Henry "Red" Duke, Jr. |
November 16, 1928 – August 25, 2015
I met Dr. Duke my first day as an intern as I waited
wide-eyed and apprehensive in a conference room
at The UT Health Science Center at Houston in 1993.
It was the first day of our surgical internships, and
we had no time to enjoy wearing our freshly starched
white coats for the first time. And with good
reason: the program was structured as a “pyramid"
in those days, which meant that of the 9 interns sitting
in the room that day, only 5 would make it to a coveted
Chief Resident spot after a grueling 5 years of clinical
training, plus additional years in the laboratory.
In my case, I would be the sole survivor of the
intern class of ’93.
But I didn't know that then, and as Dr Duke entered
the room we were at once mesmerized by his larger-
than-life presence. He was the classic Texan, surgeon,
cowboy, and movie-star all rolled into one. He made
his appearance and brief speech to us with panache,
a cup of coffee in a styrofoam cup in his hand.
A down-to-earth welcome flavored with true
hospitality greeted the group, many of whom were
out of state. A nice letter typed up on the departmental
letterhead completed the process.
He seemed genuinely concerned about all of us interns,
I could tell. Today, I know he was also giving us the once-
over. He knew he would be having each of for lunch
before the year was through.
A week later in the ICU, I had my first teaching from
Dr Duke as I prepped a patient for a minor procedure.
“One thing, it was just one damn thing I asked you to remember.”
He strode off out of the unit to go attend to other things
while everyone looked at me, standing there stupidly at
the bedside. I honestly didn’t know what a DeMartel
clamp even looked like, but then suddenly remembered
that he’d asked me to have it ready the week before.
I carried one around for the next 5 years in my white
coat pocket, and there's still one in my desk drawer to
He was that kind of surgeon: regimented, by-the-book, an
Eagle Scout, and not too tolerant of poor preparation.
Worse yet, he often loathed the “new silly shit” we were
always pulling on him. He would listen to our proposed
treatment plans on occasion, but I learned mostly to shut
up and watch.
I learned, way later than you might think, that his chief
concern was for the well-being ofhis patients. His version
of teaching was not trying new things or doing research, it
was showing us the value of what was tried and true to
keep patients safe and outcomes predictable. As such he
was often at odds with his colleagues at the University,
and even us, the lowly trainees.
As I advanced in the program I was at times frustrated
by his ways until one night during my 3rd year. I was
hurrying off to surgery with another doctor to use the
newly developed video-laparoscope to remove the
gallbladder of a very ill patient, I excitedly told him
of our plan. He remained silent, and we
Five hours later I emerged from the ICU after barely
stabilizing the patient, who ended up never leaving the
unit. As I left, ashen-faced and in disbelief, I looked up
to see Duke in front of me. He would be in the
hospital at the oddest hours.
“Bit you in the ass, didn’t it ?”
That was his way of saying “the procedure you selected
didn’t afford you the exposure needed to get control of
the bleeding. And you ought to have expected that,
but by the time you opened up to get in there and stop
it, it was too late.”
In the years ahead, I was to learn that he was intolerant
of a lot of things. And I realized it wasn't really the new
procedures he didn't like, it was the bad outcomes he
so hated and strived to avoid.
Today, I navigate a system driven by cost-containment and
"efficiency." I also drive by billboards and see the TV ads of
the personal injury lawyers. Drug and medical device
names explode the headlines, promising millions in malpractice
and product liability settlements"
"These are different times" I think.
But then I realize that not everybody got to train under
We spent hours together in the emergency room, his second
home. He’d sit an an old schoolroom style wooden chair with
side-arm desk attached. The thing was from the 60's and
encrusted with carvings, inscriptions, and medical graffiti.
When needed, he'd be in the room directing the organized
chaos that was a trauma resuscitation. When multiple
patients would arrive, he might get up and enter the room
to help us prioritize the plethora of xrays, lab tests,
IV catheters, and drainage tubes that critically injured patients
were subjected to.
“Now it’s gittin’ interesting”
He was always an island of calm, and never lacked direction.
In emergency surgery, he stayed as calm as the goats they put
to pasture with racehorses to prevent them from getting
too riled up.
When, and if, you earned the right to actually hold an
instrument during surgery, his demeanor was an immense help. If you were
clumsy or unpracticed, you would be quickly be relegated to
cutting stitches the rest of the case. For good measure, he
would add a few choice comments, ensuring that we had a
good case of "chewed butt syndrome" to think about on the way
out of surgery.
