Dr. C. Everett Koop, the 16th
Surgeon General of the United
States, is a formidable man.

First, there is his aflpearance. At
6' I" and 210 pounds, the bearded,
Lincolnesque Koop would abso-
lutely dominate any room he was in
were it not for the softening effect of
his gentle speech patterns and his
unfailing sense of humor. He looks
more like a grandfatherly, under-
standing psychiatrist than the
world-famous pediatric surgeon
that he is.

Then, there are his achievements.
He was the sixth surgeon in the

United States to devote his full
surgical practice to children only.

He created the first neonatal
surgical intensive care unit in this
country.

He is known throughout the
world not only for the extraordinary
surgical procedures he has per-
formed - such as separating Siam-
ese twins and reconstructing parts
of the body that did not turn out just
right in the first place - but for the
ordinary operations he has done
that have guaranteed a better qual-
ity of life, 07 even life itself, for
thousands of babies.

He has written I35 articles and
four books, one of which was
dictated to a secretary in a single
day.

He is a man who has the absolute
courage of his convictions. An
ardent anti-abortionist, Dr. Koop
was an active anti-abortion cam-
paigner and proponent of preserv-
ing the sanctity of life prior to his
appoint)nent as Surgeon General.
He has said that he will not use his
job "as a pulpit for ideology."

During an hour-long interview
with Mimi Craig, Noreen McHugh,
and June Shibe, members of the
TODAY'S OR NURgE editorial
board, and Ann Caputo, managing
editor of this publication, Dr.
Ko?p spoke freely and favorably

about the operating room nurses
with whom he has worked. All
four women were influenced by
the simple impressiveness of the
man and by his forthright views
on the nursing profession and,
specifically,  on operating room
nurses. The conversation among
Dr. Koop and the representatives
of TODAY'S OR NURSE follows.

13


I set myself the task, in 1946, of building
the most comprehensive group of pediatric
surgeons anyplace in the world, and I think
I succeeded before I left Philadelphia.

Q

What made you decide to special-
ize in pediatric surgery?

0

How did you go about setting up
the first neonatal surgical intensive
care unit?

A

I have to be very honest and tell
you that there was an opportunity,
which I seized, and I seized it
because I didn't think the children
got a fair shake in surgery. They had
to compete with adults for every-
thing they had. So I set myself the
task, in 1946, of building the most
comprehensive group of pediatric
surgeons anyplace in the world, and
I think I succeeded before I left
Philadelphia.

A

I actually did that with a grant
from the Children's Bureau, which
was not a funding agency in the
usual sense of the word. But through
the good offices of Dr. Ivy, the
plastic surgeon of Philadelphia
fame, who had a lot of connections
in the Children's Bureau, they
finally listened to my plea. The
Children's Bureau funded it for the
first three years then the State of
Pennsylvania took it over and even-
tually it was part of the categorical
grant-half federal funds, half state
funds.

0

When you're dealing with sur-
gery on a child, do you think that
your thought process differs a little
from how you would think if you
were considering whether or not to
do surgery on an adult?

A

No, I don't think so. I think the
major difference is that you can't

take the patient into the decision-
making process about what you're
going to do. Instead of that you have
two parents and sometimes four
grandparents, so it doesn't become
any less complicated. I don't think
that in making decisions about
what to do, that it ever made any
difference to me whether the patient
was two pounds and two minutes
old or whether he was 200 pounds
and 50 years old. Decision-making,
is the same.

0

You've operated on a lot of
children. Do any of the children
that you've operated on keep in
touch with you?

A

_ -

Oh yes, especially at Christmas
time and especially those who have
gone into medicine or dentistry or
some other paramedical- group be-
cause they have become interested
in this during the time they knew
me. A lot of my patients know me
for years and years, you know, and
some of them get very concerned
about health carp and decide they
want to go into nursing or some-
thing like that. So those groups
particularly do keep in touch.

14


Q
Any pediatric surgeons among
that group?

A

Not yet. But I can tell you that one
of the most poignant moments of
my life was when I made the film,
"What Ever Happened to the Hu-
man Race." There was one scene in
my living room and I had eight of
my patients around me. These were
all children I had operated on the
first day they were born and they
were now up to 34 years old. What I
was trying to do was bring out to the
audience that would be seeing the
film the idea that these kids, no
matter what they had been through,
thought life was very special and
very precious to them.
I asked this one gorgeous, brocn-
eyed, black-haired, Italian girl on
whom I had done a colon transplant
- I put her colon in the place of her
esophagus - and I asked her what
she thought about her life. I said,
"There are people who said I tried
too hard, I did too much to you, it
3ost too much money and so forth."
She interrupted me and said, "No, I
have a better quality of life than
most people and besides, if this
hadn't happened to me, how would
I know I wanted to be a pediatric
surgeon?"

