Doctor

By William Henry Lewis

Doctor is a chronicle of the many ordinary and the fewer extraordinary people encountered by one physician during his forty years of practice. It serves as a testament to the grace, poise, and spirit manifested by so many in the midst of tragedies and triumphs, agonies and joys, and dying and living. Conversely, Doctor exposes some of the worst in some reprehensible characters who regrettably made careers of it.

Some parts of Doctor are inspiring, some shocking, some very routine, and some really funny. But all of it is true.

• Language: English
• Publisher: Xlibris US
• Release date: Jul 8, 2015
• ISBN: 9781503569416

William Henry Lewis

William Henry Lewis, MD, was a 1972 graduate from a large northeastern medical school. He received his training in internal medicine at his alma mater and then his training in cardiovascular diseases at a top university program on the West Coast. Including service as a medical officer in the United States Air Force, he practiced medicine for forty years. Doctor is a chronicle of people and events that he encountered during those years. “By observing so closely and so profoundly the humanity of others, I became more and more acquainted with my own.” “I am certain that many other physicians have had similar experiences and made similar observations. Perhaps the only difference between us is that I simply took the time and put forth the effort to write about them.”

Book preview

CHAPTER I

T HE DECISION TO pursue a particular career or calling may not always be strictly rational and well thought out. In my case, it was a collage of images, ideas, and concepts. As medical school applicants, we were warned of the classic question we’d be asked during interviews: Why do you want to be a doctor? The moth-eaten traditional response was To help people. I myself was not asked that question during my interviews; rather, I posed it to myself over and over. I cannot candidly confirm that to help people was my overwhelming response; however, I have long held to the notion that there is virtually no downside in aiding the welfare of others.

Mathematics was my major in college. I loved math. It made perfect sense. It always worked. It was indifferent and unbiased. I had two math courses almost every semester during my four undergraduate years, and I did very well in them. Once I understood the concept at hand, it was mine forever. I never had to read a math textbook. Hearing it explained in class was sufficient. Fortunately, almost all my professors were excellent. As a math major, I was required to take two years of physics, so my science background was quite extensive and included two years of chemistry and one of biology. I opted against the usual premed pathway and decided to stick with math. The vast majority of premeds in those days were bio majors. Biology actually made me cringe. It lacked the rigor and firmness that I enjoyed and seemed like more green history.

I thought about careers in math, but I never really knew what one did after an undergraduate degree except to go on to graduate school. I was fortunate to have been selected in the very first honors program that our university offered in mathematics. There were only about a dozen of us all together. The honors courses were all graduate level. It was then that this boy became separated from the real men. Although I did well enough in those advanced courses, it seemed that I had met my match—perhaps I wasn’t all that good. Suddenly, my math skills seemed to fall short of the degree of excellence I would demand of myself in a career.

A second great love was of stage and cinema. I’m sure I saw all the good movies from the 1930s through the 1960s. A high-school friend and I diligently saved all our pennies from after-school jobs and card games so that once we paid for cigarettes, we could attend the theater. Usually about twice each month we’d get seats up in the ozone layer. We did see some darned good plays and some great performances. We fancied ourselves cultivated critics. We actually did put together a scholarly treatise on our two biggest heroes, Gary Cooper and Humphrey Bogart. Then during my freshman year in college, I decided to read for a part in a play to be staged by the Drama Department, then one of the finest in the nation. I studied the part and rehearsed it by myself for several weeks. On the eve of my audition, I simply chickened out. My theatrical career ended before it ever began.

If math and movies were loves, baseball was my passion. My mom would take me by trolley to the ballpark on Saturdays for ladies’ day—free admission for her and only seventy-five cents for me. I got to see in person some of the all-time greats during those mid-1950s excursions. There was no little league or organized sports of any kind in our inner city neighborhood. Therefore, we became creative in improvising a variety of street games. A ball was a precious commodity and would reside with only the most trustworthy members of our group—usually me. Bats were abundant. Broomsticks and broken table legs could always be scrounged from the trash.

By the time I got to high school, I was very good at all facets of the game. I decided to try out for the toughest position on the diamond—catcher. At 120 pounds and never having used a catcher’s mitt, this was a bold undertaking. I borrowed a mitt from a more affluent kid—a doctor’s son. Once I put it on, it felt like my hand belonged in it. In only ninth grade at the time, I rose to number two on the varsity depth chart—almost unheard of. I thought this was a pretty good accomplishment, since the starting catcher was a senior linebacker on the football team.

My parents were both fine athletes, but neither participated in team sports. Consequently, I received little encouragement to pursue baseball. I probably was good enough to continue after high school, perhaps at the college of semipro levels, but that would have required abdicating the priority on academics. This would have been unthinkable in our family. Hence, my baseball career had no postgraduate activity.

