This is the Washington University School of Medicine Oral History Program. Oral History #50. May 6, 1981. My name is Paul Anderson and this is our series on alumni of Washington University School of Medicine. I’m speaking today with Harriet Smith Kaplan, M.D., Class of 1956. Let me begin with a review of Dr. Kaplan’s career. You were born in 1929, began college at the University of Wisconsin, transferred to the University of Southern California, and received your B.A. in zoology at the University of California at Los Angeles in 1951. In 1952 you entered Washington University School of Medicine and graduated, as noted, in 1956. You were an intern at San Francisco General Hospital, part of the Stanford University service, in 1956 and 1957 and a resident in internal medicine at Wadsworth Veterans Administration Hospital in Los Angeles, 1957-59. Then you were assistant research physician in the Department of Nuclear Medicine and Biophysics at UCLA, 1962-64, followed by a period of six years, 1964-70 in private practice, part time, in internal medicine. In 1970 you re-embarked upon residency in psychiatry at the Los Angeles County Harbor-UCLA Medical Center, a facility at Torrance, California Your training in psychiatry ended in 1973 (Dr. Kaplan gives corrected information) [and] you were certified in 1979. You’ve been associated with Torrance ever since in various capacities.
At the Harbor-UCLA Medical Center. I’ve remained there on staff since completing my residency in Psychiatry.
Since 1973 you’ve also been assistant professor of psychiatry, clinical professor, at the School of Medicine at UCLA.
First in charge of Psychiatric Emergency Service and more recently the Psychosomatic Liaison Service.
Are there any other corrections that we can make in your curriculum vitae?
No, I think that’s the main thing.
To begin now. Were there any factors in your family background or childhood which influenced you to study medicine?
None, except for the emphasis on the need for men and women to have an education. That was the primary orientation of my family. I had no immediate relatives who were physicians, but some distant relatives [were]. On the contrary, most of the people in my life earlier on felt that being a woman, it would have been far more useful for me to be a nurse than a physician, since that was the common calling for women if they were in a medical field. So my initial interest at about age sixteen, or even younger, to go into medicine was kind of frowned upon because one, the long training period that [profession] would necessitate. And two, being a woman the thing I was often confronted with was “What’s the point of going into medicine when you will probably get married and stop your training?” And “It’s so hard to get into medical school anyway, so why not go into nursing?”
After starting my pre-med work at University of Wisconsin and the tremendous influx of veterans from World War II at that time going into med school, or trying to, I was temporarily sidetracked into nursing. So I actually finished three years of a five year program, which I really don’t regret because it certainly, at that point, gave me the strength of my convictions to pursue medicine instead of nursing, regardless of one’s sex or the potential difficulties with practicing it or not. So at that point, with the strength of my convictions, I went back to pre-med and graduated from UCLA and on then to med school.
Did you grow up in Wisconsin?
Yes. I was born in Milwaukee, had temporarily gone to Philadelphia for a few months, I’m told, and moved back to northern Wisconsin. All my formative years were in a small town called Stevens Point, Wisconsin
That now has a branch of the University of Wisconsin, I’m told.
Right. When I left there it was still a teachers’ college, with a promise of becoming an extension of University of Wisconsin. Having not returned there [for a long time], I look forward to seeing that.
Where did you do your nursing training?
At the University of Wisconsin, pre-med became pre-nursing for me. My family having moved to southern California, I followed them after two years of undergraduate work and went to nursing school at what is referred to as “Big County” – L.A. County-SC Medical Center and took a year of nurses’ training, at which time I was also taking classes at USC, working toward a degree in nursing. After exactly one year of that, I could comfortably and with a great deal of confidence say I wanted to be a physician, as my original inclination was, and not a nurse.
So this accounts for your transfer to what was doubtless a pre-med curriculum in zoology, with a concentration in zoology.
Right. I went back and resumed pre-med courses – in a track towards med school.
I understand you were a lab assistant in Biophysics and Physiology at UCLA.
Yes, from ’51 to ’52, after I got my Bachelor’s degree in zoology. I worked at the then-very new medical school, UCLA, which was a very interesting experience for me. [This] again, gave me even more confidence that I had found the right niche, that I wanted to go to med school.
Were you still shopping for a medical school at this time?
I guess you might say that, in view of the times as well as wanting some experience and [to do] a little work. It was really at UCLA [that] I worked in that capacity with the very first class of medical students taken into UCLA. That year I was applying to medical school and had a lot of encouragement from people. When I was fortunate enough to be accepted by Washington University, [some said] that no matter where else I was accepted that I ought to go to Washington U. because of its fine reputation.
What specific reasons were advanced why you should apply here?
Originally, one of my reasons for applying here was rather frivolous. I applied to some schools on the east coast and some on the west coast. I needed someplace in between. And Washington U. was one [of my choices] because a gentleman I was working with in the Department of Physiology at UCLA knew of Washington U. from a family contact and spoke very highly of it and encouraged me to apply here. And I did.
And who was he?
I was afraid you would ask. I believe it was Dr. Robert Smith, but I’m not sure. However, [it’s] fascinating – his relative at Washington U. was Dr. [Joseph W.] Kennedy, the co-discoverer of plutonium. I think he had been a relative of his and it was very exciting to hear about all this. Like I say, I felt fortunate when I was accepted here. Even some people at UCLA who had just come to create the medical school there, encouraged me to accept this [offer] even if I had others to consider. So it was quite an adventure for me because I had never been to this part of the country. Being a Midwesterner, yes, but not this far south.