Q

In our January issue we had an
interview with an OR nurse in a
children's hospital. She said that
one of the things that pleases her
most is that the children keep
coming in to see her, and she's seen
them grow up physically and found
that they're not scarred either men-

15


I would like to be remembered as a person
who recognized public health problems,
addressed them, and handled the difficulties
that had to arise with justice.

tally or emotionally, and that gives
her a feeling that she has actually
accomplished something.

A

I think that in pediatric surgery,
more than in most brands of surgery,
you get to play a very important
part in the families of children that
you operate on when they're born.
So you grow up with theirproblems.
If you have a child with an imper-
forate anus, that's going to be a
patient for 12 years. You get to
know the families very well and get
in on their decision-making process
- where they ought to go to school,
what they ought to do for their
hobbies, and so forth. It's a very
satisfying kind of a life. I'm so sorry
I left it.

You said that you think the
Surgeon General should be the
family doctor to America.. .

A

I didn't say I thought he should
be. I said in my confirmation
hearings that many people regarded
the Surgeon General as a family
doctor in thesense that they expected
him to give them competent and
truthful advice about the preven-
tion of disease and the promotion of
health.

Would you elaborate on another
quote? You have said that you want
to "reverse the tendency of the
practice of medicine to be described
as `a health delivery system.' It
sounds as if you're eating cereal or

16


   <delivering gasoline. I would like to
   see the personal aspects of medicine
   restored and say a patient is a
   patient and not a consumer, and a
;     doctor is a doctor and not a health
   care provider."

A

Well, I think that's perfectly
clear. When you talk about the
health care delivery system, I think
the consumer or the patient begins
to think of this as some great big,
monolithic structure from which
perfection is to be expected. And
wheh things don't go totally the
way he'd like them to, he forgets
that we aren't like carburetors and
we can't be adjusted to a fine point.
There are certain things that you
can't always fix. I think it's a
mistake in this big monolithic
system that leads to so much mal-
practice litigation.

Then, I would hope that you, as a
nurse, would share with me my
concerns that I do a better job when
I know I'm a doctor and you know
you're a nurse, than when we are
just providers giving somebody
what they're entitled to. And I
certainly, when I'm a patient, want
to be a patient and not a consumer. I
just think these terms take out the
very thing that I went into medicine
for, and that is the personal contact
between physician and nurse and
the patient.

Q

In the personal contact area,
where do you see the nurse in the
hospital, particularly the nurse in
the OR, fitting into this kind of
practice of medicine?

A

Well, I think she's a very impor-
tant part of the team. I think that the

care of the patient is a team effort,
and I am perfectly willing to see the
nurse do any aspect of that job that
she is qualified to do, and that will
vary in different places at different
times. The only thing I think one
has to be careful about is that there
always has to be a captain of the
ship. You can't have two different
sets of people giving two different
sets of instructions to families,. two
different prognoses, two different
plans for treatment, and that sort of
thing.

As far as the operating room is
concerned, I think that it should not
be just a technical exposure to an
operative procedure. But, just the
way a head nurse is someone who
has had experience doing a variety
of things, and therefore her various
kinds of competencies are brought
together in a supervisory job, I
think that the nurse in the OR
should have been a nurse taking
care of patients. And particularly in
reference to the OR, she should
know about the preoperative prep-
aration and the postoperative care,
particularly in a recovery room or
an intensive care unit, so that she
just doesn't function as a technician
doing just one little job, but sees
herself as fitting into one segment of
a continuum of care. I think that
makes her far more intelligent, to
see the things that are happening
and to become part of that team
rather than just a technician.

0

Then you do see the need for an
RN in the OR?

A

Oh definitely. Had we decided we
didn't want them?

Q

Well, we have another question.
What are your feelings about the
proposed change in Medicaid, Med-
icare regulations that would permit
technicians and licensed practical
nurses to circulate in the OR?

A

Well, I think what I was just
trying to say to you is that when you
have a person who is an RN, she has
broad vision, and she knows the
patient from previous days and
from different kinds of experience,
and she's going to see the patient
postoperatively. Whereas, if she is
just a technician, then she's looking
with gunbarrel vision at that pa-
tient as a technical project, and I
don't think that's good.

