for the first time, what procedure did until 2103 patient 78221 receive?
select d_icd_procedures.short_title from d_icd_procedures where d_icd_procedures.icd9_code in ( select procedures_icd.icd9_code from procedures_icd where procedures_icd.hadm_id in ( select admissions.hadm_id from admissions where admissions.subject_id = 78221 ) and strftime('%y',procedures_icd.charttime) <= '2103' order by procedures_icd.charttime asc limit 1 )