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-0354 Dr. ABC (pseudonym) 28 September 2012 Transcript - 2

2 2 Interviewee: Dr. ABC, MD Interviewer: Rachel Gooding, MD Candidate 2015 Date: September 28, 2012 Location: The Beach Café at UNC, Chapel Hill, NC Note: Use pseudonym, and release after 5 years So I guess the whole point of this interview is to learn more about you and to learn more about your experience at N.C. Memorial during its first few years. For this, I want to start out asking questions about when and where you re from and what your childhood was like. Well, I m from Boston originally. I grew up in Watertown, Massachusetts, which is just down the road from Cambridge. I had a, I think, an uneventful, rather terrific childhood. Growing up in Boston was great fun. And I went to high school at Boston Latin School, which is in town, in Boston. And although I was sort of an out of city student there, being able to go to school in the center of Boston, close to the Museum of Fine Arts, close to Symphony Hall, close to Northeastern and all those kinds of things. It s a great young city. So that great fun. And then I went to Harvard College and that was a good experience. I don t know if I would do that again or go to a smaller school. I ve thought about that a lot, especially within the context of looking at UNC, how they compare, you know, a place like UNC, a place like Harvard and then a place like maybe Bolton or Irwin or one of those other very small liberal arts schools. And I don t know, but it was an interesting and a very good experience. I went to medical school at the University of Pennsylvania. Didn t get into Harvard Medical School. I think I ve gotten over that, but I m not quite sure. So I went to Penn in Philadelphia for four years. I thought that was a wonderful experience. It s a very good school and I made some wonderful friends and I think I got a very good education. After that, I interned and did my residency at the University of Vermont in Burlington, Vermont. I always was very fond of northern New England and while in medical school, I had clerked with a family physician north of Dartmouth in the Connecticut River Valley where he took care of general practice kinds of stuff. I thought it was wonderful and just fell in love with that, decided I was going to be a family doc in northern New England and take care of patients. I used to go fishing a lot in Maine, in a remote part of Maine on the Canadian border. And once they wanted to know what I was going to do and I told them I was going to go to medical school. So they asked me to come back and be their doctor. And I thought, well, goodness, that would be a wonderful thing.

3 3 But when I was at medical school excuse me, when I was a resident and an intern, I met a guy who was an immigrant from Poland who was sort of a concentration camp survivor, this kind of stuff. He is Borys Surawicz and he was very interested in cardiac electrophysiology. He was one of the first people who started thinking about how what goes on in a single cell relates to what goes on in the intact heart and how that impacts on understanding arrhythmias, patient care and all that kind of stuff. So I kind of got into that. I kind of fell in love with the electrocardiogram. I really got very excited about the idea of being able to know what s going on so rather than going directly into fellowship after my residency, I took a year off and did some research with him where we were sticking microelectrodes into beating rabbit hearts and correlating that with the cardiogram and testing the effects of electrolytes and drugs. And I thought it was fantastic. And so all of a sudden, my career trajectory changed and I no longer decided I was going to be a family physician in remote corners of New England. So I went into the Air Force for a couple of years. In those days this was what I was a resident from 1958 to In those days, there was a doctor draft. It was after Korea, but before Vietnam. And so I went into the Air Force after I finished my residency and I had one year in the laboratory doing that research. And after I got out of the Air Force, I followed Dr. Surawicz down to Kentucky where there was a brand new medical school and he had gotten a job as the Chief of Cardiology down there. He invited me to go down there with him and so I did. And so as part of that, I finished my training in cardiology down there and was part of the original faculty group down there. And Boris and I worked together for about 18 years. And it was really wonderful. It was nice because we were out of the main stream of almost academic cardiology for the part and so we almost could do whatever we wanted to without looking over our shoulder to see who and it was really a very liberating experience. And he and I got along so well. It was great fun. We had a wonderful time together. Now he s 90 years old. He still writes. He still worries about these things. And then, I finally decided that probably I had to cut that cord sooner or later and grow up on my own. The position as the Head of Cardiology here opened up. Dr. Ernie Craige, who had been here since the beginning of the medical, and he came in oh, goodness gracious he came about 1953, 1954 as a head of cardiology before even N.C. Memorial was built I think or just at the very beginning of when it was first turned into a clinical school. He had been Chief of Cardiology for 25 years. He was the first group. And after he stepped down, then I was recruited to come

