FARM to TABLE: Amish Boy Becomes Neurosurgeon
Table of Contents with Annotations (Approx. 153,000 words)
Night in the Belizean Jungle
My story begins with the exodus of my small Amish community in the Ozarks to the Central American country of Belize, as our parents hoped to preserve their simple life and keep their children from straying from the Amish church. My three younger siblings moved with them, but I stayed in Oklahoma City to fulfill my draft requirements by working two years in alternate service, also called 1-W service. On one visit to see my parents in Belize (then called British Honduras), I got lost in the jungle and spent the night in a tree before reaching my parents' house the following morning.
2. Early Memories and my Family
My earliest memories are from my first 6 years of life when we lived in Michigan. These vignettes are written purely from memory as I did not begin writing my diary until age 11 after my family had moved to Arkansas. I provide brief introductions to my family that consisted of 11 boys (including me) and 3 sisters. My parents reared the older half of my family, but my older siblings assumed an important role in the upbringing of the younger half. My two younger brothers, Alvin and Garner, and I were a clique, referred to as the “three little boys” in our Amish dialect, commonly called Pennsylvania Dutch, but is actually a high German dialect, heavily infused with English words, but isn’t a written language.
3. At Play in the Fields of the Lord
This title I borrowed from a book by Peter Matthiessen and is about our hobbies and other aspects of our lives apart from work on our farm. We built a treehouse and tower, slept in cots hung from trees, and searched for a missing bull that had been killed by lightning. My brother and I fantasized about hearing Beethoven’s symphonies, somehow knowing we would like them without ever hearing a bar of classical music.
Pomperly Cave University
My two brothers and I, with our best friends, the Wickey boys, created a schoolroom in a hidden cave with a wooden floor, chairs and a lectern where we gave lectures on word power, public speaking, astronomy, music, and other topics of interest. We got a kick out of its grandiose name and its existence remained a carefully guarded secret, as our parents and church elders would not have approved.
Bird Watching and Turkey Vulture
As young boys we were influence by of our older brothers who had a passing interest in birds but we took the hobby to a new level, accelerated by the acquisition of our monocular and Roger Tory Peterson’s revolutionary field guide. My oldest brother Victor was fanatically devoted to purple martins and was said to have the largest colony of these swallows in the US. We developed a fascination, even devotion, to turkey vultures that may have contributed to the notion in our family and community that we three little boys were lazy and not likely to amount to much.
6. Bird and Nature Periodicals
Alvin and I wrote periodicals each spring during the 1960’s in which we reported the first arrival of birds in the spring, the excitement of identifying new “life” species and finding bird nests. In the first season, our newsletter was handwritten, black and white, but in the next season our newspaper was transformed to typewritten editions, painted illustrations, and titles in color. (You can see illustrations in the Photos section).
Pet Birds and Mammals
The most prized pet from the wild was a young red-tailed hawk that we successfully reared, but it met an untimely death when it caught a chicken. My dad gave the order to my brother Ira to dispatch the young hawk with a shotgun blast, all before I knew of the hawk’s transgression. The effect was devastating, no different than a teenager losing their pet dog. It had not occurred to my dad to even consider the feelings of the three little boys. We had a series of pet crows that made wonderful pets, and one of them reared a family with a wild mate. Other pet mammals consisted of a woodchuck and an opossum; not true pets as our crows were.
Stoll Farm and Household
Describes daily life on the farm with chores assigned according to gender—growing vegetables, fruits and watermelons. In the winter the community scheduled a “frolic,” centered on butchering a pig, an all-day event.. We were largely self-sufficient, milked cows, had a colony of chickens for eggs, grew vegetables in our “truck patch” and gathered wild blackberries, huckleberries and grapes. We separated cream from milk, made butter and cheese, and my mom’s bread was legendary, which has been carried on by my sister, Emma. My dad’s primary cash crop was making sorghum molasses each fall, using a horse-drawn cane press, and cooking down the sap over a partitioned wood-fired pan. His sorghum, with its mild flavor and amber color, was famous in our community.
Good and Bad Wildlife
In our community in the Ozarks, whether Amish or natives, wildlife was categorized as either good or bad. A National Audubon Society pamphlet introduced us to the “value of predators” such as hawks and owls, and the conservation movement with the importance of balance of nature. It decried the indiscriminate killing of predators. We joined the environmental movement in the 1960’s, influenced by Rachel Carson’s “Silent Spring.” The recent discovery of a keystone species—critical to the health of an entire biological community—has confirmed the importance of the environmental movement on which our existence depends.
10. Astronomy and Space Exploration
Under the dark skies of our rural community we learned to identify the constellations from star charts and why their position in the night sky changed with the seasons, the Earth orbiting around the Sun. With our small reflector telescope we were thrilled to see the four moons of Jupiter, Saturn’s rings, and the Great Nebula in Orion, a veritable star factory. The twin spacecraft of Voyager 1 and Voyager 2, launched by the Jet Propulsion Laboratory, used the newly engineered gravity assist or slingshot and achieved remarkable discoveries of our solar system. Now 48 years after their launch, these spacecrafts continue their journey into the cosmos. I firmly believe the launching of the James Webb Telescope marks a milestone of human existence on our planet, even if it went was largely unnoticed by the general public.
