Remembering Sylvester Parham
1963, University of Mississippi Hospital, Jackson
The enduring appeal of clinical medicine is, of course, the patients. In a way, the joke’s on me: I am a pathologist, which, apart from laboratory research, is about as far from direct patient contact as practicing medicine allows.
Pathology attracted me in the sophomore year of medical school because I had enjoyed anatomy and physiology as a freshman, and pathology is nothing more than anatomy and physiology gone wrong. It was fun to study, I made good grades, and the professors gave me attention that was flattering. Satisfying though it was, like every other medical student I eagerly anticipated the junior and senior years, during which we were to rotate through surgery, obstetrics and gynecology, pediatrics, internal medicine, psychiatry and a few specialty electives. Eager though I was, I was wary, too: I had watched how general practice in a small town had consumed my father. He was a solo practitioner in a time when the doctor was always on call. And he had other problems—a toxic mix of smoking, drug addiction and alcohol abuse. I was certain the stress of patient care contributed to his death at age forty-seven.
During the third and fourth years of medical school I found it difficult to confront the harsh realities of severe, deforming, or crippling disease. It was not revulsion, far from it. Rather it was the stark reality of my vulnerability to the terrible conditions I encountered: disfiguring burns; neck fractures with complete paralysis, and throat cancer patients breathing through a hole in their neck. Pathology, on the other hand, was appealing because I loved the science, and it didn’t require confronting such unpleasant realities.
After graduating from medical school, I became an intern and relished the expanded responsibility, authority and freedom of action that came with it. The drama and intimacy of direct patient care was not as glamorous as modern TV medical soap operas; it was decidedly more gritty, compelling, and seductive. By the middle of my internship year, I was questioning my earlier thoughts about pathology—late at night in the subdued light of hospital corridors or the rooms of sleeping patients, I would rewind the mental tape and replay the debate.
The matter crystallized while I was serving a three-month assignment on general surgery. I was assisting two resident surgeons exploring the pelvis of a man with a large bladder cancer. Actually, I was just standing there like a statue, holding a retractor to keep intestines out of the way, but I had a clear view of what they were doing deep in the pelvis to remove his bladder. Bleeding was becoming a problem—blood welled up into the operating field at an alarming rate from some source deeper than we could see. They couldn’t get it stopped: they’d suction blood out trying to see the origin, but more blood quickly appeared.
By the tone of their voices, I could tell desperation was mounting. I wondered if they’d call a staff surgeon for help, a bald admission of they were in trouble. As I watched them struggle, an idea began to form. In preparation for the surgery, I’d boned up on the anatomy of the bladder and pelvis, which included detailed illustrations of the blood supply. The bleeding had to arise from some small branch of a nearby larger artery that ought to be nearly and easily exposed. They could expose it, clamp it closed to stop the bleeding, suction the area dry of blood and slowly loosen the clamp to restart enough bleeding to identify the bleeder.
Finally, timidity succumbed to the bullet-proof confidence familiar to most 24-year-old males, I ventured to make the suggestion, worried all that all I would earn was scorn. They clamped, the bleeding stopped, they found and tied off the bleeder and the remainder of the surgery proceeded as planned.
I thought little more of it until a few days later I was summoned to the surgery chairman’s office. it couldn’t be good. I was being called on the carpet; that was certain. Imagine my surprise when he referred to the case and appealed to me to become a surgery resident in his program after my internship year. I was flattered and began to consider the possibility.
Then along came Sylvester Parham. Though it is a violation of the usual code, I am remembering him by name because I wonder if anyone other than me, even in his own family, remember this poor, young black man from rural Mississippi now gone over forty years. But Sylvester can never know how he affected me: he died while in my care. Even had he survived, “thank you” is not the right sentiment.
Sylvester was nineteen, just out of high school nine months earlier, and had bought his first car. His mother told me how he loved having that old car even though it always needed tinkering to keep it going. One fine day in the spring of 1963 Sylvester and a friend were cleaning out the fuel line. Sylvester, bending over the engine end of the line, cigarette in his mouth, asked his buddy back at the gas tank to “blow on it” to clean out the line. The spray of gasoline covered Sylvester and he exploded in flames.
I first saw him in the emergency room. I had seen burns before, but nothing this bad, nor this fresh. He was delirious with pain, hair and eyebrows burned away, the pink under-surface of his black skin showing through, the remainder blistered or hanging in shreds. The only unburned skin was around his genitals, in the crease of his buttocks, where his shoes covered his feet, and where his belt fitted around his waist. And the smell of burned flesh and hair awful. It was all I could do to stay in the room. I wanted to run, not because the sight, the smell, or his screams were too much for my senses, but because I could not bear was being on intimate terms with such agony and tragedy. It was too easy to put myself in his place and to imagine the pain and despair.
His mother brought a picture and propped it in the window of his room. He was a robust, handsome young man, only a few years younger than me, but I could not match his face to the swollen, grotesque mask that lay nearby. I tried to be optimistic, but I wasn’t very good at deception; my heart wasn’t in it. I knew, and she knew, he was going to die. Within a week his burns became terribly infected with a bacterium that stimulates copious amounts of malodorous, thick, green pus, and I found it almost impossible to go into his room. But his mother came every day; she never flinched. In the face of such courage only the shame of cowardice drove me through the door and into his room to confront my inadequacy and his agony.
Sylvester lived thirty terrible days and I was with him much of the time. By the time he died I had was certain I could never be a surgeon or practice any other discipline that offered much chance of having a case that would so overwhelm me. I was never tempted again.
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