4 4 as the head of cardiology, at that time from Kentucky. And so that was in And that s about it. I ve been here ever since. And I was able to continue my research, at the same time take care of patients, train fellows and developed a large research group in studying mechanisms of sudden cardiac death using a variety of investigators in pharmacology and biochemistry and physiology ourselves, trying to put it together. And we were very successful in that endeavor for about 25 years. That worked out really kind of cool. And now, people tolerate me being sort of the old guy around town and they are very kind and let me sort of participate in things. It s really cool. So that s about it. Okay. So you came in 1978 from Kentucky? 1978 from Kentucky, right. And you took over the position of Head of Cardiology? That s correct. Was there any difference where were you in Kentucky? In Lexington, the Lexington School of Medicine at the University of Kentucky. Oh, I was actually just there over the summer with a friend who s starting grad school there. Did you notice, were there any differences between where you were in Kentucky and when you came to N.C. Memorial? Are you talking about the medical school or the hospitals? I guess just your experience working in the hospitals. You know, at that age and going into that change of jobs was very dramatic. Obviously, cardiology was pretty much the same. The patients were fundamentally kind of the same. We had a combination of rural and an urban group of people in Kentucky and we continued to have that here. I think maybe we had more really rural people in Kentucky because we used to go down into Appalachia into the coalmine areas and that kind of stuff. And we had cardiology clinics off site. That was a little bit different. But I think that essentially the practice was pretty much the same. I think the schools were different. It s hard to really know. I mean, I like this place very much because I ve found that people were very nice to one

5 5 another here. That I thought was kind of unique, growing up in the northeast, which is pretty competitive. And then it was just a different atmosphere down here. And I think it was different from Kentucky. This is a more academic institution, the whole university, than University of Kentucky is. I think it places a little higher premium on academic excellence. We place equal premium on basketball and football, but I think that in addition to that, it has a much higher premium on academic excellence. And I think the state has always had a greater influence or a greater priority for schooling, if you will, than Kentucky. So I think that primary, secondary education and therefore the quality of students we had here was perhaps a notch above what we had in Kentucky. I don t want to but the house staffs were really wonderful in both places. And I think that basically it was sort of the same. And I think that the trends in medicine at that time, it was a very exciting time in medicine in the 60s and then the 70s and the 80s at this time because technology had expanded so much. And we were learning so much about so many things. And there was money at the NIH to fund research, which made it much different than it is right now particularly. So it was a wonderful time to be in academic medicine. It was just terrific. And I think that would have been true in Lexington or here, but I found I had the opportunity to really I had certain thoughts about what an academic cardiology division could and should be like and so I had the opportunity to try to put that into practice. And that was kind of neat. I really enjoyed that opportunity. In Kentucky, were you just a cardiology attending? I was cardiology attending. Well, I had my own laboratory. I was a funded investigator for the American Heart Association and for the NIH. I was a head of the CCU. I gave a course, I was the director of a course in clinical pharmacology and I had my own private clinic, you know, the usual, so I had my own private stable of patients, if you will, a small private practice. So I was essentially doing pretty much the same things that I was doing here, except for the administrative things. What I did here was to take on the administrative responsibilities and the opportunity to develop the training program. So when you came here in 1978 as the Head of Cardiology what s the title exactly? I don t know, Chief of Cardiovascular Medicine or the Division of Cardiovascular Medicine. I guess the cardiology is a division of the Department of Medicine. It s not an independent department. And I think it was either chief or director, I don t know. And I also became the Foscue Professor, which was an endowed professorship that Ernie Craige

6 6 had had that one of his patients had provided to the institution. It s still in existence now with Dr. Stouffer now is I think is a Craige Professor in cardiology. So that was what was going on. So your responsibilities were basically the same, but now you were the head of the department so you had those administrative responsibilities, too? Yeah, basically. And that was being the head of a department is sort of like, you know, you just have to oversee what s happening and you have to recognize the problems that all the people that are working within the division have and how they impact on what you re trying to do. And you have to set priorities. You have to decide what your image is and balance what the surgeons want from you, what the institution wants from you, what the students need from you, what the NIH hopes from you, all those kinds of things. And putting them together, it was really terrific. I don t think I did it very well, but I really enjoyed the chance. So did you come here specifically because you wanted that new responsibility? Yeah, I really did. I wanted the opportunity to try to put together a group who are interested in and being academic, not just being in private practice. I thought that having the opportunity to work in the university as a physician gave you the opportunity and the responsibility to do things somewhat differently than you would do them if you were in the private practice of medicine. And I thought it was important to recognize what those differences were and try to exploit them. I also thought it would be interesting because there was so much competition going on between us and what was going on at Duke and there was always everybody looking down the street at Duke to see how that to recognize the unique capabilities and the unique opportunities of the University of North Carolina vis-à-vis Duke, was also important. You know, there were lots of limitations, lots of opportunities, but I thought it was important to try to dissect those things to see how you can work within those parameters to optimize what you were doing. It was terrific. I really had such a good time. I did that for 13 years. And I resigned from that because I lost a daughter in an accident and I just had to spend more time with the family and sort of make sure everything was holding together. So I missed that a little bit at the time, but I think it was terrific. I had a wonderful time doing it. And after that, I had a very large program project grant from the NIH that I was a principal investigator on with about 12 investigators. So that was

