Interview 43, May 8th, 1980. We’re here this afternoon with three St. Louis area doctors. We’re in the office of Dr. Robert C. Drews, who is an ophthalmologist. With him we have Dr. August W. Geise, who is a neurosurgeon and Dr. Miles C. Whitener, who is an internist.
Gentlemen, to begin, a logical question is to ask why did you choose to attend the Washington University School of Medicine? Dr. Drews?
Robert C. Drews: Having been born and raised in St. Louis, I really only applied to two different schools: St. Louis University and Washington University. The terms of my acceptance at Washington University were much better and I went there.
Dr. Geise?
August W. Geise: Well, in a way it’s similar to Bob’s response in that I grew up in St. Louis, in North County, and went to high school in St. Louis. I did apply to three different places, to Vanderbilt, Tulane and Washington U. At the time that we were applying for medical school, as I recall, Washington U. was probably very highly-ranked and was more highly-ranked than the other two. At that point, as I remember, the admission policies were such that apparently the Association of Medical Colleges, medical schools, had agreed to send out applications at a specific point in time. However, some of the medical schools sent out acceptances early. I remember that Vanderbilt did that and left me in a quandary because my first choice was Washington U. When I got my acceptance to Vanderbilt I had a deadline to meet in terms of letting them know, so I proceeded to take that paper to Washington University and ask them what I ought to do about it. They, then, went through the interviewing process and I was accepted into Washington University.
Dr. Whitener, I understand you transferred here from the University of Missouri. Is that right?
Miles C. Whitener: That’s correct. I had originally applied to Washington University as well as [to] Missouri University and although it sounds like it’s a made-up story, one morning I got my notice to report to Uncle Sam for induction. The same morning I got my acceptance to Missouri University, [I] called Washington and they said they had not made their decisions yet. So I accepted Missouri to stay out of the service.
It doesn’t sound made up at all. I recall my own war and I had similar decisions to make. What do you gentlemen recall about the preclinical facilities of the medical school when you were students? Were they adequate to the needs of your class?
RCD: I think they were adequate, but they were left over from when my father went to medical school, except for the new Cancer Research Building which we really had no part in – it was used strictly for research work. We used the same classroom facilities, the same laboratories, that many men before us had used.
AWG: And the same elevator that was put in about 1902.
RCD: I don’t think that really worked that well. I always took the steps.
AWG: I had the opportunity to work for Dr. [Oliver] Lowry when I was in undergraduate school and kind of learned the run of the various places. At that time the Cancer Research Building, which connected the two big, old parts of the medical school, was used primarily for research activities [and] I don’t believe even had any teaching facilities incorporated in it – certainly no classrooms. There were offices: the Registrar’s office and the bookstore on the first floor, but the old buildings [provided] teaching facilities.
How about the clinical facilities. How did they stack up in your estimation?
AWG: Stack up with what?
As adequate to the needs of your—
RCD: They were first-class for the day but would certainly seem antique by today’s standards: the old open wards and white sheets hanging between white wrought iron beds, the student laboratories, where the CVCs and urinalyses were done across the hall.
MCW: Some of them [laboratories] were in closets in the same ward.
RCD: Again, these were the same wards – 1418 and so forth, 2200 – the same divisions that my father went through.
AWG: To make an analogy a little bit further, those facilities, especially the ones that most of us vividly remember at, say, City Hospital, were not quite as nice as the University although a lot of the principal kinds of care were the same. I had an opportunity to spend some time in a hospital in Brazil when I was on the hospital ship Hope, and the facilities in 1972 when I was in Brazil were exactly the same facilities that we had at the City Hospital in St. Louis in 1952-56. In comparison, we’ve come a long way with carpeted hospital wards and essentially no wards left, only two-bed rooms [compared] to the old open, sort of public wards that were present in [1952].
So what you’re describing is a kind of recognizable vintage through which clinical facilities have passed at hospitals, and some countries probably haven’t even arrived at that point yet.
RCD: You don’t have to go to Brazil. I worked at a hospital in England last September that was built by the United States Air Force as a temporary hospital for the second World War. [They are] still using the same Quonset hut-type one story buildings and the same metal, painted beds and the same – well, I’m sure they’ve got new sheets between the beds – but the same type of division between patients and so forth. It’s left over from another era.
AWG: It’s [through] this kind of change, I think, that somehow the general public can appreciate what’s happening. This kind of evolution happened subtly and people on a day-to-day basis really don’t appreciate the dramatic differences in care. If they could go back, and actually relive or even see pictures of what it was like at that time I think they’d be more appreciative of what they have at this point.
RCD: That isn’t so long ago.
AWG: That’s right.
MCW: You know, it even seems like that ought to be before my time, but I know what you’re talking about because we were in it.