I gather that you had a summer project at UCLA in 1953 in pediatrics. Can you tell me about this?
Again, that was an interest that was stimulated here in retrolental fibroplasia, which was fascinating because it was a new disease of premature babies or very small infants. Nobody understood at that time the etiology of it. It was on an increasing scale; it was manifesting itself in large numbers, and it was very frightening. These babies were becoming blind, many of them, or [had] impaired vision from this condition. I did a little literature research project on it here and then from that interest I worked at UCLA with a pediatrician who was very interested in it, for that one summer. It was fascinating because they were considering tremendous extremes of causes for it. But it really turned out to be something that was really right there under everybody’s nose – unless they come up with some other cause now. It was the increased oxygen tension that these babies were being exposed to. The clue to that was [that] most of these babies were coming from fairly well-endowed hospitals, not from general hospitals, but from hospitals that were getting these fancy, new Armstrong incubators that allowed for a very high oxygen tension that the baby was exposed to. This was later then felt to be cause of this devastating problem.
Were you there when this discovery was made?
I can’t say that I was there, but I was certainly one of the people who was right on the margin of it at least; very excited about it when it did show itself as the cause. There were very extreme things they were considering – all the way from vitamin E deficiency to mother’s milk [and] cow’s milk. I’ve been away from it now for many, many years, but I understand there’s some resurgence of interest in it and wondering if they really did have the total answer. So I don’t know at this point.
Back to St. Louis now. What do you recall about the pre-clinical facilities of Washington University when you were a student. In retrospect, were they adequate for your needs? How did you find them then?
I had no exaggerated needs as far as the pre-clinical years. I prefer to think that I was one of the students that felt that I had the respect for this school and that they would know what I needed. As far as conditions, sometimes labs were a little crowded. But one of the things I remember about it is [that] most of our instructors in the pre-clinical years were very cordial and encouraging and supportive people. It was very exciting to work with people who were famous. Some of them were even good teachers – not necessarily all.
Can you think of any people who impressed you in particular?
Oh, the Coris. Gertrude and Carl Cori. Gertrude Cori was already ill so I really saw little of her, and, unfortunately, I think her demise wasn’t many years after I started here. But Carl Cori was a very exciting man to listen to, especially knowing about his fame and his accomplishments. There were lots of others. In Neurology, even though Dr. [Joseph] Erlanger, I think, was emeritus already at that time, it was still exciting to be almost in the same room with people like that. And from time to time he would give us a little talk or come around. Then there was, of course, Dr. [Oliver H.] Lowry of Pharmacology who always had been a fine gentleman and a good teacher and always had time for students. So I remember them well. I’m sure you would want to ask me about Dr. [Mildred] Trotter.
Yes.
Dr. Trotter was a very pleasant lady. I enjoyed having her as [an] instructor. But if you think because, both being women, that she would have been more embracing of some of us, I didn’t truly feel that she was. I thought she was pleasant. I might have taken advantage of the fact that she was one of my few female instructors more than I did. I think she had extended hospitality, invited some of the women over on rare occasions, and I don’t believe I ever had the chance to accept an invitation. So maybe I unfortunately didn’t get to know her as well as I might have – and part of that was my doing. But her enthusiasm was always contagious. When you think about the years she’d been doing it, to remain that enthusiastic about what she was doing was very exciting.
She still is. I speak to her very frequently.
I hope that I’ll have a chance to see her during this reunion.
As long as you’ve brought up something of very great interest to us, how were women medical students treated?
How were women medical students treated? Probably as well as their attitude on an individual basis warranted. By that, I mean I personally don’t think I felt very much prejudice because I was a woman. I was aware of the fact that there was prejudice and the very fact that our class had two women in it [out of a] class of eighty-six – as most medical schools did in those days. When I would go for an interview someplace and be confronted with, “Why should we accept you? You’ve going to get married and have children,” it sounded much like family and friends from the past. I would just say, “Look, you’re going to accept a woman or two and I would hope you’d want a normal woman. I feel that I qualify and it would be useful that that woman might be me.”
Did you hear comments such as this even after you had become a medical student?
Not so much. I think some of my male classmates had their prejudice and their biases, but that would not have been surprising. The class was large enough that I could have and did have and do have, I hope, enough in the class to have good friends, regardless of the sex. Strangely enough, I had very little contact with, or very little relationship with, the other woman in my class. Which maybe isn’t surprising. Just two women – why should we necessarily be together just because we’re women. As a matter of fact, that wasn’t the case; there wasn’t that much friendship between the two of us. As another woman came in for the last two years, I had more of a relationship with her than I’d had with the previous one.
But your training didn’t differ in any degree?
No. I can give you an interesting example – this would have been in the clinical years, though. I’m trying to remember the gentleman’s name – a Professor of Urology – I think it was Dr. [Justin] Cordonnier, who was a fine fellow. It was really fun because he took great pride in telling us – this was either in junior or senior year – that the women in the class were the best urology students of that year that he had. He went on to inform us that – did we realize – that at Stanford Medical School in those days female medical students were not allowed to participate in anything to do with male urology. Here, there was no such bias, nor should there have been, because it really is the attitude of the individual or the respect of the individual towards the patient and vice versa that makes the difference. If anything, and this may be my compensation, I felt it was an advantage most of the time – not always, along the way – to be a woman in medicine. Whether it would be the mother figure, or sensitivity, or caring – most of the time I felt that I did not experience much prejudice from either patients, regardless of sex or color or anything else, or my faculty. I think some of the fellow students may have been a little prejudiced toward women – chauvinistic. But allowing for that and appreciating that there would always be some of that, I think I was not particularly overwhelmed with any difficulty.