7 7 what I really focused on after I stepped down from being the head of the division. And you did that research here at Memorial? Yes. What was the research in? Well, as I say, it was understanding the mechanisms of sudden cardiac death. But my own thing was trying to understand what happens why do people who may be healthy or even if they have a little bit of heart disease, why we have that incidence, why do they die before they get to the hospital, what causes ventricular fibrillation, is there any way you can predict that, what is the electrophysiology, the pathophysiology of that and then how can you modify that pathophysiology? So that was terrific. So I studied single fibers, I studied intact hearts, I studied patients. All over. It was kind of neat. We just finished our cardiology block and we talked about a lot of times if someone has hypertrophic cardiomyopathy and suddenly just dropped dead, especially when they were really young, like playing sports. Did you focus more on was it all ages who just suddenly had sudden cardiac death? Well, the question was what is the event which leads to the death? And usually that s ventricular fibrillation. So then the question sets up, what is the substrate for ventricular fibrillation? Why does it occur? The atrial fibrillation is very common. Ventricular fibrillation is very uncommon. Why is that different? What is going on, on the cell level? What is there about hypertrophic cardiomyopathy that provides the substrate for ventricular fibrillation to occur in certain settings? Why does it happen? It s with exercise, they get dehydrated, they obstruct, they get ischemic and then they have more inhomogeneity. So it was a question of what causes inhomogeneity in the electrophysiologic properties that provides these circuits, multiple re-entry circuits that degenerate and lead to ventricular fibrillation because that s what causes sudden cardiac death. And can you do anything? And why do patients who have heart attacks, why do they die? Why do patients die suddenly? You know, they have a heart attack and wham, they go down, within minutes they collapse. That s why we have automatic defibrillators in airport and in airplanes. And that s why we ve all known people who have dropped dead suddenly. Why does that happen?

8 8 It was terrific. It was a great question and it was a question that the NIH were very interested in and we were able to put together a rather unique group of people to study that. And that was kind of cool. Everything you re talking about we just talked about. And probably a lot of your research or your group s research went into what we know now and what we just talked about. So it s really just interesting. It s cool. About arrhythmias and how it sets off usually the sudden cardiac death. You said it was a unique group of people you worked with. Can you talk more about all the different types of people you came in contact with at Memorial? Well, this was because again we are it s such a fine medical school and it was such a good group of investigators with a real emphasis on scholarly activity and science. So I was able to tap into the people in biochemistry, pharmacology, the people in physiology, as well as the people in my own the clinical people and the people in public health, using their understanding, particularly in biostatistics. I was not in the epidemiology I was not involved in the epidemiology kind of stuff. But understanding biostatistics and how do you design experiments that are going to allow you to get the information that you re seeking. And to have the availability of that group of people and to be able to enlist the help of graduate students to work with you, I mean, it was wonderful. So we could put together a group of very talented investigators, each studying their own thing but somehow within the context of this overall sort of focus and overall goal. It s kind of neat. A lot of collaborative A lot of collaborative stuff, yeah. And not necessarily being collaborating in the study, but being collaborating in the ideas that were circulating and that were used to generate whatever hypotheses or whatever experiments of each individual. So Gerhard Meissner, who was over in biochemistry, was one of the people who was very involved in calcium movement in and out of the sarcoplasmic reticulum and how does that trigger contraction in the skeletal muscle. And he got very involved so we were able to convince him to start studying the heart and to look at heart, as well as skeletal muscle, and to then tie together the relationship between excitation and contraction and then get to the heart failure business. And so that was the kind of stuff we could do. I mean, I didn t understand how the calcium release mechanism from the SR, but he did, you know, so if I were at a cocktail party, I could sound pretty damn knowledgeable about