RCD: But it’s left over from a previous era; it just hadn’t been updated through the Second World War and the years immediately thereafter. It wasn’t long after that that major innovations began to be made in hospital facilities.
AWG: Partly, the war was responsible for the mushrooming of technology which allowed a lot of this to occur, which didn’t occur up to that point in time.
While you were students, the Wohl Hospital was completed in the medical center, I believe. Did this represent a new generation of hospital design?
RCD: It did, except aside from the fact that it had more semi-private rooms, it still had four and six-bed wards. So it wasn’t a quantum jump, but a step in the right direction.
Tell me which professors in your medical training had the most influence on your thinking and which did you consider the best?
RCD: I’m sure the one that’s the dearest to everybody’s memory is Mildred Trotter in Anatomy.
AWG: I would certainly agree. She probably is the most outstanding in terms of reminiscing and thinking back; probably had the most impact. And maybe [that is] because she was one of the first people in terms of the curriculum that impacted on you as a medical student, because you ran into her the first week of class – at least we did.
MCW: But, Augie, I’d like to say that [even though I was not] there the first two years, Dr. Trotter is probably one of the most impressive people I met over there, also, and it was not because I had her in class. She’s just that kind of an individual, and I think probably one of the most impressive that I’ve met at Washington University.
AWG: Perhaps my reasoning for the initial impact was not accurate. I perceive this as running into her right off the bat and she sort of set the tempo, I think.
What about her teaching technique added to this impression.
AWG: It was very memorable. (Laughter)
RCD: She was a great teacher; she had a difficult subject to put across, and she did.
AWG: I think the thing that most people will remember about Dr. Trotter is that she was super-meticulous, that she could, I’m sure, dissect as well as any surgeon or anybody that became a surgeon that I know about personally. [She] had the way of knifing, so to speak, to the heart of the problem and getting directly at a student who was struggling and didn’t know exactly how to approach certain aspects of anatomy. She always did it with a sense of humor, as I can recall, which made your learning fun. In our class, I [think] most people really looked forward to Anatomy, whereas some of the other subjects, as schools go, became more drudgery. I think everybody really enjoyed that training.
RCD: Mildred Trotter always showed individual concern for each student and that just came across.
How about some of the others? What do you recall about other faculty?
RCD: Of course in clinical years, [Dr.] Carl Moyer was outstanding, though flamboyant.
AWG: He was outstanding, I think, from a little different aspect.
RCD: Yes, a completely different aspect.
Can you illustrate his flamboyance?
RCD: Well, you’d have to first put on a white jacket and put your hands under the collars and turn slightly and rock backwards and look over your glasses at the class. After eliciting what was probably an inappropriate response to some deep question that you had asked, you would then ask the student for the reference: “Who said that?” and “On what basis?” Then you would make some erudite pronunciations that were sure to be ones that nobody had ever heard before, but [that] made people think.
AWG: You mean, he made those pronouncements.
RCD: Oh, yes. Right, right.
AWG: I think the other thing was [that] he was always able, or seemed able, to quote some bizarre or little-known paper in the literature. I think [at first] when students were exposed to that, they were so overwhelmed [that] they simply accepted it, until somebody started trying to find some of these references and they were not as readily available as we thought. I suspect he used it as a teaching device.
RCD: He did. He was a great showman.
AWG: The other person that I developed a great fondness for was Dr. Oliver Lowry. I worked with him in my last year of undergraduate school before I started medical school and it was at that time that he began doing single-cell type chemical analysis. He then developed a balance scale that seems to weigh single cells and then to do chemical enzyme determinations of certain cell processes. He was another individual who was brilliant to the point of almost not being able to understand [him] but was so meticulous that he was able to concentrate on weighing single cells through a microscope. At that point in time that was a fairly dramatic breakthrough and [it] stands out in my mind.
MCW: My interest in internal medicine, of course, has to go back to Dr. Barry Wood, who I believe was only there for a short period, mostly during the time that we were there, and Dr. Carl Moore, both of whom were so terribly brilliant. Speaking of quoting literature – and theirs you could find – I think the thing I’d like to remember about Carl Moore is that he was sort of the typical, aloof professor, but I remember one Sunday morning that I was doing some urinalyses and blood counts and I felt a hand on the back of my shoulder and a voice said, “Would you like to make rounds?” I didn’t even know how to answer because it was Carl Moore. He took me [and] I think for two or three hours that morning we made rounds all over Barnes Hospital. I think [that] of all the things that may have influenced me to really be interested in medicine, that little thing may have been a very important incident.
I have a quotation here from Dr. [Evarts] Graham, who said, “Truth is beauty, even when it concerns the hemorrhoid.” Do you recall anything about him?
