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Dr. Nolen was from the Northeast and purposefully selected Bellevue Hospital in New York City for his five year residency. Bellevue was and probably still is one of the toughest hospitals in the country. Two years into this residency he was drafted into the army and sent to the Black Hills Ordnance Depot Hospital. I think Dr. Nolen's time at Black Hills Ordnance Depot had a profound effect on him as evidenced by the choices he made after that experience. Also I think the laid back lifestyle at BHOD allowed him to start his writing career. Below are excerpts from two of his books that will give you a glimpse of his time at BHOD and of his writing style. (Jim Anderson)
From "The Making Of A Surgeon", pages 132-134; "I didn't like living twenty-five miles from Manhattan. It meant an hour of commuting each way, by the time I was in my second year as an assistant resident - having spent two years in the Army - Joan and I had three children and our Army life had given us a taste for the wide open spaces. Those two years were spent in a place called, believe it or not, Igloo.
Igloo was an ordnance depot built on the plains of southwestern South Dakota. (The "was" is intentional. Igloo was shut down completely in 1968 (1967).) To reach it you drove straight west (south) from Edgemont, South Dakota, a ranch town with a population of fifteen hundred. After ten miles of barren countryside you reached the cluster of barracks, shops and homes known as the Black Hills Ordnance Depot, or Igloo.
There were about two thousand people in Igloo: twelve officers, three enlisted men, and one thousand nine hundred and eighty-five civilians. Most of the civilians worked for the government, storing, shipping and occasionally detonating the ammunition of various kinds which was stored in concrete buildings ("igloos") on the many barren acres outside the town limits.
Igloo was designated as an "isolated post in the zone of the interior," which meant, in essence, that the government assumed an obligation to provide in the town itself all the ordinary essentials and conveniences of life. There was a nine-hole golf course, with buffalo-grass fairways and sand greens, a movie theater, a barber shop, and grocery, drug and clothing stores.
There was also a fifteen-bed hospital to which I, one other doctor and the three enlisted men were assigned. The enlisted men were tech sergeants who ran the pharmacy, the lab, and x-ray machine, and took care of the purchasing of supplies. My co-worker, a general practitioner with ten years' experience, and I provided all the medical care, within the limits of our abilities and facilities.
So for two years I did general practice. I delivered babies, took care of kids with runny noses and listened to the complaints of women with backaches. I also did some surgery - a few hernia repairs, appendectomies, tonsillectomies, and whatever acute emergencies presented themselves. I kept busy. I learned two things from the experience:
(1) I might not know much about surgery, but I knew a helluva lot less about the rest of medicine. If I hadn't had as a co-worker a G.P. with a lot of experience and common sense to whom I could turn whenever I was uncertain about what I was doing, I'd have been completely lost. As an example, I once followed a woman for seven months, examining her every month, on the assumption that she was pregnant. I had even written notes on her chart saying "The fetal heart tones are regular" and "Baby very active today." In my absence one afternoon my associate saw her, examined her and took an x-ray which confirmed his immediate impression - she wasn't the least bit pregnant.
(2) I really wanted to be a surgeon. I enjoyed doing the tonsillectomies, the hernias and the appendectomies. I didn't enjoy delivering babies, treating measles or listing to patients with neurotic symptoms. I acquired enormous respect for the G.P. who could do a little of everything and do it well, but it just was not for me.
It would have been cruel and inhuman treatment, after two years in the most open of spaces, to squeeze my family into a Manhattan apartment. We had to live in a place where the kids could run around a little without riding herd on them all the time. I commuted to Eastchester for the sake of my wife and kids."
From "A Surgeon's World", pages 30-31; "My training at Bellevue had been interrupted by the draft. From 1955 to 1957 I was in the army, serving as a medical officer in a place called, if you can believe it, Igloo, South Dakota. Sad to say, Igloo is no more; it was closed down completely in 1965 (1967) and the land on which it was located is now the site of a pig farm. But when I was there Igloo was an ordnance depot - an ordnance depot is a place where ammunition is stored - with a population of two thousand. It was located out on the plains about thirty miles from Hot Springs, South Dakota, and because the road to Hot Springs was treacherous in the winter, Igloo had been designated an "isolated post in the zone of the interior." Which meant that the army was responsible for providing medical care for all the people in Igloo.