9 9 that without really understanding it. But nonetheless, that was what it was. And Bob Rosenberg was in pharmacology at the time and so we talked about studies and doing things together. We had people in anesthesiology who were watching patients when they went into heart surgery, watching the cardiogram as they anesthetize these people, who are interested in arrhythmias, that kind of stuff. Kind of neat. So was it a mix of both laboratory research and clinical research? Yes, it was. It was more applied research, sort of using large animals to because we could control the situation better, to mimic certain things, particularly ischemia, particularly myocardial infarctions that we could mimic because then we could study things in greater detail if we controlled the experimental environment. But we did it also in patients. We tried to adapt it wherever we could. So it got involved in looking at why the ST segment changes during acute ischemia, for instance, or when you put patients on treadmills. Why do patients go into atrial fibrillation? There s this issue of patients who have essentially normal hearts who go into atrial fibrillation. What is different about their hearts, versus patients who don t do that? So that s a study we did in the electrophysiology group at this time. So that s the type of thing we were able to put together. This was such a nice environment for that and I don t know if it is still as fertile an environment now as it was then. I think it is because you can see what they are doing in a variety of places, but I think it s just terrific. Where exactly was all this research taking place? Right over there. Right in the Burnett-Womack building. I mean, the offices and my lab, my labs were across the corridor from my office. And that was just across the bridge to Memorial so that I could go from my office to my lab in 30 seconds and I could get to the CCU in three minutes. To have everything so at hand and available. And across the street was where physiology and biochemistry were. And across this other street was where public health was. And down on the second floor of the hospital was where the cath lab is. I mean, everything is all it was just wonderfully compact and together. And the fact that we lived here in those days, we didn t have offsite offices. Offsite offices are wonderful for patients, but they re not so good for the docs because you have to travel and it takes you you can t go back and forth quite so easily. So all over the place here at Memorial doing your research. Yeah. In those days, Memorial was a lot smaller. We didn t have the Cancer Center wasn t built. The Neurosciences Building wasn t built.

10 10 We just had Memorial. As a matter of fact, we didn t even have the wing what s the wing just you go to Memorial as you go over to Neurosciences we didn t have that either. It was a much smaller place. I think we had maybe I don t even know how many beds we had, about 500 beds or something like that total in Memorial Hospital, so smaller place. You said you were, in addition to doing the research, you were also seeing patients when you came here? Sure. Oh, yeah. So it sounds like you just had your hands in so many different pots, doing so many different things. When you came here in the late 70s, do you remember what your typical day consisted of? Or did it change day to day? Well, I think it s better to put it into weeks because I had morning clinics two days a week. So I would see patients in clinic and the clinic was in the hospital until we developed and got the ambulatory care center. So even our clinic was in the hospital here. And so I would see patients two days a week. I had a very nice contact. By that time, I was having fellows come to work with me, mostly for a lot from Japan, and a lot from here and I had a training grant to train fellow in research. So I had fellows in the laboratory. So we would develop the experiments and I would drop in in the morning and then I would go to the clinic and I would come back and see what was going on in the lab and see how that was going. I read a lot of cardiograms in those days so then I would run down and read cardiograms at the end of the day. And then my secretary would tell me that I had to go to a meeting here and a meeting there and those kinds of things. And so it was just terrific. The time went by very rapidly. But that was what it was the days that I worked. Then I was on service where I was attending physician on the wards about three months a year, plus the fact that whenever I had my own patients in the hospital I stayed in contact with them. But three months a year is not an overwhelming burden. And it was very intense and that was a full-time activity. I couldn t spend much time doing other things when I was on service because it was very busy and the patients were very sick. But on the other hand, it was three months. When I first came, we had just I think they had just fought the battle for having a cardiology service. It had been established, but there were still wounds from that argument and that battle of trying to decide should there be a pulmonary service, a cardiology service, a GI service or should it just be general medicine and everybody taken care of and everybody would

11 11 consult. And that was a big battle. And that was just in the early days of going into sub-specialization. So a cardiology service had been established. Then we built the CCU. It had been a smaller CCU, but we expanded that and so everything was a little bit more compact. But we had a lot of patients and they were pretty sick. Then we had to worry about what to do with the helicopters because Duke got a helicopter and we didn t have one. Competition. And how do you deal with that issue and the fact that you are being advertised to death out there by somebody saying that we have helicopters, we can transport patients all over the state and we didn t have that. We were about two years behind Duke in getting a helicopter service. So that was a big theme in the late 70s? Exactly. How do we do that? So we decided we would put together a consortium of doctors outside. We would bring them here and we would teach them about stuff. And that was the early days of thrombolytic therapy as well. So we would teach them. Really, it was better for them to administer thrombolytic therapy in their own hospital rather than to transport them to the big hospital because time is of the essence. And that was one of the advantages, actually, of studying simulated diseases or animal models of disease. I knew that time was such a critical factor in the development of ventricular fibrillation and in reversibility, for instance of ischemic cell death, that actually to treat the patients at the local place before transporting them to open up the vessels made really good sense. I could talk to them knowledgably because I had seen that in the laboratory. I knew exactly how long it took before cells died. And I think that without having that opportunity to do that research, you wouldn t have known it. You would have been dependent on somebody else. But when you see it actually happening in front of you, it makes a much bigger so I could teach that, I think, more effectively and convince docs on the outside. But by god, if we taught them how to administer Streptokinase that was before TPA and the others in thrombolytics came through that they could open up vessels and then we could send patients up leisurely, under controlled situations, and then we could study them to see what was going on. And so that worked out very well. Actually, that became a national model for the places that didn t have the rapid transport systems they had 24-hour cath labs, for instance as to how to take care of patients in that kind of setting.