Some of the other women – maybe someone has spoken to you about this before – I think some other women medical student – many of them were very nice and very supportive and kind. But on the other hand, there were several women students at this school who were far more sexist, if you will, and when you could have used a little support and a little friendliness from them, just bent over backwards to be anything but friendly.
So they were brusque and non-supportive toward you?
Toward other women – well, I speak for myself – towards me. For various reasons: either afraid that their love affairs were going to be discovered or maybe chauvinistic in their own way towards other women – wanting to, perhaps, not share what was going on.
That’s interesting. You mentioned clinical training. Could you describe any incidents or any reminiscences that come to your mind?
Even before that, there was one reminiscence I’m sure you’d enjoy from the pre-clinical years. I think it was in Pathology because [that] was always wild. To show you that we had a rather playful, friendly group as I’m sure most medical students will tell you they are, part of the time. I remember on one occasion being stuffed into a locker by some of my classmates, and having the locker closed. Only to be pounding on it to have it opened and, I forget who it was, but one of the professors came along, opened it, and in very good humor just said, “Greetings” or “How do you do” and walked off and left the door open so I could get out. (Laughs) And I think it was really wild.
Do you recall who your rescuer was?
No. I don’t. I think I was probably so embarrassed and it was so awkward that I’m not sure who it was. In fact, I can’t tell you who stuffed me into the locker except that there were groups that I studied with. But it was really funny.
Sort of student high jinks.
There you go. A good name for it.
What about the clinical years?
I loved them; I thoroughly enjoyed the clinical years because you were starting to get closer to being a physician and I liked that. Plus, [you] had some very fine people to instruct [you] even beyond your professors or whatever. One of my very favorite interns at Barnes Hospital (that I could remember) who always had time for the medical students – to give instruction or how to do a procedure – turned out to be and is a Professor of Medicine at UCLA now and has been for a number of years. We don’t cross paths – that we don’t reminisce about the days when he was an intern and I was a medical student. And he is a relative of one of [Washington University’s] distinguished faculty members. Dr. Lou [Lucien B.] Guze, Dr. Sam Guze’s brother, is a very fine gentleman and one of the warmest, probably one of the most-liked teachers yet at UCLA. I’m sure that’s just taking off from the days when he was a good teacher, even as an intern. He’s a very fine fellow.
[Addendum from Dr. Kaplan: During this time one of my professors, Dr. Lillian Recant, was a superb teacher, role model, and friend. Regrettably Dr. Lou Guze died a few years after this interview.]
What do you remember about the physical facilities of the medical center in those days?
Well, being a northern girl, I guess I was a little surprised, a little bit chagrined and upset to find some of the prejudice that was still existing in those days. I remember hearing how proud Barnes Hospital was, and the medical school, that they were now integrating at a racial level. And I thought, “Great.” But come into the wards and find them integrated [only] to an extent, which meant that the black patients were in ancillary rooms off on the side, not mixed with the Caucasians. Or, I think I had been here a year before I realized that the little cafeteria in the basement of Barnes or one of those buildings was called “The Chocolate Shop” not for what it sold but for whom they expected to eat there.
“The Chocolate Shop?”
Is it still there?
No, I never heard of it. I’m glad you mentioned it.
And the medical students – we ate there. Or, the bus segregation of blacks needing to sit in the back.
That was Missouri or city law at that time?
At that time. I think it was in a state of transition then, which was reassuring. But to a northern girl, this was very difficult. I always saw St. Louis as not north and not south, sort of a city with its trials and tribulations of not knowing what direction to go. But it was interesting and I’d like to hope that it’s moved in the right direction and that there is more intermingling of hospital patients, etc. [Ed. note: If blacks sat in the back of St. Louis buses it would have been by choice, as there was no segregation of public transportation mandated by law or ordinance in the 1950s.]
You mentioned Dr. Cordonnier and Dr. Guze. Is there anyone else with whom you came into professional contact at the medical center?
There are a lot of them that I thoroughly enjoyed. I remember Dr. John [R.] Smith, a cardiologist. I don’t know what happened to him; I would like to see him. He was a fine teacher of cardiology. I remember him well for being able to [imitate] heart sounds and murmurs. He could impersonate them so beautifully that it would always stay with you. [Ed. note: Due to his ability to do this so well, students affectionately referred to him as “Lub Dub” Smith.] Then there were lots of other people that made their mark. We had the gentleman in Microbiology who’s at Stanford, or at least I think he’s still there – Arthur Kornberg. He was a challenge; he never did get around to teaching us bacteriology but there was an awful lot of biochemistry that we didn’t appreciate, and [for which] he later got his Nobel Prize.
When was it that he won his Nobel Prize?
It was a few years down the line, so that would have been maybe the late ’50s. I’m not sure. It was on DNA and as I remembered, it seems to me he had us as medical students synthesizing DNA in the microbiology class. And we wondered, “What does this have to do with microbiology?” Of course there were a lot of things in his class where we wondered what it had to do with microbiology. He was a challenge and not always [teaching] with the well-being and the needs of the student in mind.
He put research, as he saw it, first and—?
Research first. But I think it was at a personality level. He would be a little bit caustic or challenging and always with an ear-to-ear smile at the same time. You couldn’t read him right off. But obviously, a very capable, bright fellow.
Where did you live when you were a medical student?