Let me give you an analogy. I said
that I wanted to develop the m&t
comprehensive group of pediatric
surgeons anyplace in the world and
I think that I did. I could never have
done that if I hadn't been, more or
less, a surgeon of the skin and it's
contents 35 years ago. Because I did
cleft lips and cleft palates and club
feet and fractures, and I did hydro-
cephalus and spina bifida. So when
I tried to develop plastic surgery,
urology, orthopedics, I knew the
breadth and the depth of those fields
and could provide for my colleagues
the environment in which they
could do their, best work. I think
that's what the RN does in the OR.
She has depth and she has breadth
and she has a perspective which you
can't get elsewhere.

Q

Given the contributions of nurses,
a lot of nurses are concerned about
the "shortage of nurses." Some
think there really is a shortage of
          continued on page 51

17


INTER VIEW continu'ed from page 17
                          L

nurses, some think they're just not
distributed properly across the
country, and the main problem
seems to be that there are a lot of
registered nurses who are simply
not practicing. Would you have any
suggestions on what could be done?

A

I would like to withhold anv
suggestions I have because right
now, as you probably know better
than I, Congress has asked for an
investigation of this and has asked
the Public Health Service to look
into the so-called nursing shortage,
and we have contracted this task to
the Institute of Medicine. It is a two-
year study. The first preliminary
report has been submitted to Con-
gress, and in about 18 months we
will have a very comprehensive
report that I think will answer just
those questions you asked me -1s it
a real shortage or an apparent
shortage? Is it distribution or is
there something about nursing
which is not as satisfactory after you
become a nurse as you expected it to
be, and therefore you drift off into
another profession? I think the
study will address those things and
then we'll have to do something to
be sure that we can work it out so
that whatever the problem is, we
correct it.

life. I think they're different in
different hospitals and under differ-
ent kinds of circumstances.

I do think that we demand a
tremendous amount of concentrated
effort from certain nurses, and I
would identify those as intensive
care nurses, nurses who deal with
cancer in children, for example,
nurses who are involved in the
operating room where you run just
back-breaking schedules. I think
they burn out because of the inten-
sity of the concentration that they
have without any relief. And, if
indeed I'm right about that, then I
think one of the things we have to
think about is rotating them off so
that they see another aspect of
nursing and come back having
learned something to further con-
tribute to what they're doing and
maybe prevent that burnout.

But that's just one little aspect of
why nurses don't continue in the
job, and I'm going to wait for the
Institute of Medicine report before I
tell you any more.

0

I just want to verify something.
Do you have any input into the
legislation that would change the
regulation and then would allow
technicians to circulate and assume
the responsibility in an OR?

Q

Having worked with nursesmuch
of your life, why do you think there
are so many nurses leaving or, more
precisely, not practicing?

A

Not specifically. The department
does have a role in legislative
packages that go up to the hill, but I
have not been involved and I don't
plan to be involved, as far as I know,
in that particular legislation.

A

I don't think you can answer that
question for everybody or for every
hospital or for every nurse. I think
things are different in different
parts of the world. I think they're
dif&rent at different times in a girl's

Q

Another problem that operating
room nurses perceive is that many
of the nursing schools across the

continued on page 67

51


INTER VIEW continued from page 51

country no longer include operat-
ing room nursing in thecurriculum,
which means that the students
aren't exposed to it and there's a
mystique about the OR. In short,
they're afraid.

A

Yes, I think fear is a better word
than mystique. If you could make it
a mystique you could keep them,
you could attract them. I have been
opposed *to this from the very
beginning when the curriculum
began to be changed in Philadel-
phia, and various places, and girls
did not rotate through.

I don't think we ought to go back
to the days when I was a medical
student where you had one girl who
just stood with her hands in warm
water wringing out sponges and
couldn't see what wasgoingon. But
I think unless you rotate a nurse
through the operating room, she's
never going to understand what role
the operating room plays in the
total care of the patient and it is
going to be a frightening place for
her. If you've never been in it, you
look upon the people there as very
special elitists, and it doesn't look
like a friendly place at all.