12 12 But it was so important to be able to do the research and at the same time to model the clinical settings, the clinical situations so that you could learn from it. So UNC, they had a cath lab when you came here? Oh, sure, yeah. Do you know when they got it? I think as soon as catheterizations yeah, it was long before I came. It was well before I came. Ernie Craige started the cath lab I would imagine he started it. Cath labs, I m trying to think when the Nobel Prize for catheterizations, I guess that was the early 50s or something like that. So cath labs started coming in probably in the 50s when they started building the cath labs. So I think it coincided a little bit with the opening of the hospital. They had a very good cath lab. The people who ran the cath lab were excellent, became world-renowned investigators in cardiovascular medicine actually that were here. Pat McLaren, Bill Grossman were the people who ran our cath lab here. Bill Grossman became the Head of Medicine, Chief of Cardiology, Head of Medicine at Stanford. Pat McLaren did his career here before he retired and was the head of the lab when I arrived. They did wonderful stuff. We just learned about cardiology so I m hearing all this and I m like it s relevant. Oh, yeah. Most everyone has a heart. There are very few people without hearts. And they all get sick. We re learning about the heart and like I feel like we definitely will see patients with those problems. So I really liked that last block, learning about that. So it sounds like when you came here you were kind of like on top of you were like man in charge, you were high up on the totem pole when you came here. Well, cardiovascular medicine occupied it s a large part of the department. So many patients have heart disease so it is an important subspecialty. Cardiovascular surgery was also very important. In those days, we had much more rheumatic heart disease, much more valvular heart disease. That was before we were able to put balloons and stents into the coronary arteries so there was more coronary artery surgery. It was an era of really trying to figure out what the best kind of surgery was to do for these patients and who to send. So we had a very strong and

13 13 meaningful interaction with the cardiovascular surgeons. At that time, Ben Wilcox was the head of cardiovascular surgery. He wanted me to always send him more and more patients and to do less and less research. And we had a constant battle about what was the role of our institution in this sort of equation of how we should be spending our time. It was really very interesting if you think about it from that kind of standpoint. It was not so much fun to debate that with him personally, but I think that we eventually got to understand that we did have things in common, but we also had things that were somewhat unique and that both things had to be satisfied. And Peter Starek did all the adult cardiac surgery. Ben Wilcox was doing the pediatric cardiac surgery at that time. But they were growing and we were growing. The era of cardiac transplantation was just dawning and so we instituted the transplant program and tried to figure out how many transplants should we have a transplant program if there s a transplant program 12 miles down the road, does that make sense. How do you put that in? How should we do it? What was the role? The heart failure program was then evolving. It was an era of tremendous excitement just as now it s very exciting about genetics, molecular genetics and clinical genetics and pharmacogenetics and all of those kinds of things. How do we do that? In my day, it was understanding pathophysiology of disease and applying new technical skills and developing new drugs around this understanding of how things work. So it was kind of much more cell biology than the genetic kind. I have to think of what I want to ask you. Let s see. When you came here, did you have someone here who kind of acted as a mentor as you had those changing roles or were you just thrown into it, new responsibilities? I think I no, I did not have I had colleagues who were very helpful. Bill Blythe, for instance, was the head of renal disease at that time. He was a wonderful source of knowledge. He had been a North Carolinian all his life. He was a really true blue kind of North Carolinian, very smart, a very smart man who died suddenly, interestingly. He was a great source of companionship and advice for me. But I think my mentorship relative to the division and running the department and what I saw as the model for academic to-do probably had more to do with Dr. Surawicz from Kentucky, with whom I had worked with for so many years. And I watched how he was doing these things and I hoped that I learned both from his successes and his failures and was able to try to avoid some of the pitfalls, but you have to rediscover all those things for yourself anyway. Everybody has to learn anew the

