A surgeon’s journey from the early days of chemotherapy and heart surgery

During his 40 years as a practicing surgeon, Andrew J. Graham, M.D., FW ’65, HS ’66, witnessed the early use of chemotherapy and experienced the profession’s evolution from a generalist practice to an increasingly specialized one. When he started out, surgeons were expected to cover a wide array of procedures and patients. “We were true general surgeons,” Graham said. “We did all the emergencies, the gunshot wounds, whatever came in.” Today, as surgery becomes more specialized and general surgeons become rarer, Graham predicts difficulty for small towns and cities that lack major medical centers and the attendant specialist surgeons. Through his work as an associate clinical professor of surgery and as president of the Yale Surgical Society from its inception in 1994 until this year, Graham has encouraged a generalist’s comprehensive view of surgery’s mission and its capacity to care for patients.

His introduction to medicine began with the inspiration of his future brother-in-law, a general practitioner and former mash doctor in the European Theater during World War II, who pursued a solo practice in Lexington, Mass. They met when Graham was an officer in the U.S. Navy. In 1956, upon entering Tufts School of Medicine, Graham lived with his wife and infant son in an apartment above the practice. He occasionally accompanied his brother-in-law on house calls to nearby farms and helped perform circumcisions in the office on Saturdays.

Graham was still a fourth-year medical student when he came to New Haven for the surgical rotation that would determine the course of his career. It was 1959, and Gustaf E. Lindskog, M.D., was the chief of surgery at Grace-New Haven Hospital. Working with Lindskog affirmed Graham’s decision to become a surgeon. “On the surgical rotation, if you had a problem, you solved it if you could,” he said. “The medical rotations were endless rounds of people trying to show how smart they were.” Lindskog invited Graham to stay for a subinternship and later, for residency. Training was rigorous, with many interns working under a few chiefs. By the time he was chief resident himself, the attending physicians “would come by once a week, just to see what we were doing.” Otherwise, the residents carried their own caseloads.

In 1965, Graham was the oncologic fellow for Section Chief Mark Hayes, M.D., and helped administer chemotherapy, then still an experimental treatment, under the direction of Paul Calabresi, M.D. ’55, “We made people sick because we didn’t know what we were doing,” he said. Because oncologic medicine was part of general surgery at that time, it fell to surgeons to administer chemotherapy. And because there was no hospice, dying surgical cancer patients would find care on general surgical floors. Graham said, “We would take care of them all the way.”

After his residency, Graham went into solo private practice as a general surgeon in New Haven. A year later fellow surgeons and house staff alumni Richard A. Selzer, M.D., HS ’61, and Bernie S. Siegel, M.D., HS ’61, invited him to join their practice. Although he no longer performs surgeries, Graham remains on staff as a consulting physician. He also invites third-year Yale medical students to visit his practice for a 12-week mentorship program that exposes them to aspects of medicine often missing from a hospital rotation. “They find out there are a lot of little things that never come into the hospital, like a thrombosed hemorrhoid,” Graham said. “Most of the residents don’t know what to do with that problem, since they’ve never seen it.” Showing the students “the big picture of medicine”—about caring for the whole patient in a surgical context—is Graham’s way of explaining why it is important to be a general surgeon. He feels that the mentorship program run by the Department of Surgery is a wonderful way to bring “young sponges” into the field.

As president of the Yale Surgical Society, Graham has led the society’s efforts both to honor the surgical faculty and residents and to appeal to medical students considering surgery. This year, Graham stepped down from his 15-year post. (The Surgical Society’s new bylaws specify that officers’ posts will be changed every two years.) Graham will remain involved with the society but hopes to devote more time to his wife of 54 years, traveling, gardening, visiting grandchildren, and mentoring students in his office and at the anatomy lab. “If someone is thinking about surgery,” Graham said, he tells them, “You have to see if you love it. … It’s a tough taskmaster, and you have to be strong mentally and physically, because operating and caring for patients requires a total unconditional commitment. … But I’ve been very lucky.”