I thought you’d never ask. (Laughs) Those were the days, Dr. Anderson, when the men had a dorm to live in – that’s one prejudice, it’s true – sexism. There was a dorm for the men; but I couldn’t feel too bad because that building was already condemned. They were living in a dorm that had already been condemned. As for where I lived, I came to St. Louis a whole week early to find a nice room so I could settle down, because they had no facilities for women – none. I looked around and found a place [on] one of those big boulevard streets not far from here – Forest Park. I found a room there that looked awfully nice and clean and I was all set to go. [By] now it’s about the weekend before school starts, only to find out that the lady that owned the house – if she wasn’t psychotic she was sure pre-psychotic. [She was] very strange and her whole purpose was for me to introduce her rather strange, retarded daughter to medical students. So here it is the weekend and I knew that I’d better get out of there.
So I ended up living in a place where I was always grateful that my mother and father never came to visit me that year, because they wouldn’t have believed the kind of dump it was. It had just been vacated, a room in a rooming house, by a man who owned one of the little greasy spoon restaurants a block away who used it for a sort of flophouse for himself. He had given up the room and I was desperate at that point. The location was fine; it was right near Euclid and Forest Park – you’re bringing back all of these memories. I cleaned it up as best possible, literally scrubbing the place, and lived there. But down the hall were some truck drivers living, across the hall was a female medical student who was one of those I described to you earlier, who would make sure her door was never opened. In a year of living there she never said hello to me and would very clearly – had to deliberately – stay in her room or not open it if I was around. [She was] very afraid to be discovered, I think. It was too bad. Right next door – this was like a twin building – there were a couple of other female medical students living who were far more cordial.
So that was my first year – quite an experience. A lot of medical students were very friendly and very supportive, not the least of whom – and the name will surely mean something to you – [was] Dr. Dan Nathans. Who at the time was Dan Nathans. He was one or two years ahead of me. [He] was a very pleasant gentleman, a nice human being who kind of took me under his wing when I needed to get a microscope, which was interesting – he ends up getting the Nobel Prize using one. (Laughs) He took me under his wing, helping me [to] choose a microscope that would be of good quality, but used. We spent several hours together socially just orienting me and being just a friend. I’ll always remember him warmly for that. After that, my housing improved and my experience with it improved. The second year, I lived with Mrs. Marriott, who was at the time the widow of Dr. [McKim] Marriott, who had been head of Pediatrics, hadn’t he?
Yes, and he was also Dean of the medical school.
I had even forgotten that. She was a lovely lady. I moved into her house though, and I tell my husband [about] this. My husband, Mel, who is an internist, was Chief of Medicine at Harbor-UCLA Medical Center in the later ’50s. [ed. note: Dr. Kaplan addresses her husband here] You had this young lady working under you as a resident, didn’t you? As an intern and resident. What was her name? Nancy Landon. [She] had left Mrs. Marriott’s house, but Mrs. Marriott was understandably a little upset because she left a family of baby skunks in her basement. And Mrs. Marriott, who was a very proper, very lovely lady just didn’t know how to handle a family of baby skunks in her basement.
I wouldn’t know either.
I was involved in getting rid of them. They were awfully cute, but we did have to turn them over to some society or other.
Did the organ for which skunks are best known come into play at this time?
Apparently not. It was just anticipating that it might [that] was a problem. But she was most upset to think that [Nancy Landon] would go off and leave this poor little family of skunks there.
I had the impression that Dr. Marriott had moved to California just prior to his death. How was it, then that you recall that Mrs. Marriott came back?
Maybe she moved back, because I lived with her in ’53 to ’54. After that, for my last two years, I lived with a friend of hers who was a delightful lady. I don’t think it’s senility, but I have had a terrible problem of trying to remember her name. She was, at that time, eighty-six years old; very independent, a marvelous lady on one of these gas-lit private streets about a half-mile from here, off Euclid. She had this big, marvelous old house, which her family really did not want her to remain in. She pacified them by having people stay with her occasionally. She had been ([at age] eighty-six, in those days, late ’50s) a biology teacher when she was younger, so this was a very intelligent, very charming lady. I stayed in this big, lovely house with her [for] two years, and there was another female medical student living there the last year. So the last three years made up for the first year, which left something to be desired, but was tolerable.
The students of the ’50s are sometimes referred to as a docile, silent generation. Was this true for you and your fellow classmates?
That must have been students of the ’60s who said that, because I think they would just like to think that they were more verbal. Docile? No. I couldn’t have been docile and gotten into med school. I [said] earlier that I didn’t really experience much prejudice, but part of that is because I chose not to interpret it that way. But I had to be a “women’s libber,” if you will, before all the noise was made years later. You couldn’t be docile. So now I don’t exactly have trouble expressing what I’m feeling.
Assertiveness comes naturally; you don’t have to do assertiveness training?
There you go – as opposed to being aggressive. There’s a difference. I can be assertive when necessary, but I prefer to think [that] not nearly as often am I aggressive.
What about rules, formal or informal, that governed students at the time?
Conscience. (Laughs)
Was it all internalized? Why were they different from what they are now?
Of course, now I think we’re not talking just about rules or regulations for students but for all young people – the generation has been liberated overtly as opposed to having to quietly assert itself, more often than not. So I don’t think it has anything to do with medical students per se. I work with medical students, by the way, and I teach medical students and I am amazed often, by some of their attitudinal problems. The dress codes are gone; in fact there are times you’re fortunate if you can tell which one is the patient and which one is the physician or the student. In a county hospital, there often the patient comes better-groomed than the housestaff officer who is attending to him. I think it’s a sad commentary, from that point of view, because I think that is a disrespect of the patient.
