The Quiet Man from Kansas
If happy little bluebirds fly
Beyond the rainbow
Why, oh why can’t I?
– Over the Rainbow, lyrics by E.Y. Harburg
I was a sickly child — fighting asthma, wheezing and frequently requiring oxygen. At times, doctors questioned my survival. As a consequence, my mother was constantly hovering. I love her dearly to this day, but she could not help but smother me in confinement and fear due to my debilitating condition.
As I came of age in the small Kansas town, I quickly realized my physical weakness would most likely limit my ability to do any type of manual labor as a profession, so I learned to use my brain. I was the oldest of three — with two younger sisters who wrestled with their own issues of self-worth and self- confidence. Dad was the breadwinner — responsible and steadfastly hardworking. My grandfather had gone only as far as the fourth grade, so higher education had never been a family imperative. However, I thankfully received my M.D. at the University of Kansas Medical School in Kansas City, pursued my surgical residency at Parkland Hospital in Dallas, Texas, and completed multiple fellowships at the University of Texas Southwestern Medical Center in Dallas.
But, for as long as I can remember, I have been truly obsessed and consumed with the pursuit of excellence — in my life, in my work, in the people around me, in the lives I touch, and in my own person. I believe I’m here to help others and to do God’s work. However, I owe my accomplishments — not to some mystical, magical talent or extraordinary luck — but to an unflinching dedication to hard work and absurdly high standards. I think I’ve always been an overachiever, always been driven to succeed — admittedly rising above the raw materials I was dealt and to make a remarkable life. I have never been and never will be satisfied with just OK.
And then, there are my patients. They are my raison d’etre. Somewhere along the way, these little souls hidden under their veils of craniofacial abnormalities captured me emotionally — accelerating my efforts and further intensifying my focus. Obsession. Compulsion. Passion. These are all accurate descriptors of my commitment to helping these kids find healing and wholeness. In reality, I suppose these children remind my on some deeper level of the trapped, sickly little boy I once was. I am always utterly consumed with the desire to unmask the “little Kens” I see shrouded in the faces of all these helpless children.
To that extent, I suppose I have always been in the right place at the right time. What is that old adage? “Preparation plus opportunity equals success.” Well, I had the opportunity to literally redefine plastic surgery as one of the coterie of founders of craniofacial surgery. In 1969, this unique, interdisciplinary specialty did not even exit. There were the disciplines of plastic and maxillofacial surgery, but nothing that adequately addressed the multi-faceted requirements of a craniofacial patient. And the essential team requirements are staggering.
The craniofacial surgeon never operates alone. He or she is typically both surgeon and impresario — performing the intricate, surgical techniques, as well as coordinating the dynamics of the highly skilled, interdisciplinary team. Each member of the team is absolutely essential to a positive patient outcome. Attracting and maintaining the necessary cadre of exceptional professionals, who have been meticulously trained, can be an enormous challenge. In addition to the craniofacial surgeon, key players include the pediatric neurosurgeon, pediatric anesthesiologist, neuroradiologist, pediatric intensivist, neuro-ophthalmologist, pediatric ophthalmologist, otolaryngologist, orthodontist, speech pathologist, geneticist, anthropologist, pedodontist, pediatric nurses, psychologist and often social workers. The challenge is complex; the need clear, and the result changes lives.
Early in my training and career, I considered many paths and specialties, but this one captured my imagination. Collaborating as mentors and colleagues with some of the world’s most brilliant and dedicated physicians, such as Paul Tessier of France and Ian Munro and Linton Whitaker in the U.S., I have been privileged to be part of the birth of one of medicine’s most unique and remarkable specialties.
Today, one of my greatest joys in showing a young person the intrigue and challenge of the field. And one of these young inquirers has now become one of my proudest professional accomplishments — and heir to my practice. As I prepare to enter the next phase of my work and my life with the World Craniofacial Foundation and leave behind the daily demands of a surgical practice, I am gratified to know that Dr. David Genecov, who began his career as a sixteen-year-old intern with me, will be carrying on the essential work at a comparable level of excellence. I think of myself as his “professional” father.
