
Chapter 03: A Small Town Offers Good Training
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Description
Dr. Hortobagyi begins this chapter with a brief description of some of the rotations he completed at the University Hospital, then describes his year serving as a doctor to the small town of Pacho to repay the government for tuition support.(Dr. Hortobagyi describes how the State assessed tuition based on need and merit: by his second year,Dr. Hortobagyi’s tuition was fully covered because of his exemplary performance.) Pacho is located in the Andes and the tiny town has a 100-bed hospital. Dr. Hortobagyi saw the results of violent conflict between gangs of emerald smugglers. He describes treating the victim of a murder attempt. Dr. Hortobagyi describes treating a woman who was continuously pregnant for eighteen years and had sixteen children.
Dr. Hortobagyi explains that the experiences in Pacho taught him that medicine is an art, not a science. He gives other examples of caring for patients and describes the organization of the hospital in Pacho, where the generator was turned off at night so Dr. Hortobagyi had to study by candlelight.
Dr. Hortobagyi describes how he fit into the social life of the small town and how he came to understand how this situation could be comfortable, but ultimately limiting to his professional and intellectual growth.
Identifier
HortobagyiGN_01_20121130_C03
Publication Date
11-30-2012
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Gabriel Hortobagyi, MD, Oral History Interview, November 30, 2012
Topics Covered
The Interview Subject's Story - Professional PathCharacter, Values, Beliefs, Talents Personal Background Professional Path Inspirations to Practice Science/Medicine Influences from People and Life Experiences Evolution of Career Professional Values, Ethics, Purpose Professional Practice The Professional at Work Formative Experiences
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Gabriel Hortobagyi, MD:
And then at the completion of that [rotations] in Colombia—as in many other third world countries—in order to get—you don’t get your license until you pay the government with about a year of service. So, the Ministry of Health designates a place where you are being sent, and you will be a government employee and you will practice as a physician in that area, which is usually an underserved area.
Tacey Ann Rosolowski, PhD:
Can I just ask a quick question? Is that because the medical education—the higher education—was very low cost or free? I mean—how did that work?
Gabriel Hortobagyi, MD:
Okay—so this was a government—this was a public school. All right let’s say UT except that it was a national. So, tuition was based on two things. One was your ability to pay, so in my case it was based on my father’s previous or last year’s income tax return. And secondly, it was based on performance. So, when I went to medical school my father was fine—he was certainly not wealthy—so it was not very expensive. But by the second year—since the top five in the class got full tuition support—so I essentially paid for tuition the first year, and the rest of my medical education, my parents; and later on we just bought the books and—so yes, in a way it is to give back what the state gave you or the government gave you, which was in my case an almost free medical education. So, I was sent to this little town of about 30,000 people about four hours from Bogota in the mountains. And there was a 100-bed hospital there, and I was the only doctor. Actually, that is not true; there was a retired pediatrician who lived in town, and he worked part time to take care of the kiddos, which was great because I didn’t have the stomach for pediatrics. It is terribly painful to watch those little tots as sick as they get. So I lived in this place for about a year.
Tacey Ann Rosolowski, PhD:
What was the name of the town?
Gabriel Hortobagyi, MD:
Pacho.
Tacey Ann Rosolowski, PhD:
Pacho.
Gabriel Hortobagyi, MD:
Pacho. It is in the same department or province as Bogota. And it is in the central—Colombia has the Andes divided into three ranges, and Bogota is in a plateau in the central range. Pacho is sort of on the other side of that same range, and on the Bogota side of the range are the richest emerald mines in the country. And the only reason I mention that is that there is a lot of smuggling, and all of the smugglers came our way because, of course, going towards Bogota they would risk being caught by army and police and whatnot. But they were gangs of smugglers, so they attacked each other, and I had plenty of work to do with people who had been cut up or shot up or hurt in some way or another. So, I would make rounds in the hospital in the morning. I would make rounds over a hundred beds, which were usually full. Now it wasn’t like it is today here because fifty years ago—and especially in a place where many people lived a long distance away—they couldn’t afford to go back and forth. So sometimes they stayed for simple treatments, but that required daily administration. They would stay in the hospital for two or three months. So, it wasn’t exactly that they were deathly ill, but it was full at all times. And so, I would do that in the morning, then I would do a little surgery depending on what was needed. And in the afternoons, three times a week I would go out on a bus or on a helicopter or a Jeep with the captain of the police to a smaller town two or three hours away and would do outpatient consultation there and then come back either the same day or early the next morning. And then I would do—in between I would do emergency room calls and whatnot. So that was—that went on for a year, and it really makes you a good doctor.
Tacey Ann Rosolowski, PhD:
How so?
Gabriel Hortobagyi, MD:
Because you are it. When you are in a medical school in a university hospital, you are protected. If you don’t know what to do you just asked the guy next door or the passerby saying, “Hey, how do you do this? What’s the answer to this?” There, there’s nobody. In the 1960s in a third-world country in a small town, there were not even phones. So, it wasn’t like, gee, I’ll call the world’s expert in appendicitis or whatever it was. You had to figure it out. You were on your own, and the life and health of that individual sitting across from you depended entirely on you. So it forces you to grow up.
Tacey Ann Rosolowski, PhD:
Can—is there an event of treating a patient or some patients that you really recall from that time that really made you grow as a physician?