Looking back to the ’50s, were attitude problems less because there were these codes that people lived by?
I think the attitude problems were a little less back then because even though now it’s not that easy to get into medical school – but then I think there was, and I use this word advisedly, a more matured individual trying to get into med school. There were big numbers of veterans coming back, there were people, as [there are] now, who may have had more graduate work waiting around to get into med school, or other experiences. It was something that they wanted. Medical school was something they wanted for themselves. There’s always still, and was then and now, the one who goes to medical school because mama or papa want him to, or because it’s a tradition. But I really think there was a little more maturity in some of the students then compared to what there is now. I work with medical students, as I said, and obviously there are lots of outstanding ones. But I marvel sometimes at some of the problems that some of the medical students have in attitude, in respect – self-respect as well as for others. This has to reflect not just the student but the people who are accepting them into the medical school. I think that that’s often neglected. Almost from year to year, as admissions committees change, there will be a totally different mass personality for those students who get in.
Do you think attitude is something that can be read through applications?
Not necessarily. There are always personal interviews and letters of recommendations. We all know that letters can be misguiding and masking of things, but it is interesting that in any one year you may see a group that seems to have more problems than in another year. Or a different orientation – a far more individual, much more scientifically-oriented, if you will, as opposed to better-read or into more sociology and history, whatever. The docile 50s? I’m not quite sure what would have made us docile except just pounding our heads, trying to get into what we want to do. Now, [from] a lot of the people of today, I hear much more complaining. This is interesting, and Mel, (addressing her husband) I don’t know if we’ve talked about it – I hear more medical students now at the stage of internship or early residency bad-mouthing their experiences in medicine and the lack of imagination and this and that.
What specific ways do these expressions come forth?
Something as subtle as, “I hate medicine,” and wishing that they hadn’t gone into medicine or really intending to leave it, supposedly, although I haven’t seen much of that. But [I see] a great deal more of taking off [from] finishing medical school [or], more often, your internship or your residency and then going around the world for a year. Or doing just odd jobs or working in emergency rooms, having not been able to make a decision about what you want to do with the rest of your professional life. A lot of people [are] taking off, traveling or doing something else for a while, as though they hadn’t cleared in their own mind what they really want to do when they grow up.
As I’m sure you know, that’s always happened. I’m reminded [of] one of our pioneer plastic surgeons. Vilray Blair apparently took off a year in the middle of his medical studies to string telephone wire in the Rockies, in the 1890s.
That may be fine. We have a friend, an obstetrician-gynecologist, who took off and did farming for a year. I think they always have done some of this. But I think some of the reasons were different, or at least expressed differently, and there are larger numbers doing it now. Now, there’s more affluency, maybe. Maybe it’s easier to go around the world now or to take off than it used to be. Everybody was pretty goal-oriented back in the “old days.”
I have the distinct impression that in this age of the Bakke decision, without getting into the specifics of that case, that there was such demand to get into medical schools that no one would ever consider [dropping out] unless they wanted to drop it altogether. The opportunity would not present itself to get back in once you had dropped out.
I think they’re dropping out more commonly at stages after internship, at a breaking point. Or before internship, between med school and internship, although that’s harder. [Or] after a residency. I know several now, having been disappointed in not getting the residency they wanted, are planning just to take off and think about it. The other big difference, Dr. Anderson, is that there are many more married medical students and housestaff people now than there ever were twenty-five years ago.
It was allowed in the ’50s wasn’t it?
Yes. I understand there were certain fields that did not allow it, supposedly, or totally discouraged it.
Do you recall [which ones]?
Surgery, some places, I understood. I can’t say it authoritatively; maybe Mel would know. Years and years ago there were some surgery residencies that would say that you were disadvantaged if you were married and they expected them not to be and many times wouldn’t accept someone who was. But now medical students are often married; interns and residents are often married. I think that, although it meets many needs and makes for a lot of satisfactions in one area, it is another source of dissatisfaction and problems. Because now, with the pressures of internship, medical school, [and] residency, besides dealing with those, they have to deal with the discontentment of a spouse who isn’t getting enough of their attention or enough of their time, or [who] isn’t in a position where you would expect her or him to appreciate the demands of the work. So unless somebody has her or his own identity, own drives and needs met and comfort with herself of himself, I think you are asking for more discontentment and dissatisfaction. Many of them end up with divorce or some other kind of acting out.
Earlier we mentioned blacks as patients. Do you recall blacks or other members of minorities who were medical students when you were a student?
In my class we had none. However, I remember distinctly talking with various people here [about] how they were most eager to have minorities in the medical school.
This was already in the ’50s?
Yes, sir. But what they were finding was that there were not a lot of blacks applying then and of those who did they were not qualified. They had, a year or two ahead of me, taken a couple of black students [and] as I understood it, really bent over backwards to make every effort to support them and to encourage them. One, I think, dropped out and the other transferred to another medical school within a couple of years or something to that effect. They [school administration] were really unhappy about it. In those days, women were a minority and, right or wrong – for what it’s worth – Jews were considered a minority at a time when it wasn’t an advantage to be a minority. Of course, now Jews aren’t considered a minority any more when there could be some advantage. Again, the women were certainly a minority group, but we’ve spoken about those issues.
Tell me something about your internship.
My internship was a rotating internship at San Francisco General.
Was this the normal thing – to have a rotating internship?
