Yesterday's surgical roster had begun with a rectal procedure; tomorrow's would include snipping polyps from a patient's nose. There are no Nobel Prizes for a small-town general surgeon, no medical breakthroughs to excite the 6 o'clock news. Most local doctors learn to live with those limits. Dr. William Nolen has not. "Whatever I accomplish will never be enough for me," he says. "How the hell can anybody be content when there are so many things to do in life? On my father's 40th birthday my mother said, 'Be nice to your father today. He hasn't accomplished all that he hoped he would.' His restlessness is in my genes."
It wasn't restlessness, but the simple desire for a nice place to live, that brought Nolen to Litchfield (pop. 5,078) 25 years ago, as a freshly minted doctor. The first trained surgeon ever to settle in the county, he participated in as many as 500 operations a year. He and his wife, Joan, threw themselves cheerfully into school and community affairs, making friends easily and raising six spirited children. "He had such an adventurous nature," says Litchfield newspaper publisher Stan Roeser. "I once took him skiing on a steep slope where he had never been, and Bill just took off down that hill as fast as he could. It never occurred to him to turn—he was that kind of guy." Certainly he couldn't tolerate boredom, and by 1968 he was starting to chafe. "I'd done virtually every operation I was ever going to do as a general surgeon," he explains. "Operating is never dull, but there is a lot about medicine that is boring. Do you think sewing up a laceration is fun? Maybe the first 50 times."
Writing was a new kind of challenge. In 1970 Nolen published The Making of a Surgeon, a best-selling account of his internship at New York's Bellevue Hospital. Six more books followed, along with a monthly medical column in McCall's and an occasional spot on the talk shows. "I got into writing because I wanted to be somebody," he says. "I wanted my 15 minutes of fame. If I hadn't found that outlet, I probably would have left Litchfield."
But he didn't, and therein may have lain the key to his latest, most personal book, Crisis Time! Love, Marriage and the Male at Midlife (Dodd, Mead, $15.95). It begins with an account of his painful descent, six years ago, into the hazy world of alcohol and drugs. "I believe all men go through some sort of mid-life crisis, though they may not admit it," says Nolen, 57. "Most people, at some point in life, say, 'Hey, wait a minute, is this all there is?' People you know die. You start thinking about your own mortality. If your parents are alive, they may have physical problems. You have children to educate. You feel torn."
Or worse. "At the age of 50 my life began to fall apart," says Nolen. "I hope I shall never again come as close to disaster as I did then."
Litchfield, just west of Minneapolis, is a provincial town with bleak winters and elm-shaded summers. It is a farm community whose inhabitants, mostly of sturdy Nordic descent, are friendly but conservative. If a man chooses to take his life in Litchfield, he is likely to do it with a shotgun.
Bill Nolen was different. An Irish-Catholic liberal from Massachusetts, he loved to drink beer and argue politics and was as relentless at play as at work. "When he loses he's just like a kid with a tantrum," says anesthesiologist Chuck Fuller, 39. "We met at a hockey game when it was 20 below, and Nolen was sweating so much, he had icicles hanging from his sideburns and his stocking cap was frozen to his head. You can only go so long without losing your breath, but he would not give up, especially to a younger man. I'd never seen anything like it."
The Nolens and their children settled into a house two doors from the Litchfield Clinic. Nolen had all the work he could handle, but apparently never more than he wanted. He let other doctors know there was room for only one surgeon, and he was it. "Bill was always in a rush," remembers Dr. Cecil Leitch, one of his partners. "He'd be in and out of the clinic three times a day. I'd follow him on his rounds just to be sure all the questions got answered." From the moment he arrived in Litchfield, Nolen was on call 'round the clock. "My special line didn't ring that much," he says, "but when it did, it could mean an emergency, and I would have to operate immediately. Eventually that really wore me down."
Feeling stirrings of discontent in the '60s, he briefly considered moving his practice to Vietnam. "Then I looked at my motivation," he says, "and realized that I didn't want to go to help people. I wanted an adventure. That wasn't really fair to my wife and children." For a while he considered moving to a larger city or returning to his native New England. "But you get to a point in your life where if you make one change, you have to make so many others," he says. "Litchfield was a nice place, my kids were involved here, and Joan felt attached. I could have made more money somewhere else, but I chose not to choose and just stayed in the same rut."
