I spent my first 6 weeks in the Army at Fort Sam Houston in San Antonio, Texas. Fort Sam Houston is a dry and dusty military base that nonetheless was a pleasant introduction to Army service. I set about learning duties, obligations, opportunities, and traditions. With dozens of other drafted physicians, I learned to salute, fire a rifle, wear a gas mask, squirm under machine gun fire, and march (but not too far). One day, my peers and I assembled for a several-mile parade. We set off in formation, walking at a comfortable pace. I glanced back, noting that an ambulance followed us, apparently in anticipation of some fallouts. The Army was smarter than I had anticipated. Indeed, initial expectations to the contrary (for no good reason), my orders and instructions all seemed quite rational.

We graduated from orientation and were asked where we might like to be posted. This was a kind, considerate, but entirely meaningless gesture. I said either the East or West coast would be fine. The Army compromised, stationing me at Fort Leavenworth, Kansas.

Fort Leavenworth is near the town of Leavenworth, Kansas. The military base and the town are home to several penitentiaries, including two military prisons at Fort Leavenworth, and the infamous United States Penitentiary in the city of Leavenworth. Given this abundance, I thought I might spend my time tending to the medical needs of prisoners. I did tend to prisoners. However, more commonly I anesthetized majors, colonels, and generals, none of whom were imprisoned at the time.

Fort Leavenworth is home to the United States Army Command and General Staff College. As an elite military graduate school, Fort amenities included a 27-hole golf course. It seemed that everyone on the base was an officer. As an Army Captain, I was among the lower ranking officers.

I was paged on arriving at the post. Good grief, who knew I was here? Colonel Boyson, the senior surgeon, ordered me to the obstetrical ward.
Would I please insert an IV needle in this patient whose veins had defied Colonel Boyson? Of course! I was off to a good start! After inserting the IV, I went to the administrative office to complete the formalities needed to work at the hospital. The master sergeant in charge asked if there were anything he might help me with. “Did I need a second car?” I did, and he had one to sell, a vintage Packard, for $50. How could I go wrong? After buying it, I found that it had holes in the floor, providing natural air conditioning. But it was a heavy car with rear wheel drive undaunted by Kansas snow and ice. Two years later I sold it for $100. My early lessons in capitalism from catching flies were proving useful.

I had a grand title: Chief of the Anesthesia and Operative Section. As such I directed the activities in two operating rooms. One was of normal size, but the other was slightly bigger than a closet. With the help of two nurse anesthetists, I supplied anesthesia for each. Both anesthetists were competent. Indeed, Major Idelle Kraft was a superb clinician. Although my title was Chief of the Anesthesia and Operative Section, the real boss was the NCO (Non-Commissioned Officer) for the operating area, Master Sergeant Bufford. He guided me through a successful 2-year career.

On matters of importance I would ask for and follow Sergeant Bufford’s advice. I remember failing to ask for his advice, on a sensitive subject. It proved to be a big mistake. Despite his problems with starting IVs, Col. Boyson was a competent surgeon with one flaw. He regularly arrived late for his surgeries. The nurses would be ready, and I’d have the patient anesthetized, and then we would wait. Without consulting Sergeant Bufford, after one particularly long wait, I gently suggested to the Colonel that he please arrive on time. Col. Boyson had been a tank commander in World War II. In full tank commander voice, he told me that if I ever made that suggestion again he would see to it that I was reassigned to Korea. I never repeated the suggestion.

I usually finished work at noon. Occasionally, I had other duties such as giving officers physical examinations. I remember finding a lump in an officer’s thyroid one afternoon and anesthetizing him the next day for removal of his cancer. But most afternoons I could do as I pleased. I tried the 27-hole golf course but found that it held little attraction for me. My skill in golf hadn’t improved since my youth.

Leavenworth and Ft. Leavenworth were pleasant places, enhanced by their proximity to Kansas City, a reasonably large metropolis. I attended the weekly
seminars at the Department of Anesthesiology at the University of Kansas, developing an affection for the Department. I thought to return there if they would have me when I finished my career in the Army. It never happened. Instead, I was seduced by life at the University of California, described in Chapter 6.

Dollie and I lived in the town of Leavenworth for our first year in the Army. In our second year, we moved to Fort Leavenworth. Next door were our friends, the Bookers, he a carpenter and she a housewife. Each Sunday Cris Booker and I would walk to the corner store for supplies and the Sunday paper, accompanied along the way by a neighbor’s large black Labrador.