That's why I was there. I, and one other doctor, ran a small hospital. We provided medical care for the sixteen officers, three enlisted men and the two thousand or so civilians who lived and worked in Igloo. We delivered babies, took care of heart attacks, removed tonsils and appendices; we did everthing we could within the limits of our abilities and the equipment on hand.
Joan and I enjoyed our two years in Igloo. We had a home of our own; there were wide open spaces where the children could play. It was a welcome break from the hectic life of Bellevue.
The other doctor who served with me in Igloo was a fellow named Don Dille. He and his wife, Bonnie, and their six children lived across the street from us. Don was a general practitioner and a very good one. Until the army grabbed him for a two-year hitch he had been in practice with four other G.P.'s in the Litchfield Clinic, in Litchfield, Minnesota. Which brings me to the point of this rather lengthy digression.
During our two years in Igloo, Joan and I got to know Don and Bonnie very well. We liked them and we
liked their kids. They told us of their life in Litchfield and it sounded as if it might be a pleasant
place to live. When Don was discharged, two months before I was, we took a vacation and went to visit them.
Their home was on a lake on the edge of the city. They had horses on a farm they owned about two miles from
their home. What we saw of their life style, and of Litchfield, appealed to us. When we were leaving, after
our three-day visit, Don said, "Why don't you keep in touch with me? Three years from now when your're
through with your surgical training, we might be ready to take a surgeon into our group." We had kept in
touch, and now that I was ready to leave Bellevue the idea of going to Litchfield seemed inviting."
(Dr. Nolen did go to Litchfield, MN after his residency and spent the rest of his life there.)
From "A Surgeon's World", pages 73-74; "Ham that I am, I got a big kick out of seeing my name in print, even as co-author of a minor article in a tiny journal. By the time it was published I was in the army, and since I had some spare time, I decided to write another article.
This one was entitled "Inadequate Operation for Pyloric Stnosis," and was a case report of another failure. The patient in this instance was a three-week-old boy with a benign tumor at the lower end, the pylorus, of his stomach. It's not a rare disease and the operation isn't terribly difficult, though it is a bit delicate. The surgeon cuts through the thick muscular coat of the pylorus down to the inner lining, the mucosa. He then spreads the muscle fibers apart, unblocking the end of the stomach. The trick is to cut all the thickened muscle, but not to nick the inner lining. If all the muscle isn't cut, the lower end of the stomach won't unblock; but if you cut too deeply and open the mucosa the patient may get peritonitis.
I had never seen the operation done, but I though I could manage it. I did it under local anesthesia, after looking up the technique in a book, and everything seemed to go well. The baby, however, continued to vomit. Three weeks later, when he was six weeks old and still weighed only six pounds, I reoperated on him. Thinking back on it, I'm amazed that I had the courage - perhaps "stupidity" would be a better word. I found that the muscle fibers had healed together, reblocking the end of the stomach. I hadn't spread them sufficiently. I redid the operation and the baby made an uneventful, rapid recovery. This was a very strong baby.
I reported the operation; the point, such as it was, was to warn other surgeons to be sure to spread all the muscle fibers. The article was published in the Archives of Surgery. It's amazing, the amount of insignificant junk that clutters up the medical literature.
Again I enjoyed the thrill of seeing my name in print. I was driven on to even greater heights. I did some research and "authored," as we doctors say, two more medical articles, "The Use and Abuse of Antibiotics in One Small Community" and "The Incidence of Drug Resistant Pathogenic Stapylococci in an Isolated Community." You've probably read both of them; they were published in the New England Journal of Medicine. But if you haven't just write to me; I've got hundreds of reprints of each. (Medical journals, like most scientific journals, not only don't pay their authors, they charge them for reprints, which the author can then send to anyone who requests one.)"
The "very strong baby" that Dr. Nolen operated on twice was Craig Johnson, the son of Margaret and Murdoch Johnson.
50 years later he is alive and well. (Jim Anderson)
Dr. Nolen was born March 20, 1928 and died from heart disease on Dec. 20, 1986. Dr. Nolen appeared 5 times on the Johnny Carson Tonight Show after "Making of a Surgeon" was published in 1970. He had a syndicated medical advice column in McCalls Magazine for several years. Besides the above books he also wrote "Spare Parts for the Human Body", "Healing: A Doctor in Search of a Miracle", "Baby in the Bottle", "Surgeon's Book of Hope" and, his last, published in 1984, "Crisis Time! Love, Marriage and the Male at Mid-life." His son, William D. Nolen was born at Igloo.
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