And yet the operating room that I
ran at the Children's Hospital of
Philadelphia was, I think, the hap-
piest part of the whole hospital. The
five girls that had been with me the
longest had 137 years experience
with me together. We had a great
feeling of camaraderie because we
had one goal - we were trying to
get as many unusual kids through
very complicated surgery with as
few complications as we possibly
could. I think that they shared in the
triumphs and successes that the
surgeons had. I used to make it as
much a part of my conversation
with them as I could to bring them
up to date on patients that I had
seen last week, that they had seen
the previous week, the previous
month, the previous year. Some-
times when we had a teenager come

back that some of those girls remem-
bered as a newborn, I'd take her up
to the operating room and strut her
around so that they could see why
this was worthwhile. If you can see
something more than just an open
abdomen on a premature and know
that eventually becomes a function-
ing human being that's going to go
out and get married pretty soon,
then I think you realize that you've
made a real contribution and you're
not just a cog in a wheel but you're a
member of a team.

When Florenz Ziegfeld had the
Ziegfeld Follies, he had written over
the door, along the lintel and over
the top that went from the dressing
room of the chorus girls onto the
stage, the words, "Through these
portals pass the most beautiful girls
in the world." Every Christmas I
used to put that on the door of the
operating room in the Children's
Hospital, "Through these portals
pass the most beautiful girls in the
world," because I told them many
times, they were beautiful in their
effort. They all would sign their
communications to me, "The most
beautiful girls in the world".

As a matter of fact, when I retired
they gave me these two retractors
that I must have used on about
17,000 hernias. The day I was
confirmed, they sent me a balloon
bouquet from "the most beautiful
girls in the world."

Q

While we're talking about the OR
nurses, what are the-chief qualities
you look for in nurses who are
going to be working with you in the
operating room?

A

Two very simple things -people
that I get along with and people
that are teachable. Everything else is
secondary, I think.

continued

67


INTER VIEW

Q

Do you expect the nurses in the
operating room to take independent
action on their own?

A

I think they can take independent
action on their own in certain ways.
One way is to recognize that in a
children's hospital, the patient
needs a different kind of support
than if it's an older person. The
girls in the OR that I come from did
that beautifully. They just stepped
right in, made it a happy, joyful
kind of occasion, played with the
children, kidded with them, poked
fun at me and that sort of thing for
the benefit of the children.

I don't think there's anything
more satisfying to a surgeon than to
work with an operating room nurse
and you don't have a single missed
motion. I did so many hernias and
undescended testicles that I used to
say to the new girls - "You're
going to feel strange in the begin-
ning. It won't go as well as it will in
the future. But let me tell you that
the day I will feel that you and I are
working as two pieces of one
machine is the day that I never have
to look at you, and we get to the end
of it and say we didn't have a wasted
motion."

I think that must bring satisfac-
tion to a nurse as well. There aren't
many opportunities for indepen-
dent action on the part of nurses in
reference to the specific patient.
There are in reference to the man-
agement of the operating room, to
the management of the children in
the operating room, and to ways of
cutting down on procedures that
will save the patient time and will
eliminate risk. I have always kept a
very informal attitude in the operat-
ing room so that operating room
nurses felt free to say, "Whydon't we
do this or that? Why do we have this
many kinds of suture when we can
do it with only half as many?"

I prefw to see nursing
not get @intered into
different kinds of nurses
so that one cannot shift
from field A to field B.
I think that will further
  un&rmine the
shortage situation.

Q

Nurses are now seeing themselves
as patient advocates. How do you
see that in the operating room?

A

Well, I hate the term because it
sounds as if the rest of us were doing
something to the patient so that the
patient needed an advocate. I don't
think that they do. I think the idea is
all right. What I think this all
started from was nurses seeking a
role where they would be appreci-
ated as the individual who saw the
whole patient, saw the patient in
the family, and acted in such a way
that all those things were addressed,
where there might be an opportun-
ity for the physician to look at it
more with gunbarrel vision, But I
don't look on that so much as
advocacy as I do on a nurse recog-
nizing that the patient is a whole
person and that there's more than
just his wound to be taken care of.

Q

Would you  encourage your
daughter or your granddaughter to
become a nurse?

A

I think it's always been thought
of as probably one of the most
satisfying professions. I have three
granddaughters, and certainly if
they had the slightest inclination to
become a nurse, I would do every-
thing I could to encourage them. I
think in any profession that takes as
much personal dedication as nurs-
ing, that you should not do it as a
livelihood. Or to put it another way,
it isn't something you should do
unless you found you couldn't be
happy doing anything else. I think
it's a calling. I don't think it's just a
job.

