L.11.2 University of North Carolina: School of Medicine and UNC Hospitals: N.C. Memorial Hospital Oral History Project

Transcription

1 1 L.11.2 University of North Carolina: School of Medicine and UNC Hospitals: N.C. Memorial Hospital Oral History Project Interview L-0352 Dr. Arthur Finn 7 November 2012 Transcript 2

2 2 Interviewer Name: John Curtiss Interviewee Name: Dr. Arthur Finn Interview Date: Monday, October 15, 2012 Interview Location: The home of Dr. Arthur Finn in Chapel Hill, NC Okay. So I guess we ll just start and go chronologically. So start with your early life, if that s okay. Sure. So where were you born? I was born in Boston, Mass. in Is that where you were raised, too? I was raised in North I was in Boston until I left for my residency at Duke. Oh, really? Yeah. So I went to high school in Brooklyn, Mass, and I went to college at Harvard. And I went to Boston University Medical School because I didn t get into Harvard. And then I did a residency, first year resident. We used to call it an internship. Now, we call it a first year residency at Boston University Hospital. And then I came to Duke to do a residency in medicine. The plan was that I wanted a real role model at medical school. I was able to find one, I fell in love with the person who was a nephrologist there in scientific educational love with this wonderful man who is still around. His name was Arnold Relman. He became editor and chief at New England Journal of Medicine at one point in his life. But he was a phenomenal person and turned me on to nephrology. And he decided after we chatted for a while that the best person in the country that he thought for me to do a fellowship with was a person name Louis Welt who was the second chairman of the Department of Medicine here. So I was going to plan to do a fellowship with him in renal physiology, and to do two years of residency, I decided that I d rather do them at Duke rather than here at UNC, so I didn t apply to UNC.

3 3 So I came to Duke to do those, and then sandwiched around my two residency years. I did two years as a post doc with Lou Welt at Chapel Hill. Okay. And then so that brings me to so that was I finished my residency back at Duke in 63. So I graduated medical school in 58, came down here in 59, and did four years. So I lived in Durham during the years of residency at Duke, two years of fellowship at Chapel Hill in between. Then while I was here, I met another fantastic person who was then the chairman of the Department of Medicine at Mass General at Harvard who gave an incredible talk. I never heard anybody give a talk like that before. The talk was on the state of water in cells. And I said whoa. So he was a physician, professor of medicine, talking about physical chemistry of water in cells of an amphibian system. So I just got totally wiped out by that and decided I wanted to go to work with him. Yeah. That s my wife s phone. It can t be very important. She doesn t have it with her. So I decided that I d try to work with him, but he didn t have a place for me. So the next person for that year, that would have been And so I found somebody else with Lou Welt s help, and he was doing the same sort of thing, and I went up to the NIH for two years. And the plan was to come back here and be an assistant professor of medicine in The job was waiting for me, and I was very excited about coming back. And while I was in Bethesda, I was offered a job as assistant professor of physiology at Yale and decided I would so it was a bit of a problem for me because I was supposed to come back here, and there was an opportunity I really couldn t turn down. So I called up Dr. Welt who was the one who was making the job for me here. He had now become chairman of medicine here. And I called him, and I said help. I said I ve been offered a job as assistant professor at Yale, and he said to me without batting an eye, he said can I come as your post doc? Now, the reason he said that was that he had been to Yale Medical School, and he always wanted to end up as chairman of the Department of Medicine at Yale. But he came here when this place

4 4 was open as a four year school in And he was professor of medicine, and then he became chairman of the department. So I decided to go to Yale where I took a joint appointment in medicine, and my regular appointment was in physiology. And after two years at the NIH, and I really loved it there. But the Department of Medicine was very bad. It was just they didn t make it pleasant for me. I didn t like the way they took care of patients. I didn t like the way they treated people and each other. And finally, after three years two years, I dropped my appointment in medicine and just stayed in physiology. And I was becoming somewhat of a cellular physiologist and enjoying it and growing and then began to think did I ever want to see a patient again? It was heavy duty training. And I finally decided oh, besides, Lou Welt kept calling me every five minutes. Well, at least every three months, come back, come back, come back. I m very happy here. Come back, come back. We ll make a nice place for you. So finally, toward the end of 1970, more toward the end of the 69/ 70 year, he called me. And then I finally decided if I really ever wanted to see a patient again, I wouldn t do it there. I d have to find out if I wanted to see a patient again. So not such a simple problem. So here I am doing science and loving every moment, and we didn t do molecular science then. We hadn t gotten to that stage of understanding molecular medicine or molecular physiology or anything molecular but I was excited about cellular physiology, and I was doing all right. And if you like something say 10 out of 10, and what do I like about the practice of medicine? I don t know, 3 out of 10. And maybe I liked it 10 out of 10. I hadn t done it in four years two years. And I was pretty good at that I thought. And it was a really tough decision. So in the end, I decided that I would come back here because and find out. That s the only way I could ever find out. So I accepted the job, and they didn t want to let me go (from Yale), but they couldn t you know, sometimes people play this game. They re offering me the job at X University, and if you ll double my salary, I ll stay here. But I had nothing to discuss with them because it was just a totally different life, and it was did I want to do that? There s nothing they could do that would make me feel more comfortable seeing patients. So I came here, and I decided after a

