The engrossing memoir of a plastic and reconstructive surgeon involved in groundbreaking and life-changing procedures
Through his work in plastic and reconstructive surgery, Dr. Donald Laub changed the lives of thousands of people who had been shunned by society. Dr. Laub’s influence fostered the development of three key areas in the surgical profession: pioneering and influencing international humanitarian medical missions in the developing world, being at the forefront of gender affirmation surgery for transgender people since 1968, and the education and training of over 50 plastic and reconstructive surgeons.
His unstinting efforts to surgically correct cleft palates gave new lives to thousands of children in developing countries. As one of the original surgeons to perform gender affirmation surgery, Laub not only continually improved on his methods, but he also became a tireless advocate for the rights of transgender people. His non-profit foundation (Interplast, now called ReSurge International) has sent thousands of multidisciplinary teams to perform transformative and reconstructive surgery in the developing world.
Second Lives, Second Chances is more than just a memoir; it’s a testament to how the determination of one person can bring others together to make a lasting difference in the world.
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About the Author
Dr. Donald Laub was chief of plastic surgery at Stanford University School of Medicine from 1968 to 1980 before entering private practice. In 1969, he founded ReSurge International, the first organization to advance the idea that plastic surgeons could help those in the developing world with injuries or congenital conditions. In the 1970s, he was a pioneer in gender reassignment surgery in the U.S. Dr. Laub lives in Redwood City, California.
Read an Excerpt
Amazed and Sockless
I became a doctor because my father didn't, and I became a plastic and reconstructive surgeon because of a maroon Cadillac, a bunch of high school bullies who threatened to beat the crap out of me, and an embarrassing DIY tattoo.
But perhaps the path was laid even earlier.
I was almost born on December 31, 1934, at 11:38 p.m., but the doctor pushed my head back into the birth canal to await the stroke of midnight. I was unable to be brought down again by my mother's efforts, and the doctor had to extract me using forceps. I was the first baby born in Milwaukee in 1935, and my picture was in the newspaper. The pressure of the forceps accounted for a small bald area on the right side of my forehead and may, some members of my family think, be responsible for a lifetime of outside-the-box behavior. I was the second of four children, three boys and a girl. We all went to Catholic school. My father, Rudolf Laub, sold insurance, and my mother, Ella Donnersberger Laub, not only made a safe and happy home but was an energetic organizer of community projects and probably ought to have run for elected office.
Growing up in the Milwaukee suburb of Shorewood, a place with lots of elm trees and plenty of parental emphasis on education, our crew — me and the six boys I'd hung out with since kindergarten — stood out for our swagger. Or so we thought. During our freshman year at Marquette University High School, my best friend, Bill Griffith, had the habit of borrowing his father's new maroon Cadillac while his parents were at church on Tuesday evenings. He'd hotwire the car in the church parking lot by shoving a silver dollar under the ignition. Then all of us would drive around town pretending we were adults. We'd return the Cadillac just before the service let out, hoping we'd get the same parking spot. We were never caught.
One night we got cocky; we took the car right from the Griffiths' garage and drove to a football game, our school versus Whitefish Bay High School. While we were strutting around during halftime thinking we were pretty tough, some much bigger, much tougher Whitefish Bay boys picked a fight. Outmatched, we ran to take refuge in the Cadillac and locked ourselves inside. But the Whitefish Bay boys jumped up on the hood, tried to smash the windows, and put a dent in the rear fender that was detected the next morning by Dr. Griffith, Bill's father. Griff got a good licking from his mother, a tough German lady.
The seven of us dedicated ourselves to revenge, determined to beat up those Whitefish Bay guys. We taught ourselves ju-jitsu from a library book and took some rather extreme steps in our quest to toughen up. Dan Riordan cut the veins on his wrists with his hunting knife, and we drank his blood. Jack Slater fashioned some brass knuckles by pouring molten lead into a homemade plaster mold of his fist. I burned my initials, DRL, into my forearm with a cigarette in order to prove that pain could be overcome by the force of the brain — mind over matter, à laLawrence of Arabia. I washed the wound with alcohol daily to prevent infection, and I wore a long-sleeved shirt for a couple of months so my mother couldn't see what I'd done. When the burn scabbed over and healed, my initials stood out in white. I also demonstrated the concept of mind over matter — and my toughness — by eating dirt and, I'm chagrined to recall, personal waste products. I was willing to eat shit to prove to my pals that I was a wild man.