RCD: Graham was sort of out of things, at least as I recall, when we went through.
AWG: The way that I remember Evarts is that his wife [Helen Tredway Graham] was Professor of Pharmacology and as part of that department at the time I was there, there were a number of extra-professional or extra-curricular activities, one of which was a party at the Graham residence out in the county for the whole department. He was very prominent as part of the group. Of course it’s more important in retrospect now, but at that time he was working on his research regarding cancer of the lung and cigarette smoking. He had stopped smoking at that point in time and he was constantly telling Helen, his wife, that she ought to stop smoking. She, being the kind of person she was would not hear about it [and] continued smoking. But this was a constant banter between him and his wife about the smoking, because after his findings were becoming obvious he became very certain about it – almost became a crusader.
Were most of the students in your class from the St. Louis area?
RCD: No. Not by the time you got to medical school. Washington University out on the Hill at that time was still largely St. Louis students, but the medical school was quite a mixture.
Did they recruit to get a geographical balance or did it just work out that way?
AWG: I don’t have, and I don’t know whether anybody else here has a way to know what the Admissions Committee’s policies were at that time. I suspect, at least in our class, we did have people from the coasts, we had people from various parts of the country and we were coming into medical school, you have to remember, at a time when there was a very, very large influx of GIs finishing colleges who got through with the war, did their GI Bill and it was about time to enter medical school, if that’s what their desires were. So there were tremendous numbers of applicants for each space that was available. I suspect that [the Committee] could simply pick and choose. We had eight or nine or ten people from St. Louis and the rest were—
RCD: I would agree that 10-12 percent of [my] class was from St. Louis.
Were there any foreign students?
RCD: We had one student in our class, who as far as I could tell was a political appointee, from one of the islands in the Caribbean. Jamaica sticks in my mind. No, I think he was from the Dominican Republic. [He] obviously had no business being there and was not able to keep up at all and left at the end of three months.
AWG: At this point in time [they] would not be considered foreigners, but we had two boys from Hawaii who were Oriental in descent but were quite bright and did very, very well. We had another person who, I think, was a United States citizen but had some education in either Czechoslovakia or Poland.
MCW: [Since I] transferred in at the [beginning of the] clinical years, I know there were a number of students who came down from Missouri University with me and this maybe gave me a little slant that it seemed like there were more Missouri residents in the class – but that’s the part of the class I knew better.
Where did you gentlemen live when you were medical students?
AWG: I lived at home.
RCD: I was one of the few people in the class who was married before starting medical school and my wife and I had an apartment on McKinley Avenue where there’s now a parking lot, just down the street from the medical school.
MCW: I was also married [which] at that time was unusual. We had an apartment out in the West County, and my wife taught school to get me through _____(?) and I commuted back and forth.
RCD: My wife worked as a legal secretary.
Did you feel that you were missing the campus social scene at all – fraternities, etc? Was that a big part of medical education?
RCD: It might have been a part of somebody else’s medical education but I didn’t miss it. I was too busy studying and trying to have a little family life.
MCW: I didn’t [feel] any loss in it either. There was plenty of time [spent] around here without having to find other things to do.
AWG: I really think the fraternity part of medical school had to do more with furnishing people who were [from] out of town with a place to live, rather than any significant amount of social togetherness.
RCD: It was a way for people who came in from other places to get to know a group of people. But an awful lot of that was, as you say, [finding] a place to live.
Students of the 1950s are considered the “silent generation” you know, kind of docile and disciplined.
AWG: I think that’s an apt description.
RCD: Let’s say “disciplined” rather than “silent and docile.”
MCW: The statement previously made that we were so busy studying that we didn’t have time for other things, I think is applicable at that point.
AWG: Knowing Bob for longer than just our medical school time – and I’m sure Miles is the same although I don’t know him quite as well – [our situation] is that we grew up in, compared to this day and age, a severely disciplined environment. I think that many of our classmates came along in that same era and we were geared – programmed – to accept things that we were told and to do as we were told without rebellion, without even sometimes questioning whether it was right or wrong to the point where we just did what we were asked to do and did the best we could. Now, I think, the freer thinking, the independence thing, which is not all bad of course, [has been] more prevalent, especially in the 1960s.
MCW: There may have been more free-thinkers but they didn’t get into medical school at that time. You had to be more scheduled and organized, I think, than that.
Was this an informal, unwritten situation or were there stricter rules too that you can recall?
RCD: I don’t recall any rules; it’s just what everybody did.
So it was more like unwritten conventions that you were following?
RCD: In particular, people entering the practice of medicine were expected to be responsible citizens and responsible citizenship included having respect for the rights and property of other people and respect for the law.