11. Strawberry Patch
Picking strawberries became a much-cherished annual rite of spring. Members of our Amish community lived in barracks for a 4-week stint picking strawberries for 7 cents per quart, every day except for Sunday. This chapter relies on my journal, now consisting of multiple type-written pages per day, and includes actual dialog I recorded at the time. We relished the company of our best friends, the Wickey boys, and it was the only time we had meaningful interaction with non-Amish teenagers. Migrant workers from Mexico and Black families from Little Rock (African Americans were outlawed in northwest Arkansas at the time) picked strawberries with us and during this brief time we formed incipient friendships, exchanged Spanish greeting with the Latinos, and Black teenagers sang spirituals for us. Our peculiar dress and friendly manner made us non-threatening to the Black girls and boys, who undoubtedly had experienced hate and ostracism from white people.
12. Pilot and Boat Mountain Expeditions
With our best friends, the Wickeys, we undertook camping trips to iconic Ozark peaks, and in the case of Pilot Mountain, we planned to “live off the land.” Busybodies in our community managed to cancel our proposed wilderness expedition (too dangerous!), but our brother Harold came to our rescue by offering to accompany us, acting as a spiritual advisor. With rudimentary gear and supplies, we camped out on Pilot Mountain, spending the idyllic days in pursuit of squirrels and frogs, and foraging on wild grapes and persimmons. We fashioned a shelter from tree branches and gathered moss for bedding that allowed us to sleep comfortably and, equally important, we heard owls hooting.
13. Amish Religion and Culture
From my earliest memories I was aware we dressed oddly and lived differently than the “English”, but I was among the lucky ones, and heaven would be ours if we stayed Amish. Rumspringa, an Old Order Amish custom, was discarded by our self-exiled, reform-minded Amish community in Arkansas. The term rumspringa has become widely known, being used in non-Amish context, but is often erroneously portrayed as something encouraged and sanctioned by the Amish, whereas it is just tolerated. Unique features that distinguish the Amish religion from other Protestants is their belief in nonresistance (pacifism), a distinct form of dress, and avoidance of “modern conveniences,“ best known by their iconic use of horse and buggy. Old Order Amish do not have church houses but take turns gathering at a member’s home every two weeks. Amish trace their heritage to the Anabaptists, a minor contingent of the Protestant Reformation, and get their name from being baptized again for acceptance into the church.
14. Health, Medicine and Science
How much the Amish participate in modern healthcare is not part of their core doctrine but is largely left up to the individual. For example, there was no official teaching against vaccines, although as children we were not vaccinated because we did not attend public schools. My family saw a family doctor only “when necessary.” My father, a minister in our church, preached against modern healthcare, especially major operations such as heart surgery. The Amish are attracted to anti-establishment or marginalized causes and in healthcare they fall victim to reflexology and assorted other nostrums pedaled by unscrupulous practitioners.
15. Leaving Home
In my late teenage years I became deeply religious and sought to find the Christian church most true to the teaching of the New Testament. I did not join the Amish, as living a life I did not believe in was untenable. I took the difficult step of leaving my family, especially my two younger brothers, and traveled by bus to Pennsylvania where I lived with the Daniel Martin family. They were Holdeman Mennonites, who have the distinction of being the only Mennonite church that claims to be the one “true visible church.” I traveled with the Martin family to Ohio to attend a revival meeting that was followed by an eventful mission to New York City where we “witnessed” to a farrago of people who were hanging out at Times Square.
Fall and Winter in Pennsylvania
I registered with the Selective Service at age 20 (federal legislation designated age 18) and obtained a driver’s license, which was surprisingly laborious. Juxtaposed with a Sunday lunch with friends, during which a Holdeman man voiced his stubborn belief that people lived on the North Pole, we met with a Holdeman minister at a nearby church where I was baptized “upon confession of faith.” I had become a member of the Church of God in Christ, Mennonite. During a frenzied week at the Martin household, I sang tenor in a quartet with the Martin siblings, went to Wednesday evening Bible study, and at night caught “broilers” with their son Howard. When Friday night came we caught young chickens from ammonia infused cages and in the wee hours of morning, while driving home I fell asleep at the wheel and drifted silently into a snowbank but fortunately caused no damage to the car or its occupants.
1-W Service at St. Anthony Hospital
I began working as an orderly and a surgical technician at St. Anthony’s Hospital in Oklahoma City where I lived in the “unit house” for young men in 1-W service as conscientious objectors. A tall, muscular, social young man from Georgia, fulfilled his reputation for being “wild” when I accompanied him to a smorgasbord restaurant. Enroute, Dale made an illegal left turn, tried to elude the police, and earned a brief sojourn in jail. I evolved rapidly in my beliefs and religion which led to my being officially expelled from the Holdeman Church for dating a non-Mennonite girl, expressing a belief that banning musical instruments had no basis in the Bible, and a few other minor infractions.