Our self-confidence increased significantly. The next year, at the same game, we found that the menacing Whitefish Bay gang had somehow shrunken in size and ferocity. We threatened them, and they backed away before we could deliver justice.
After high school, I enrolled at Marquette University as a business major, because my father ran an insurance agency and I thought I should follow in his footsteps. I realized after two days that I hated the subject and consulted my dad. "Why did you go to business school?" he asked.
"Because you're a businessman and I was following you," I said. "What would you do if you were me?" He said he would be a doctor and told me something I'd never known — that he'd started medical school in Milwaukee but had to drop out because he couldn't afford tuition. I'd had no idea about this episode in his life, and I dearly wish now that I'd asked him more about it. The day after our talk, I switched to pre-med and instantly loved the course of study. The change also helped me make good on a rather rash promise I'd made to God in a moment of panic as a young teenager — a vow to do great good for humanity in a very particular way. I'd figured that I could keep the promise working in business by making loads of money and then giving a bunch to charity — the Robin Hood theory. But medicine would offer a more direct approach to good deeds, and the thought of becoming a healer felt much truer to my original pledge.
When I was fourteen and an enthusiastic Boy Scout, I belonged to the Wolf Pack Unit. We practiced our howls and qualified for woodsmanship badges explained in the Boy Scout Handbook, which was written by a naturalist I admired, Ernest Thompson Seton, the author of Wild Animals I Have Known. I wanted to know some wild animals, too. I thought I might get the chance when my family decided to road test a stretch of a new highway to Canadian gold country. We drove through Wisconsin and Minnesota and into Ontario, Canada, as far as a lodge at Cliff Lake, to catch walleyes and muskies. After a day of fishing and dinner at the lodge, it was still light. I hoped to hear some wolves, so I set out on a hike. I was sure I'd be fine because I had a hatchet, and I'd learned as a Boy Scout that I'd never get lost if I notched trees as I went so I could find my way back. Wolves were indeed starting to howl. Wonderful! I tried to follow the sound, and soon, despite my faithful notching, I was utterly lost, and it was dark. I tried looking for moss to indicate the north side of a tree, another Boy Scout trick, but I found none. So I built a shelter out of branches — that's what Ernest Thompson Seton would do — intending to spend the night, though I was terrified that wolves would attack. I lay down on some springy pine boughs and thought, What are you doing? No one knows where you are, and there are wolves! Get the hell out of here. I swore to God that if I got rescued and lived, I would become a priest.
Then I remembered another Boy Scout trick that had slipped my mind: follow a creek downhill to a bigger creek, then follow that creek to a river. This system led me back to Cliff Lake. I thought dawn was about to break, but it was only 10 o'clock when I got back to my not-nearly-worried-enough family.
Now I had a bigger problem: I was stuck with being a priest. It took me several steps to reason my way out of the deal I'd struck with God. First, I figured that only half the deal was solid — I'd lived, yes, but I hadn't been rescued; I'd saved myself. Yet the spirit of the bargain still seemed to require my entering the priesthood.
Even as a young child, I took seriously my relationship with the Almighty and the call to service. Consider the case of the pagan babies. When I was in sixth grade at St. Robert Catholic School, students were urged to contribute to the Pagan Baby Collection, offering money and prayers for unbaptized infants far away — Africa, I think, or maybe China. If you donated a certain amount of money, you were given the right to name a "pagan baby" in some mysterious part of the world. My classmates donated a nickel, a dime, a quarter — no baby-naming for them. I coughed up ten bucks, the entire proceeds from my summer vegetable project, earned helping in the garden of my Aunt Genny in Illinois, who had a master's degree in agriculture from a fancy eastern college. No one made me donate; I just thought it was the right thing to do. And, frankly, I'd developed a sharp yearning to be the best at whatever I tried, and that included pagan-baby salvation. My generosity entitled me to name ten pagan babies.
