As It Was … but Not Now: A Memoir

By Joseph Merrill

In 1923 in Andalusia, Alabama, twenty-odd miles north of the Florida line, a physician was born. Its a place deep in the piney woods that was an area of sand beds, sand roads, and sandspurs. In As It Was But Not Now, Dr. Joseph Merrill tells his story that began in that little town more than ninety years ago.

In this memoir, Merrill recalls a boy educated in the public schools of the rural South who was transformed into a physician. NIH and Baylor College of Medicine provided him an environment to study the vagaries of academic medicine in Americas changing health care industry.

Filled with anecdotes and stories from his youth to his college days in medical school to his career as a physician, Merrill offers a look at the life of a doctor and the ebb and flow of the practice of medicine.

• Language: English
• Publisher: iUniverse
• Release date: Oct 28, 2015
• ISBN: 9781491774540

Joseph Merrill

Joseph Merrill is a ninety-one-year-old physician who attended Harvard, Vanderbilt, and London’s Hammersmith Hospital. Merrill worked at NIH and Baylor College of Medicine. He currently lives in Houston, Texas.

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Copyright © 2015 Joseph Merrill.

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the author except in the case of brief quotations embodied in critical articles and reviews.

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ISBN: 978-1-4917-7455-7 (sc)

ISBN: 978-1-4917-7454-0 (e)

Library of Congress Control Number: 2015913401

iUniverse rev. date: 10/27/2015

CONTENTS

Author’s Note

Introduction

CHAPTER 1 Preparation Of A Physician

Family’s Contribution

Summers in South Alabama

The Lumber Mill

Georgia Caravan

New York World’s Fair, 1939

Grandpa Jordan and Merrimac Plantation

Education’s Underpinnings

Tuscaloosa, Alabama

Fort Benning, Georgia

A Death in the Family

Texas A&M

Medical School

Harvard

CHAPTER 2 The Practice of Medicine

Nashville

A Florida-Style Air Force Doctor

Another Death in the Family

Introduction to Clinical Research

London

Career as a Physician

Pygmies and Heart Disease

Falling in Love

A New Broom Sweeps Clean

NIH

CHAPTER 3 Houston

Texas Medical Center Ambience

I told you so … I don’t wanna hear it.

How DeBakey Became Vice President for Medical Affairs

CHAPTER 4 Forty Miles of Unpaved Road

Strengthening Our Management Team

Baylor’s Association of Physicians

Texas Heart Institute, Saint Luke’s Hospital, and Baylor

Texas Children’s Hospital

Overaged Professors

Getting an Appropriation from the Texas Legislature

CHAPTER 5 Headhunting Turns Up Some Good Specimens

Medicine

Ophthalmology

Cell Biology

Psychiatry

Biochemistry

Pathology

Ob-Gyn

First Community and Then Family Medicine

Other Faculty

CHAPTER 6 Win, Place, Or Show

Genetics

Howard Hughes Medical Institute

Jim Sammons’s Own Mini-Medical School

Library

Baylor Meets Albert

Kelsey-Seybold

Center for Allied Health Manpower

High School for Health Professions

A Center for Ethics

Continuing Education

CHAPTER 7 Free At Last

London 1976–1977

Professional Life (1977–2003)

Harvard Again

Art, History, Medicine

Good-Bye

Essays

If it were not for my girls, I would take my life.

A Requiem for Medical Education

Alzheimer’s: A Personal Diary of Dissolution

My Homage to Vanderbilt

A Bridge between Islam and the West

From a Chicago Pub Crawl: Two Literary Classics

Fingers and Hallucinations

Science on the Alabama Frontier

Appendix

Association of Physicians

Medical Library

References

To

Gudrun

Maria

Caroline

AUTHOR’S NOTE

Sixty-seven years ago when I graduated from medical school, I was given a copy of Osler’s Aequanimitas. His essay summed up medicine as an art not a trade and attributed its 2500 years survival to application of rational science, a progressive character, beneficence, and high moral ideals.

Today, we read of crimes committed in medicine’s domain: falsifying diagnostic codes to increase reimbursement; accepting bribes for laboratory test referrals; unnecessary surgery; and corporate offers to doctors to hospitalize people.

A new kind of leadership in the health-industry sector is now being offered by a prestigious business school. It features opportunities for those interested in entrepreneurial health care technology, management, consulting, or investing. For others, there is tremendous room for opportunity at the intersection of health and business or an array of activities to foster a rich health care experience.

Is this new leadership directed toward the greater good?

Future doctors are now taught clinical medicine in tax-exempt health-industry clinics and hospitals. Faculty are compensated on the basis of generated RVUs [Relative Vale Units]. These units are determined by the number of patients seen and the diagnostic codes entered.

Is this assembly-line atmosphere the optimal one for either patient care or medical education? Will medical school faculties be able to remain a community of scholars who value intellect? Will the university offer faculty the opportunity to do research independent of what the public, pharmaceutical industry and government want at the moment?

Leopold von Ranke, the 19th century historian, wrote: Every historical period is justified in the sight of God. My sixty-seven years hardly qualify as a historical period, but as a physician-educator it seems fair to examine if our current environment is the optimal one for developing humane caring physicians and surgeons?

INTRODUCTION

A colleague half my age asked me if I could tell that I was deteriorating. I said, Yes … I noticed it at age forty on water skis. Fifty years later, people offer me their seats on buses, hold doors open, and offer to carry my luggage. When walking, I have broadened my stance to compensate for a tendency to weave. With sudden turns, I grab whatever is at hand; in going down a flight of stairs, I hold on to handrails. All of this creates the prototype of an old man. Deterioration of soma and psyche continues as if it were a work in progress. But the spirit is willing, hence, this progress report on my continuing education.