14 14 lessons that their fathers tried to tell them. I had to go through that period myself. The deans changed. It was interesting. When I came, the chairman of the Department of Medicine, the dean of the medical school and the head of the hospital, the three people who recruited me all stepped down within a year of my coming. So we had a new dean, a new chairman of medicine. And therefore, the atmosphere changed, the personality changed in recognition of these different people. I mean, they had different goals also. They had different styles. They had different priorities. So that impacted. That was very interesting time to see how now the kind of rules had changed and how do we adapt to that and how do you sort of see that happening. I spent a fair amount of time talking with these people and trying to figure out where they saw cardiovascular medicine within the part of the institution that they controlled. So the dean saw it from one perspective, the chairman of medicine saw it through a different perspective and the head of the hospital saw it through a different perspective. And cardiology was not central to those things, but was an important component to all of their goals because it was fairly large with a lot of patients that we were talking about. We had a lot of students, a big block of the teaching, we had to train the fellows and the residents in it and teach students in there and sort of see how we feed patients to the surgeons to make sure they meet their quotas and all that kind of stuff. So it was kind of cool. You said the atmosphere changed. You mean just because the new people coming in? Yeah. As I say they had different personalities and they had different goals and they had a different style. How were the goals different with the changing of the leaders in the hospital, in the school? I don t think I can really be specific of that. Not because I don t want to, but number one, my age now, I forget things, but also more importantly, it was more subtle than that. It was a style sort of thing. And sort of the emphasis rather than the sort of the words didn t change, but the syllable where you placed the emphasis maybe changed a little bit sort of thing. So I think it was more that I mean, we all wanted to take good care of patients. We all wanted to do scholarly things. We all wanted to be good teachers and good role models and all those kinds of things. And I think that overarching goal didn t change. But I think how we achieved those ends just sort of was somewhat different.

15 15 Nowadays, there s increasing numbers of minorities and women in medicine. Do you remember kind of the makeup of your colleagues in the late 70s when you first came here, like the number of blacks or African Americans, non-whites and the number of women? It was very dramatic, as a matter of fact. I think that the my wife is a doc and when she went to she and I went to medical school around the same time. She went to Tulane. And she remembers medical school as a time of great discrimination against women, almost of hazing where she felt angered and excluded from a lot of stuff that was going on in medical school. I think in part because I have three daughters it was important to me that I paid attention to those I was probably as much of a male chauvinist as anybody. My dad was a terrible male chauvinist. And so I figured that was me. But I did have three daughters and I had a wife who was not reluctant to tell me what she thought about things. And so I really tried to bring women into the training program and I think we were pretty successful in that. But I also found that it was extraordinarily difficult for women in those days. I mean, to be able to and it still is. I don t know how women do what they do. I truly don t. How you can go through the training process of as many years, at the same time try to be a wife, a mother, a lover, a physician how do you do all that? You have three major jobs. So the women experience much more psychological crises, I think, in trying to do all those things and recognizing that they couldn t do them all well and how are they going to balance those things. What has to suffer? It s much easier for men to do that. We were much more goal driven. We didn t have to worry about who did the shopping, who took the laundry, who cleaned the house, that kind of stuff. We didn t have to worry about if the kids got sick at school who was going to take care of them. That was the gestalt then. The men did their thing and they were the hunters and the women took care of the kids. That was the thing. And everything was changing so much and has changed so much. And so it was very interesting. I did think that women had a much more difficult time. And my daughter now is a physician and has two kids and tries to it s her second career, actually, so she tries to balance many, many things and how she does it without going crazy, I don t know. I think the women are stronger and smarter. And they are somehow able to be less their approach is different. Perhaps the competitiveness is not there. Their testosterone level is a lot lower. They are not driven by these kinds of things to quite the same level. It s just very interesting to observe it.

16 16 Yeah, I think 50/50. So yes, it s changed dramatically. Now our medical school class is 50 percent, at least, women. 50/50. Last year it was exactly 50/50. Some years it was a little more one or the other. I think that we have now many more women on our faculty in the division of cardiology. When I came here, there were no women in the division of cardiology. When I left and there were no blacks. When I left, I had one African American faculty member and one or two female faculty members at that time. Now, there s more. So it continues to open up. I think that the social revolution in the United States that has been going on for the last 50 years is just extraordinary. So it changed the whole profile. How does that impact on medicine? That s an interesting question and I don t know the answer to that. And what year did you leave? Pardon me? What year did you leave here? I left I stopped running the division in 91. I m still well, when did I retire? I don t know. I started gradually pulling back. I had my own heart surgery. I had to have bypass surgery done when I was 65. I m almost 80 now so that was 15 years ago. I think I really retired where I closed my lab when I turned 70 because I just didn t feel like competing for the grants. So that was what, that was nine years ago. And then I gradually stepped down about three or four years later, I think I formally retired from the division so I think I was probably 72 or 73 years old at that time, however long ago that was, six or seven years ago. And I still come in. I still do some teaching in the division in electrophysiology in the EP group. I still do some clinical research with the fellows. I m a senior editor for a journal. I m revising a book that I wrote, that kind of stuff. So I m still keeping my hand in a little bit. So between 1978 and 1991, when you left the first time, did anything stand out that was like when you came and when you left, like huge differences in the environment here at Memorial? No, it was just everything was expanding. Everything was progressing. Just more development.