In 1968 he sold a comical account of his first appendectomy to Esquire, presenting himself as a self-assured novice who becomes so befuddled in the presence of a real patient that he ties the end of his rubber glove into the abdominal incision. The piece led to a contract for The Making of a Surgeon, which sold more than 1.5 million paperback copies in the first year alone.
As his writing career blossomed, Nolen found himself spending less time in Litchfield. "At first, fame hit him like a door," says a colleague. "We were all proud, and he was always nice, but he didn't seem as interested in his practice. The town began to feel less loyal to him because it was without a surgeon." As his children grew, so did his financial burdens, and in his mid-40s he developed angina. A double coronary bypass operation in 1975 kept him going, but shortly after his 50th birthday, Nolen began to feel the world—and the grave—closing in. "My father died at 58 of heart disease," he explains. "I had writing deadlines and kids in college; I was jumping more than ever at the sound of the phone. I knew we needed another surgeon in town, but I was afraid that he would cut into my income."
Beset by insomnia Nolen tried to cure it with Scotch. "I'd lie awake and think of all the things I'd never get to do," he says. "Booze puts you out immediately, but when it wears off a few hours later, you have a hell of a time getting back to sleep." He began taking 30 mg of Valium, and when he built up a tolerance, he tried to overcome it with Quaaludes. Soon Nolen's interests, always prolific, dwindled to a precious one. He spent his Sundays traveling from bed to easy chair, where he passed his mornings sipping vodka and grapefruit juice. Joan was bewildered. "I didn't know he was going through a crisis," she says. "I just knew he was impossible. I thought I could ignore him and live my own life, but I couldn't."
"I wasn't a rip-roaring addict," says Nolen. "Most of the time no one would have known." But Nolen was a surgeon all of the time. Twice he remembers rescheduling operations because he was uncertain he could do what he had to. Nolen's partners began referring some of their patients to surgeons in neighboring towns. "You could see in his face that he was going through something terrible alone," says Fuller. Eventually Nolen's partners confronted him. "He's a darn good surgeon, but he wasn't himself," says general practitioner Frederick Schnell. "He would walk down the hall and lean into the wall. We just said, 'Do something or goodbye.' " At first Nolen denied there was a problem. Then he stopped drinking for a few weeks. Shortly after that, on a trip to Minneapolis, he traveled to the very edge of oblivion, mixing Scotch with 90 mg of Valium and 1,800 mg of Quaalude in a 12-hour period. The following afternoon Nolen and his wife met with a physician friend who diagnosed his condition as acute mid-life crisis. Then Nolen, the saver of lives, set about saving his own.
For the next six weeks he suffered the tortures of withdrawal. At night as he lay yearning for sleep, muscle spasms jerked him awake. He continued to work, often finishing an operation in a cold sweat with his surgical gown soaked. He forced himself to exercise, and slowly, over a period of four months, his sleep and sex drive crept back to normal.
"It's very important to know that these things pass if you can hang in and not self-destruct," says Nolen. "The critical thing is not to change your life-style radically when you're not thinking clearly." Another recommendation is that you have friends and relations who'll grit their teeth and put up with you. The book's dedication reads, "To my wife, Joan, for not tossing me out on my ear." "I was embarrassed when the book came out," she says. "I knew he should do it, but I was thinking of the people in Litchfield. I heard they sold a lot of copies at the pharmacy. If people I don't know well say, 'We bought the book,' I tell them, 'Don't read it.' "
There are those in Litchfield who believe that Nolen's career has been tarnished. "His reputation is a little gray," says Cecil Leitch. "Word travels fast in a place like this." Others disagree. "Bill doesn't put up a front for anyone," says lumber dealer Al Nelson. "When you read his book, you realize he's an honest, sincere person. It took guts to tell his story, and he didn't pull any punches."
Neither did Nolen's father, a Holyoke, Mass. lawyer. Young Bill was the second of his four children. "My father used to say, 'If I could get you kids educated, I'm going to cash in my life insurance, move to Ireland and write,' " says Nolen. "He always wanted to be somebody. I regret that he didn't live long enough to see me on The Tonight Show. My mother, who has a better sense of values, is not so impressed."
As a young man Nolen flirted briefly with the dream of making his living playing jazz saxophone, but his father urged him toward medicine. "Billy," he used to say, "those bastards have it made." After graduating from Holy Cross in 1949, Bill enrolled at Tufts medical school and almost immediately chose surgery. "There's something about the guy who takes the knife and makes the incision," he says. "That's where the action was." While interning at Bellevue, Nolen married Joan Scheibel, a Massachusetts girl he'd met on a blind date four years earlier. Seven years and five children later, he took her to settle in Litchfield.
