In the first few years of his surgical practice, Leonard performed most of his surgical procedures in Navasota, but the shortage of surgeons in the area provided a demand for his services in Caldwell, Hempstead, Brenham and both Bryan Hospitals. One evening he was called to Hempstead to do an appendectomy. Just as he was about to prepare for the surgery, Leonard received a call from Caldwell regarding a patient with a ruptured spleen—an extreme emergency. Leonard jumped in his car, rushed to Caldwell, removed the hemorrhaging spleen, and then hurried back to Hempstead to take out the appendix before it ruptured. He felt like his ancestors traveling cross country to make house calls.
In 1963, before heart surgery was a routine procedure, Leonard was called to Caldwell to perform a thyroidectomy. Opening the neck, he noticed that a mass continued down into the mid-chest. He sterilized a cast cutter and split the patient’s sternum. He continued to dissect the tumor that was wrapped around the heart. After all the mass was removed, the tissue was sent to the pathologist for a cellular diagnosis. The tumor proved to be a lymphoma. The patient was sent to M. D. Anderson where she was successfully treated. Twenty years later Leonard encountered the patient in a Bryan Hospital where she was working as a nurse. She proudly showed him her scar.
Another patient became extremely ill. Leonard thought he might have leukemia. Three bone marrows proved negative for any pathology. The patient became sicker and sicker. The pathologist from Bryan, Sid Koworski, MD, suggested that the patient have an exploratory laporatomy. Sid was present when Leonard performed the surgery. They found a huge spleen weighing about 10-15 pounds. Because a diagnosis was necessary for proper treatment, the spleen was removed and sent to M. D. Anderson. The pathologist from M. D. Anderson called Leonard and scolded him for removing the spleen of a patient with leukemia. Leonard explained that they were unable to make the diagnosis of leukemia without removing the spleen because three bone marrow biopsies had been negative. The patient was treated at M. D. Anderson and survived. Three people who the same type of leukemia had died within six months. Leonard’s patient and the three others who died proved to have a rare form of leukemia, hairy cell leukemia. Spleenectomy is now the treatment of choice for hairy cell leukemia.
Although well-trained in the standard of care, Leonard was unafraid to use radical approaches if he felt a different method might produce a beneficial outcome. He described the following case that emphasizes the importance of independent thinking based on sound judgment:
In performing an exploratory laporatomy, I found a rather large cancer of the left colon as well as a huge mass in the right lobe of the liver. The liver mass was fairly accessible. I thought I could remove the mass without causing too much damage to the liver. In those days, we were taught that a mass in the liver in the presence of colon cancer indicated lymph node involvement so that resection of the liver mass would be superfluous. After carefully exploring the abdomen and finding no evidence of lymph node involvement, I decided to remove both the mass in the right lobe of the liver and the cancer in the colon. I then referred the patient to M. D. Anderson for follow-up treatment. They found no evidence of recurrence or any remaining cancer. The patient remains healthy and vibrant twenty-five years later. Now the thinking has changed. In the case of colon cancer combined with a mass in the liver in which there exists no evidence of lymph node involvement, removal of the liver mass prolongs life.
Sometimes patients refuse the recommended standard of care. When this happens many surgeons refuse to operate. Leonard was willing to attempt innovative approaches if the patient agreed. He gives this example:
A young lady had lost from 50 to 70 pounds in a short period of time because of a severe case of ulcerative colitis. She refused an ileostomy, the treatment of choice, whereby the entire colon is removed and the ileum of the small bowel is brought out of the abdominal cavity and attached to a colostomy bag. So I opened her up and removed the entire large bowel except for about a foot of colon. That way we could do a sigmoidoscopy to make certain she did not develop cancer of the colon which is common with ulcerative colitis. Then I took about eight inches of small bowel, cut it, turned it backwards, sewed it via anastomosis to itself, and then attached the other end to the colon. Remarkably enough, this procedure worked. She gained her weight back. She did very well. She very rarely had diarrhea. We did a lower GI on her on two occasions, which looked almost normal, as it would if there were large bowel in place.
Leonard sent a report of this case to several medical journals. None of the journals would accept the article for publication. The editors told Leonard that the case lacked originality. He was able to present the case to the Texas Surgical Society suggesting that others try the procedure to confirm his results. Thereafter several successful cases were performed.