AWG: And respect for each other. I think this was more of a peer type of agreement – unwritten – than it was any type of a formal code that the school put down.
RCD: Nobody handed us a set of rules.
AWG: For instance, I don’t recall through the years any problems with fellow students in terms of theft or cheating or copying or any of these things. I guess maybe there were some incidences but either I didn’t hear about them, or certainly I didn’t experience them. Whereas, I think this is a different problem.
MCW: I think this is a very real observation because, again referring back to Missouri U., the same situation [existed] there as here at Washington University. There was a respect for many of the existing mores and morals that maybe have changed. It was not written down [at] either place; you could do pretty much what you wanted to. Although I do remember a couple of professors who got a little concerned when somebody showed up without a tie, and I think one showed up with some sandals on one time on the ward and was turned around. But that was not anything of any great importance; it just began to reveal some of the changes that were to come about later, I think.
I count only five women students in your class roster.
RCD: That was only after the second year, though. We had less than that, I think, to start with.
AWG: Our class had only two.
RCD: You’re talking about two different classes here.
Yes. I’m talking about the class of 1955.
RCD: Yes. The class of 1955 had five [women], I think, in the third and fourth years, but less than that to start with if I recall correctly.
Was this considered normal? It didn’t wake any attention or indignation on anybody’s part?
RCD: Not on the part of any of the males, anyway.
MCW: I think it was a fairly significant number of females in the medical school at that time.
RCD: Yes. It was more than had been [enrolled] some years before.
Were female students treated any differently in training?
MCW: I think they might be treated differently now since they have had some other things to say, than they were at that time. No, at least in the atmosphere of the medical school I think they were treated very much the same.
AWG: I frankly think they were treated like women, as compared with some of the treatment that they get in this day and age.
MCW: I agree with the respect, but I think that’s just part of the general attitude that we were talking about a while ago.
AWG: Of society – I agree with that.
MCW: They weren’t given any benefits from the viewpoint of being women that I’m aware of.
RCD: Yes. They were neither catered to from the educational standpoint nor was life made more difficult for them.
How about blacks or other minorities? Were they present?
RCD: Well, this one student who dropped out of our class was black and that was the only black student in the class.
Were there any rules excluding blacks at the time?
RCD: No.
AWG: Just the background that they came from as meeting the qualifications.
RCD: It would have been difficult at that time for a black person to have had enough education, I think, to have gotten in.
AWG: Plus, I think that in that era the black students tended to go to black medical schools. There were several in the country. I think to answer that question you’d have to go back to the applications to see how many [from] blacks were even submitted to Washington University. I have a hunch that there were very, very few, if any.
MCW: There were a number of them who benefited from the teaching by the Washington University faculty because we had the biggest all-black hospital, I think, in the world here in Homer Phillips [Homer G. Phillips Hospital] at that time. Most of the [black] students who graduated from other schools came here to learn and Homer Phillips was staffed in part by Washington University people.
What do recall about the Medical Library? Was it adequate for your needs?
RCD: The library facilities were not plush but they were certainly excellent.
MCW: The only thing about the library facilities that I didn’t particularly care for, as I remember, was trying to locate things in the stacks. But it was very adequate.
You all were interns at St. Luke’s. How did you happen to go there?
MCW: It’s a good hospital.
RCD: I went because my father went and therefore I applied there and was accepted. It was an excellent hospital. I think one of the things I looked at in an internship [was] I wanted a place that had good teaching, plenty of clinical material, but was pleasant to work in. St. Luke’s had that tradition. [Since] you’re going to work your rear end off in internship anyway; it would be awfully nice to do it at someplace [where] the people are nice.
MCW: I knew that a number of the faculty at Washington University who were people that I admired were on the staff at St. Luke’s. And the other things that Bob said interested me in going there. My father also was on the staff of the hospital at that time, which I’m sure didn’t affect things adversely, either.
AWG: The other thing was that this was a hospital that, at that time, was fairly small in relation to the hugeness of the medical school. I thought the support of a more one-to-one type of learning situation as a house officer would end up being better, and I think it actually did.
RCD: There was another factor involved in my case, at least. The medical center as such had a tremendous drive on to force people to take straight internships. They wanted you as a straight medical intern or a straight surgical intern and I thought that was wrong. Although Carl Moyer, for example, ranted and raved about rotating internships being absolutely an anathema, most of our class chose rotating internships and that was one of the things that St. Luke’s offered – a rotating internship – and that’s what I wanted. I didn’t want a straight internship.