Fortunately, golf was not the only entertainment option provided by the Army. Dollie and I tried playing duplicate bridge, but our second or third experience dissuaded us from persisting. I was dealt an oddly fortuitous hand with seven cards of one suit. We made an extravagant bid, which we won. Our opponents were Vivian and Hank Krawchek. Hank was a radiologist. Vivian did not take well to losing. She upbraided me, fuming “You should not have bid so much! You had no right to make the bid!” We apologized but kept our winning score. I thought I saw her husband smile.

We availed ourselves of theater in Kansas City, once coming a week late to a performance of The Music Man. The theater took mercy on us, giving us left over seats in the balcony.

Dollie bore a second child, Doreen Joyce Eger, so now we were four and the rocking chair did double duty. Dori began to walk 9 months after birth, but her walking was peculiar. “She walks like a little old woman,” said Dollie. Dori had a congenitally dislocated hip that the pediatrician, Major Joernes, had overlooked at birth. For a year, Dori wore a cast that slowly caused the restructuring of that hip to normal. I made devices that accommodated her cast and allowed her to sit up and to be mobile. She could scoot along at great speed, but she was not happy with her confinement in a plaster cast.

Most of our time was spent raising our children. We read stories and sang to them in that heavy Iowa rocking chair. We took family vacations to Sioux Falls to visit Dollie’s parents, or to Chicago to visit my parents. I busied myself with writing equations in the attic of the hospital, giving anesthesia or physical examinations, reading, sleeping, and eating. My days passed easily in my thoroughly unremarkable life at Fort Leavenworth. Without realizing it at the time, I was setting the foundation for my life’s work. It’s easier to judge life through the rear-view mirror than through the windshield.

I continued to experiment with my patients. No Institutional Review Board (IRB) existed to advise me otherwise. I had the notion that positive pressure ventilation should cause the extravascular movement of intravascular fluid, thereby decreasing intravascular fluid volume. I consulted with my friends in the clinical laboratory and found that they could determine intravascular fluid volume by injecting Evans Blue dye intravenously and measuring the resulting blood concentration of the dye. Evans Blue, I read, was a harmless substance that disappeared from the body. One of the patients in the prisoners’ ward was to have an orthopedic procedure that required my care. I took the opportunity, while he was anesthetized, to inject Evans Blue to measure his blood volume with and without positive pressure ventilation.

I don’t remember how many times I repeated the injection during his procedure to make the measurement, but it was many times. By the end of the procedure, the prisoner turned a dusky blue. I had anticipated this possibility but understood that the color change was short-lived. It was not. Perhaps a month later, toward the end of November, the physician in charge of the hospital, a dermatologist, stopped me in the hospital hallway. “Dr. Eger,” he said. “Would you please do me a favor?” “Yes, sir”, I replied, “What might that be?” “I’d like you to turn that patient in the orthopedic ward back to a normal color by Thanksgiving.” The color did fade with time. A long time. My one-off, one-patient study with Evans Blue (I never did that again) wasn’t a stellar contribution to research.

I had better luck with other studies. One made use of Major Kraft’s talents. She managed the anesthesia for tonsillectomies and adenoidectomies, anesthetizing all these pediatric patients with the same divinyl-ether/diethyl-ether sequence. Same procedure, same anesthetic, same superb anesthetist. It allowed for a controlled comparison of the effect of differences in premedication. As we said in the opening statement of the report that resulted: “Approaches to the problem of preanesthetic medication in children are infinite as may be inferred from the variety of drugs and dose schedules advocated. Few controlled studies have been done and these have failed to show any great differences in the effectiveness of any particular drug or drug combination.”¹ That was about to change.

In our double-blinded, randomized study of 248 children,¹ we gave vagolytic agents (atropine or scopolamine) with either nothing (the control), an opioid (morphine or meperidine), or with a barbiturate (pentobarbital) as premedication. Those given scopolamine had less fretfulness and irritability, reduced secretions, and more drowsiness than those given atropine (Table 5.1). The addition of an opioid or barbiturate added several other significant (P < 0.01) differences. Most impressive to me were


the differences in postoperative vomiting. 39% of control patients vomited, but only 18% of patients given pentobarbital vomited. However, a whopping 71% of patients given an opioid vomited. It didn’t matter whether the opioid was morphine or meperidine; 71% in each group vomited. Today we might explain these differences by effects on opioid and GABA_A receptors.