5 5 short time that I really didn t like seeing patients. But my friends all said I was lying. And I had a pretty good reputation at Duke. And I was offered the job as chief resident at Duke. And that s a really sought after job under the chairman of the Department of Medicine. And it was arguably the world s best internist in the second half of the 20th century. His name was Eugene Stead, and he was very unusual. And he offered me the job, and I decided I didn t want it. Anyway, I came here with a deal that I would be able to spend 80 percent of my time in the lab and 20 percent of my time seeing patients. And that they would pay me you couldn t get in that time 80 percent of your money from grants. It just doesn t work that way. It never worked that way. But even though I brought in 50 percent of my salary from grants, they would pay me 80 percent of my salary and allow me to work I mean, they would pay me 50 percent, but they would get only 20 percent of my time essentially because I spent 80 percent in the lab. So that worked fine. And I was successful as I wanted to be. And until around 1995 or 1996 when money got much tighter and grants got harder to get. Although I was always funded, they didn t want to give me 50 percent salary for 20 percent time. And so I began to see patients more. And I have to say, I didn t dislike it. I just preferred spending time in the lab. And that s it. And then I quit. I quit in 2000 because somebody said what, are you crazy? And I said well, I always thought that I would quit and have another career. It was just something that I always wanted to have. I don t know why. And somebody pointed out to me that one of the reasons I gave was that I noticed that when people leave, everybody forgets them anyway. It doesn t matter whether you won a Nobel Prize or what. That s the end of it. So why not change and do something else? So then someone said well, is that the reason that you re doing it just so that people will know who you are? Interesting question. I never thought of it that way. But I had just always looked forward to another career. So now what I do is I fix clocks. Really? Wow. I didn t know anything about clocks before I bought that one, and that clock is from And after I had it for a while, I began to

6 6 wonder what is a clock? And the school of horology is horology is the study of the hour. Really? And NAWCC stands for National Association of Watch and Clock Collectors. And so I went, and what happened was I could look in the back of that clock, if you take the top off, you can look in there and see all these gears and things in there. Yeah. So I wondered what it was. I had no idea what who knows what a clock is, how it runs. The person who sold it to me, and I knew nothing about clocks. And I called the person that sold it to me and said tell me what s a clock? And it turned out that he had not only been selling antiques, mostly clocks, but he had also been repairing clocks for 30 years. In his day, you went and became an apprentice and learned how that way. And so I went to clock repairing school, and now I repair clocks. Wow. So you ve been doing that since 2000? Debbie: Debbie: Yeah. Wow. So I do it sort of half time, and I like to leave my afternoons more or less free so that I can play squash and be interviewed. And I have a lot of fun, and life is good. So that s and I do this most every day about half the time. Yeah. So you really enjoy repairing clocks? Oh, yeah. Some of them are very, very frustrating. Once in a while, you get and it is Hello, I m Debbie. I m John. Nice to meet you. Nice to meet you, John.

7 7 So I think that one of the things that s happened to me, which never happened when I was working and seeing patients or working in a lab, is that I don t think my whole life I ever woke up at night worrying about either a patient or an experiment or a paper I was going to give. But now, I wake up worrying about working on a God damn clock. Wow. And it s very strange. And then I can t go back to sleep. And I think the reason is it relates to something about I think my own I don t really care about having my dreams analyzed, but if I wanted to go to a psychologist, my own sense of that would be that it had something to do with incompetence. I don t have the sense of competency that I had when I was a physician or a scientist. So that s what I do. That s my life. That s quite a resume. That s quite a life. Wow. Yeah. I ve been very lucky. And when I came here, it was a very different place. So what do you want to know about NCMH? Basically Or anymore about me. So I ve got a string of questions here. Can you talk more about how you developed an interest into going into medicine? Did that develop really early in life for you? Or did it develop later in college? Well, my family tells me that when I was three, I wanted to be a doctor. There s never been a doctor in my family ever. Now, the descendents, my second cousins and first cousins twice removed who are, but nobody in my generation or earlier had ever been a physician. And I had no idea. I just always wanted to be a doctor. And my family tells me that there were three things that happened when I was three years old. I wanted to be a doctor, I could tell time, and I learned how to play Cribbage. When you were three? That s what they say. Nobody believes that anymore, and my parents are dead, and nobody my sister believes it. She thinks I