My decision to pursue medicine was less by design than by destiny. Although I was endowed with sufficient folly and youthful arrogance, nonetheless, given the time and the necessity, I would rally to a rational, reasoned assessment of career paths. Medicine was composed of a blend of valid science and essential art. The importance of hands-on physical examination skills added a vibrant, dynamic dimension. One could be a thinker and an artisan at the same time. There also was an impalpable factor that drew me. I perceived that a physician might have a unique and special relationship with people, unlike any other calling. There would be unparalleled privileges and license for a unique brand of intimacy yet unmatched obligation, responsibility, and accountability. One would touch naked bodies and, often, naked souls.

It was during that era that the public’s esteem for us would provide an element of safe passage. Gradually over the ensuing years, that umbrella would develop leaks. I think the group that got the wettest was those of us who took most seriously the lofty notions held about doctors. Fortunately, an exalted self-image was not one of my major afflictions.

My destiny to practice medicine was inspired largely through the legacy of one man—Warren, my uncle, my father’s brother. Warren was the eldest of four brothers and two sisters. He was fifteen years my dad’s senior. After military service during the First World War, he enrolled in a prestigious medical school. My grandfather earned a craftsmen’s wage, certainly not tuition dollars. Warren’s younger brother, Leonard, worked and sacrificed to foot the bill for his older brother’s schooling. Consequently, Warren and Leonard would remain very close for the rest of their lives. Family lore had it that Warren owned but one pair of pants, which he removed at home after class and hung them neatly, and he studied in his underwear or pajamas.

He was of average height and build. His whitish hair was cut short and tightly combed over. He had a small, gray mustache, which was neatly trimmed. Whenever I saw him, he wore a dark conservative suit and white shirt with stiff, straight collar. His tie-shirt-collar ensemble was perfectly constructed and looked more sculpted than knotted. His face glowed with a special warmth and welcome, and he generally sported a smile. He was soft-spoken but not reticent. He made entertaining and timely conversation. Whenever I was in his presence, he made me feel as if I were his favorite relative. And maybe I was.

Of course, he was old enough to be my grandfather, and when I was a kid, he would bounce me on his knees and magically excavate a quarter from my ear. Being with him was indeed worth a lot more than the twenty-five-cent reward.

After medical school and internship, Uncle Warren opened a general practice across the street from his family in the inner city. After a few years, he earned enough to close the practice and take a surgical training residency. He had a very successful surgical practice and became chief of the Department of Surgery at the largest private hospital in the city. His endearing manner was not restricted to his youngest nephew. He was well liked and respected by all who knew him. He was a perennial executive officer in the city’s medical society and eventually was elected its president.

Warren’s generation had five sons, of whom I was the youngest. His two sons went on to become physicians—one a general practitioner, the other also a surgeon. His sister’s son, also a physician, pursued a brilliant academic career in molecular genetics but never took care of patients. Another nephew, his youngest brother’s son, dropped out of high school, worked odd jobs, and then became a businessman (actually a crook and con artist who, to my amazement, managed to elude the penitentiary). Therefore, except the one black sheep, there was a tradition of sorts afforded to me yet without an expressed mandate. I can truthfully state that there was no coercion over my career choice, either explicit or tacit, from that generation of relatives. This is rather remarkable, since that collection of ancestors had no inhibitions about telling others how to live their lives. Perhaps in my case, they were distracted by my cousin, the rogue, or they had simply gotten too old to bother pressuring me.

In the early days of TV (mid-1950s), Uncle Warren occasionally appeared on medical panel discussions. The spots were brief in those days, generally about fifteen minutes. With advanced notice, the entire family would gather by my grandmother’s TV to watch our celebrity. The discussions were usually lusterless, but it was awesome just to see him.

He rarely visited our house, except for brief quarterly stops to pick up new shirts, which my dad would purchase for him. His entree through our doorway was like that of a national dignitary. We all dropped what we were doing and ran to greet him. My father simply adored him.

I had but one occasion to consult Uncle Warren professionally. During high-school baseball practice one day, I injured my hand. I went to the hospital where he practiced and waited for him to exit the operating room. He came to see me still in his scrub suit and cap, and he wore a surgical mask, which dangled from his neck. He examined my hand, his hands still powdered from the surgical gloves. He acted toward me as if I were his most important patient. I felt like I was in the presence of Michael DeBakey or some other giant of the time. He slapped me on the backside and told me I’d be fine. He was right.

Warren died suddenly from a heart attack in his midseventies. I was always thankful that I had made it through my second year in medical school while he was alive. He was proud of me. I adored him too.