Q

Is the emotional climate any
different in the operating room
when the patient is a small baby, or
even a child, as opposed a full-sized
adult?

A

Again, I think it depends on how
familar you are with what you're
doing. When I was a resident and
operating on large adults, just the
thought of doing a baby scared me
to death. Toward the end of my
career, an adolescent was frighten-
ing to me. I preferred a five pounder.

Q

If the opportunity presented itself
over this year, could you or would
you operate on a child?


A

I don't think that I probably
would. First of all, I haven't oper-
ated for almost nine months now
and if I were to do an operation, it
would be responding to someone
who asked me to do a special favor.
And I think if I wanted to do a
special favor for that person, I
would put him in the hands of
someone who was operating every
day.

Q

One of the things we all realize is
that the general public doesn't
understand what a nursedoes, never
mind in general but specifically in
the operating room. What.do you
think nurses could do to get their
image across to the general public,
not only correctly, but to gain a
little more respect?

A

I don't think that nurses are
lacking in respect. I think the
public respects nurses. I think that
what has crept into the public's
image of the nurse is the same thing
that has crept into the rest of our
lives, and that is that the media,
particularly television, have dis-
torted what a nurse is supposed to
be. You seldom see a nurse that isn't
depicted as a sex symbol or some-
thirrg like that. I just think that
nurses have to work hard on their
PR and demonstrate the kind of
things that they do best.

c2

That's tough though, especially
when you're an OR nurse.

I think that in a
pluralistic society,
someone who is
omosed to something
has just as much right
to talk against it as
someone who is in
  favor of it.

Sure it's tough. It's tough when
you try to project any image that's
become tarnished because of the
way one might to treated on tele-
vision. But I think you just have to
be innovative and make clear what
the true mission is. I have that
problem right now with the Com-
mission Corps of the Public Health
Service. Many people don't know its
mission, don't even know its exists,
and are reading periodically in the
newspapers how the OMB (Office
of Management and the Budget) sees
no reason for its existence. One of
my jobs is going to be to try to
change that image so that people
out there in the world know what
the Public Health Service does for
them, and what they would be if
they didn't have that aspect of the
Public Health Service working for
them.

Q

Would you tell us, briefly, how
the Commission Corps fits into
that?

A

The Commission Corps is one of
the most remarkable things that this
country has. There are about 6,000
commissioned officers - doctors,

nurses, dentists, veterinarians, san-
itary engineers, civil engineers, die-
ticians, physiotherapists, radiother-
apists, and so forth - and this
group of people is the only rapid
deployment force for a national
emergency that we have in this
country. If there is a nuclear leak at
Three Mile Island, or wastes that are
noxious to people at Love Canal, or
people are dying of heat strokes in
Los Angeles, or there is an eruption
of Mt. St. Helens, these are all
public health problems and every
public health commissioned officer
is available on immediate notice
to go any place in the world where
he is sent. This is what protects you
from exposure to some of these
things that go on in our society.

If you count the reponses that the
commissioned officers at the Cen-
ters for Disease Control in Atlanta
respond to in the course of a year, we
have over 1500 such emergencies.
When the Cuban/Haitian refugees
arrived in such large numbers on
our shores earlier this year, we had
125 people down there in no time@
all and we rotated them through so
that about 450 of our doctors served
down there. We also had some
sanitation engineers and some den-
tists and some nurses and so forth to
do the whole job. But that is the
only way that this country is
equipped, at this moment, to re-
spond to such an emergency.

0

You mentioned the Haitian refu-
gees. I talked to some nurses in
various parts of the country who are
concerned about large groups of
people from other countries coming
in for medical care. They feel that
they can't communicate with them,
even if they know their language,
because their health ideas are differ-
ent from our American ideas. In-
cluded in your Commission Corps,
do you have people who speak other
languages and who are familiar

continued on page 74

69


INTER VIE Wcontinued from page 69

with the strange ways some other
countries may handle a health
problem?

A

We don't always have people who
can sneak the various dialects that
peopie arrive with, especially when
they come from Indochina. But
what we do have is a large group of
people who have spent time with
our Indian Health Service. They
know a lot about folk medicine.
They know a lot about the ways that
medicine men treat patients and are
sympathetic to that form of health
care. I think that they are, for that
reason, particularly understanding
of people who come with a whole
different system of health care, from
say Haiti or Vietnam or someplace
like that.