8 8 am super human anyway. So and I went chock o block. I went to high school and to college and to medical school. I never took time off. That s not what my kids did. All my kids took time off after high school. And I went to college out of high school. And they all went to graduate school but nobody went to medical school. So I just wanted to be a doctor. And somewhere along the line, I suspect that I might have let me say that when I wanted to be a doctor it was different from now because if I asked you that question, and I won t, I would dispute whatever you say as to being a good reason to want to be a doctor now. I have a granddaughter who is now just graduating from Hopkins last year, so she did one year. But I don t know, did you just graduate from college I graduated from college in So you went straight to medical school. And my granddaughter graduated in 2011 also. This would be her second year. She s now skipped a year. And she I tell her why do you want to be a doctor? It s a little different now. First of all, we re going to have a world, if the right president gets elected, where we still have a medical plan in place that we re going to have 50 million more patients who are insured, which I think is grand. But who is going to take care of them? And that s a big problem. Can you make a living right now doing general practice or family practice? And it s not easy anymore, especially in relatively poor communities. I loved taking in patients. No matter what I said about it, there is something special about caring for patients that was always very important to me. I m a very caring person, and it was sort of a natural thing for me to do. Nowadays, I just don t know. I mean, medicine is there s this thing in the paper that I m sure you re aware of about these kidney tumors that Roy Williams had. And I m trying to figure out why they d find them? Two benign tumors in which he never should have had surgery. Who gives a damn if it s benign? They re not going to hurt him. How did they find out about it? They found out because he went into the hospital because he had upper GI symptoms. Now what do we do? We go get an MRI or a CT? That s what must have happened, and I think this is just awful. And who are the doctors who are giving these tests? Now they ve done $50, worth of testing that hasn t done one

9 9 single thing for this guy except get him really, really scared. And some lunatic said you re 95 percent likely of having a malignancy. I have a colleague who is still a nephrologist now. He s younger than I am by about 10 years or 15 years. And he well, first I ll say a colleague who just retired, there s another Dr. Finn. Bill Finn, he s a little bit younger than I am, and he told me he was interested in some of the causes of acute renal failure. So he decided that he wanted to study the CT findings in acute renal failure. And nobody had really done that. And he wanted to know if this would help in diagnosis and treatment. Okay. Fair enough. He was going to get paid for the study, so he wasn t wasting money yet. So he asked me if I d like to be a normal control. And I was this is like 25 years ago or something like that. So it was 78, so let s say I was in my 50s. I said what are you nuts? Why would I want to do that? Well, you have the signs. Bullshit. I don t want to do that. I m perfectly normal inside. I don t want to know anything about me inside because if you do, something is going to get screwed up, and I don t believe in that. Okay. So then he goes to it may have been the beginning of MRI s. So it s not quite that long ago. But anyway, whatever the study was. So my other colleague quite a bit younger than I decided he would do it. So he has the study done, and five minutes later he gets a phone call from a gastroenterologist and radiologist to come down and talk to us. We want to explain something. So you have a cyst on your pancreas. Oh my God. Is it malignant? As far as we know, pancreatic cancer does not begin as a it s not a cystic disease. A cyst is a fluid filled mass. So, but it s a solid tumor. All cancer of the pancreas is, supposedly. We don t really know how they begin. So I don t know what to say to you. Whatever you think is right. So he decides I better have surgery. So he has surgery A: B) It s benign, and C) he s miserable for a whole year. His enzymes get released. He has difficulty with indigestion. He can t eat. He loses weight. A whole year, and he s back to normal. For what purpose? Anyway, so I think that we re and there s a fellow I don t know if you ve been directed towards somebody work done by Atul Gawande who is a surgeon from Harvard who writes like an angel. He writes articles in The New Yorker. But a year ago, he wrote this article about the way medicine was practiced in two

10 10 adjacent cities in of all places Texas with very similar everything. The patient population was similar. Everything about the place was very similar. But in one city, I can t remember the reasons, but the way the doctors had gotten together, they had joined more and they spoke to each other about patients more. And in one case, the cost of taking care of the patients was like three times that. And the other city, the adjacent cities, and the medical outcomes were no different. Better in the people who didn t do the tests. I mean, I had a mass one day that I studied on my arm. Below my elbow, and I don t know how long I had it before I felt it. I couldn t see it very well. It was non tender, rubbery, and it wasn t discolored. But I still figured that the most likely reason for me to have it, I don t know of any cancers that occurred there. It could be a metastatic lymph node, but there are no lymph nodes there. So I thought I must have banged it while playing squash. I go into the wall a lot from time to time, but I didn t remember. I finally said so a surgeon, another one of my colleagues came in to have me fix his clock, so I showed him my arm. He said I don t think it s anything, but I think you ought to have it looked at by so and so who does cancer surgery. So I call this guy up. I make an appointment. So he says before I want to see you, I want you to get an MRI. I said what are you crazy? No, I won t see you without it. And in the end, I decided okay, I m not paying for it. My insurance is paying for it. It isn t right. And of course, it showed nothing. And he decided it was, as I thought it was, probably a resolving hematoma. In the end, it disappeared. Anyway, so I m sorry. I shouldn t be so long winded. That s how I got into medicine. And I got into nephrology, as I told you, because of this one man who really turned me on to nephrology. Very impressive, articulate, eloquent, brilliant mathematician. He liked ph and electrolytes, and he turned me on to them. So I became a nephrologist. Yeah. What was his name again? Arnold Wellman. Arnold Wellman? And can you go more into your relationship with him and how he turned you on to nephrology?