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Upon entering my third year in college, the pursuit of medicine was a strong option but not yet firmly set in my mind. I thought it might be profitable for me to acquaint myself more thoroughly with the language and the ambience of the medical school. A part-time research job would do nicely. It might answer some questions in my mind and also edify my credentials. I checked out the landscape for investigators who might utilize my math skills. I preferred not to stand in some lab, pouring and pipetting chemicals and smelling like exhaust fumes.

I came upon a group of Cardiac researchers, headed by the chief of Cardiac Surgery. He had developed one of the early artificial heart valves and led a team of Cardiologists/Cardiac physiologists and surgeons in the study of the complicated mechanical functions of the heart. They were evaluating and constructing a variety of mathematical models of how the heart might work. My math skills would blend nicely with their efforts. I could do a lot of the legwork analysis and free them up for more focus on the primary issues. I knew nothing about the physiology of the heart, but I would soon learn some crucial and complex concepts that would avail me in the future.

Actually, I was lacking in the math discipline that would have served me best—namely, statistics. I viewed statistics as banal in comparison to the loftier and sexier math courses I was taking; consequently, I never enrolled in the course. Fortunately, I was able to give myself a hurry-up intro into the basic statistical tools I would need. There were no office computers in use in those days, so all my work was done either by hand or with the help of calculators.

Their experimental animal laboratory featured a complete operating suite with all the equipment used in the human facilities in the hospital. Being a dog lover, I was relieved that the animals were, by and large, treated compassionately. A few times each month I would assist in the lab, so I learned some basic surgical techniques with my own hands and got to see up close the cardiac surgical procedures that were actually performed in humans. So as it turns out after all, I would regularly shift from the tidy, odorless domain of mathematics into an arena replete with bodily fluids and smells, just not human ones.

The group of researchers I worked for was an international assemblage of some very interesting characters. The two principal members were there full time. There were at any time usually two or three other guys who rotated through from other countries. Since they came and went so often, I got to know most of them fairly well, inasmuch as this novice could get to know experienced and established physicians and surgeons. The collection of personalities enjoyed a common trait. They all seemed to be real playboys. While I can’t say with certainty that they were all philanderers, I can attest to the fact that they all seemed to enjoy a good time and were definitely partial to ladies—that is, any and all ladies. Be that as it may, they were all highly skilled and talented professionals who took their work very seriously. My impression then was that they were all pretty good doctors.

That summer I worked at the medical school in the cardiac research area all week long. I loved going there. I learned something each day and experienced something new regularly. The doctors I worked for were great company and were very entertaining. It was easy for me to enjoy it, not having been exposed yet to the stresses and demands of the profession.

I drove my car there each day. In that era there was no parking for the medical school. The hospital across the street had a small lot that was strictly reserved for faculty and emergency room customers. Students were prohibited from parking there. I would park my car on the backstreets of the inner city neighborhood that surrounded the entire medical complex. It would entail usually a three- to four-block walk to the medical school building, usually from the same parking space each day. Having grown up in that neighborhood, I was all too familiar with the potential threats one might encounter on those streets. As I negotiated those sidewalks, I was not constantly gripped by fear, but I always exercised a proper measure of caution.

One summer morning, I had left my car, walked three blocks, and stepped over the curb of the final block leading to the medical school building. It was around 8:00 a.m. On my left was a brick wall; on my right was a row of parked cars in the narrow street. The sidewalk itself was only about twelve feet wide. As I mounted the curb, a car suddenly stopped in the middle of the street. The driver jumped out, leaving his car door wide open. He moved hurriedly and clumsily in my direction. He was not quite staggering, but his gait was unsteady enough that I leaped to the conclusion that he might be sloshed even this early in the day. My reasoning proved valid in short order. He shouted at me, Yo, white muh-fuh, ahmaw cut out cho mu-fuh heart! By this declaration, I posited that he might be in possession of some pointed utensil and that he might attempt to apply such instrument to my person in an unwelcome fashion. His right hand fumbled around in his pants pocket, lending credibility to this notion. Racing through my mind in an instant, more like a blur than an organized thought, was the idea that while the booze might embolden him, it might, conversely, impair his efforts. However, I opted not to test this theory but, rather, to proceed as if he were as sober as a saint.

The man looked in his midforties. He was roughly my height (six feet) but moderately heavier. He wasn’t huge. Not having a physical fitness profile on him at my disposal, I could not predict how I might match up against him physically. Therefore, I played it safe and backpedaled a few feet as he charged at me. Instantly I realized that my back was only a few feet from the brick wall, against which I’d be essentially pinned. I was now within his reach, which also meant that he was within my reach. Rather than wait and see what this charging bull might pull out of his pocket, I stepped forward and issued a right hook to his face. It connected. He reeled, staggered a step or two, and then fell headfirst, striking his forehead on the bumper of a parked car. He was down for the count.