“Shortcuts and shit? Is that what they teach you here?”
It wasn't easy working with him much of the time, but we
warned the junior residents what to expect, and it seemed they
either "got it" after a short while or they didn't.
Those who didn't usually weren't in the program too long. Fair
or not, that was the nature of the training and Dr Duke and
the other faculty put out a fine group of surgeons, and
many of them now lead their own departments at prestigious
institutions across the nation.
Dr Duke founded Hermann Life Flight. You couldn't think of
those big red helicopters without also imagining Dr. Duke
being on the other end waiting to care for you. It was an
enormously reassuring feeling, and we felt special that our
city had those angels buzzing around overhead. Ours was
one of the earliest helicopter evacuation services in the
country, and Dr Duke he knew the flight crews like family.
It was his idea to assign the interns to "do scenes" on the chopper.
That meant strapping in, holding on, and trying to
stay out of the way while the flight paramedic and nurse
sorted things out in the middle of a highway or at some job site
where something had gone terribly wrong.
Assigned in 24 hour shifts, I was just coming "on" one evening
when I heard a "physician to the helipad call" from my
counterpart on the helicopter. I ran to the OR and tried to
help the nurses set up.
"Lets get a chest set out, Bobbie."
"It's in the room, you open it."
Minutes later the patient exploded in the room, CPR in progress,
right as anesthesia arrived. My buddy had managed to get a
breathing tube in and he had an IV. A quick look at the
monitor showed his heart was beating but his color and a
quick pulse check showed that he wasn’t pumping blood.
His left chest was rounded and bulging out.
Dr Duke walked in, took one look, and barked "get a damn chest
tube in him."
He turned to find me standing there with a clear tube resembling a
small garden hose in one hand and a scalpel in the other.
|2 AM with Dr. Duke|
The author performing a repair of a ruptured diaphragm with Dr Duke
Hermann Hospital 1997
"Are you gonna put it in, sunshine?"
Seconds later a huge rush of air and blood shot out across the
room from the small incision between the patient's ribs.
That which didn’t hit me splattered on thewall. The room
seemed frozen for that few seconds as the patient's color
immediately came back. I don’t remember anything else other
than Dr Duke using his funny, Jed Clampitt singsong voice he
reserved for moments of extreme light heartedness:
"Well lookie there."
It was small victories like this and Duke's way of acknowledging
them that gave you hope you might survive, but also kept
you on your toes.
Our training extended beyond the O.R. with "Red", as I came to
call him in my final years in the program. He could be found
cooking a pizza during happy hour in the kitchen of
our favorite dive bar in
. He'd bring turkey every Rice Village
Thanksgiving to his call room in the hospital that served as his
apartment much of the time. The small group of tired residents
unlucky enough to pull call that day were all invited.
As residents, he knew we were under a lot of stress and were prone
to excess in our time away from the hospital. He briefly attended
one of our happy hours, and a few of us remained there well into
the evening. The next morning on rounds, Red noticed a team
member absent from the lineup "Where's sunshine?" (his name
for any generic junior resident whose name was not yet worth
"Umm he didn't make it in this morning." I said.
"What, he get drunk....arrested ?"
"Yeah, in the parking lot before he got in his car. We tried to stop
him but the cops got there first."
"Aw hell you should have called me, I would have bailed him out."
He was just that kind of a person, true to himself and understanding
of others. His TV persona was as big as
Texas, but that was just
one color in the palette. He had a heart big enough to share with a
lot of people in many ways. Dr Duke the Eagle Scout, the Aggie,
the tank commander, the
Afghanistanfield surgeon, the cowboy,
the professor, and more.
Simply knowing him you got a taste of all of that. He would tell
outlandish stories, and we would make our own as we went
"Back in '71 we were developing this new dialysis solution in the
laboratory, you see. There at
Parkland Hospital. This other
surgeon and I would mix this stuff up in a big vat.
And that crazy bastard was funnier than a rubber crutch,
he'd be smoking a cigarette the whole time."
My memories of Dr Duke are many, and they run the while
spectrum of what we all went through doing what we did
in those days. Although 2 decades have passed, it still seems
like yesterday. I never once felt sorry for myself after his
numerous reprimands, because even then I knew
where they were coming from. Today I am grateful for them.
Words are hard to come by when writing about someone
who made a difference for so many but I know that I,
and all of us who trained under him honor him every
day in caring for our patients the way he would have.