contemporaries.
The phrase “do no harm” is not a part of the Hippocratic Oath.
Hippocratic Oath, Modern Version
“I will apply, for the benefit of the sick, all measures (that) are required avoiding those twin traps of over treatment and therapeutic nihilism.”
—Written in 1964 by Louis lasagna, Academic Dean of School of Medicine at Tufts University
The Question
Is the Hippocratic Oath rewritten in a combat zone when abiding by the moral code of war, not peace?
Is it intellectually honest for the public to apply and therefore judge a warrior’s actions by the moral code of peace, while safe at home, as that warrior is fighting to stay alive and living by the moral code of war: the concept of justified killing versus murder?
The fact is the warriors and treating physicians usually existed in a moral limbo, vacillating between both the moral codes of peace and war.
In Vietnam, when I triaged in the emergency department during a mass casualty, I condemned the very most seriously wounded, who may have been salvageable, to death by withholding treatment, for multiple lives could be saved by redistributing the many resources and manpower that would have been utilized on that one patient.
My words are dedicated to my wife, Robin, for without her incredible strength, foresight, and forgiveness, our family would not have survived and been made complete.
LEAVING ON A JET PLANE
Robin’s eyes were injected red and full of tears. Her pitiful expression on that sweltering Dallas morning at Ben and Helen’s in early September 1970 is forever burned into my memory. It conveyed panic, my desertion, loss, fear, and disbelief. Her eyes asked, “How could you do this to me?”
I had no choice. The US Army was sending me to Vietnam as a trauma surgeon for a year. The good-bye was as sad as attending the wake of a loved one.
Not to say we did not know this day would eventually challenge us. We had prepared, but there is nothing as devastating as having to experience that onset of separation.
ROBIN AND EDDIE
Robin Viverito and I, Eddie Kappler, first dated at Port Jefferson High School in 1957. She knew she would marry me. I had no idea seventeen-year-old girls (women) thought that far ahead. We committed before I departed for Cornell University in Ithaca, New York, to begin my pre-med studies.
I studied incessantly, majored in chemistry, joined the Theta Xi fraternity, played some basketball, did some partying, did honors research in chemistry, was president of the house my senior year, and was accepted to Cornell Medical College in New York City.
Dr. J. Johnson was my faculty advisor. The best advice he gave me was to take the rigorous German language course, a requirement for chemistry majors, in my junior year. I could not process the spoken portion and did so dismally that I had to take a makeup course the next year to graduate. Thank goodness I did have the senior year. There were three of us in that class who had been accepted to medical school. I felt a little better.
Robin visited Cornell frequently; took her SATs during a fraternity homecoming weekend milk punch party; studied elementary education at Notre Dame of Maryland in Baltimore; partnered with me in the summers in the Hamptons; taught in Middle Island, New York, after her graduation from college; planned our wedding; and with her mom began sewing her wedding dress and the bridesmaids’ dresses.
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After I was born, my mother negotiated with my dad and his parents that yes, I would be named Gustav Edward Kappler III, but I would be addressed as Eddie. She disliked the name Gus and referred to my dad as Kappy. Once I left home for college, I became Gus. Robin causes great confusion in the faces of new friends when she discusses her husband, Gus, in their conversation and then asks me, Eddie, to pour more wine.
OUR NEW LIFE
On June 29, 1963, after my second year at the Cornell Medical College, we were married in St. John the Baptist Roman Catholic Church in Wading River, New York, followed by the reception at Felice’s in Patchogue, New York. This event was their first such function, just having opened for business, and in spite of that, we all had a great time. Back then on Long Island, the centerpieces were practical, a cluster of various liquors with mixers in a bucket. As we entered for the event, the substitute band leader asked the name, and Robin replied Viverito. When presented to the gathering, we were referred to as Mr. and Mrs. Viverito. Everyone exploded in laughter. My mom was not too happy, for her German son was marrying an Italian.
In a way that introduction was a premonition, for during all our fifty-plus years of marriage, she mastered the sometimes-daunting task of defining our family as I concentrated on my study of and the practice of surgery.
We experienced an abbreviated honeymoon at Mt. Airy Lodge in the Poconos. Loving to camp, I wanted to stay in a cabin not knowing we would share accommodations with a skunk. Thus, the early departure to return to our newly painted one-half tenement at 425 East, Sixty-Ninth Street, just up the block from Cornell Medical College in New York City.
Ed, Jack, Ron, George, and I became fast friends. Robin would fix them up with dates from Notre Dame.
I generated income by donating blood and performing EKGs on hospital patients. During exam time, a professor would pay a male student for his semen to study sperm mobility under stressful conditions. He was referred to as the professor of manual arts. I skipped that one.
Our windows bordered on Sixty-Ninth Street, and the pedestrians passing below ran the risk of being bombarded with water balloons.
The drug companies gave free formula to new mothers, a lot of it. We used formula as a cream substitute in Grasshoppers, Black Russians, and our coffee.
MOVING ON
The third and fourth years of medical school were more clinical, hands on, and a time to decide on one’s specialty. I administered anesthesia, did research in colon surgery, rotated through the notorious Bellevue Hospital, and reaffirmed my passion for surgery. I sought out a hospital where I would operate from day one and chose to apply for a surgical residency headed by Dr. David Hume at the Medical College of Virginia (MCV) in Richmond, Virginia. Dr. Hume had participated in the world’s earliest kidney transplants, directed a universally renowned kidney transplant department, and as chief of surgery was the ultimate teacher. He was also instrumental in redefining death.
Traditionally, death was defined as the stoppage of the heart. The concept of brain death in a patient with a beating heart was essential to move the field of transplant surgery forward. The courts became involved and accepted the change. With this new definition, even though the patient’s brain was dead, his organs were being kept viable and available for transplant.
My first rotation at MCV as an intern was neurosurgery, and I covered the emergency departments (ED). In the sixties, there were two EDs, for segregation was alive and well in Richmond. My first surgery was to drill holes in the skull of a gentleman with a subdural hematoma to relieve the pressure. This was done in the ED as an