No surprise, he was bleeding pretty good from the scalp wound, but he was still conscious. I myself, still a bit shaky, observed what was only seconds ago my predator, now a pathetic pile before me in the street. While infused with a sense of pity, I still felt sufficient relief that I was the one still vertical and intact. I bent over, hoisted him up to his feet, and swung his arm around my shoulder. The two of us inched along across the street to the hospital emergency room. I plopped him down on a chair in front of a triage nurse and filled her in on what had happened. The narrative didn’t take long. She was not surprised. She saw stuff like this all the time. She said she was always surprised that more students hadn’t been accosted or worse.

If the guy was a sorry sight laid out on the street, he was really sad looking sitting there in the ER. But then again, so were most of the people waiting there.

I left and went back across the street to my research job. Without a change of clothes, my greatest challenge remaining that day was explaining why my shirt was all covered with blood.

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Another bloody incident occurred later that year; this time it was my blood that was shed.

I was exiting a building on the main campus one icy winter day and fell flat on my face, crashing into a concrete step. There was a two-inch laceration in my chin, which bled quite a bit. Unbeknownst to me at the time was a fracture of the right side of my jaw, explaining why there was bleeding from inside my mouth as well. Equal to the discomfort I had from the injury was the sheer embarrassment I felt over my public ineptitude.

I definitely was in need of medical attention, but I didn’t want to hang around forever at the ER in the hospital, which was two miles away. I didn’t even know where the student health dispensary on campus was, or if there was one. Therefore, I decided to see the guys I worked for in research. They all knew how to do suturing. The dog lab had plenty of instruments and suture material. They could sew me up as easily as they could a dog.

I must have been quite a sight as I dropped in on them. The chief promptly looked at my facial wounds. Instead of sending me to the ER, he called Dr. Barrister, a surgeon. Dr. Barrister agreed to see me immediately in his office.

Phillip Barrister was professor of surgery. In his late forties, he had spent his entire career at University Hospital. He had an excellent reputation. From a long line of physicians, his roots were an old, established Virginia family. He himself was a paradigm of southern gentry. He was tall, about six feet three inches, and slender. His face wore a serious but cordial expression. He looked both competent and comforting. He was groomed and dressed conservatively and immaculately. His name was embroidered on the lapel pocket of his white coat. The coat itself was stiff and perfectly pleated. There was not so much as a hint of a crease or wrinkle.

Dr. Barrister spoke softly and sparingly. There was wisdom and authority yet humility in his voice. As he traveled the corridors, he seemed more to glide than to walk. He embodied and epitomized poise, dignity, and graciousness. He carried himself and conducted himself exactly as one might hope an academic physician would. In short, he was elegant—a cool guy.

It was my first experience with stitches, and he put me at complete ease as he put eight sutures in my chin. He arranged for me to be seen next by oral surgery for my jaw. Fortunately, the fracture was small and no wiring would be needed, just a liquid diet for four weeks. The twenty pounds I lost testified to my adherence with such a diet.

Three years later, Phillip Barrister’s role at University Medical School would change substantially. Ten years after that, our roles would reverse.

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Later that winter I submitted my application for admission to the medical school. In those days it was occasionally possible for a student to obtain admission after only three years of college (i.e., shy of a bachelor’s degree). The thinking usually went something like this: since one is committed to earning the degree of MD, why bother with the fourth year needed just for the bachelor’s degree? Therefore, I decided to give early acceptance a try. I did not subscribe to the notion that an undergraduate degree was irrelevant; I simply thought that getting a one-year head start was worth it. I went ahead and submitted application for early entry at the very medical school where I was currently working. About one month later, I received a response acknowledging receipt of all my transcripts and letters of support. It was fortunate that I had taken so much math, physics, and chemistry. These classes were small, thus affording me more personal contact with the professors. My letters of recommendation were quite good.

Six weeks hence, a thin eight-by-eleven-inch envelope arrived in the mail. For any student applicant, thin envelopes usually contained bad news. The favorable responses usually were accompanied by other documents, hence thicker envelopes. (Every student knows this.) It always seemed that bad news could be written briefly and on one sheet of paper. This envelope, however, was an exception. It was an invitation to come for an interview. Naturally, I was elated. They could’ve sat on the application for six months and politely rejected it. Or they could have laughed at my request for early acceptance and dismissed it summarily. Therefore, to get as far as an interview was a formidable achievement.

Come the day of my interview, I found myself outside the office of James Carlsen, associate dean of admissions. My wait was not very long but certainly long enough for a crescendo of anxiety. He opened his door and invited me in politely but formally. He was a big guy, about six feet two inches and 220 pounds. I could not assess his musculature in detail, but he sure didn’t look flabby, more like a linebacker. He had short, thinning light-brown hair and a round face. His hands were huge, swallowing my right hand completely during our handshake. He wore a smart tweed checked sport coat and fine-looking beige slacks, which coordinated perfectly. On the other hand, his shirt and tie not only mismatched each other but also clashed with the rest of his outfit like a bitter divorce. Rounding out the ensemble was a pair of elegant tasseled loafers. Overall, I thought his image was an odd conglomerate of some fine duds thrown over the body of a Neanderthal.