My mother wrote to my grandmother about this astonishing largesse, as well as the state of my brothers' souls. Her letter reads in part:
Don is getting confidence very slowly but Ray [my younger brother] is still a big baby and needs to be tucked in by hand every night. Bill's paper route is doing a lot for him, and he hasn't missed another day of school ... I urged him to buy himself malteds at the drug store instead of candy bars, and he was simply indignant: "Why, I can't be spending 20¢ a day on ice cream when I only make 60¢ — I know a kid who did that, and he went bankrupt — had to sell his route!" He only contributed a quarter to the Pagan Baby Collection — whereas Don blew in $10 of his summer garden money and caused a sensation at St. Robert with the tremendous donation — ten pagan babies — and Rudy [my father] in a rage! The irony of it all is that [one of the babies] is to be named Rudolf. The Pagan Baby issue didn't bother Ray in the least. He is the King in Sleeping Beauty — a play they are giving. The children voted on the parts, and he said everyone wanted him to be king — he is big and jolly and has an air of superiority at school. They tell me that he can beat up all the fifth graders.
For a couple of years after the night of the wolves and the priestly promise, I went anxiously back and forth with myself about how much I still owed the Lord. Then I met a girl named Judy McCotter. Our parents knew each other, and we got together when she asked me, via my mother, to the prom at her all-girls high school, Holy Angels.
Now I really had to resolve my deal with God. I knew at sixteen that Judy, a year younger, was the one for me and decided that the honorable thing to do was to get married when we were a bit older and then help other people by doing priest-like work, improving lives and setting a good example. Switching from business to pre-med finally set my mind at ease. I don't know how God feels about my revised vow, but I've felt great about it ever since, regularly renewing my promise to serve. I certainly haven't felt guilty about it. In fact, I've rarely felt guilty about anything. Sad, pained, and humbled, certainly, but rarely guilty. I don't see how that would do any good for me or the people I've pledged to help. Making an error means that I've enlarged my skill and knowledge and learned what to do differently the next time.
My dad had offered to help me through Marquette Medical School by giving me $150 a month to cover various costs. He made me promise that during the academic year I wouldn't work at anything but my studies. I gratefully agreed. But almost as soon as I arrived, I was presented with the opportunity to embalm cadavers in a basement morgue for $35 a body. I considered the promise I'd made to my father and, by extension, to God, and then accepted. The $35 swayed me. I rationalized that the job was really part of my studies because it involved learning how to perform an operation on the femoral artery and vein, major blood vessels in the thigh.
I met my first cadaver during a classic Frankensteinian thunderstorm, arriving in the damp and dreary brick basement with a black bag containing all my sparkling new equipment and an anatomy book. I had studied the femoral artery and vein very carefully.
The morgue had pipes in the ceiling that contained formaldehyde under pressure, hooked up to a hose. I was to insert the hose into the cadaver's femoral artery and vein, filling the fellow's systems with formaldehyde in order to preserve the remains from bacterial degeneration. The poor body weighed about eighty-eight pounds; it belonged to a withered guy from skid row who seemed to have died of starvation.
I was about to insert the hose when I thought apprehensively, Well, now, this guy looks like maybe he isn't dead yet. I got out my stethoscope, listened to his heart and lungs, tried his pulse, looked in his eyes with my ophthalmoscope, and decided that he was indeed a goner. So, I started my dissection and began pouring formaldehyde into the veins. After I'd put it in about a gallon, I noticed that he'd begun to puff up. He almost looked healthy, like he was gaining weight before my eyes. I thought, Oh my God! What if he wakes up? What am I going to do?
I tested him again, and he was still dead. I introduced more formaldehyde, and he began to look healthier and healthier — almost robust. As I was pondering life and death and my guilt over breaking a promise to my father, the cadaver suddenly let out a loud "Ooomph!" as air from his stomach came up through the esophagus and vocal cords under the pressure of the formaldehyde. At the same time, the pressure of the fluid made his arms, which had been lying at his side, shoot straight out as if he intended to grab me. I flew back and hit the brick wall, thinking, Oh, dear God, I'm so sorry for doing this! I repented, quickly sewed up the cadaver, and quit the embalming business.