11 11 Well, he gave lectures in the first year in physiology. And he was one of these he had this way of talking about the kidney and about acid-base metabolism. And then I met him on the wards when I was a third year student, and he knew everything. Well, but all professors seemed to know everything. But for some reason, he really turned me on. And later on when I was here many years later, and I would begin to ask people how it was that so few students were really interested in nephrology. We re a bunch of wonderful guys. It was guys then, now it s guys and gals. Well, the answer was usually something like it requires knowledge of math or it s too scientific. And maybe that was what turned me on because I was already more oriented to the quantitative things. And he but again, it s one of these things that turns out to be I don t know what the word is. I got it from him under false pretenses because when I met him later as more of a colleague when I was on the faculty, we d go to meetings and deliver papers, and he would go to meetings, and he was now sort of a senior citizen. He didn t deliver papers. His fellows did, but he would be in on the meetings. And on a couple of occasions, he would get up and say some young person like me, so let s say me, gets up and gives a talk in a meeting with 1,500 people sitting in the audience about his or her science. A gentleman raises his hand after it s over and says first, I want to congratulate the author on this nice presentation. And then he goes on and tears that person apart. Really? Tears him apart? Yeah. And it s science. He tries to make a fool of him or something. And then it turns out, he has a reputation for that. So, he really wasn t much of a nice guy. But when I was a student, and he was a professor, that relationship was spectacular. And he wrote me letters of recommendation, and he got me the job down here with Lou Welt. And so I owed him that debt of gratitude. He just wasn t a good person in many other ways. But he is now turns out to be. And I haven t seen him in 30 years, 20 years. And now, he turns out to be a really wonderful proponent of single payer plan for medicine. And I m very much in favor of that. And he is one of the people, one of the spokespersons. He s about 90. Not 90, he s well over 87 or 88. And he has been in the New York Times in the past year

12 12 or so with a long article. And so he s a good person. Just that that experience with him, more than one, made me think well, people change. Yeah. But you said he never did that to you though? No. That s good. No. I would seek him out, in the earlier years of my career, seek him out at meetings and say hello. And he wasn t terribly friendly. And he knew he just I don t know what it was. I was maybe I was a very outspoken person. And I thanked him one time for - you re the person who got me where I am today or something, and he didn t even like that. Really? Gosh. So now I guess I ll move on to more of your time at Memorial if that s okay. And so at that particular time, I know you went into details about why you came to Memorial. But was there anything special about Memorial that brought doctors there? University of North Carolina. Well, it had opened as a four year medical school in I didn t come here until July of I had done a residency at Duke. So the reason I came here was just because of Dr. Welt. As to why other people got here, it s a state hospital. There weren t that many hospitals around the state in those days. We were a big what we call tertiary care center. It was between Duke and us. And all the complicated patients I mean, East Carolina University didn t exist. And the medical school didn t exist. Was there anything down in Charlotte at this time? Those were the only two medical schools in the state. We still have only two in the state, three in the state now. Sorry. There s Wake Forest. There s only two public ones. Yeah. Right. But I mean, Bowman Gray was there then, too. But you know, it s really funny. But these two are right here. The Research Triangle hadn t even developed yet, so you wouldn t say they were two on the research triangle. So when we came here,

13 13 there was nothing here really. There s the two medical schools, and our patients came from all over the place. And I don t know that I m not sure that Duke or UNC, which of us drew more patients from say Wilmington. But certainly none of us we hadn t reached out. Now, we have a sister school in Wilmington. We have Grand Rounds, it s every week that s broadcast - telecast in Wilmington. So we have a relationship with them. When the area health education centers began (AHEC), we all went there and gave rounds there. And that spread out all over the place. And then there was just us and Duke as far as I know. And people came from everywhere. And so was there any type of particular patient that went to Duke or any type of particular patient that tended to come to UNC? Or was it just kind of There was always the wealthy patients. Duke was more of a drawing card for the wealthy patients. It s not that we didn t have rival patients here. It s just the really wealthy ones because Duke had a reputation, has always had a reputation, for having the money people go there. And Duke had their private they had a private medical service, and they had a private medical practice also so that you could if I was a resident in medicine, and I did rotate through the private services. But afterwards, if I had joined the faculty, one of the things that I would have done or might have done would be to join what was then called the PDC, the Private Diagnostic Clinic, where I would be basically paid for service. I mean, it was essentially it was not straight salary. You got a percentage, and you got big salaries then. And that continued forever. The amount of money I earned here, I would have earned five times as much at Duke if I had done more medical practice. Whereas if I had done more medical practice here, I wouldn t have made any more money. We re all on a straight salary. Yeah. So that was it. I can t think of anything else. And we got them from everywhere. Yeah. So when you were at Memorial, what was a daily work day like?