All other elements of his appearance blanched in comparison with his most outstanding feature—his eyes. His eyes looked like steel pellets that straddled his nose. Their icy-blue color only added to the steely threat they seemed to pose. They were penetrating and menacing. I am convinced that it was after him that the expression beady eyes was fashioned.

The interview itself was bland. I cannot say it was unintimidating because its very nature was intimidating. Carlsen himself did nothing to put me at ease, nor was he overbearing or demanding. I do not recall being asked even a single question that the student grapevine had alerted me about in preparation. Overall, the interview was about as complex and arduous as buying a pair of shoes.

As I exited his office, I was naturally relieved that the event was over and that I had survived. I even felt a twinge of disappointment that he had not asked me anything challenging or even thought provoking. In fact, the only question during that interview was one that I posed to him. I asked, What are my chances of being accepted? I thought that by asking that question I might demonstrate a degree of assertiveness rather than desperation. I was stunned by his response. Oh, gee, I wouldn’t know, he said. Then I thought to myself, Buddy, if you wouldn’t know, who would? Aren’t you the dean of this place? Then as days and weeks passed, I became more and more puzzled by his response. It seemed surprisingly vacuous.

I think medical students, unlike high-school or undergraduate students, always possessed a sense of reverential awe toward their faculty superiors. To be more candid and analytical, I would add that this sentiment was not pure. It was also tainted by a healthy degree of fear. These guys tended to be viewed as larger than life, especially since they seemed to have over us the power of life itself—that is, the life of one’s career. They would decide who got in, who graduated, and where and how one would practice. So much of our fates seemed determined by the temperaments of our faculty and not simply by objective measures. Most of the faculty were competent and capable of handling this responsibility. Yet there were some bad guys.

Following my interview, it took several weeks for my intimidation by Carlsen to begin to fade. Once it did, I acquired a sense of unease about him. Why was so much of my interview so inane? Was it simply his style? Mine was so unlike any of the interviews I had heard about. Had I missed something? Who was this guy anyway? Where did he come from?

To scope out this man, I went to the fount of information, the source, the student grapevine. In the student grapevine was an abundance of material. All one had to do in order to gain access was to knock on the door of any frat house. In short order, you’d be provided with all the information you could possibly want and some you didn’t want to hear. Most of the stuff obtained from the source was either completely accurate or in large measure correct. Some info was erroneous and misleading. But usually the major issues were reliably depicted. Furthermore, there were independent limbs of the source that always could be accessed for corroboration.

I learned that almost all the executive administration at our medical school shared backgrounds of academic tenure, usually at our institution. Those who were not homegrown had similar credentials from other academic centers. It turns out that Carlsen had neither. Word was that he was a graduate of our medical school but then went on to general practice somewhere in Indiana. There was a large void in the rumor warehouse about just how he came to be our associate dean for admissions. There was speculation about some sort of quid pro quo, but no one from the source stands behind this theory, and no details were given. So Carlsen’s ascension to his rank was a mystery.

At least I was encouraged that my suspicions about him had some merit. How this news might impact the outcome of my application, I could not even speculate. Perhaps there was even truth about his plea of ignorance about my chances. Maybe more traditional and reliable voices would be heard. After all, there was a committee.

During the spring semester of my third year in college, just a few weeks before final exams, I received notification of the Admissions Committee’s decision. I was designated as an alternate for the fall class. I was elated at the news. It actually turned out to be the best outcome. First, I had eventually come to the conclusion that I would be best served by completing my fourth year, especially since I was heading toward graduation with honors. My parents would cherish my graduation ceremony, even one that involved several thousands of students. If I short-circuited this pathway, they’d have to wait another four years for a commencement ceremony. Second, one more year of undergraduate rigor would be an asset to my education in general. Third, being designated an alternate might hold me in good stead for acceptance the following year. I had even hoped that having been designated an alternate might mean automatic acceptance upon completion of my degree. As it turned out, my hope for an automatic acceptance was not far-fetched. My reapplication the following year went quickly, smoothly, without even requiring a second interview. The fact that I had obtained a 3.9 grade point average during my senior year didn’t hurt either. So for the next few months I could relax and enjoy life. There would be plenty of opportunity for stress and anxiety on the horizon.

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I enjoyed the summer of work for the research group. They were very kind to me, and they treated me more like an embryonic colleague than an ignorant student. They had just completed a textbook on new developments in the understanding of cardiac performance. They credited me as a contributing author. This represented a major accomplishment for a novice at my level. Recognition in print was a significant piece of credentialing. It was the first item in my curriculum vitae.

