C. Everett Koop - Career

Career

Although he was most widely known among Americans for his years being the Surgeon General, the vast bulk of Koop's career was actually spent as a practicing physician. For 35 years, from 1946 to 1981, he was the surgeon-in-chief at the Children's Hospital of Philadelphia (CHOP), and this at a time when pediatric surgery as a specialty was moving from its infancy to a full fledged profession. (When Koop established the pediatric surgical division at CHOP in 1946, it was the first such service in Philadelphia and only the second such service established in America behind Boston, where William E. Ladd and Robert E. Gross had pioneered pediatric surgical services.) Koop was able to establish the nation's first neonatal surgical intensive care unit there in 1956. He helped establish the biliary atresia program at CHOP when pioneering surgeon Morio Kasai came to work with him in the 1970s. He also established the pediatric surgery fellowship training program at CHOP. During his tenure there he graduated thirty-five residents and fourteen foreign fellows, many of whom went on to become professors of pediatric surgery, directors of divisions of pediatric surgery, and surgeons-in-chief of children's hospitals.

While a surgeon in Philadelphia, Koop performed groundbreaking surgical procedures on conjoined twins, invented techniques which today are commonly used for infant surgery, and saved the lives of countless children who otherwise might have been allowed to die. He invented anesthetic and surgical techniques for small bodies and metabolisms and participated in the separation of several sets of conjoined twins whose condition other physicians at the time considered hopeless. He first gained international recognition in 1957 by the separation of two female pygopagus infants (conjoined at the buttocks) and then, again, in 1974 by the separation of two ischiopagus twins (conjoined at the spine) sharing a liver, colon, and parts of the intestines with their entire trunks merged.

Koop was active in publishing articles in the medical literature. Koop later wrote that "each day of those early years in pediatric surgery I felt I was on the cutting edge. Some of the surgical problems that landed on the operating table at Children's had not even been named. Many of the operations I performed had never been done before. It was an exuberant feeling, but also a little scary. At times I was troubled by fears that I wasn't doing things the right way, that I would have regrets, or that someone else had performed a certain procedure successfully but had never bothered to write it up for the medical journals, or if they had I couldn't find it." Koop helped rectify this by publishing his own findings and results. Additionally he became the first editor of the Journal of Pediatric Surgery when it was founded in 1966.

In contrast to his years as Surgeon General, when it was his policies and speeches that had bearing on other people, his years as an operating pediatric surgeon involved a more individualized, direct, hands-on effect on others. During the course of his long career, for example, he performed some seventeen thousand inguinal hernia repairs and over seven thousand orchidopexies (surgery for correcting undescended testicle). He developed new procedures, such as the colon interposition graft for correcting esophageal atresia (congenital lack of continuity of the esophagus) or ventriculoperitoneal shunts for treatment of hydrocephalus (accumulation of excessive cerebral spinal fluid in and around the brain causing neurological problems). He also tackled many difficult cases ranging from childhood cancer to surgeries done on conjoined twins, of which he and his colleagues operated upon ten pairs during his 35-year tenure. In all he operated on many children and babies with congenital defects 'incompatible with life but amenable to surgical correction'.

Much of the opposition that Koop later faced in being confirmed as President Reagan's choice as Surgeon General came from his widely known views about right to life. In 1976, after spending an entire Saturday with his pediatric surgery fellows operating on three patients with severe congenital defects, Koop sat in the cafeteria and remarked that together they had given over two hundred years of life to three individuals who together barely weighed ten pounds. When one of the surgical fellows replied that next door at the university hospital abortions were being performed on healthy babies, Koop was stirred to write The Right to Live, The Right to Die, setting down his concerns about abortion, infanticide, and euthanasia. Koop also took some time off from his surgical practice to make a series of films with Christian apologist Francis Schaeffer titled "Whatever Happened to the Human Race". These films, along with a book published by the same name, reflected Koop's opposition to abortion, infanticide, and euthanasia and fired much of the controversy and initial antagonism that surrounded Koop's nomination for Surgeon General.