14 14 So I was here from 1960 to From July of 60 to July of 62, or June 30, I was a post doc. I was not a resident. One thing I noticed, it was very different for the residents. For example, the residents didn t work the same hours that they did at Duke. Nobody did. We worked five nights a week, got home two nights a week, and didn t do much sleeping those five nights a week. But when we were here, I didn t see patients very much as a fellow. It was almost strictly a research fellowship. I would make rounds with the boss every day, so in that sense, we d go around and see patients. I would come to work well, everybody came to work early. I mean, so we d come to work at 8:00 in the morning, and I would start in the lab. And the first six or eight months, I didn t know anything. I mean, I didn t know anything about kidney disease, except what I had learned in medical school as a resident. But then you start having to get into serious details about kidney physiology and try to recall everything you learned before. And it took a little while. It took a little while for me partly because I think that I got the feeling that what happens when you re in a post doctoral fellowship is almost the same as an internship. I mean, you don t know what s going on. A) It was a strange place. B) I had the sense that everybody knew more than I did. But the other thing is I think that in every case, a lot depends on who the people are who are mentoring you. And if they re willing to say you re really not a dumb shit. You may think you are, but you re really not. Stick with it. Soon it will all be just as natural as anything else. And it happens. You do learn. And I had to study a lot. And my days, I must say, as a post doc, I really don t remember whether I worked too often at night. But I know that at the beginning, Dr. Welt wanted us to come in at night for 10:00 conference. And of course, we had to do that. But in general, I probably so I was a post doc from 60 to 62. My children were just being born. And my first child was born in 1960 in February. So when I came here, she was here. And I lived in Durham. But when I came to Chapel Hill, she was born, and then I had two more children after that. So I personally made it a rule that I would go home for dinner. And whether I had to go back, and that happened throughout my career. Whether I had to go back at night, which I had to do quite a bit, especially later on, I mean, the more

15 15 successful you are in a laboratory setting, the more you have to work. That s just the way it is. Some people well, it s really not possible. I mean, if you have let s say a couple of post docs in the lab, and then if you get to be really big like there was just a notice the other day that Bob Lefkowitz won a Nobel Prize at Duke. And it says that he now has 30 post docs in his lab. And that s really big. That s a big lab. And in that case and he called himself a geek, which I m sure he is, and I m sure he never goes home. But on the other hand, he won a Nobel Prize. And so I think that in retrospect, I can always say that I could have worked harder. I m not sure I was smart enough for it to have made a difference. I just don t know. But I worked I would say that during my fellowship years, I doubt if I worked more than 60 hours a week during my not much less. During my years after that as a faculty member, I always worked at least 60 hours a week. That s just the way it is. And I rarely took vacations until I got to be much older. Yeah. And yet, I always was home for dinner with my children. And some of that work was done at home, especially after computers became available. But that was very late in my career. Yeah. And so I guess the hardest time I had ever was residency years at Duke when I was working all night every night. I mean, I don t know how we ever did that. But they don t ask it of you anymore. Not anymore. They limited our hours. Yeah. I don t know how you guys did that. I don t either. I think the issue was did we kill patients, and the answer is no. Only the bad docs did that. None of us ever did that. We never made a mistake.

16 16 Let s see here. So back then, I m interested in what around nowadays, they throw around terms like professionalism a lot. So could you talk more about when you were at Memorial, what was a good doctor? What was a doctor s doctor? I guess what did you aim to be like? Well, that s a good question. I can tell you want I didn t want to do. First of all, as I said, I cared for people. I think that I ll give you a couple of examples. I went to visit well, I ll do this one first. I went to visit the mother of a close colleague. I had known her for some time. She was in the hospital. She had chest pain. I think she actually had a small MI [myocardial infarction]. So I went to visit, and I was walking down, and I see that there are these two residents standing in the doorway whispering. And this woman is in bed, and just as I am about to enter the door, she screams to these two guys, I don t know what you re talking about. If you re talking about me, get your asses in here, and if you re not, get the hell out of here. You have to be aware of what you re doing. And part of caring for patients is being careful what you say around them. We used to use words that we thought were clever like is the person on how much ethanol does the person drink? Well, the fact is that most people know what ethanol is. And I think that and a side of caring, another thing is that Dr. Stead imbued us with the idea that we really had to know everything. The only way we were going to know anything about patients is to see them, which is one of the reasons why we worked five nights a week - or the only reason. He said that the only way you get to know patients imagine that you have a marble. And that marble isn t really yours. You don t own it until you understand everything about all the colors and how the light goes through it, and what happens when the light goes through it, and so on and so forth. And he would go on like this. And you needed to know your patient. And you needed to know everything about the disease. And that s the way it was. And I always learned that there were other things I wanted to do. I wanted not to miss anything. And if I could play the game that we all played, it was could I find something that the attending physician wasn t going to find? And there s an old story about that. But the attendings are doing the same thing. I mean, we re all out to help the patients in one way or another. And if we can teach, make it a teaching moment as