A woman consulted Leonard because she had pelvic cancer. All treatments had failed. She asked Leonard to keep her alive until her four-year-old son was grown. Leonard did a pelvic exoneration, a rather horrific procedure. He removed the uterus, the bladder, the colon, the vagina and the anus and removed the pelvic lymph nodes. He made an artificial bladder by suturing the ureters into a segment of small bowel, and brought this out of the pelvic cavity to form an ileostomy of sorts. A colonoscopy was done on the other side. The patient not only lived to see her son grow to manhood but outlived her husband and died at age 80.
Leonard also did pediatric surgery. He saved the lives of infants with pyloric stenosis (a blockage at the head of the stomach). He had several cases of imperforate anus that he corrected. He successfully repaired cases of duodenal atresia—an exceedingly rare disorder whereby the stomach contents cannot be emptied into the small bowel. An even rarer case, ileal atresia, a blockage in the small bowel, was repaired.
Leonard successfully repaired a ruptured aortic aneurism. He saved the life of a man injured in an automobile accident who had a punctured lung, ruptured spleen, subtotal hematoma, broken femur and a smashed tail of the pancreas. He also performed numerous neurosurgical procedures.
A man who was in a car/train wreck was brought to the emergency room. He had a few fractures that I set. Unexpectedly, he complained of a severe headache and his right pupil began to dilate. His left arm and leg became paralyzed. As I was laying him on the x-ray table to do a skull x-ray, he began having convulsions. I performed an emergency tracheotomy, shaved his head, and whisked him into the operating room. Because I had recently arrived in Navasota to begin my practice, I had no instruments for neurosurgery. I quickly sterilized a cast cutter and cut a large circle of skull out of the right side of the head. Outside a violent thunderstorm was raging. Suddenly all of the lights went out. Dr. Hansen, who was helping me, retrieved a flashlight from his car. With the illumination of the flashlight, I removed a blood clot about the size of my fist. As soon as the clot was removed, I asked the patient to move his left arm and leg which he did, although he has no memory of this. Underneath the clot I found a small epidural vessel pumping away. I clamped the vessel and tied it off. During the procedure the circle of skull fell on the floor. After finding the fragment, I put it in a bottle mixed with penicillin and saline, sutured the skin over the scalp opening, and sent the patient to a neurosurgeon in Houston who, after sterilizing the skull fragment, placed it in the circular wound. The patient had no residual damage. For at least ten years he sent me a Christmas card with a thank you note enclosed.
Another accident victim fractured his pelvis. A series of x-rays showed that the patient had severed the urethra from the bladder. Leonard reattached the urethra to the bladder. Next he inserted a Foley catheter into the bladder through the urethra and hung a one pound weight from the catheter to hold the urethra in place until healing could occur. A temporary suprapubic catheter allowed the bladder to drain until the urethra was functional again.
Leonard enjoyed trauma surgery more than any other procedure. Every trauma case is different and challenging in its own unique way. Perhaps the most dramatic cases involved penetrating wounds of the heart.
On a shooting range a boy had been accidentally shot with a .22 caliber pistol. The bullet went into his chest through his heart and out his back. I opened the chest and sutured the small holes in both sides of the heart. It took only a few sutures to repair the wound. There was very little blood loss.
A construction worker had a truck load of lumber fall on him, fracturing a rib that became lodged in his heart. Blood began to flood the space between the heart and the fibrous tissue covering the heart creating a pericardial tamponade. That is, this blood filled sac began to constrict the heart so that it couldn’t pump enough blood to keep the man alive. Using a large needle and syringe I aspirated the blood from the sac. We then wheeled the patient into the operating room where I opened the chest, removed the rib from the heart, and sutured the slash in the heart. Again there was an insignificant amount of blood loss.
The most dramatic penetrating heart wound occurred when a man was shot through the chest with a nail gun. Like the .22 caliber bullet, the nail went into the chest through the heart and out the back. This time, however, the accident created extensive damage. There was a tremendous amount of blood loss. By the time I arrived at the hospital Dr. Kenneth Matthews, the physician on call, had IVs going in both arms with blood pumping. Ken had already intubated the patient. My assistant, Terry Erwin, a former lab technician who I had trained to help me in surgery, was there. Because it would take twenty to thirty minutes for an anesthetist to arrive from Bryan and because the patient was already unconscious, we quickly swabbed him with iodine and opened his chest. We put our sutures where necessary in the heart and repaired both sides of the heart. We gave the patient a total of 24-pints of blood and I sent him to Houston to recover under the watchful eye of my cardiac surgeon friend, Grady Hallman. The patient has had no complications and has lived a normal life.