Yes. As a matter of fact – I can’t tell you exactly the year it stopped, but back then in order to be licensed in California you had to have a rotating internship. To this date, I would urge and support that requirement, because I think a rotating internship is a fine experience for someone who’s just finished med school.
One of your classmates, I believe [it was] Dr. [August W., Jr.] Geise, was telling me that they were already discouraging rotating internships here at Washington University. Was that an issue that you were aware of?
Yes. At Washington U., [they] jokingly would say that they didn’t feel there was much medicine west of the Mississippi River anyway. Just like the west was no-man’s land.
And that was a common feeling?
Yes. And that feeling may still exist for all I know.
Certainly they’ve learned some things about the west since then.
Right. If they [would] only came west they’d find out. Rotating internship, I thought, was great. However, I must say that I could have chosen a place that would have been a little easier to cope with than San Francisco General. However, by the time I finished a year of rotating internship there, I often say I could have practiced rural medicine anywhere in the world and been pretty well equipped.
Why rural?
Because I learned how to treat and diagnose patients with less-than-ideal conditions and with less-than-ideal support of laboratories and other modalities.
Would you say that San Francisco General was comparable to St. Louis City Hospital?
Probably. But it had an advantage – which was exciting – like its emergency room service. San Francisco General Hospital in those days, and I think it’s still true, was the only big emergency room for all of San Francisco. So it was a tremendous experience. I liked my internship; it was hectic, very hectic, but for one year – like I tell people even now – the internship is a self-limited disease. It’s over in exactly one year and the sequellae from it aren’t necessarily too devastating. You live through it, most of the time.
Being part of the Stanford service I imagine you met many Stanford graduates. How did you compare in your training to them?
I [thought] then and I still think that our training here was as good, if not superior, especially as far as attitude. Since you mentioned it, I must tell you that as an intern looking forward to working with medical students, I was very disappointed in the attitude of many of the Stanford medical students, who felt [that] to work with a live patient was interfering with their book reading.
I remember having a couple of encounters. One example was [when I was] on call one night I had this patient come in who was a classic pulmonary edema problem. I called up, as I should, the medical student who was scheduled to be on call to see the patient – this was about eleven at night. His response was, “Well, what does the patient have?” I said, “Wouldn’t you like to come and examine the patient and we’ll talk about it so you can decide.” [He replied], “What’s going on with the patient?” I said, “Well, it’s pulmonary edema.” He said, “Oh, I’ve seen one. I’ll see him in the morning.” At that point I said, “Well, I’d like to hope that he’ll be a great deal different by morning, and this is your opportunity to participate in this.” That was not a rare attitude. I’m told that that particular class, and again that’s [the] class, was a little less than ambitious and interested in what was going on.
You’re not aware of any reform at Stanford?
No. Stanford, though, is a fine medical school in many ways. They are rather non-structured in the courses that they expect of their students, but I think that’s probably a little trend of many other schools now.
We had an interview recently with a former Dean at Creighton University who described reforming the school with the specific aim of changing that attitude – that students were no longer to have their noses in books all the time and would, indeed, get that clinical exposure.
That’s right. I think that is really vital to correlate anything you’ve learned from a book – to see it in the flesh.
Tell me about your residency at the Wadsworth V.A. Hospital.
I can tell you briefly about that. Compared to a general hospital experience, which I always liked and obviously still do or I wouldn’t be at a general hospital – on staff – the V.A. was a slow, tedious pace, where patients can stay almost as long as they choose to. There’s no push to get them out. It was an interesting experience in that I had some good teachers. Their staff in those days was very good. But it was a big change for me from a general hospital to a veterans hospital and I felt that two years there was quite enough.
Was it unusual for a woman to be a resident at a V.A. Hospital, outside of being in a minority?
That’s an interesting question; let me think about it. I think there weren’t very many of us – there weren’t many women anywhere – so I wasn’t overly aware of that. The difference is that they had no female patients; that was a conspicuous difference. They had a relationship with what is now called Harbor-UCLA Medical Center. In those days it was called Harbor General Hospital, L.A. County. They would send each medical resident, to Harbor General Hospital for two months of female medicine. Everybody looked forward to it because of their very outstanding Chief of Medicine there who was a fine teacher. That’s Mel Kaplan, who I very cleverly later married. Afterwards – he was ethical; we never even dated while I was there. But long before there was any social encounter, I really felt that the experience at Harbor General was really what they had said it would be – a fine experience with a lot of support and good teaching from my husband, who wasn’t at that time my husband.
When did you marry Dr. Mel Kaplan?
I was on the service at Harbor General Hospital [in] September and October of ’57. We started to date mid-November – and this was dating a gentleman who was called “a confirmed bachelor” by some of his associates. We dated starting mid-November; we were married February 23 of ’58, so that was a rather fast-moving courtship.
Judging from your vitae you were still associated with the V.A. Hospital at that time.
I was, yes. While at Wadsworth I went from being Dr. Harriet Smith to Dr. Harriet Kaplan on the same ward, which was confusing to some of the patients.
There’s a three-year lacuna in your vitae following this period.
Lacuna is probably a good word, because I had babies. (Laughs)
So the eldest of your three sons was born at this time?
Actually, he was born in ’58 while I was still a resident. You might believe that some of my colleagues to this date will often remind me of how I was walking around with Ace bandages on my legs and acutely pregnant at the V.A. Hospital. [After] all the other times we’ve had encounters, they take great delight in teasing about that time.
Other than the Ace bandages, how did this affect your practice?
As a resident it didn’t affect it too much. Sometimes at the end of rounds we’d have to sit down and talk about the cases so I could elevate my legs. We’d sit down and talk about [the patients], but otherwise it didn’t interfere too much.