Evidently, my misgivings over Dean Carlsen must have been shared by others, especially those of high rank in the administration. By the time I entered the freshman class that fall, he was not only stripped of his deanship but had been ousted entirely from administration. Surprisingly, no one was ever able to dredge up any details, and Carlsen’s reign as a potentate ended as inexplicably as it began.

Though Carlsen may have been dismissed, he was not banished. Three years henceforth, he would reemerge through one of the most bizarre constellations of events I have ever observed. What I myself witnessed then, I would like to forget but never will. The Dean Carlsen era (or experiment) might have ended, but his impact was still to be felt.

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As we began our freshman year that fall, we would endure one week of orientation, which included introductions to all the members of the dean’s staff. Providentially, this would include our new dean for admissions—Phillip Barrister.

During the previous year, while I was still busy with applications, there was a concurrent development that would have transforming consequences on the character, quality, and reputation of our institution. At the time, I had almost no awareness and certainly no appreciation whatsoever of its monumental significance. This was the appointment and arrival of Simon Schiller as chairman of the Department of Medicine. The previous chairman had retired two years earlier. At the time, the former chairman was eighty years of age and was a real good country doctor. But this was a new epoch in medicine. Our institution would have to remodel itself accordingly. During those two years of transition, the post of chairman was shared temporarily by two respected faculty members, while an exhaustive search was undertaken.

Schiller was fifty-two years old. He was trained in Internal Medicine at one of the finest academic hospitals in New York City. He went on to become professor of Medicine at a fine university center in the Midwest. Thereafter, he rose to the rank of cochairman of Medicine at one of the top-ten programs in the nation. He was vigorously recruited by our search committee and was, to our profit, appointed the chief of Medicine. Truthfully stated, Simon Schiller was one of the most remarkable individuals I have ever observed, either up close or remotely. I have encountered those who were brilliant scientists and investigators, those who were superb bedside physicians, and those who were effective organizers and leaders. I have never met any one man to whom all these attributes could be credited to the degree Schiller could. I came to this conclusion not merely as a young, inexperienced aspirant in awe of this new king figure but after twenty-five years of contact with the man himself and after almost forty years of exposure to the giants of our profession. My perspective of him had weathered several different vantage points that I had occupied as well as more than one evolutionary phase of his career. I can genuinely claim that of all the chairmen of Departments of Medicine that I had witnessed or heard, Simon Schiller was heads and shoulders above them all.

His scientific background was in molecular chemistry. He had assembled a small cadre of skilled biochemists and constructed an institute for research. The entire outfit was transposed to our university upon his arrival. As his career took on newer dimensions, especially in his latter years, the research institute functioned independently. He conceived of and developed an enzyme system that would revolutionize the treatment of a catastrophic and often fatal disorder. In time, as our understanding grew and techniques were refined, the impact of this discovery would approach the significance of penicillin or sulfa and might one day begin to rival the lifesaving impact of the polio or small pox vaccines. I was extremely pleased that his scientific work would manifest nearly full fruition while he was still alive and working. With the passage of years, I became increasingly disappointed that he was never awarded a Nobel Prize. I could not have imagined a more deserving recipient.

Our medical school traditionally had the reputation for training students to be good doctors. To this end there were many fine physicians and teachers who were committed to and responsible for our years of clinical tutelage. Dr. Schiller’s policies and efforts emphasized clinical excellence as the framework upon which he, moreover, would build investigators, scholars, academicians, and leaders. Almost overnight, he would boost our ranking to within the top twenty nationwide. In just a few short years, our residency in Internal Medicine would become one of the most sought after in the entire East Coast. This renaissance would require the infusion of new blood. He would restaff and restructure many of the subspecialties that comprised the Department of Medicine. He successfully recruited and appointed new chiefs in Cardiology, Pulmonary, Nephrology, and Infectious Diseases. All of the new leaders either were brought directly from the National Institutes of Health or had recently completed stints at that prestigious facility. Each of the new leadership appointees in turn would bring supporting staff also of NIH vintage.

The revitalization and emergence of our department had effects beyond its own boundaries. The other departments in University Hospital would grow stronger and more capable as a by-product of Schiller’s presence.

An inevitable and sometimes unfortunate consequence of our institutional transformation was the housecleaning attendant to such changes. Depending on the program and its new czar, there may be a purge resulting in a large exodus of faculty and staff. Or there might be more-lenient degrees of restructuring. In our case, there were departures but not mass departures. There were just a couple of removals that were probably warranted—guys who were marginal contributors. One or two truly outstanding faculty members would leave of their own volition probably because they wanted to call their own shots. Conversely, there were a few really good people who were retained in slightly different roles, probably to make room for the incoming recruits.