17 17 well, then that s all the better. We are in a teaching hospital, and we re expected to be at the cutting edge of everything in terms of taking care of the patients. So when I was a resident in medicine at Duke, the interns oh, when I was in Boston, the interns had to know as much as you could. But then your next up knew more, and you were going to ask him or her the questions. And you mustn t ever be afraid to ask. And if you re going to write a consult note, you damn well better write it in such a way that the other people can understand what it s about. I used to get really angry with the ophthalmologists because they d come around. And after they d see if the patient can t see or something, or it s an eye complaint. We don t know anything about the eye. We had to look at the retina. They don t even do that anymore. But I learned how to do that. And I look at the patient, and I said jeez, I think the ophthalmologist comes and sees it. It s a note I can t read, and then puts a circle. They draw these circles with letters because they have their special notation. And the first couple of times it happened, I called the ophthalmologist over and I said tell me, who do you think you are? I don t know what the hell that s all about. Oh, I thought everybody knew what that was all about. That sort of thing. So it was a matter of teaching and learning and taking care of. And all those things I think have always been a very strong part of my wanting to take care of patients. And I can t ever I mean, I have had some unpleasant experiences with patients. The one that really stands out was we had I guess I was a resident then. So I m just taking a history, and out of nowhere, this person says do you believe in God? Out of nowhere. It was a woman maybe in her 50 s. So I did what I was always trained to do. I said well, why do you ask? She said I m leaving. Why are you leaving? You don t believe I didn t say I don t believe you didn t tell me. I don t want to talk to you anymore. She signed out. And then one of my earliest patients at Duke was and here I am from the north, had never, ever been south of Washington. Must be my second day as a resident. And I m sitting there, and I m talking about patients. And the patient says I said so what brings you to the hospital? Well, he said, and he just spoke very slowly.

18 18 Well, you want I should start from the beginning? Of course, I said yes, and I was there for about two hours taking a history. And the other thing that happened to me when I was in an elevator at the hospital at Duke, and two men were on there with me. And they were both dressed in overall type things. One was white and one was black. And they were talking to one another. I didn t understand a word they were saying. I wasn t trying to listen. But after I realized I didn t understand them, I tried to listen to what they were saying. So that took me a while. We also had black and white wards when I worked there. I want to ask you about that. Yeah. And that was an experience. Remember, I came here as a resident in And I mean, as a fellow in And civil rights hadn t really arrived in Chapel Hill. We had segregated movie theaters and segregated restaurants. The Supreme Court decision about schools occurred in 1954, and here it is 1960, and nothing much is happening. But on the other hand, I was working full time. And I didn t get out I didn t have a sense of what that was like outside the hospital either as a resident, or when I certainly didn t ever leave the hospital. At Duke, we had these black wards and white wards, and I did have a couple of experiences that were very unpleasant for me. I wasn t accustomed to it. I wasn t accustomed to seeing black and white restaurants and bathrooms. And I wasn t accustomed to people treating patients in a discriminatory way. Was there a lot of that? Well, there were some some of the people at Duke were old timey southerners. And so there was a good deal of them. I ll never forget the experience I had with one professor, it was a professor of medicine and a cardiologist, and he was the attending that month. And I introduced him to a patient. And his name was Jimmy Jones. This is Mr. Jones, this is Dr. so and so. The intern was on the case, but I sort of did introduce him. So after presentation is over, the attending goes over to the chart, picks the chart up and looks at it. He just looks at one thing, and he introduces this man as Mr. Jones. And he says so, Jimmy, and he didn t do that with white patients. And so it was very unpleasant and uncomfortable for me. I had

19 19 grown up in a home to be sure, there were no blacks where I grew up. It was worse than that. I m Jewish, not very, but I always call people lapsed Catholics. I m a lapsed Jew. But anyway, but in my youth, I was somewhat more religious. And my family, we observed Jewish holidays, but we never saw blacks. I mean, everybody lives where people like them live. And so in my elementary school, it was like I would say 60 percent Jewish and 40 percent Catholic. There were no Protestants in my elementary school. None lived in my community. It was bizarre. Then I went to high school, and in high school, we had one black student in our high school. Then I went to college. Now, that was different. They would come from all over the country, and we had 2 or 3 percent blacks. And then things began to change. And but when all of the integration issues came up so I grew up in a family where there really was no talk about that. There were times when I sensed that there was, in retrospect, some discrimination in my family. But we didn t know any black people. So it wasn t serious. And there wasn t much talk about it in the family. And my family was very loving, and that s how I grew up in that kind of environment. But again, I don t think they were really tested very much. For example, there were people in Boston who my father was pretty poor. He was a blue collar worker. And we had enough to get by. And so he and his cronies used to bet on the numbers. It was like the lottery. I don t even know exactly how it was done. But if you bet $1.00 and you won, you might win $ No millions. But it was called the nigger pool. Really? Yeah. And I never knew what that meant, the nigger pool. And I think in the end, what it meant was the blacks in the community who were running the numbers would get the information and bring it to whoever had the money. I don t really know where it came from. That s the first time I d ever heard that name. And I didn t grow up with it. But when I came here and read the newspapers, and I m getting to be an adult, and I begin to see what s happening in the world, and I was aware of all of that. So I didn t have I didn t think that I had that I was a person that discriminated, but then, most people don t think that either.