Was the attitude of your patients affected in any way.
With white lab coats you can cover up even a pregnancy sometimes. They were all very cordial about it.
So you didn’t practice medicine at all for a period of three years?
Well, very little. I would go into my husband’s office a little bit. But not really. I’d go to a [medical meeting], do a little reading. Certainly, but no, I really did not [practice medicine]. Then we had our second son within nineteen months of the other one, so it kept me pretty busy. Between the second and third son, I was in nuclear medicine for the two and one half years.
How did that opportunity open up?
I was eager to get back into professional life. That was such a new and exciting field and I had had an opportunity, again at Harbor, to associate with the Nuclear Medicine Department. I knew the woman who was running the department and had the good fortune of knowing a gentleman who is probably one of the nicest people I ever knew, who was head of Nuclear Medicine at UCLA, Dr. George [V.] Taplin, who is one of the big pioneers in nuclear medicine. I spoke with him, had the opportunity, and got into the field where I [worked] for two and one-half years. [I] did some of the first lung scans that Harbor General Hospital [had] ever done. So it was fun to be in an area that was so new.
Did you ever run into Dr. Crawford Sams in connection with nuclear medicine? He was a brigadier general in the Korean War and also, I believe, was in nuclear medicine at San Francisco.
No, I didn’t. This was a department that was mainly run by internists as opposed to radiologists, which I think still should happen because of the pathophysiology.
What did your work entail?
Most of my work was really dealing with the clinical aspect of it – dealing with the patients, evaluating, participating to some extent in getting patients for the studies or getting studies for the patients. When I had to make up my mind a little later on about what I wanted to do with the rest of my professional life, as an internist I could have continued nuclear medicine and it would have been compatible with family. But in all honesty, I was not as interested in the physics and the machinery of the field and did not envision myself staying in it forever. Through various processes, in spite of Mel, who many years ago said, “Go into anything, honey, but psychiatry” – I’m sure with tongue in cheek – was quite supportive of my going into psychiatry.
This didn’t happen for quite a while yet, though. For seven years you practiced—
During that time I was doing a little part-time practice with my husband, doing a little lab work – not as much as I would have liked. By the time all of our children were in school [ed. note: Dr. Kaplan’s third son was born in 1964] is when I made the decision to go back into another training program.
Why did you do that? What led you to decide to become a psychiatrist?
One, the appreciation that in almost any field you’re in with a lot of patient contact, you’re going to be doing psychiatry, whether you choose to or not. So I thought that to have a background in psychiatry was useful. I’ve often found myself in a situation of being an “ear” for people, or needing to listen to problems. I like that kind of relationship; I enjoy hearing people’s problems, if you will. And number three or four, which ever one it is, it was possible to get a training program twenty minutes from home – very practical when you have three little kids. As a matter of fact, part of the appeal was – and I think it was very cagey of them – they led me to believe for awhile that I could get one of these modified programs; that I could go during school time, when my kids were in school, and be off with them during vacation time, which was already going on in some parts of the United States. That was very appealing – having an extended residency over four or five years.
I did get things set up so I could do that, and at the last moment they told me, “Gee, I’m awfully sorry, Harriet. We’d be glad to have you as a full-time resident, but we can’t make these other arrangements.” By that time my taste buds were up for it, and I was ready to take on a residency, so I plunged in. It wasn’t easy, but I did it. Especially household help was a problem and remains a problem. If somebody wanted a cause in this country for women who want to work or be in professions, that would be an admirable cause – of proper care for children in the homes. I had Mel’s support, my husband’s and my children’s support. [They] were very cooperative and I did it.
Tell me briefly about psychiatry at Harbor.
I was comfortable at Harbor because I’d been there in various capacities before. During the time I was there my department was fairly analytically-oriented because of the chairman of the department, [Dr.] Pietro Tedesco, who is now at Vanderbilt. He is an analyst. That’s particularly interesting, since it’s a general hospital, that you would have a psych department that was psychoanalytically-oriented.
Does this mean Freudian in its orientation?
Freudian, right. But it did allow those of us who were interested in a more eclectic approach to get some background in that. And I prefer to see myself as an eclectic. As far as the training there goes, let me say that twenty-five years ago, or at the time right after my medical school and so forth, I probably would have wanted to look for a fancier, more elegant training program. But, I mentioned maturity before. I guess [because of] the number of [intervening] years, and having children, and being at the place I was, I was matured enough at that point to appreciate that it’s not how fancy a program is [that is important], but what your attitude is, and what you get out of it, and how much you put into it. The choices weren’t that great – I wasn’t going to go to some other state or some other city and I didn’t want to drive huge miles. [So] I went to this program and I really felt that I got a fairly adequate psychiatric training. Then I was asked to stay on in Psychiatric Emergencies and I liked it. Now I’m in Liaison Consultation.
I take it you have always felt that psychiatric care and psychiatric wards have a real place in the general hospital, particularly the large general hospital.