Romance, College and Land of Parties
I fell in love with a nursing student and savored a celestial existence for a few months until she left me for her previous boyfriend. I suffered miserably for months from post-romantic rejection, having no clue that there are physical alterations in our brains (visible on functional MRI scans) and measurable changes in associated hormone levels that only fade with time. I enjoyed attending parties thrown for no particular reason, which were a regular part of life in Oklahoma, where invitations always read BYOB at the bottom.
19. Medical School
Being a medical student brought with it a wonderful feeling. I received a small stipend for being among the freshman students with the highest GPA. Obviously, I had excellent grades in college, but now I was competing in a vastly more challenging environment. My roommate and I took a stimulant for an all-nighter to study for an anatomy exam and in the afternoon when I took the test, I crashed and was completely unable to function. It was the only exam in college or medical school that I flunked and it came as a shock. I did not view medical school as drudgery, but a privilege, as my school had a solid reputation and was exceptionally affordable. The most memorable extracurricular activity was dropping LSD on a Friday night with my roommates and friends, and the psychedelic lived up to all expectations.
20. Internship and Residency Training
I was delighted to have matched with an internship at the University of Oregon and my friend and fellow medical student, Gil Child, also matched with the program. Gil and I had climbed Mount St. Helens a few years before the summit of this mountain slid off from a violent volcanic eruption, partially buried Spirit Lake, and took the lives of 57 people. My rotation on neurosurgery solidified my choice of specialty. Professor Harold Paxton chaired one of the more benign neurosurgery training programs in the US, and the lineage of that training program can be traced back to Sir Victor Horsley in London who is credited with performing the first craniotomy.
Fellowship and Neurosurgery Practice
After graduating from Dr. Paxton’s neurosurgery program, I completed a fellowship in a microvascular lab in San Francisco where I perfected my skills in microsurgery, allowing me to perform a new operation in neurosurgery: connecting an artery from the scalp through an opening in the skull to an artery in the brain to prevent stroke. After my fellowship, I began neurosurgery practice at Broward General Medical Center in Florida, confident of my technical skills, but made costly mistakes due to lack of experience. There was a scarcity of neurosurgeons at my hospital, allowing me to perform brain surgery regularly. In highly competitive communities, young neurosurgeons eke out a living performing spine surgeries, which are much less desirable than brain surgery.
22. Neurosurgery – Part 2
An exquisite microsurgical operation for the treatment of trigeminal neuralgia became my favorite operation. Descriptions of this diabolical condition, causing bouts of lancinating pain in the face, date back to the first century CE. As the disorder had no treatment until the modern era, persons afflicted with the condition often committed suicide. I write in detail about surgical complications that are the bane of a neurosurgeon’s life. I felt anguish and sorrow that lasted for months. A hallmark of an excellent surgeon is facing up to a complication, and doing everything to mitigate the injury instead of hoping it will go away, before it becomes a more serious problem.
23. Malpractice and Medical Errors
Physicians are loath to talk about being sued for malpractice as the stigma lingers. I argue that burying the issue is unhealthy—as long as you treated the patient correctly, you have nothing to be ashamed of. Our fault-based liability tort system is neither good for the patient nor the physician. It consumes 70 percent of the liability insurance premiums, leaving only 30 percent of the premium dollars to compensate patients. There are accepted definitions of medical error but Florida’s healthcare agency, with little medical expertise, defined a medical error in surgery as any complication not expressly written on the operative consent preoperatively. How can l list a possible complication in a new operation I learned when the complications of that surgery are still not known? Non-medical experts should not undertake to write medical definitions. This was a legalistic ploy to protect the hospital rather than the patient.
24. Haiti Missions
A devastating earthquake (Richter scale of 7) struck Haiti in January 2010, taking the life of 3.5 million people, including an estimated 10% of the healthcare workers. I flew to Port-au-Prince that summer with a group of doctors and nurses on a medical mission, working at Bernard Mevs Hospital. Each week, a new group arrived at the hospital to provide continuing care. My life on our Amish farm, where making do with less was a necessity, helped me to adapt to providing medical care with only basic lab tests, X-rays, and a CT scan. The next summer I returned for another week of service.
25. Ancient Operation Saves Trauma Victim
A few years before my retirement, I was awakened after midnight by our Level 1 Trauma Center to treat a young man who had sustained a severe head injury from an electric scooter accident. He was in a deep coma, eyes fully dilated and unreactive to light, a most ominous finding. I removed a large blood clot from his brain, and left out almost half of his skull to treat postoperative brain swelling. He made a spectacular recovery, extremely rare, and he subsequently invited me to visit him in the Dominican Republic where he lived with his father and I was treated as a royal guest. The ancient operation called trephination, which resembles the decompressive craniectomy I performed in this case, involved removing a small area of the skull and was mysteriously performed by ancient humans in many regions of the world. The Inca surgeons became masters of this operation, and at the end of their civilization they had achieved an approximately 80 percent survival, determined by remodeling of the skull that occurs only if the patient survives. Recently, there has been widespread acceptance that trephination was a therapeutic treatment for head injuries. I explain why this cannot be the case and offer an alternative explanation.