17 17 More development. The changes in clinical care and cardiology were extraordinary. The balloon came in. We all of a sudden we turned from being interns to being surgeons almost overnight. It was a very interesting development how that happened. We could now do things that we had to previously send to surgery. We began this era of invasive electrophysiology. All of a sudden we start treating with devices, almost handmade the pacemaker industry, figuring out how that interacts and works and when to do that. The transplant program, I mean, everything just became just exploded. And it s continuing to do that. When did the transplant program come in? Oh, goodness. Let me think. Oh, 1986 or 87 I guess, something like that. So ten years after you came in, less than ten years. I think so. I don t remember quite the history of the first transplants when they were done and all this sort of stuff, but it didn t take very long before. In those days, too, you had to sort of submit you wanted to develop a program, get more hospital grants, you had to submit a certificate of needs and sort of go through procedures to do that and I don t think we had to do that for the transplant program, but there were lots of things we had to sort of get approval from one body or another to initiate changes. State legislature funding was, you know, funding was every two years. In the alternate years, they had bridge funding that they can sort of change it, but that was one of the things that how do you work within that framework where programmatically you are sort of limited by funding and all this kind of stuff. And the legislature meets every two years to do that. So you now work with the admissions for the med school? Yeah, I m on the admissions committee. When did you start doing that? Oh, I started interviewing I guess I ve been on the committee about four years now. I think I m on my fourth year on the committee itself. Before that, I just did a lot of interviewing. It s wonderful. It s a wonderful experience. That s why I have to know exactly what s going on in the medical school. The medical students are the best recruiters that we have. Do you ever drop in upstairs when the kids are here?

18 18 I went by sometimes, but there s always like a lot of other people in there and they get on us to not crowd them and freak the interviewees out. So it s usually too crowded for me to step in. Do you just drop over there on your own just because somebody told you about it? Yeah. There s no schedule, no rotation? No, they send out an like every, I think, Sunday night telling you which schools the interviewees are coming from on each day. And so I always look to see if someone is from Appalachian State so I can kind of look and see who they are. But just if I m over there in Bondurant, I walk by sometimes if I know they re in there, but usually, like I said, other students are also really interested in talking to them so there s always a ton of students in there talking. That s wonderful. And they get so much out of that and it s I think the feedback that they get from the medical students here is so positive. That s what I ve learned. I ve learned more about the school of medicine not the hospital so much, but the school of medicine since I ve been on the admissions committee from trying to figure out why people are coming to look at our school. I mean, it s obvious it s in-state and the tuition is low and all that, but we also have an awful lot of out-of-state state students who apply here. And to try to understand why they come here and what is it that takes people, even from North Carolina who decide to apply here, rather than Duke, or vice versa, and to see what the strengths and weaknesses, the special characteristics of the institution are. It s very nice. It s very rewarding. You guys are a wonderful group of students. I think we have as good and to be a state school, it s also interesting how that works. I mean, what are the responsibilities of the school, the institution to the State of North Carolina that are more or less unique, that separate us from other hospitals and other schools in the state. And how do you do that? How do you fold that in? How do you bring in minority students? How do you bring in more women into the class to make sure that they are represented? And how do you balance differences somehow to see how do you account for that? To bring somebody in means that you re going to reject somebody else and this kind of stuff. And how do you put all that together? It s a wonderful puzzle, fascinating puzzle. And it s something that occupies the thoughts of a lot of people around here. It s done with much more care than probably a lot of people realize.