Oh, yes. That’s one of my favorite subjects. My feeling is – remember, I have an internal medicine background [and] nuclear medicine – I think that it is essential that there be at least some psychiatric beds in a general hospital. I am concerned about strictly free-standing psychiatric units because many, many organic diseases manifest themselves with psychiatric problems, but they need a good, general medical approach. I think psychiatrists need to be physicians who have specialized in psychiatry. They mustn’t divest themselves of their role as physicians, interested in the patient’s medical well-being as well. Plus, being in psychiatric emergency work, I personally saw, let alone am aware of, many catastrophes that present initially with psychiatric manifestations. [These are] brought to psychiatry and catastrophes happen, not the least of them death, of course, but seizures and many other problems. So without being in a general hospital where these could be attended to, I think [that] it’s really irresponsible to have them anywhere else. Down the line that might be different, once they’re triaged and observed. And then some select, ongoing patients that psychiatrists have, fine. But I would be much more comfortable with most psychiatric problems first seen and dealt with in the general hospital.
How has your assistant professorship been a part of your career in this regard?
It’s been compromised in the sense that it’s only one of the many hats I need to wear. That’s just a fact that I need to accept – and maybe it’s what I want. I don’t know for sure.
What do you mean by “compromised?”
Well, I can’t devote – or I don’t or won’t devote – as much time to my role as a faculty psychiatrist as I might want to or maybe, sometimes, should, because I’m also a mother, a wife, a homemaker, and, right or wrong, I have continued to maintain a lot of involvement in all of the above. So, the publish or perish thing is a risk. I have a little advantage in that I’m not right in a big mecca [but in a place] where other things are considered. This is a area where chauvinism is still manifested. Women, yet, and [this has been] by my choosing, are into all the roles with emphasis distributed across the board. Whereas most men, maybe not the newest generation in medicine, but most men give priority to their profession and the other jobs come next in line.
What percentage of your professional time is devoted to academics?
To teaching, supervision, the whole works? A lot of it – comfortably I would think, at least a half, or more.
What does it mean to be in Psychiatric Emergency Service?
I’m head physician of the Psychiatric Emergency Service Crisis Center. It means heading up that section, having interns, residents to supervise (under you) [and] social workers; being the administrator of that area – which is another role. [It means] relating to the community; dealing with the problems that come up over it, evaluating teaching.
Do you go outside the hospital much in your work?
Not a lot. But in psychiatric emergency work I did [go out] more than many other psychiatrists would in other areas because you are always worried about the need to deal with acute psychiatric beds – being able to find some when your hospital has limited numbers, working with community mental health agencies who send you patients to be evaluated.
Do you have any research projects in the fire?
I’ve just finished – it should be going into publication – a chapter for a book on seizure disorder, the psychiatric aspects of seizure disorder. I’m very interested in group phenomenon and am doing an interesting group with visiting nurses who would like to do a little writing about that.
Would these be psychiatric nurses?
No, these are hospice nurses. We’re doing group therapy with them over their feelings about having to do hospice work and what it does to them. [It’s] a very stressful situation that they’re in. That would be interesting [subject] to write about because I’m sure it hasn’t been written about, or I don’t believe it has. I just had something come out in Emergency Medicine. I relate a lot to paramedic training. I teach paramedics psychiatric emergency work and I had an article in Emergency Medicine Journal just last month about mental status, about evaluating patients and so forth. I like teaching about mental status examinations of patients. I think it’s so important to separate organic from functional.
That brings us up to the present. Is there any major area of your activity that we’ve glossed over?
I think we’ve shortchanged a little bit, if you will, my family. I’m very proud of our three sons and my husband, who I can be very proud of.
You mentioned his position when you met. What position does he hold now?
(Laughing) A very high position. He’s in the private practice of internal medicine. But having been Chief of Medicine at Harbor General Hospital, having been resident there, for the last three and one half years he’s been President of the Professional Staff Association of Harbor UCLA Medical Center [ed. note: and of the Research Education Institute of Harbor UCLA Medical Center]. So, he’s one of those few people who has had experience at that institution almost from every aspect possible, so can bring to it a tremendous expertise. As I said, I appreciated him as a teacher even before I realized that I could appreciate him as a husband. Our oldest son is a medical student
Where?
At Harvard. I should say that he had a nice problem of having a number of places to choose from and really had to struggle with the choice. I think it boiled down for him [to a choice] between Washington U. and Harvard.
So he could have come here?
Yes. He would have been very privileged to come here. In fact, they had offered him a scholarship here and he really seriously considered it. He went undergraduate to Harvard and I think that probably influenced him, too. He knew Boston; he liked it.
What’s his name?
Robert. Robert A. Kaplan.
And your second son?
Marty [Martin] Kaplan is our twenty-year old who’s a junior at UC-Berkeley, who next year will be going for a year to France to study through the University [ed. note: the University of Poitiers]. Our youngest son is a junior in high school.
What’s his name?
His name is Roger and he’s very busy and is in the throes of thinking about college now. So we’re very proud of our sons and just hope that they’ll all find happiness and contentment, regardless of what they do.
It seems that you’ve had a very well-rounded and fulfilling life in many major respects. Is there anything else.
No, except that I thank you for the invitation of participating in this program. I think you can tell that I do enjoy talking about it. It was kind of fun because it gave me a chance to reminisce about things that I hadn’t thought about, in some cases for twenty-five years.
I hope you have the opportunity to see some of your old haunts in St. Louis. You might find Euclid [Avenue], if you haven’t been back in the city recently, changed quite a bit. It’s kind of the “art” quarter of the city now. It has a lot of restaurants, and renewal and antique shops, so it’s one of the more interesting areas. St. Louis, perhaps, doesn’t shine as one of the world’s metropoles but when people want to go out in the evening they frequently go to Euclid [Avenue].
Thank you for the recommendation; we’ll look forward to seeing it. This is my husband’s first time in St. Louis – ever. So, twenty-five years later I’m going to introduce him to it.
Welcome to you both.
Thank you.
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