MCW: I echo that and I’d like to tell a little story about Carl Moyer after he said that. Carl was my adviser in medical school and when I went down to appear before the man who was – what did they call him, Student Relations? – it was Dr. [Robert] Glaser, anyway. He told me why I should not take a rotating internship and [that] I should go see my adviser immediately. I did, and after almost a full ten minutes with Dr. Moyer telling me all the reasons why I shouldn’t take a rotating internship, he suddenly said, “Now, what are you going to do?” And I said, “I’m going to St. Luke’s on a rotating internship.” He said, “Fine. Now here’s how you do it.” We sat there for another 20 or 30 minutes and he told me why he thought it was a good idea and all the things I should do. [He was] one of the greatest men I think I’ve ever known from that point of view.
RCD: (Laughing) If you’re going to do it anyway, let’s do it right!
AWG: That is one of the things that everybody remembers – that they really almost ostracized you for doing [a rotating internship]. It was such a bitter pill, seemingly, for the deans to swallow because at that time they were so geared in to training research-type people or professors or whatever.
RCD: Or sub-specialties.
AWG: That’s right.
RCD: That was the era in which the general practitioner was being drummed out. The medical school thought that the idea of somebody being a general practitioner or any broad-scale type of medical activity, was just incompatible with current knowledge.
MCW: With all the knowledge that they had at that time nobody could know all of it. The explosion has been 10, 20 times that knowledge.
RCD: And we have family practitioners being trained again. So there’s a great dichotomy. You talk about people being disciplined and accepting things – they accepted things up to a point in our medical class but they did not accept the University’s dogma of the need for straight internships. The majority of the class took rotating internships.
Could you sum up the experience of being an intern? What kind of life was it?
MCW: Well, the Bobbsey Twins here – Bob and I – I’ll speak to that to begin with and then let him take over. In St. Luke’s you were paired in rotation and Bob and I were actually paired all the way through our internship. [We] served every other night and covered for each other, and tried, if the next day was outlandish, to keep the other one awake long enough to keep going. But it was a great experience and the residents and the private staff there were the greatest. I’m going to mention – I don’t know whether he’s Washington U. or not – [Dr.] Paul Hagemann was our mentor and the head of the training department. A great deal of what I learned – the practical use of it at any rate – I owe to him.
RCD: It was an era before the present time; there was a tremendous amount of clinical material available which we not only made use of but were obliged to take care of. The idea, for example, that a house officer shouldn’t take care of more than – I don’t now what it is these days – 12 patients or something, because otherwise he’s overburdened. We cared for 40, and sometimes more than that, patients at a time on whatever service we were on and were expected to know everything about every one of those patients by heart and be able to render instant service to those people. And we did. It was a tremendous experience from the standpoint of tremendous hours put in and a killing job, but what we got out of it was proportional to what we put in. We got a tremendous amount out of it. It was hard on our families.
AWG: Generally you got out of your house officer serviceship what you put in it. It was almost a direct relationship.
RCD: That’s right. I’m concerned for the present house officers that I have contact with who are busy working 40-hour weeks. That’s not quite true – but who want to quit on a time schedule. The practice of medicine doesn’t run that way.
AWG: It always distresses me now to hear a house officer on the phone at five o’clock giving the list to the guy who automatically takes over at that time to take care of – things that are left undone that should have been done.
MCW: Except I must admit that after being on 36 hours, at eight o’clock in the morning I was willing automatically to give part of the list to Bob.
RCD: Yes. That 36 [hours] on, 12 [hours] off got kind of rough sometimes. I came home one evening to find my wife in tears. She had been cleaning out her desk and she came across a little picture of me. My little daughter, who at that time was two years old, saw that lying there and she grabbed it up and ran over to my wife and she said, “That’s my daddy. He’s my friend. He lives here once in a while.” She hadn’t seen me for a week or so, you know. And my wife dissolved.
Was this common?
AWG: These guys were a lot more precocious than I was, but we were all married at least by internship. But that’s the way things were at that point in time, that’s all.
MCW: You didn’t question the every other night on – well, you questioned it, but you assumed that it was part of the medical system.
RCD: Well, there wasn’t anybody else to do it and those patients had to be taken care of.
MCW: I figured you might have something to say if I disappeared for an evening, too.
RCD: I would have had to cover for you.
AWG: This is part of the peer kind of thing that we’ve talked about before: you don’t do the other guy unless you want to get done yourself. (Laughter)
RCD: There was no business of hiring house officers to cover.
AWG: You had the emergency room and right on up. You had no units. This is another interesting thing – we all now have an acute coronary unit and an acute intensive medical care unit and a surgical unit. At that time you followed [patients] on upstairs and if they were emergency you tried to divide your time between them and the emergency room and the rest of the patients in the house.
You’ve talked about how you tried to avoid specialization and yet—
AWG: Everybody specialized.
Yes. How did this happen?