Despite his success as a writer and the suspicions of some of his neighbors, Nolen remains first and foremost a doctor. "I've never wanted to give up surgery for writing," he says. "One, I get a lot of satisfaction from it, and two, what the hell would I write about?" His workload has diminished since the arrival of a competitor, Dr. Dhanush Prasad, in 1981, but Nolen is not a man who welcomes time off. "Dr. Prasad is an excellent technician," he says, "but I'm hurt, more than jealous, when I see him doing procedures I think I should be doing."
When he does operate, Nolen follows surgery with a few hours of writing in his basement office at the clinic. He is currently researching his ninth book, on recent changes in the world of medicine. "I always wanted recognition," he says, "but for something worthwhile. I would not be proud to have written Everything You Always Wanted to Know About Sex but Were Afraid to Ask. For all the dough David Reuben made, I'm not sure he has the respect of his peers or that he's invited to give commencement addresses. I'm very proud to be asked." In fact Nolen doesn't like to turn people down. "Bill has a broad tolerance you don't find everywhere in this community," says his friend Stan Roeser. "He's devoid of pettiness. Once he was asked to be a grand marshal of our Watercade Summer Festival. I know it pained him no end to have to ride in a car and wave at people, but he didn't say, 'I don't give a damn about your celebration.' He just did it."
At noon, after a morning's surgery, Nolen ambles home for lunch and a nap. He may spend the afternoon on hospital rounds or in his office seeing patients. He feels irritation only with those who don't really need him. "The most boring thing about medicine is treating people who aren't really sick," he grumbles. "Someone who says, 'Gee, Doc, I'm really feeling punk.' Hell, it's been 20 below, they have cabin fever like the rest of us, that's why they feel lousy. Then they say, 'Do you think vitamins will help?' " He chuckles. "Well, 99 percent of those things aren't necessary. Americans have the most expensive urine in the world." But Nolen is not a callous man: He has nothing but compassion for genuine suffering. "It's so frustrating when you can't help someone," he says. "It never gets any easier to tell a patient he has cancer. It's something we all fear. But if you can't walk away from those things, you really shouldn't be in medicine."
Nolen is least conscientious when it comes to his own health. In 1982 he had a second heart operation, which left him with a total of six artery bypasses. "I have a terrible metabolic system," he notes. "I should try to lose weight, I shouldn't eat carbohydrates or drink, but I don't believe it would make any difference." The 16 pills he takes each day to control blood pressure, gout and mild diabetes have slowed him physically, but he remains intellectually restless. He still harbors fantasies of a new career teaching writing or a new home by the sea in New England. Yet he is fond of quoting from Milton's Paradise Lost: "The mind is its own place and in itself/Can make a Heav'n of Hell, a hell of Heav'n." "That," says Nolen, "explains why I never felt a terrible urge to live elsewhere." He believes he has tailored his expectations to fit impending realities. "Women are more sensible than men," he observes. "They are better at accepting the fact that they are never going to have all their dreams come true. I know now that I will never be a geologist or a roving journalist; I will never know what it's like to be married to Sophia Loren. I'm going to miss all that."
Retirement is another experience Nolen plans to miss. "I'd go nuts, and so would my wife," he says. "Some of my partners might like me to retire, so they could get a young gung ho surgeon who would bring more money into the clinic. But I've stuck with them all these years; they can stick with me now." He takes his eyeglasses in his hand and gives them a twirl. "I don't expect to be alive five years from now," he says matter-of-factly. "For a doctor, I'm a fatalist. I believe in an afterlife because I'm too egotistical to think that part of me isn't going to go on forever. But if heaven is a place with golden streets and everybody playing harps, I'd be bored." He keeps twirling and reconsiders: "Maybe if they played jazz sax."
Snow covers Litchfield, Minn. like a lumpy down comforter. The wind-chill factor is a numbing-53° F. In the operating room at Meeker County Memorial Hospital, a woman in her 60s lies beneath a white sheet with one leg exposed, her lonely foot tinted amber from an iodine wash. Curved over his patient, Chief of Surgery William Nolen moves quickly and gracefully, brandishing a gleaming succession of instruments—all to remove a troublesome bunion. As the patient is wheeled away, Nolen rewards himself with a Styrofoam cup of decaffeinated coffee. It is 8:36 a.m.