CHAPTER 1

PREPARATION OF A PHYSICIAN

Nothing that is human is alien to me.

—Terence

Andalusia, my hometown, is twenty-odd miles north of the Florida line. It is deep in the piney woods of Alabama—not a part of Margaret Mitchell’s mythical South. When I was born there in 1923, it was an area of sand beds, sand roads, and sandspurs—the kind that made you holler when you stepped on them.

In the twenties, hookworm and pellagra were so common that the Rockefeller Foundation’s International Health Division established a field station in town to train public health officers. Wilson G. Smillie, MD, the director, was no slouch. He became a professor at the Harvard School of Public Health and Cornell University Medical College. His terrain around Andalusia wasn’t entirely sand. Twenty years later, Dr. Smillie would still recall the red mud where his car got stuck when he was making his rounds on the way to Red Level or Rose Hill.

While the field station was in operation, Dr. Wilbur A. Sawyer from the Rockefeller Foundation visited and recorded his impressions in letters to his wife:

You cannot imagine the depths of ignorance and physical degradation of many of the white farmers living in the rough cabins. At one house we went to see a case of TB in the mother of the family … her 18 year old daughter had advanced TB, her 16 year old daughter was in bed with the survivor of a pair of illegitimate twins born four days before. An assortment of younger children were floating about the place and viewing what the future held for them. Most of the farmers seem to be tenants and move most every year, adding failure to failure. When they are talked about health precautions, about one idea out of ten seems to penetrate the drawn and impassive face with mouth hanging slightly open.

Dr. Sawyer made these observations about poverty in the South twelve years before James Agee and Walker Evans wrote and photographed certain predicaments of human divinity that they observed in Hale County, Alabama.

In the first three decades of the twentieth century, large lumber mills operated in Andalusia’s vicinity, but when they finished cutting, they left behind a trail of sawdust and cutover lands that looked more like bombing ranges than pine forests. During the Great Depression years, a textile mill supplanted the lumber mills and steadied the local economy.

Many southern writers have commented on the importance of sense of place as a source of their prose. Didn’t someone once say all literature is gossip? In The Meaning of Human Existence, E. O. Wilson—who went to high school in Brewton, forty miles from Andalusia—wrote that gossip is an important element in how we derive meaning, and as born gossips, we cannot be sated by too much detail. And so it was that Andalusia’s people and their vivid stories prepared me for the vagaries of human nature I would encounter as my career as a physician unfolded.

When telephones came to Andalusia, Bean’s Boardinghouse had number 1, and our number was 5-2. My uncle observed that the next-door neighbor’s wife had pulled her favorite rocking chair up to the phone and never moved it thereafter. That way, she’d know when a woman was pregnant before the woman’s husband did. My mother had two primary information sources: a nurse who boarded across the street and a friend who clerked in the county judge’s office. She then had both the medical and legal beats covered.

From the nurse, we learned that Volusia Goldthwaite had three washrags and that if the nurse mixed ’em up, she had a fit. The nurse also knew which World War I veterans had acquired syphilis from the French whores. Or whose coughs were bad enough for them to be sent on their way to Ashville’s TB sanatorium. And which schizophrenics required certification to be sent to the insane asylum at Tuscaloosa. If they were veterans, the family attributed their mental problems to having been gassed in France. Or incest: when a court order took a fourteen-year-old’s baby, sired by her father, away from her, you could hear her yelling all over the town square.

Our town had two one-legged men. Cy O’Malley operated a livery stable; Will Taylor was the county tax collector. In separate accidents at the lumber mill, O’Malley lost his left leg and Taylor his right. Once the mule merchant learned the tax collector wore the same-sized shoe that he did, they shopped together when Cy’s shoe wore out.

After the livery stable operator’s lost leg was buried in Magnolia Cemetery, his sister—married to the local doctor—learned that pouring boiling water over the amputated extremity could prevent phantom pain. So they dug up Cy’s leg and poured boiling water over it. Cy was never troubled with phantom pain. But the tax collector missed out on this good advice; for the remainder of his life, he had phantom pain that felt like someone squeezing rocks between his toes.

One Saturday morning, a lad came by the livery stable peddling butter at the right price for Cy, so he bought all he had. Several weeks later, he ran into the boy on the streets and asked, When are you going to bring me some more of that fine butter?

The boy replied, The cat hasn’t fallen in the churn since.

Mrs. O’Malley (Miss Josie) was cut from the same mold. One night she cooked scrambled eggs for supper, and the family complained the eggs were too salty. At breakfast the next morning, she said, Now don’t complain to me about these eggs being too salty, because I washed the salt out last night.

On another occasion, a married couple—friends from out of town—dropped by for a visit. After a while, Myrtice (the daughter) said, Why don’t you spend the night? When they agreed, Myrtice disappeared to find some fresh sheets.

Mrs. Cy interjected, No need to do that. Those sheets have only been slept on once, when Cleve and Annie Ruth were here last week.

Cy was a big Mason. When he died, one of his fellow Masons asked Miss Josie if there was anything he could do for her.

She promptly replied, Yes, you can pay the electric bill.

During the Depression, most banks in South Alabama went bankrupt. One bank was different. The head of this bank was in poor health; he was in the end stages of syphilis that he had acquired from a circus