The cardiac research group I worked for became one of the evacuees. The work they did was excellent, and they published several high-caliber research studies in high-profile journals. I do not know with certainty that they left because of the change in leadership, whether they were asked to do so or on their own. But I strongly suspect that their departure was more than a coincidence. In fact, they vacated shortly after Schiller’s arriver, leading me to believe that they had made their plans just after he was appointed. I also suspect that they fell into the category of those who wanted to write their own tickets and carry out their own agendas wherever they worked. Finally, I am pretty sure that their penitent for good times would have clashed with Dr. Schiller’s tone of austerity and sobriety.

The cardiac research group moved to a large academic hospital in the Pacific Northwest. Subsequently, I learned that within just two years, they would fall of the map, not only out of research prominence but also out of research—period. The group disbanded, each going his separate way. Most of them returned to their homelands. I ran into one of the principal members a few years later while attending a conference. Otherwise, I have never heard from them or heard of them since. It was a pity.

Our institution would reap the benefits of the advent of Simon Schiller for years to come. Many of the advancements he had fostered became self-propagating and self-sustaining. The outstanding staff he installed would attract other quality individuals. The atmosphere of excellence he created would itself engender excellence. For several years, it seemed that his legacy alone was a living, moving force. But life is not sustained by legacies, and in time his too would weaken and fade. I find it remarkable, though, how long it did endure.

As circumstances would have it, Simon Schiller turned out to be a very important influence upon me, both on a professional and personal level. Several key moments were shared by us through different phases in both of our careers. Small, unanticipated, and unheralded encounters with him would prove profoundly meaningful to me for years to come.

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There was one summer left, just ten weeks, before the start of medical school. Those final weeks began just after undergraduate commencement ceremonies. This was an event of epic proportion, which included four thousand undergraduate degree recipients alone. Add to that all the graduate students and all those from daughter campuses, and the number of graduating students was thousands more. The spectacle was held in the city’s convention center. Even the newly constructed sports arena was not adequate to hold all who attended. For obvious reasons, diplomas were not handed out individually. My name was listed in the graduation booklet as honors. Mom and Dad were there with me. They were very pleased. So was I.

I spent the rest of that summer working in the physics section of the medical school. This was a small outfit that served as an instrument for several research groups, including the cardiac guys I had worked with but who were now gone. The work was definitely less challenging and sexy. But I did get to handle some math simulations on the old analog computers.

On the eve of my monumental new endeavor, my moods vacillated between smug self-satisfaction on the one extreme to utter fear and inadequacy on the other. Working in the medical school physics lab at least helped moderate these emotions. Mainly, I think it provided a distraction from the anxiety. In a few short weeks, that also would change.

CHAPTER II

O UR UNIVERSITY OPENED the doors to its medical school in 1901, seating an initial class of thirty-five students. They met in a temporary facility on the campus while commuting two miles away for clinical teaching at a private hospital. That hospital was soon absorbed by the university and was renamed University Hospital. This facility remained in full operation for more than eighty additional years. It was largely supplanted as a patient care site by a new hospital that was erected in the 1950s. The old original building was eventually demolished, and the new est and current hospital was constructed on that location in 1990.

The doors that opened to my class were not that much newer than the old original hospital. The first medical school building opened in 1919. My freshman class was composed of 140 students. Our 140 was not the largest class in the city. One of the other three medical schools in town enrolled classes of more than two hundred. Word had it that that particular institution traditionally enrolled inordinately large numbers of freshman students and then trimmed the herd precipitously after one semester through a rigorous plan of attrition. Rumor had it that their students were greeted with the admonition Look to your left then look to your right. The student seated next to you might be gone in six months. There must have been truth to this myth because on day one, our faculty assured us that we would function under no such conditions. It was expected that everyone who began the journey would complete it with an MD degree.

There was no implication that ours would be some guaranteed cakewalk or academic sinecure—quite the contrary. The message transmitted was that we were chosen with great care and after extensive scrutiny. All of us were felt to be up to the task and committed to the rigorous demands ahead. There would be no free passes, but help and encouragement would be there in abundance as needed. As it would turn out, only four students fell from our ranks after one semester, each for different reasons.

No, there would be no free passes. What we were embarking upon was unlike anything that any of us had ever experienced before. To phrase it kindly, we would be captivated and engrossed by what lay ahead. To state it truthfully, we would be imprisoned. No thought, no breath, no step taken, no meal eaten, no sexual encounter, nothing would have meaning compared with the process we would undergo. This would be the boot camp of academia, except that they were not in the business of building character or instilling pride or inspiring camaraderie. There was simply an enormous volume of information we would be forced to devour. There would be no sponsors or counseling to be offered in order to facilitate our task, no maps provided for guidance, and no official support net to anticipate our fall and catch us before we broke our necks—none of these. There was only the tacit mandate—just get it done. For the next two years anyway, we would be greeted only with the notions of how to be doctors, yet we would be overwhelmed with what we’d need to know to be doctors.