20 20 Some do, but most don t think they are. When I went to join the faculty at Yale, that was from 65 to 70, so that was in the middle of heavy duty civil rights work. And I got very involved in that. I don t know how that happened, but it just happened. And then I became the physician for the Black Panther party. And so I was really in all that stuff. So when I came back here in 1970, where even in 1970 we hadn t gone too far, we did have integrated wards. And then I came here at UNC and then to Memorial. But you couldn t find any black faculty. There weren t many blacks in the university. There were a few. And if you saw actually, you ought to look at it. In yesterday s New York Times, there was an editorial excuse me. An obituary for Bill Friday. And that obituary, unlike the ones the day before in local papers, which were all very derogatory, and he was a wonderful man. In the New York Times, it started off by saying a little bit about how he was president of the university for 30 years or whatever. And he helped the university grow. But then it went into the whole - 90 percent of the article was about his late integration in the University of North Carolina. How he didn t think it should happen quickly since the government chose North Carolina sort of as the bell-weather state. We had all these institutions, although we hadn t formally yet created the 16 institutions of the greater university. Still, he was the president of most of them. And he recognized that it was the most I mean, there were the traditional black schools and the traditional white schools. And he didn t feel that we ought to hurry to integrate them that a little more slowly than the government wanted. And the New York Times just talked about that. So in the end of reading that article, you think that he was like Governor Wallace. And so anyway, that was unfortunate. Some friends of mine and I are thinking of writing a letter, but they won t publish it. So anyway, when I came back here, a lot of that had disappeared. I mean, it still goes on after all of these years. And the place was so much smaller then. It was only NCMH, and just the one building. And my lab was in that building and all the chemistries were done in the one building and the patients and so on. I mean, it was small. And then just they began to add. It was astonishing. Was it kind of set off from the campus even back then, too?

21 21 Yeah. It s what it is now. And I mean, there was Gravely, which is now Vaughn, so there was the main hospital. And the first thing they did was enlarge the downstairs and build a bed tower that was added later. I don t know if they call it that anymore. But then they added a clinic. They added new clinics to the main building. And then it was just Just kept getting bigger, yeah. And what I did when I came here, we had a it wasn t a very big Department of Medicine, I made a habit for the first probably 10 years of my career, I m going around to everybody in the Department of Medicine, sitting down with him or her and saying what do you do for a living? What kind of work do you do? Everybody does something scholarly. What do you do? And so we talk about that, and I got to know everybody. But then suddenly, the place got to be too big. And I didn t know half the people anymore in my own department. Well, not quite half. But there were some people I never got to meet. And then there would be post doctoral fellows, and I wouldn t get to meet them. And we formed with Dr. Welt in very early shortly after I came. He and I decided we would have a Monday morning conference in which members of the department a member of the department would talk about what he or she did of a scholarly nature. Everybody would be able to talk. And so I got to know the members of the department that way because I kept a list, and I went around from person to person and asked him or her what they d like to talk about. Wow. So kind of going along with the theme that we were talking about earlier with segregation, Memorial also used to be a hospital where female physicians were really rare as well. So what was it like for you? Were you there when they started to integrate with more females as well? What was it like working there with not only African Americans but also more females as time went on? Well, first of all, we never had as many African Americans as we have women. But as a teacher, we began to see more women become students. And of course, now, more than half the class is female. And I thought it was very clear that the girls are better students than the boys. I mean, there s no doubt about that. And I don t really believe that it s in our genetic make up for girls to be more sensitive than boys. As a matter of fact, the ones that you

22 22 see, in general, that s probably the case. My wife would say of course that s the case. And I don t know. I don t know where the sensitivity genes are. But I think it s like those two guys who are standing outside a woman s room whispering. It doesn t take many brain cells. But my sense has been as I ve gotten older that it seemed to be a larger number of people who would come to medical school who aren t sensitive, don t have a real feeling for their patients feelings. And then I wonder can one learn that? Well, the way you learn it, of course, is by seeing someone else behave that way. And how many people are in it for the money? And how many people are in it for something else? And I think that I didn t notice anything at the beginning. I didn t have sort of a preliminary notion that the women were any brighter than the man. I think that as we had more and more women in the class, it was just more pleasant. I think that I kind of tell that I notice an atmosphere because I didn t do that much teaching. I did like what everybody else did. If you re in the Department of Medicine, I taught every year. I don t know what s happening now, I m out for 12 years. But in the first year, there was a section of I think the physiology course, there was nephrology. Yeah. And we taught for two weeks. And it was a pretty rigorous two weeks. And then it was tough for the students. Yeah. Nephrology is tough. And so I would have I worked in Berryhill, and there were four the class was divided into I guess there were just four rooms. There would be 40 in each one. That couldn t be. So I must be Well, I m sure the class was smaller. Well, how big is the class now? My class is 170. Anyway, we had 20 or 25 students in each section. And I would get to know them for that period of a couple of weeks. And since I

