Donald R. Laub - Second Lives, Second Chances

Donald R. Laub, MD

I couldnt write the letter g.

Id just finished a complicated and successful gender confirmation surgery giving a trans man the completely functional penis he longed for using techniques Id developed that are now the global standard. My older son assisted me in the procedure; hes a talented plastic and reconstructive surgeon, and working with him was a pleasure. My wife, all five of our grown children, and their children were thriving. So was Interplast, the medical humanitarian organization I founded in 1968 to bring free surgical care to the developing world. Since then, volunteer surgeons in association with Interplast have performed more than 200,000 life-transforming operations to correct devastating physical deformities, from cleft lips and palates to burn scars.

Though Id recently retired as the head of the Department of Plastic & Reconstructive Surgery at Stanford University Hospital, I still had a lively and satisfying career as president of the nonprofit Gender Dysphoria Program in Palo Alto, California. I was in my mid-sixties, fit and feeling fine for a man in what I liked to think of as the early autumn of life more like the Indian summer. All was well. I began a postoperative report to the patient, intending to write the magic words, Surgery was successful but I couldnt remember how to form the letter g.

Soon my brain was unable to summon other letters. I couldnt walk down a hallway without bumping into walls. Then I flunked a couple of simple neurological tests. Clearly, something was wrong. Youve had a stroke, my neuropsychologist told me. Ive had a steak, I reported to my wife.

But it wasnt a steak or a stroke. It was a rare, aggressive, and lethal kind of brain cancer intravascular central nervous system large cell lymphoma. After more than forty years as the physician, I was about to be the patient.

An extraordinarily skillful and kind team at the University of California San Francisco Medical Center deployed a new kind of smart bomb chemo, and after six sessions of treatment in the hospital, I recovered from a disease that has a reported survival rate of only 15 percent. That can get a man thinking.

This book is a result of those musings. Its a look back at a life in medicine, told through key moments: hard knocks, soft landings, stupid mistakes, and smart mistakes; tough choices, lucky breaks, happy coincidences, and scientific leaps; life-changing encounters with mentors, patients, colleagues, friends, and enemies. Ive written this book for people whove been patients and those who care for patients; people with deep medical backgrounds and people with none. (For the latter, Ive endeavored to explain medical terms and procedures in an accessible way.) Its for anyone whos interested in what makes their fellow human beings tick and how theyre fixed when the ticking goes awry.

Every step of my life as a physician has been powered by the same internal forces: a deeply felt sense of duty to do good in the world; an unending appetite for interesting (i.e., difficult) cases; a love of adventure; a contrarian streak that always made me react to the word no with an ornery yes; and a dash of showmanship. Again and again, I had to take on members of the medical establishment who were quick to tell me that the things I wanted to do deliver free surgery to the developing world; invent and improve surgical procedures that allow trans people to have the bodies they want; teach surgical interns not by the time-honored method of slowly doled-out graduated responsibility, but through early hands-on training in the operating room were unethical, immoral, impractical, or plain crazy. That they couldnt and shouldnt be done. At times my enthusiastic embrace of risk in the name of humane medical innovation has gotten me into big trouble. Sometimes, with the help of farsighted and forward-thinking mentors and colleagues, its gotten big, beautiful results. And sometimes, I couldnt tell the trouble from the good results. Ultimately, the outcome has been high psychic income the great joy that comes from saving and enriching the lives of patients, and from teaching others how its done.