Gabriel Hortobagyi, MD:
Well, sure. First of all, you start off—you get there, and you’re shell shocked during your first week because, “Oh, my God. I’m alone. What do I do?” You know? And then there are things like—I remember they brought in a man they had found in a cornfield, and he was chopped up to pieces. Because his sons wanted to inherit and the guy wouldn’t die, they caught him in his cornfield and—with machetes—they hacked him and left him for dead. It turns out that he didn’t die, but several days later he was picked up and brought in. And he had—I don’t know—eighty or 100 cuts. So, I worked on him for probably the best part of an entire day just cleaning him and sewing him up and rehydrating him. Of course we didn’t have a blood bank. So, you did the best you could with what you had. And I had to do things for which I was totally unprepared. So one of the cuts lifted the top of his skull—not just the scalp but his skull—so his brain was hanging out. And surprisingly he was awake and fine and thinking, and I had no idea what to do with it because the brain was swollen because of the injury, and I couldn’t just stick it back. And of course I had no training in neurosurgery, so I had to figure out what to do. And eventually the guy recovered and survived and did fine, but you have to think quick on your feet, and you have to be prepared to do your best realizing that you are going to make mistakes. So that reminds me. There was another one that was fascinating. There was this woman who came in and she was extremely pregnant, but she didn’t remember when she had had her last period because she had been continuously pregnant for about eighteen years. She had had sixteen previous children, so she never recovered between pregnancies. She came in and she looked huge, and I examined her and she seemed to be in labor, so I admitted her to the hospital. I go back in the evening to check on her change—next day no change—the following week no change. And she is happily there resting and eating in the hospital because, of course, she left her sixteen kids at home to fend for themselves. So, a month later she is still there. Nothing is happening—she is getting bigger, so I sent her home. She comes back a week later—same thing. I readmit her—again the same story. So, at that time we didn’t have ultrasound or any of these things, so I ended up taking an x-ray of her abdomen. Well, it turns out that she had triplets. So, she is there—we don’t know how long her pregnancy has been going on, and after a while—just judging by the size and the one x-ray—I said, “Well, it must be time.” But she had no intention of delivering. She was just perfectly happy eating and sleeping there.
Tacey Ann Rosolowski, PhD:
Well, it was a retreat for her.
Gabriel Hortobagyi, MD:
It was a retreat for her. So, I finally induced her with Pitocin, and then that didn’t work very well. So, I ended up doing a C-section and three healthy boys were born. And in fact, the middle name for all three of them was Gabriel because she was very happy. And so, I will always remember that because it made me look like a fool—or at least feel like a fool—because I had no idea what I was doing. The C-section—I had done plenty of C-sections by then, but this thing—and then you realize how people until really the 1940s or ’50s—they just did it like that. I mean it was an art and certainly not a science. So that was an interesting one. And then there were a couple of—well, not a couple—a number of cases where people would come in with symptoms that didn’t match anything, and you wouldn’t find anything. Then you would work on them with very limited resources and—because I was also the head of the laboratory, and I was the radiologist and everything. So, it was it—I was it. There was nobody else to help me, nobody else to consult with. And the hospital—the hospital director—well, I was the hospital director. But the administrative director was a nun who was an RN, and she was the only RN in the hospital. There were two that were an LDN equivalent—so no graduate nurses. And then there were a bunch of girls from town who were trying to do the cleaning and changing the beds and bathing the patients and doing the gofer stuff. So, I couldn’t even consult with experienced nurses saying, “Gee, what do you do here?” because there weren’t any. I had taken some books with me—some medical books—so I would in the evenings go in and read a while. But you couldn’t do much of that because the hospital generator was turned off at eight p.m. So, you could light a candle or have a flashlight and do some reading, but other than that you got up at sunrise, and you went to bed after the lights were turned out because otherwise there was not much to do. So, then as you become familiar with your surroundings and you become more comfortable in your skin then yeah, I can do this. Then comes the social problem. So, you are in this town and, of course, I was single at that time, and you become the most eligible bachelor in town, right? So, you are invited to every wedding, every funeral, every baptism, and every birthday celebration. And the four personalities in town were the priest, the captain of the police, the judge—who was a young woman who was doing the same thing I was, so she had been assigned by the government to work in this town for a year—and I. I mean the four of us by force became not only acquainted but friends because we were the only—we were the high—most highly educated people in town. So, there were not many places to meet, so you would meet in the main square in front of the church, and there were two bars. You know, there was the church, and then on the other side of the square there were two bars. So, you would sit at a table chatting, and people from town would pass by saying, “Doctor, here goes a drink for you.” And then they would bring attention of the passerby for drinks; and then while that is very pleasant and sort of interesting, after a while you realize if I stay here, I am going to become an alcoholic. And then it also dawns on you that there are no intellectual challenges because there is nobody who knows more than you—certainly about medicine in my case—and that if you stay there, it is very hard to stay on the top of your game because it is very comfortable. You’ve got—well, you are in very modest surroundings. You have no needs really. You have no material needs. They feed you; they did my laundry; and they mended my clothes and my shoes. So, I had—I only had to concentrate on my profession. But then you sort of start sinking into this very comfortable surrounding that demands very little from you. And I became aware of that probably about halfway through that year saying, “Oh, my God. I’ve got to get out of here.”
Tacey Ann Rosolowski, PhD:
Right. Sure. Well, I suppose for some people it would be hugely attractive because you have such a huge position in the community.
Gabriel Hortobagyi, MD:
Right. Right. Right.
Tacey Ann Rosolowski, PhD:
Yeah.
Recommended Citation
Hortobagyi, Gabriel N. MD and Rosolowski, Tacey A. PhD, "Chapter 03: A Small Town Offers Good Training" (2012). Interview Chapters. 1108.
https://openworks.mdanderson.org/mchv_interviewchapters/1108
Conditions Governing Access
Open