I would have made a lousy priest and an even worse embalmer. I was much better suited to serve as a clerk for Dr. William Frackelton, a distinguished reconstructive hand surgeon. The choice was an especially lucky one. For starters, I was thrilled when Frackelton allowed me to assist regularly with three procedures that moved and amazed me: otoplasty — surgery to correct misshapen ears; tendon grafts to repair the soft, bandlike tissue that connects muscle to bone and thus restore mobility to shoulders, elbows, ankles, knees, and fingers; and skin grafting, replacing skin lost to burn or injury by peeling a healthy slice of skin from another part of the patient's body and carefully stitching it into place. As amazing as seeing what grafts could repair was learning that the procedure was first described in detail by the Indian surgeon Sushruta, who lived between the seventh and sixth centuries BCE. I learned how to perform these operations skillfully as a senior medical student long before they'd ordinarily come up in the curriculum. So I enjoyed a wonderful head start, racing ahead of my competitors — my fellow students.
I never did have surgery to correct my scars. That brave, stupid DIY tattoo remains a set of ever-fainter initials, their ghostly presence reminding me of a quote from the British poet William Blake, born in the eighteenth century, a maxim perfect for a fellow with a tendency to go overboard: "You never know what is enough unless you know what is more than enough." I've had to relearn that lesson quite a few times in my life.
An early example of my overzealousness came in med school. As a junior extern at the VA hospital in Milwaukee, I was on call overnight for the first time, covering all 2,000 of the hospital's patients. I was hugely excited by this important new duty, and I wanted to make sure I didn't sleep through a summons. So, I elected to sleep with the lights on whenever I was on call, usually downing a nice cup of coffee just before hitting the hay. I thought of myself as a cowboy sleeping with a loaded pistol under his pillow
Judy and I got married in 1958, while I was in medical school and she was in the middle of an internship in occupational therapy; though after we started having children, she didn't practice. What she has practiced in our fifty years of marriage, along with exemplary and extraordinary parenting, is unwavering and at times seemingly uncanny support for my healing mission. That support often came in the form of hosting in our home many, many visiting colleagues and recovering patients from around the world. It also included a stint as a successful kiwi farmer (a scheme of mine that fell to her to enact). The fact is Judy has made my work possible.
As Frackelton's fellow, I was to serve as general factotum at the 1960 annual meeting of the American Association of Plastic Surgeons, held in Milwaukee and hosted by my boss, a member of this elite society comprising the nation's top practitioners. At that meeting, I had the good fortune to witness some of the earliest public presentations of four breakthroughs that would revolutionize medicine: the first successful organ transplant — a kidney donated by a man to his identical twin — for which Joseph Murray, MD, of Brigham and Women's Hospital in Boston, would be awarded a Nobel Prize; homograft skin transplantation, which enabled badly burned patients to receive skin from another person when harvesting skin grafts from their own bodies proved impossible; craniofacial surgery — developed in France but new to the U.S. — which allowed the repair of severe facial deformities by rearranging the bones of the skull; and microsurgery that allowed the reattachment of body parts, performed using the magnification of an operating microscope, tiny instruments, and minuscule handmade needles, thinner than a human hair, fused to microsutures that enabled the connecting of blood vessels as small as five one-hundredths of an inch.(Continues…)
Excerpted from "Second Lives, Second Chances"
Copyright © 2019 Donald R. Laub, M.D..
Excerpted by permission of ECW PRESS.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Introduction Brains and Brawls
In a brief introduction, author Donald R. Laub, MD, tells the story of his sudden onset of brain cancer, explains his reasons for writing this memoir, what it contains, and the resulting great joy and positive psychic income of his life’s work spent doing good in the world.
Chapter 1 Amazed and Sockless
Laub revisits his childhood to explore why and how he became a doctor and plastic surgeon with amusing childhood and teenage anecdotes. He continues on to the highly ambitious days of his early career when he married the woman he credits with making his life’s work possible and discovered the fascinating world and potential of plastic surgery.
Chapter 2 Cut to the Chase
This chapter begins by introducing Dr. Chase of Yale University and explains why Laub admired him and chose to follow him to complete his residency at Yale. Stories of both his successes and failures at Yale follow, along with all the new and interesting medical professionals he was meeting, how he was developing under Dr. Chase’s unique method of teaching, and how they both ended up moving to Stanford to continue their careers.