The old medical school building was just that—old. It looked every bit its age. Red brick exterior, six floors high, flat roof, it exhibited a certain quaint charm. There was an air of dignity, an aura of reverence about the structure. Somehow, its external surfaces had always remained free from the vandalism and graffiti that decorated so many facades in that area of the city. I long suspected that even among the most lawless and violent denizens of that war zone, the medical center was somehow off limits to hostilities, a green zone even in that part of town. After all, it was the only safe haven for combatants in that area. So the old place wore its years well.

At the level of the second story, the red bricks were interrupted by a row of white granite blocks. Each block was engraved with a name: GALEN, HIPPOCRATES, VESALIUS, VAN LEEUWENHOEK, PASTEUR, CURIE, LISTER, REED . . . the ancients and the greats. Through all my years there, as often as I had passed through her doors, I often sensed that I was confronting a profound history—that I was being reminded of the presence of another era. We were, all of us, being drawn, if only for a short time, by something larger than ourselves.

The three pairs of chestnut doors at the main entrance were handsomely stained and polished. Each had a tastefully decorated and designed glass window. Three brass bars crossed the bottom of each window just above the waist of each door. There were no doorknobs. Locks were visible only from the inside.

The floor of the entry foyer and the main corridor of the first floor consisted of alternating black and white squares of marble. I don’t know how the floor was so well maintained over the years because it always looked immaculate. Perhaps they had replacement squares stashed away somewhere. But the marble squares never had any visible flaws.

The walls of the main corridor were paneled halfway up with what was probably also chestnut, although a lighter shade. Above a darker strip of chair rail, the walls were painted off-white. The ceiling was plastered and was congruent with the off-white walls. Suspended from the ceiling every fifteen feet or so were hexagonal glass lampshades framed in brass. The décor upon entering the first floor could be described as understated courtliness, a quiet grandeur.

A single pair of elevators serviced the entire building. These were very plain passenger vehicles, perhaps ever-early Otis prototypes. They sure looked and felt ancient. Since there were no rear service elevators, the odors inside were sometimes interesting.

Exit the main area of the first floor and notice a distinct degradation in the interior appearance. The door to the first floor stairwell was still attractive wood. The doors to every other stairwell were gray of clangy sheet metal. The stairwells themselves had bare concrete floors and steps. The walls were painted uniformly beige. Lights with metal lampshades hung from the ceiling at each landing. The lighting was adequate at best.

The main corridors on the upper floors varied somewhat in appearance but were consistent in the genre of their décors—namely, unimaginatif. No more marble floors. These were either sheets of good old-fashioned linoleum or more-recent twentieth-century vinyl tiles. Whichever substance, the style was decidedly inoffensive. The flooring on every level had its share of gauges and scars. Only the most blatant flaws would prompt repairs. The walls were either painted entirely with some institutional shade or paneled halfway with some bargain grade of plywood, like one might use in a basement storage area. Each corridor was lit by fluorescent fixtures mounted on the ceilings. These were the nondecorative forty-eight-inch types that are used in workshops. As a result, the hallways always radiated a silvery glare, and the wall and floor coverings certainly made it no softer. The ambience of the corridors emphasized only pragmatism. They exuded about as much charm as a Laundromat.

Improvement could be found in individual offices. Their interior appointments varied according to the tastes and efforts of their occupants. Some had nice carpeting. Others had higher grades of vinyl. Most were painted. A few had half paneling. Many had lowered ceilings covered with foam tiles and recessed lighting. Generally the office furniture was attractive with different styles of desks, tables, chairs, and bookcases. Artwork on the walls was rare, but family photos abounded. The offices were clearly more pleasant to be in than in the corridors; however, interior furnishings were never sufficient to obscure the timeworn fuselage that housed them.

It was on the sixth floor of that building that we would find, at the same time, both our home and our prison for the next six months. The bulk of our lives would be spent there. The bulk of our lives would be consumed by one monumental endeavor—anatomy.

CHAPTER III

A NATOMY CONSISTED OF three subdisciplines: histology, the microscopic anatomy of all organs and tissues; neuroanatomy, the anatomy of the nervous systems; and gross anatomy, the way the organs look and feel in the whole. The course was taught in three locations on the sixth floor. There was the lecture hall, the histology laboratory, and the gross laboratory.

The lecture hall was an unadorned but comfortable facility. It often consisted of tiers of seats. A wide center aisle divided the rooms into right and left halves, each with ten seats. The seating capacity of 200 adequately accommodated our 140 students. Narrow aisles were located on