Q

Back to the nurses again. A lot of
the nurses I've talked to are very
concerned about other things that
are happening in health care, for
instance,  paraprofessionals like
physicians' aides. Now they have
medication technicians in a hospital
down in Houston whose job is
simply to give medications to pa-
tients. And there are also a lot of
LPNs. Nurses are afraid that they
are being phased out of the system.
I even read an article recently about
a futuristic health care system that
did not have nurses - it had medi-
cation technicians and IV tech-
nicians and you-name-it-hyphen
technicians but no nurses. Would
you have any suggestions to offer
to nurses?

A

Well, I think one only has to look
a,; history to see that this doesn't

work very well. We never had
medical manpower shortages dur-
ing the last two wars - more than
the last two wars. We didn't have
them in Vietnam. We didn't have
them in Korea. We didn't have them
in World War I and World War II.
But our enemies occasionally had a
real shortage of manpower. When
they turned over the care of patients
to technicians that were neither
doctors nor nurses, they might have
been able to do certain things well,
but they couldn't do the broad
aspects of medical care that's neces-
sary.

I think that's really the saving
grace for nurses. As we said before,
they have the breadth of under-
standing. They have the back-
ground and I think these people
will always be a very important part
of the delivery of any kind of health
care in this country. If indeed it
turns out that we do have true
shortages of nurses, then it makes
sense for these people who are RNs

continued on page 76

74


INTER VIEW continued from page 74

to be in a supervisory capacity and
in a teaching capacity so that we
stretch our resources to the limit in
order to provide the care that we
think a patient should receive.

0

In other words, it behooves nurses,
to let people know, often and loud,
exactly what they can do in health
care services. What do you think of
the nurses who specialize - mid-
wives, gerontological nurses, psy-
chiatric nurse specialists?

A

I think there are true specialities
and those that are just sort of a
special interest. I think , for exam-
ple, that urology is a true specialty. I
think someone who gets very pro-
ficient at doing mastectomies has
not created a new specialty. I think
there is difference, therefore, be-
tween those two things.

I prefer, I think, to see nursing
not get splintered into different
kinds of nurses so that one cannot
shift from field A to field B because I
think that will further undermine
the shortage situation and, inciden-
tally, this is another aspect that's
being addressed by the Institute of
Medicine - nurse specialization. I
think there's no doubt about the fact
that there are some very critical
shortages presently being addressed
by nurses such as primary care
nurses and nurse midwives.

0

Nursing is a profession and a
calling. How do you feel about
unions in the nursing profession?

Every Christmas I used
to put on the door of
the operating room,
"Through these portals
pass the most beautiful
girls in the world." I
told them many times,
they were beautiful
  in their effort.

A

I am not opposed to unions in
general. I think there was a time in
our country when unions were
absolutely essential to bring about
the changes that they did bring
about. But I have to say that I still
think you shouldn't mix up unions
with a calling.

0

Can you describe any experiences
that you've had with nurses in the
operating room where the profes-
sional quality of those nurses has
been shown and saved the day?

A

I like to think again about treat-
ing the whole patient and being
concerned about what goes on in
the operating room and what effect
that's going to have on the family
later. The things that I remember
are not the dramatic operations that
we got through together, but the
times where we would perhaps take
a malignant tumor out of a small
child. Then, when I would go to see
the family on the ward, I might find
that the girl who had assisted me
with the operation was there with
her arm around the mother, sym-
pathizing with her about the un-
I

favorable prognosis, and offering to
be of any kind of help that she could
be. That again is another example
of not having gunbarrel vision
about the technical procedure you
just did. They recognized what a
tremendous impact a child with
cancer has not only on the family,
but on the whole community.

0

Day Surgery Units are popping
up all over the country. I know my
own staff is extremely excited about
it because it's not only the technical
skills that can be used but also the
planning and implementing of
those types of skills with discharge
planning of the patient. Do you see
this as definitely the wave of where
everyone is going?

A

I don't think there's any question
about it, and all the things that you
said are true. You provide a better
quality of care, but you also provide
it more economically and that's the
bottom line of everything these
days. I think it is not far off when
there will be certain procedures that
third-party payers will not pay for
unless they are done in outpatient
surgical centers.

