the show the stagehands or the moderator or the secretary. They would always say, you know, I hate to bother you or this Stockton all I know you're out here to push a block, but can you give me a little help a little medical advice? I don't think it ever occurred to me. In such desperate Straits for medical information and it made me think then of course, I started writing a column for my calls and I would write a piece on varicose veins are floods of letters about patients without they do the been mistreated or they wondered whether they should have the operation all this sort of thing. There is a tremendous demand for this information. And I think the reason that we sometimes ignore it or if some has not aware of it is that first of all, we assumed patients know more about medicine than they do they really don't I know very much about things that we take for granted. For example, I operated on a doctor's wife not too long ago. And I swore that I was going to tell them everything you I warned her and I are going to the hospital. I'm sure you know this but you're going to get shaved going to put a tube in your stomach in the morning before the operation. You'll get a hypo you'll get an animal that night you come in and set her at Sutter and I thought while I'm just repeating myself and I'm not going to miss a trick the next day. The operation went well and that evening. I went in to see her and I said how you feeling good and she said fine, but you said I'm awfully upset with you and I said why and she said you didn't tell me that they were going to take my teeth out and I'll never be able to face Doctor Johnson again. Well, you know, that's a little thing and but to her and she was a doctor's wife. It was a came as a shock and it bothered her consider. It was something I shouldn't have missed them. And I did that's one of the things the second point that I think we sometimes overlooked is a to assume that the patients can't understand even if we try to explain things to them. They can't it's sometimes difficult but one of the books which hardly anyone has ever heard of his called spare parts for the human body and they was written for kids and in it. I had a chapter in the immune reaction and I had to explain that the children will that was difficult. It's a lot easier for us to talk to our confreres about gastric acidity and gas drilling in the vagus nerve than it is to explain an ulcer to a patient. I suppose you can make a case for the patient who says that every time she gets up quickly. She gets dizzy. But I mean, you know that there are a number of ailments that Bora To death the only time that I find a bad back fascinating his one. It's my back. And as a consequence, I'm sure that the patients realize that we are bored that we sent as I'll take a couple of aspirin will be done in a couple of weeks so I can see from my office the office of the chiropractor who has his office right across the park and before I can on to this there are more times than I like to remember. I would see the patient leave my office and cut across the park to the chiropractor who would take a total body X-ray and explain in a point out these vertebrae and how they're not in perfect alignment and they were happy with this. So I think the whole point of this discussion is that I since I've gotten into writing and certainly much more aware than I was that what we have to offer. Our patients is better communication. We have if we would instead of running in and out of their rooms and I'm notorious for this but you see I have a and all I want is people tip toes into the room and it the patient's asleep. I tip toe out again because it saves a few minutes and I know she's doing well I shouldn't do that, but I can get away with it a little bit in Litchfield because I see the patients over and over again as medicines become more fragmented as people become as we become more specialized and we see patients for a shorter. Of time. We have to increase the energy we put into establishing good rapport with them. We can't do everything for them. But one thing that we I think neglect at our Pearl is to communicate better to make more of an effort than we usually do in this year of a tremendous scientific Advance. We can't lose back to the site lose sight of the fact that medicine is to Resort or cliche an art as well as a science and communication is part of that art and if we all fall Physicians make more make increase their attempt to communicate better than Ann Landers and I will get fewer letters and I for one will be delighted. Thank you very much.