AWG: I don’t think we were talking about it in that relationship. What we felt was [that] to be a more adequate specialist it would be better to have a broader experience early in the game and then specialize at the appropriate time.
Tell me, how did you get into neurosurgery?
AWG: How did I get into neurosurgery? As I came through medical school, I think that one of the most difficult parts of anatomy for me was neuroanatomy. As I recall, I was pretty much overwhelmed and thought at that point that I would never in my life ever have anything to do with the brain and the spinal cord. As time went on it became more interesting and I actually [did not make] the decision until my internship and residency. I had also had a residency in general surgery in which I rotated through the neurosurgical service and became very interested. I did general surgery in the service for two years and had another chance to get this jelled together and then went into neurosurgery [with] four years of general-type experience after medical school.
How about ophthalmology?
RCD: My father was an ophthalmologist and I had worked in his office for a number of years before I even went into medical school. So, when I went into medical school I went with the idea, at least in my own mind, that I was strongly considering going into ophthalmology. He insisted that he would not put me through medical school if I went with the idea that I was only going to do ophthalmology. He wanted me to go in with open options. So I did. And I considered some other things, too, especially in internship. I enjoyed OB very much, but unfortunately if you do OB it turned out you had to do Gyn, too, and I didn’t really like that. So, there were various things that came along. I wound up in ophthalmology where I really had had the inclination in the first place. It was ophthalmology that attracted me into medicine, not the other way around.
AWG: In other words, your M.D. degree was a means to an end.
RCD: In a way, yes. In high school the last thing I wanted to be was a doctor. I wasn’t really thinking about that when I went into college. It was only later on that I began to think about the practice of medicine, and largely because of contact with my father and experience in his office I began to think about medicine as a career.
Dr. Whitener, your experience in internal medicine?
MCW: Before I get started on that I’d like to ask Augie whether he was planning to be a doctor before medical school also, because I, like Bob, grew up in a medical family. That’s one of the reasons I guess, I’m where I am. But the very fact that I grew up in a medical family made me say at least until the middle of college, “No way am I going to be a doctor.” I’m sure, though, that’s what eventually led to it.
AWG: In response to that I, interestingly enough, signed into undergraduate school as a pre-med student my freshman year. Maybe that’s the antithesis of what these two fellows are saying, [which] is that they grew up with physicians as fathers. I grew up with a carpenter as a father. I think the thing that he wanted most was for me to do anything else but be a carpenter or a builder. So maybe I was led into the medical field from a more glamorous type of aspect, whereas the other gentlemen, having more practical experience with the hardships of a family physician, didn’t make the decision until later when they became more rational.
MCW: At any rate, the internal medicine sort of grew out of [the fact that] my father was a general practitioner in what at that time would have been a small community. To me, that’s what medicine really was all about if you were going to be in it – the direct care of a patient. Internal medicine gave you this kind of contact without the surgery and the Gyn and so forth which is, I think, really the reason I went into it.
All of you have touched on the subject of research and research careers. Were you at any time tempted to go into medical research as opposed to clinical practice?
RCD: I was never tempted to go into full-time research, although I have done a considerable amount of research work, both beginning in medical school and continuing afterwards. I think the two can be combined. Of course, as you become busier clinically, most of the research that you do wind up doing is clinical research, rather than test tube-type projects. But research was very interesting to me. My background and training in college was in physics and mathematics and I had a research orientation. Ultimately, though, the care of patients becomes, perhaps, more interesting to many of us than pure research.
AWG: As part of my training, I was required to spend a year in full-time, pure research-type activity and I think at that point you make a decision whether you enjoy this or whether you enjoy taking care of people. My decision simply was that I didn’t feel as good about doing research in the laboratory as I did about taking care of sick folks.
The relationships between Washington University and the affiliated hospitals of the medical center are considered beneficial on the whole, but at times I understand the partnership has been strained. Do you have any recollections about this?
RCD: The only real strain that I know of was the Queeny Tower incident when there was a major strain between the medical school and Barnes Hospital. I don’t know of any great strains between Washington U. and places like St. Luke’s. Perhaps there have been some rough times that I wasn’t in on. The building of the Queeny Tower put a deep rift temporarily fortunately, between the medical school and Barnes Hospital, as full-time departments suddenly collapsed with members of these departments becoming part-time or going into private practice. The whole foundation of the medical school seemed to be threatened for a time by this project, a project which turned out to be very worthwhile from a business standpoint and from the hospital’s standpoint and ultimately, perhaps, was not really detrimental to the medical school, either. But it was not viewed as such by the full-time staff at the medical school at the time that it was proposed.