Now when it comes to children, I
think one of the most difficult
things in dealing with children
with problems such as hernias,
undescended testicles,  or small
lesions that bring a child into the
hospital is that he is exposed to
children who have other illnesses.
He goes home the morning after his
operation. He doesn't get his gal-
loping diarrhea until the next day
but he got that in the hospital. If
you can totally segregate the out-
patient facility from the inpatient
facility, you have done children a
tremendous service in eliminating
the morbidity that comes from

76


respiratory and gastrointestinal in-
fections. That was the whole reason
why I went to outpatient surgery. I
,was moving my patients almost as
fast as outpatient surgery but they
were mingling with the patients in
the hospital and that was not good.

Q

Children seem to bounce back
easier than adults.

A

That's tradition. That's the way
we were brought up. When I was a
resident, on the rare occasion when
we operated on a child with a
hernia, he was in the hospital two
weeks. He was sewed up like a
thirty-nine-cent football. He was
wrapped up in bandages to keep
him from having a recurrence and
we did him more harm than good.

Q

Day surgery didn't start with
children, did it?

A

No, it didn't start with children,
but because of the nosocomial
infection problem they immediately
became prime targets.

a

Lets move into an entirely differ-
ent field. Given their ability to
sustain life or decide that death is
inevitable, do you think physicians,
and by extension nurses, are obli-
gated to speak out about things that
affect the human race, such as
abortion and nuclear war?

Well, I hate the term
patient advocate
because it sounds as
if the rest of us were
doing something to the
patient so that the
  patient needed
   an advocate.

for newborns and we now have a
situation where there are people
who say, "Well, this youngster has a
quality of life that's not worth
living, and I don't think we ought
to try to feed this one." Well that is
very, very difficult for some nurses
to tolerate and I don't think they
should make that decision on the
day they are told that, but before the
situation ever comes up.

:t

A

I think they don't have to become
proponents for a cause. But I think
that in a pluralistic society, some-
one who is oposed to something has
just as much right to talk against it
as someone who is in favor of it. I
would hope that our profession was
broad enough so that they could
permit certain latitude and freedom
for people not to do things that they
found repugnant.

0

Do you have any advice for a
nurse who might be requested to
take part in an abortion or any
situation that would be difficult for
her?

A

I think, as I have always told
nurses who have asked me this
question, you don't wait until the
occasion occurs as an emotional
emergency, but you make up your
mind where you stand on a given
issue long before the issue arises.
Then when it comes you say, "Well,
I always planned that when this
happened that I would do thus and
so." I think this comes up more and
more frequently as we have devel-
oped so many lifesaving techniques

Q

Have you seen any evidence re-
cently that society's respect for life
has increased?

A

No, I can't say that I have. And I
think we're going to have to be very
vigilant about our concept of the
sanctity of life because as we see an
aging population being suppoited
by a smaller and smaller group of
young people, economics is going
to be talked about more and more. I
hate to see economics and the
quality of life get mixed up in
anybody's mind.

0

To an extent, though, there's no
getting away from it.

A

Well, I think we can always care
for our patients. I think one has to
be assured that you never get caring
and killing mixed up.
                    continued


INTERVIEW

Q

0

Q

If President Reagan, who is about    Does that make you feel better?    How would you like history to
the same age as you are, is reelected                     remember you?
and asks you to continue serving,
will you continue serving?    A         A
A                  Well, it did all the time people    I would like to be remembered as
                  were saying I was too old for the job.  a person who recognized public
I don't think that's a question I                     health problems, addressed them,
could possibly answer now. And he                          and handled the difficulties that
is older than I am.                             had to arise with justice.

Dr. C. Everett Koop has come a
long way from Brooklyn, New
York, where he was born in 1916.
An only child, Koop attended
Dartmouth College at the age of
16. While studying for his Bach-
elor of Arts degree there, he met
Elizabeth Flanagan. Later they
married and became the parents
of three sons and one daughter.

After graduating from Dart-
mouth, Koop attended Cornell
Medical College and received his
medical degree. He was interned
at Pennsylvania Hospital in Phila-
delphia.

In 1948. Dr. Kdop joined the
staff at Children's Hospital of
Philadelphia (CHOP). At thattime
he was the hospital's only pedi-
atric surgeon (Koop was among
the first group of surgeons to
devote a practice strictly to the
treatment of children) and, in fact,
the entire pediatric surgery de-
partment. This was also the time
in Koop's life when he became a
fervent, fundamentalistChristian
who was willing to publically
make his beliefs known.

By the time Dr. Koop "retired"
from Children's Hospital at its
mandatory age of 65, he super-
vised 26 full-time surgeons in
eight specialties who worked in
what was namedthe"KoopSurgi-
cal Center."