19 19 Interesting to know. So now in the med school, even before we start third year into our clerkships, I think there s more of a push to get us first and second years exposure in the hospital. Do you remember what the med student, like how they were exposed in the hospital back in the 70s and 80s? Well, we were always informed when they were coming on the wards. We were invited to help participate in, for instance, teaching cardiac exams. I was never invited to teach a musculoskeletal exam or a neurological exam, but I was certainly invited to teach students how to examine the heart and vessels and how to do a cardiovascular exam. So we would do that. That was usually the second year. And then we would be mentors or preceptors when they would come on the ward and we would sort of help them. And some of us got very involved. There was a course what was it called, not physical diagnosis I don't know what the course was, but you would talk to them about the patients, they would come and present patients to you, talk to you about the physical findings. Then you would go to the bedside with them and review those kinds of things. And so we all participated in that to a greater or lesser extent, depending on what our clinical responsibilities or other things that were going on at that time. Those were third year students? Second year students. Then third year they came on and they were clerks, they were actually on the wards as part of the rotation. So they would spend a month on the ward. And there, when you were on service, you would be very active. You would have teaching conferences, you would talk to them at the bedside, you'd examine them at the bedside. You would examine the patients and the students, actually, and see what they knew. And you would have to grade the students at that time. I m nervous about that! Right. We had a lot of involvement at that time with them. It's interesting to know that the second years went in there so this was in the hospital and they came and presented patients to you? Well, we would assign the patients. We would identify patients who would be good for second year students. So they would have a good story, they would have good physical finding, they would be nice people to talk to, they would enjoy the participation. And then so we would introduce the students to the patient and then they would come back to us after they had spent about an hour with the patient or so and then they would present

20 20 the patient to us. We would go with them back to the patient and review a little bit of the history, go over the physical findings. Kind of neat. How do you examine a heart? In those days, it was before the echocardiogram. After the echocardiogram came in, people decided they didn't have to examine hearts anymore because they could see it now. So physical examination was really very important. You could learn so much about cardiovascular physiology and pathology by talking to the patients and listening. It was important to recognize how much you can learn from that and how you go about getting that information from the patient, both in terms of the history taking, as well as the examination. So it was great. That was a nice exposure. It was great fun. And were you assigned a specific med student or just all the med students eventually came to you? No, they would assign medical students to us. They would send certain people over. I don't remember quite what the mechanism for that was, but they would be assigned. Or they were assigned to the patients and then we would take them to them. Let me think what else. So when you were in Boston, it sounds like you really enjoyed the arts that the city provided. I also enjoyed the Red Sox. In those days, the Braves were in Boston at that time before they moved to wherever they moved to, the Atlantic Braves started off as the Boston Braves and then they went to Milwaukee. And then they eventually ended up in Atlanta. So we had the two baseball teams. And college sports were as even they were much less emphasized, but certainly as equally important to everybody, that kind of stuff. So there was a lot going on. Boston was it was such a young city because of all the schools. It s a small city. Have you ever been to Boston? I think I was laid over there in an airport once, but, no It s a fairly small city and yet it has so many schools that it becomes very young. So there s Harvard, BU and BC and Tufts and Northeastern and MIT all in a very small area. And so the place was just crawling over with students. And so it had this and they had the 128 around Boston, which is like the Research Triangle here. So it had this very sophisticated sort of high techy kind of feel to it at the same time in the setting of all this history, the Revolution and Faneuil Hall, all that kind of crap. So it was really great fun. There s a lot to do, a lot to see.

21 21 I was involved in music at that time so I knew what was going on with the symphony, played in the Boston public school orchestras and that kind of stuff. And the Gardner Museum was right next to the Latin School. And so we had friends who would be performing at the Gardner Museum, the Francis Gardner Museum, which had a wonderful art collection and would have musical recitals weekly. And you could walk to it from the school. You could walk to Fenway Park from the Latin School. Across the street was Harvard Medical School. It s all right there and you couldn t escape it. You just couldn t escape it. When you came to North Carolina, were you able to get involved in similar things? Oh, yeah. I mean, North Carolina, and especially Chapel Hill don t forget that the clinical school, this clinical school was populated primarily, when they opened up the clinical school, populated mostly from people from the northeast. Harvard and Hopkins were very major contributors to the young faculty. The young faculty came here to train in a large degree from the northeastern institutions. And as a result, their connections were sort of looking up to the northeast. And so that flavor permeated the place. I was recruited by people that I from when I came here, the head of the search committee was one of my friends at Harvard. The chairman of medicine had been a classmate at Harvard. The chief Jim Bryan had been my chief resident at Penn when I was a medical student at Penn. I mean, the relationships were already established. And so Chapel Hill, obviously it s a very eclectic place, but it really has a much more northeastern flair to it, as much as it has a southern flair. That s one of the things it s that combination of things that makes it. My daughter, who used to say that who went to Duke actually, but then spent a year studying cello at ECU because there was a great cellist there. She would say in Chapel Hill everybody talks fast and drives slow. And at Greenville, everybody drives fast and talks slow. It was kind of cool. Is it still like that where most of the faculty has that northeastern background? Oh, no, I think now it s much more opened up. I think it s much more general. But that s where they originally found the people because they were training a lot of young people at that time so where were the jobs being part of a new medical school is very exciting. I found that in Kentucky. I mean, to be a part of that initial faculty, there s so much excitement. You have so many number one, you have a honeymoon period, number one. Everybody really is good to you and they want to see