I think it’s one of the great tributes to Carl Moore, who was made Vice Chancellor for Medical Affairs. The position was created in order to try to heal that rift and he was able to pull that show back together and keep things on an even keel. It took somebody of his stature and his abilities to do that job. The rift healed [and] most people don’t even know about it. Now they’re building more private offices on top of Barnes Hospital – it’s an accepted way of doing things now.
AWG: [Was] your question that Bob responded to directed at the medical school’s relationship with their own hospitals?
The relationship with Barnes, Children’s and Jewish Hospitals is closer than with St. Luke’s, is it not?
RCD: Physically, yes. You really felt that you were in a completely different environment when you went to Children’s. The association there when I was in school was very sharply demarcated. I also wondered when you asked the question whether you were referring to Homer G. [Phillips] and City [hospitals], which is another layer of education that was being used at that time.
AWG: As time goes on, I think that the relationship between the medical school and the surrounding community and surrounding physicians is deteriorating. I think as more doctors are being put out in the community in competition, which now is becoming apparent, [this has] caused a bigger rift between so-called full-time people and practicing physicians. There are a number of graduates and training programs at Barnes that do not have access to staff appointments at Barnes Hospital and probably never will. I think I’m more distressed about that kind of a situation at this point than I am about almost anything else. The other thing, I think, that is part of the Alumni Council meetings that we’ve been privileged to participate in is the tremendous amount of unrest within the staff; people within the University itself. For instance, right [now] I could name a number of very good physicians who are leaving the University or looking for places to practice outside it because of their tremendous unhappiness with whatever administrative problems are going on within the University setting. I think this is distressing. I think the fact that Washington University does not have a recognized, full-time professor of surgery at this point is also very troublesome.
Could you expand on that?
RCD: I just served in consultation to the Hanley Committee and these are the types of concerns that this committee looked at, too. Certainly, the University should stand in an intimate relationship to the practice of medicine in the community. We’re making great efforts these days in post-graduate medical training, in continuing medical education and so forth. The influence which the University should exercise in upgrading the level of medical care in a community as important as St. Louis can’t be overestimated. The only way it can do that is [through] a day-to-day involvement in physician education and training. There’s no way you’re going to have [that kind of] involvement with physicians who are not involved in the medical center. You can’t have everybody involved day-to-day in the medical center, obviously, but those who are involved are the ones who then go to the other hospitals, too, and carry these traditions and this knowledge with them. The idea that you’re going to have a one or a three-day seminar on some subject and this is going to be continuing medical education is helpful, but that’s not as important as the weekly grand rounds and the daily rounding with residents and rubbing elbows with professors and so forth.
AWG: I think that’s all well and good, but I’m talking more about the University’s relationship with the surrounding medical community and how they interact and react when they have problems. I’m talking about departments from the University now sending their people out and having their offices in other private institutional areas in order to siphon patients back into the University and maintain their clinical practice. I feel that this is embittering a large number of physicians in the community against the University.
RCD: We don’t have that experience in Ophthalmology.
AWG: That’s correct. You have a little different setup in Ophthalmology, but there are other departments that are doing this and right now, I think, _____(?) has to do with the number of patients available to the University and the support of their programs.
RCD: Of course, the program support is of major concern. We do have that concern within Ophthalmology. The clinics that used to support University training programs now are a thing of the past. With third party payers, the University available to patients, you don’t have the clinic population that we had when we [came] up for the residency training program to use as their basis for training.
AWG: This is the result of the new social-type of order and what is privilege and what’s a right and where health care fits into it and a whole lot of things that are going to be difficult to solve. Nevertheless, they are problems.
RCD: I wrote an article for the Washington University Magazine, gosh, that must be 15 years ago, on that subject: “How are we going to train the forthcoming generations of residents in surgical specialties, especially, without a clinic base?”
MCW: This, to me, seems to be somewhat cycling. I’ve heard the discussion go off and on in the past in different specialties. As [one who has] more or less become a family physician, we find that we’re closer to the medical centers now than [primary care physicians] were even when I graduated. At that time there seemed to be very little indication of interest in someone out in practice in medicine who was not directly related to the research of the medical center. Now, there are certainly more programs, more attempts to reach out and communicate. So, at least from the standpoint of Medicine, I think this has improved – as opposed to some of the other specialties. I don’t know.
RCD: That’s interesting.
You’ve all seen very significant medical breakthroughs in your careers. Can you identify any that were particularly important in your practices?
RCD: Looking at Augie, here, the most important thing that’s happened from the standpoint of neuro-ophthalmology is the development of the CAT scan.