23 23 always knew that this was difficult for students, I tried to make myself available just to sit down with anybody who wanted to. It s amazing how people don t want to. And then I thought well, it s not easy, even if I could stand up here and say to you I m always available. Come call me. Come visit me. I ll sit down and talk to you. That doesn t mean you re going to be ready to do it. And how scary is it? And it might have been easier for me to do it because I was more daring as a medical student than most people are. And so there was I mean, you try not to be that way. And then after that in the clinical years, because of my special treatment of having only 20 percent time in taking care of patients. Taking care of patients, that meant that I would spend half a day a week in a clinic, in my own clinic seeing my own private patients. I made it a habit they were all being referred to me. I made a habit of getting them back to their family doctor, to their referring physicians as early as possible. I didn t want to keep patients on a string. I didn t think that was right, but a lot of other people did. And I didn t do that. And so where else would I see students? I didn t see students much in the clinic. And they were there once in a while, there would be someone who would work with a patient for me. But there would be two or three students attached to the nephrology clinic, and then six or seven nephrologists. And I didn t get one sometimes. When I was attending, at most, one month a year. And you do it one month a year, that s 8 percent of the year. And so I don t have much more time to give away. But I would usually get one month, and it would be on the nephrology service. I wouldn t be a general medical attendant. So I didn t get to know too many medical students. And I didn t get to so looking back on friends of mine, so did you ever meet Dr. Kaplar? He was in biochemistry? Do you take biochemistry? Well, we take biochemistry the first part of our first year. His name doesn t sound familiar. Okay. Well, he s pretty much retired anyway. Was he a medical doctor? No.

24 24 So he s a PhD? Yeah. Well, he could have very well lectured to us. He s a very funny man. But the way the old scheme was, even now, he s my age. He hasn t been full time for a few years. But he still works. We were walking the streets of Chapel Hill, a lot of people will remember him. But not many remember me because I didn t have much time with them. So I liked doing it, but I just didn t have the time. And I wasn t required to. And so I d rather teach them science than medicine. And I couldn t teach people how to be caring. But when I got a chance, I did. So we had for a few years, we had a special class to give it to first year students. And everybody had to take it. It was where you got to interview a patient one on one not knowing any medicine. Not knowing how to take a history. Just your job was to talk to this patient. And do whatever you wanted. Strike up a conversation. And the patient knew that you were a first year student. And you could talk about whatever you wanted. And it was going to be videotaped. And after it was taped, the faculty member, me, we all took turns at this, they d sit down with you and go over the tape. And the day before this all happened, I can remember meeting with about 12 students. I had 12 students. First year medical students still early in their career, and they wanted to know when we see this patient tomorrow, what should we wear? And dress the way first year medical students did in those days. Maybe not as neatly as you re dressed because you re talking to me. But you know the way college students dress, and first year medical students dress the same way. I said you just dress however you feel comfortable. And the most astounding thing was all the males wore ties, and all the females wore dresses. In those days, they weren t wearing slacks. And so it was very funny. But this was interesting to see the body language and how people respond to body language. And when you could show that to the student, you might not have noticed how he or she was behaving to a patient. It was kind of fun and interesting - challenging for the students. So, but I can t tell you anything about what happened

25 25 when the classes because more diverse with regard to people of color. Yeah. Was there even after the hospital was desegregated, was there still a lot of resistance, even though there was no longer any separate but equal type stuff. I noticed there was much of that among the students. I think all the students got along. But I mean, more like the older guard. I think a lot of the black students saw it, and they still see, that they have difficulty with some of the patients. After all, we are in North Carolina, and a lot of the patients don t come from Chapel Hill. And so there was always some resistance. But quickly it subsided. I mean, there were some patients who said I don t want to have a black physician or whatever word they use. Generally, they were told they d have to leave or someone would try to coax them to do it, and it usually worked out all right. There were some bad instances, but nothing really serious. As far as the faculty was concerned, I never heard of a single instance where faculty discriminated. But I did hear of instances where students felt discriminated against. There was absolutely no doubt about that. It goes on and in New Haven when I was I told you I was active in the civil rights movement. And I ll never forget going to a talk given by, as it so happened, a member of the Black Panther party was giving a lecture to a mixed audience when they were being beset upon by police and other people. And it was a tough time for them. This guy is giving this talk, and he said oh, this is a mixed audience. Do you want to see a bigot? He said look in the mirror. Beautiful. Just beautiful. And I thought that was one of the best things I d ever heard. But he didn t use bigot. He used racist. And so if you do that, and you re forced to face that s what you re looking at, then you have to deal with it in some way because everybody is supposed to notice. I noticed that you re younger than I am, so I m an ageist. I noticed that this person is a woman. I notice that person is black. There s nothing wrong with noticing it. It s how you treat them that counts.