Regrettably, these extraordinary professional accomplishments and significant medical milestones have come at a daunting price — a profound, personal sacrifice. Unable and unwilling to suppress my unquenchable drive for excellence and quest for perfection as a surgeon, I have paid dearly for my pursuits in the realms of family and human relationships throughout my life. A series of failed marriages and immeasurable time lost with family and friends have been the inevitable liabilities of my success.
Fortunately in recent years, I have transformed as a human being, as well as a surgeon —
just as I have been blessed to transform the many lives I have touched. Though I struggle to balance my addiction to excellence versus facing the finite number of hours in a day, I still strive to connect in some meaningful way with my adult daughter Lee and my son Ken, Jr. Of course, my fourteen-year-old grandson Hartman Green of Beaumont, Texas is the light of my life. And my dear, dear Luci, by wife and partner in the journey for ___ years, has lifted me to a new level of awareness of the forces of the universe, spirituality and the requisite balance of love and light in life. For her patience, fortitude and beautiful spirit, I am endlessly grateful.
Ironically however, this personal shift in consciousness is likely one of the most significant transformations I have witnessed in my entire life on this earth. Many colleagues, acquaintances – and even patients and others I have encountered along life’s path would describe me as arrogant, flamboyant, egotistical, pretentious, sometimes obnoxious, and fundamentally ruled by hubris. I don’t deny these perceptions, and though I do retain a sliver of each, I am relieved to admit to the softening of Dr. Salyer’s soul – a mellowing of my spirit and dissolution of my hard-hammered facade.
Looking back, many experiences throughout my life have shaped and molded the person I am today — inside and out. And the sum total of these events has brought me to this very place. Yet one particular day shimmers with as much clarity today as it did over forty years ago — November 22, 1963, as day permanently seared on the psyche of America.
As part of my surgery rotation during my residency I spent the month of November on neurosurgery at Parkland Hospital in Dallas, which means I was on call for any emergencies that occur in the emergency room related to neurosurgery. Usually, I was called down once or twice a day to the emergency room to examine emergency cases. That day was different. I was upstairs viewing a movie when a nurse I had seen only once or twice ran into the break room, and shouted breathlessly, “The President is downstairs in our emergency room.”
Before I knew it, I was standing just inside the squeaky, flapping emergency room doors. The room was bustling with a stormy sea of white coats — in stark contrast to the slender figure in a red-streaked pink suit – sobbing audibly and clinching the hand of the lifeless body on the table.
It all seemed like a blur. There were many people moving around – and so many nurses. But I could see the President’s condition was critical. “My God,” I thought. “What has happened?” I removed my glasses to wipe away the fog that clouded my view after entering the ice-cold operating room. Though rubbing my bleary, disbelieving eyes, I could see clearly that he had a wound in his right temporal region. I also observed a large, sucking wound on his neck — as we carefully removed his crisp, blood-soaked shirt and the brace he wore to alleviate his back pain.
My colleagues and mentors — Doctors Jenkins, McClelland, Carrico and I, along with others, followed the treatment protocols we had employed so many times before. We struggled to save a life. Hours seemed to pass, but eventually, we created an adequate airway, administered some external cardiac massage, and inserted I.V.s in a number of sites.
“President John F. Kennedy died at approximately 1 p.m. Central Standard Time here in Dallas. He died of a gunshot wound in the brain. I have no other details of the assassination,” announced Assistant Press Secretary Malcolm Kilduff.
As a resident in training, I will never forget losing a President – right before my very eyes and in my own hands. I suspect being part of that event and witnessing it will certainly have quite an impact on the rest of my life. We felt so very helpless. We ultimately realized our President had succumbed to fatal injury, and no matter what we did, no matter what heroic measures we administered, we weren’t going to correct it. From this day forward, I resolve to dedicate my practice and my life to conquering the biggest challenges I can possibly master.
And today, over forty-three years later, I still remember the promise I made myself that day, with the world as my witness. Now, as I stride forward into yet another world of unknowns and opportunities, I trust I my ability to challenge, guided by God’s hand, as I endeavor to make a positive difference in the lives of others.