AWG: I don’t think there’s any question about that. As a matter of fact, I have a hunch that that breakthrough will be significant not only in the neurological sciences and in ophthalmology, but it will be true in all of medicine, eventually, as the fourth and fifth generation scanners are being developed. More and more sophisticated pictures are made and resolutions become better so they may be able to eliminate some of the multiple tests that have been used and simply use one [test]. At this point of time, I think we’re in a transition period where the technology is [developing] so rapidly and the instrumentation [also]. If you buy a scanner, they’re running now $700-$800 thousand and they’re almost out of date in four or five years, or even less now, with the next generation being more expensive. That’s our problem, as I see it – the cost of medical care.
RCD: But the quality of medical care that this makes possible—
AWG: I agree. But when you’re talking to the general public, they don’t appreciate the tremendous increase in quality. They’re looking at the bottom line for the dollars and cents.
RCD: You know, I don’t think that’s the general public; I think that’s the politicians.
AWG: Maybe.
MCW: When they’re on the line, then they want the best quality they can have.
RCD: They don’t want that room at the hospital that I work at right now that doesn’t have the private bath in the room. [It’s] unbelievable that they have to go across the hall to the bathroom, as they do at home. But they’re not supposed to do that in the hospital.
MCW: That, diagnostically, is important. To me in Medicine, again as opposed to the other specialties, there are two things. One – you mentioned earlier [Dr. Oliver] Lowry’s work in cellular biology. I think the information in enzymatic biology and cellular biology is just absolutely changing medicine. But from a very practical point of view, from a guy that’s out practicing, I would say that the thing that has changed the practice of medicine more than anything else is diuretics. It’s a very interesting thing in that the patients that used to be the main problems – I’m not talking about cancers and things of this sort, I’m talking about people who are in congestive failure, borderline renal disease [and so forth] – are now comfortable. This was a tremendous part of the population. In the 25 years I’ve been in practice, this has probably changed my practice more than anything else; more than antibiotics, more than diagnostic material – anything else – in volume and in care of the most patients.
RCD: It seems to me we’ve seen two explosions in medicine – not necessarily instantaneous explosions like the CAT scan was – both of which tend to be technological in a way. One is the development of active pharmacological agents. You go back 70 years and there was practically nothing that truly did something. You used potassium iodide and you used warm compresses—
AWG: For instance, we’ve mentioned Carl Moyer before. Carl Moyer’s favorite statement was that he could practice very adequate medicine with three different things: aspirin, morphine, and penicillin. He felt he could cure as much of the population and treat as he thought necessary.
RCD: In those days that was not too far wrong. The other technological explosion is literally technological, including the CAT scan. In Ophthalmology we constantly see new devices coming along right now, but in particular the development of microsurgical techniques and the equipment to back these up has revolutionized things for us from the surgical standpoint. You give us the pharmacology [to] care of our medical problems, and the understanding of the diseases on a molecular basis so we know how to use the pharmacology, and the technical backing to help us out surgically and what we’re capable of doing these days compared to what was being done 40 years ago – it’s a whole new ball game.
AWG: Just the onset of aspirin and its prevention of strokes and so forth is pretty dramatic.
MCW: Just knowing what aspirin does – we used [it] for years and didn’t have any idea.
RCD: We suddenly find out on a molecular basis what this is doing and now you can apply it in a much more knowledgeable way and be of greater service to people.
You’ve been critical of connections between the medical community and the medical center. Can we be positive about the connections between the research at Washington U and what you’ve just described in these developments?
RCD: Well, we’re very positive, I think, about what goes on in Washington U. in general. That’s why we’re active alumni and support the medical center. The only thing is, in the process of being positive and having been brought up in a generation that respected things and didn’t make too many waves, we also expect the medical center to do better. We’re busy trying to see to it that it does better still. You don’t make progress by saying, “Isn’t it wonderful; all the wonderful things that you’ve done!” We say that, too, but that doesn’t mean that there aren’t areas with room for improvement. And needs – there are needs in this community that are still unmet. We would like to see the medical school playing a role in meeting those needs.
MCW: We look to the medical school for leadership.
So connection with the medical school remains an important part of your practice?
AWG: I think that’s right. At least, we all feel as if we have some debt for the education that we have [received]. We feel like we want to try to pass this kind of thing on. And yet there are attitudes – and I think a lot of these are personal things – that need to be addressed and are going to be difficult.
MCW: I would echo those statements and also add that the very fact that the medical center is here and sets the level and tone that it does, makes for a different kind of practice of medicine in St. Louis and surrounding areas than you’ll run into in a lot of other parts of the country. We don’t see it as much because we don’t see what’s going on elsewhere. Occasionally, you hear it and when you do you realize just how important the medical center is to the whole practice of medicine in this area. The little things being [set] aside, as they said.
Well, gentlemen, I think that’s a good note to conclude on. I want to say that I’m appreciative of the chance to talk with you and hear your views and your histories. Thank you very much.
All: Thank you.
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