As Koop's career developed, he
gained a reputation as a pioneer
in the development of neonatal
surgery. He was one of thefound-
ers of the Journal of Pediatric
Surgery and served as its editor-
in-chief. He also created the first
neonatal surgical intensive care
department and came to believe
that, except in extraordinary cir-
cimstances, all measures possible
should be taken to preserve the
life of the newborn.

In 1979, noted medical writer
Donald Drake wrote, in a profile of
Koop called "Zealot for Life," that
"he will not persist if the brain has
been so severely damaged that
there is no awareness of self, or if
his efforts would only prolong a
painful process of dying." Drake
noted that in one case, Koop
operated on the same child 22
times.

76

In 1974, Koop achieved national
attention when he successfully
separated Siamese twins who had
been flown to the United States
from the Dominican Republic.
More than 5,000 newspaper and
magazine articles were written
about the extremely rare opera-
tion that was performed by a team
of 20surgeons.Subsequentlyone
of the twins died in an accident
unrelated to the complex surgery.
One mother, whose son was being
treated by Koop at the time of the
twin's death, described him as
"devastated" by the loss.

Koop also achieved national
attention in 1975 when he was
involved in successfully recon-
structing the ribcage of a child
who was born with his heart
outside his body. The child,
Christopher Wall, spent the first
four years of his life at Children's
Hospital. Christopher is now a
happy 6-year-old. His successful
development under difficult
circumstances often has been
credited to the nursing care he
received while a patient at CHOP.

In 1977, Koop again was called
upon to separate Siamese twin
sisters who shared a six-cham-
bered heart. The twins were
daughters of Orthodox Jewish
parents and the ethical debate
surrounding thesurgerywaswell-
reported in the media. To save
one of the twins, Dr. Koop was
forced to sacrifice the other. The
surviving twin died three months
later.

In an ironic counterpoint to a
career devoted to saving the lives
of threatened newborns, Dr. Koop
himself experienced the loss that
is every parents worst nightmare.
In 1968, his 20-year-old son,
David, died in a mountain-
climbing accident. The death is
said to have intensified Koop's
religious studies and, 13 years
later, he speaks of David with
warm affection.

During an interview with repre-
sentatives of TODAY'S OR
NURSE, Dr. Koop described how
David came to him in the third
year of his pre-med studies at
Dartmouth and asked how his
father wouldfeel if he changed his

major to geology. "I told him that I
couldn't think of anything worse
than your going to medical school
because you are doing it to please
me and I'd be very happy to see
you as a geologist if that's what
you want to do," the Surgeon
General said.

Dr. Koop's religious studies and
his career have led him to become
an ardent anti-aborionist. In 1979,
he participated in a 20-city tour
with a multimedia program de-
signed to remind the public of the
value of human life.

Explaining his viewpoint, Koop
said in an interview, "One day
when I was operating on newborn
babies, I realized that less than
100 feet away in the Hospital of
the University of Pennsylvania,
they were destroying babies.
Knowing what we can do with
abnormal children, to know that
we're destroying about one mil-
lion normal babies a year just
drives me crazy."

It was Koop's well-publicized
and ardent fight against abortion,
as well as his lack of experience in
public health, that led many to
oppose President Reagan's ap-
pointment of him as Surgeon
General. In an editorial, the Phila-
delphia Inquirer said, "It would be
unthinkable to expect a govern-
ment bureaucrat to perform a rare
operation to separate Siamese
twins. By the same token, the man
who so brilliantly performed it, Dr.
Koop, simply does not have the
knowledge, the background, or
the temperament to perform as
Surgeon General."

However, despite opposition,
and the necessity of amending a
federal law to raise the age of
qualification for the post of Sur-
geon General from 64 years old to
accommodate Koop's age, he
finally was confirmed by the Sen-
ate in a68-24 vote last November.
Koop's supervisor, Dr. Edward N.
Brandt, Jr.. Assistant for Health,
has said that "the Surgeon Gen-
eral is important for symbolic
reasons." Brandt is the-govern-
ments top policy-making health
official.

Dr. Koop says he is writing his
own job description as Surgeon

General and history awaits the
outcome of this writing. His stoic,
unwavering viewpoints are sup-
ported by President Reagan and,
whether agreeing or disagreeing
with those viewpoints, many ob-
servers admit that Dr. Koop is a
formidable man whose career, if
not his stance, demands respect
and admiration. He may prove to
be the most interesting and active
Surgeon General we have seen.