Chapter 3 Practically Pluripotent
Laub recalls his first busy year at Stanford doing medical research with different doctors, observing new types of surgery, and meeting and hiring his lifelong friend and partner on his first day on the job, Cornelis Ploeg, known as Kees (pronounced case). Despite the varied and fascinating research and surgeries taking place, Laub found himself longing for more challenging cases both diagnostically and surgically.
Chapter 4 Plans A through D
Here, Laub describes how he met David Werner, the patient who first changed his life for good by putting him on the trajectory to start what would eventually become Interplast. Laub trained Werner as an amateur doctor and they travelled together to rural Sinaloa in Mexico, where David had established his clinic, to provide much needed medical care to four communities. Their trip was a success and they followed it up with a second trip, this time bringing along more medical volunteers and equipment. Alas, their growth eventually led to embarrassment on the part of Mexican health officials and they were told to leave and never come back. Discouraged but determined to persist, Laub switched focus to the closer city of Mexicali and was able to set up a successful and lasting partnership between Mexican medical professionals there and Stanford.
Chapter 5 The Perfect Smile
This chapter is focused on the tragic story of Salvador: a young Mexican boy with a cleft palate, but a heart murmur that made any surgery risky. Laub and his team denied the boy surgery the first two times he came to them. However, on their third trip, Salvador’s mother successfully pleaded his case and the surgery went forward with extreme precaution and care. Nevertheless, Salvador died on the table. Laub was deeply moved by the experience and decided to dedicate much more time and energy to Interplast; giving 10 percent of all his efforts to building the company and reaching out for the first time to his extensive network in the U.S. for financial support.
Chapter 6 The Right Thing
In this chapter, Laub shares the story of how he met the fourth patient to truly change his life forever. Ella was his first transgender patient and the catalyst for his lifelong devotion to gender dysphoria and trans rights. Laub explains what gender dysphoria is and how it has been treated medically throughout history. Laub was the head surgeon on Ella’s successful gender confirmation operation in 1968. He would go on to perform 900 surgeries for transsexual patients and cofound the World Professional Association for Transgender Health (WPATH).
Chapter 7 – Interplast Flies High
Laub tells the intriguing stories of some of the many colourful patients and doctors involved with the development of Interplast through the years. He chronicles the phases of growth and development of what was originally incorporated as the Mexico Medical Project, soon became Interplast, and is now ReSurge International. He writes about criticism from University and medical associates and colleagues in the U.S. and the countries they visited, but also about the massive and varied support that made their mission possible and helped them grow into the well-known and respected organization they are today. Particularly important in the shaping of Interplast was the method for transporting volunteer personnel and equipment to under developed countries around the world. Laub goes through the many forms of travel they experimented with: starting with his over-worked Dodge van, to light planes flown pro bono by the Flying Doctors organization, to buying their own DC-3 plane with the help of retired pilots, to an attempt to get the military involved, up to their current solution of using commercial airlines.
Chapter 8 Shape Shifting
This chapter opens with the way the Harry Benjamin International Gender Dysphoria Association dealt with the prerequisites to admission into their program for surgery starting in the late 1960s and how their initial focus was on the patient being able to pass in public for their new gender. Laub describes how these prerequisites to surgery have evolved dramatically over the years, his own patient’s roles in changing his way of thinking for the better when it came to transgender issues, and the sometimes contentious relationship between the Gender Dysphoria Program and the transgender community; who viewed them as gatekeepers determining who was and was not eligible for surgery. Laub goes on to tell the story of how a biased donor to Stanford sparked the need for a credible academic study on the effectiveness of surgery as a treatment for gender dysphoria.
Chapter 9 The President versus the Nun
Laub narrates the events of one of Interplast’s first trips to Guatemala, where he provoked the rage of Sister Jane, a surgeon-nun at the Maryknoll mission hospital. Their disagreement began when Laub was called away in the middle of surgery for a cleft lip on a young indigenous Jakaletek boy by the President of Guatemala to advise on a friend of the President’s who had suffered a gunshot wound. Sister Jane insisted that Laub ignore the summons and stay and complete the surgery, she thought this would send a powerful message to the elitist government in her country and be a strong political statement. Laub argued that Interplast was separate from politics and was only allowed to operate in Guatemala by the good grace of the government, and therefore left the surgery of the young boy to complete the President’s request. The morality of the event weighed heavily on Laub’s mind, and he talked it over with Sister Jane four years later at a meeting in Chicago. They were still very divided in their ways of thinking and were unable to come to any agreement. Laub closes with a compromise he feels he could have taken instead, which took him forty years to think of.
Chapter 10 The Gun That Won the West
Chapter ten is the quick story of how and why Interplast got kicked out of Ecuador in 1986 and the resulting struggle to be allowed to operate there again. A small group of elite plastic surgeons felt that Interplast made them look bad, and so arranged politically to have them denied permission to operate in the country. Laub shares the story of how he leveraged his connections to reach the President of Ecuador directly. This resulted in Laub being awarded the Medal of Merit and having to scramble to find a suitable gift to present to the President at the ceremony. He ended up giving the President one of the apparently several “Gun’s That Won the West” and being awarded the Medal of Merit by the same man who had engineered to have Interplast kicked out of Ecuador in the beginning.
Chapter 11 The Rolls-Royce Vagina and the Postmodern Penis
This chapter contains detailed explanations of the surgical procedures vaginoplasty and phalloplasty and the new methods for both surgeries that Laub has been instrumental in the development of, as well as stories about patients who benefited from the old and new methods. Laub also details his experience as an expert witness at the trial of a criminal plastic surgeon known as “Table-Top Brown” and Johns Hopkins decision to ban gender confirmation surgery that lasted from 1977 to 2017 because of a discredited follow-up study and a vocal psychiatrist-in-chief.
Chapter 12 The Cast of Characters (And Characters in Casts)
Laub uses this chapter to relate the stories of some of the outstanding people he’s met during his years of practice, starting with Clair the Tattooed Millionaires. Clair was Laub’s first transgender patient without him even realizing the fact for years, he operated on her through multiple surgeries and two cancers, and she became his co-worker and close friend for the rest of her life. Next in Laub’s roster of outstanding humans is Dutch the Motorhead. He and Laub met when Dutch accidentally shot his hand and Laub successfully treated him with surgery. They became friends throughout treatment, and in the end Laub had a joyous ride on the back of Dutch’s Harley. Laub moves on to Tacho the Spy, who initially met Laub because he was spying on them for the Mexican Colegio Médico, but quickly became a close friend and ally of Interplast. Particularly important throughout Laub’s life was Pancho the Kiwi King. Pancho needed surgery for a severe bilateral cleft lip and palate, which Laub performed at no charge. After his recovery Pancho became Laub’s special assistant, living on his property, helping to maintain and grow their kiwifruit plants, which they sold to local restaurants, fruit markets, and wholesalers to raise money for Interplast.
Chapter 13 The Old Order Changeth
Laub tells the story of how he got ousted from the Interplast board of directors in the late 1990s. Interplast went through major administrative changes and disagreement, particularly over bringing residents along on trips, and the focus of educating local doctors over delivering direct care, boiling down to the way they can best help the world and attract donor money while doing it, resulted in a falling out between the new professionals on the board and Laub. Eventually the ban against residents would be lifted and Laub would repair his relationship with the new board, but not before he had to face a much larger battle.
Chapter 14 The History of My Head
This chapter begins with the personal history of the mistreatment of Laub’s skull through contact sports throughout his whole life and leads into the beginning of symptoms of stroke in late 1999 and gradually increasing until Christmas Eve 2000 when he was hospitalized and went through a variety of diagnoses. A last-minute brain biopsy revealed a rare and particularly dangerous type of lymphoma which was treated successfully with very modern techniques. Laub concludes that the reason he survived when so many with people with the same type of cancer don’t is because he still has more work to do in the world.
Chapter 15 DoctorgenarianThe final chapter chronicles Laub’s second life, starting with a long recovery from brain cancer helped by manual labour and a loving and supportive family. Laub is no longer able to perform surgery but has new ways to serve and create meaning for himself. He now teaches courses at Stanford Medical School in international humanitarian medicine and consults for gender dysphoria practices. Laub reflects proudly on the positive legacy he has left in his personal and professional life.