Chapter 02: Developing a Rehabilitation Clinic and a Rehabilitation Specialist

Authors

• Albert E. Gunn JD, MD, The University of Texas MD Anderson Cancer Center
• Allison Sáenz PhD

Files

Description

In this chapter, Dr. Gunn discusses his early career at MD Anderson and how his military background helped him acclimate to Dr. Clark’s management style. Dr. Clark had grand designs for the institution’s Rehabilitation Clinic, including proper accreditations, and Dr. Gunn recalls the steps the institution took to achieve that goal. Part of developing the clinic required Dr. Gunn to train as a rehabilitation specialist. Throughout the chapter, he also recalls his working experiences with other MD Anderson specialists, including Drs. Clifton Howe, Robert Hickey, and Ariadesa Udugama.

Identifier

GunnAE_20240627_C02

Publication Date

7-27-2024

City

Houston, Texas

Interview Session

Albert E. Gunn, MD, Oral History Interview, July 27, 2024

Topic Covered

Building the Institution; The Clinician; MD Anderson Culture; Working Environment; Building/Transforming the Institution; Portraits; MD Anderson Past

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Disciplines

History of Science, Technology, and Medicine | Oncology | Oral History

Transcript

Albert E. Gunn, MD:

And it was a wonderful opportunity. I was very impressed with the rehabilitation center and the chance to be in a place like MD Anderson, which looked to me like it was really on the verge of taking off, which it has done. And I took the job, and so that’s how I became the medical director of the rehabilitation center. And at that time, Dr. Clark was instituting a reform of the organization of MD Anderson. Dr. Hickey was the director of the MD Anderson Hospital, and he had appointed underneath him associate directors, and I was made an assistant director of hospitals. The associate director of hospitals was Dr. Howe, Clifton Dexter Howe—New England, he was from Vermont. And one of the things that I noticed about MD Anderson, and Dr. Howe right away was the strong military flavor that MD Anderson had. Dr. Clark was like a commanding officer more than a health science center president. And the first thing you learned about people that you met on the faculty was their branch of service and rank, well, so-and-so was in the navy, and he’s so-and-so. And Dr. Martin, a notable surgeon, he’d been a surgeon in the Korean War. Dr. Ed White, who was an associate of Dr. Clark’s at Randolph Field in the US Army Medical Care—Medical Corps, he had been a surgeon in the army. And so a lot of the people who had served with Dr. Clark in the army at Randolph Field Army Air Corps Medical facility, they were the backbone of the faculty at MD Anderson. It was interesting. And I fit in right away because I had been in the military, I understood it, I understood the courtesies and so forth. And many things that I found about MD Anderson were modeled on the military. Like the faculty club was a good example or, as Pat Leon called it, the O Club, officers club, and the faculty used to eat their lunch there. And it was also the faculty club for the School of Public Health, and the medical—now McGovern Medical School, and the school of allied health sciences, and so on. And the facilities had about them this kind of, oh, I would say, military order about them, and that was—Dr. Clark was the commanding officer and people underneath him were like subordinates. But anyway, Dr. Stratton Hill was the associate director of clinics. Dr. George Blumenschein, a wonderful person, was the associate director for education. Dr. Felix Haas, a very interesting and talented person, was the special assistant for research, but he, in effect, was the vice president for research. A very brilliant man, and I believe he was one of the discoverer—or the discoverer of (inaudible) and putting a methyl group on tetracycline when he worked at Syracuse. I’m not sure what company it was, Bristol Labs, but he was a great figure at MD Anderson I thought. He was from Alvin, Texas. And it was interesting to hear the kind of, oh, humor that went back and forth between Dr. Hickey and Dr. Clark and Dr. Haas. And I recall that, just if I can digress a second, an incident where we were having a research seminar in the main auditorium, and Dr. Hickey introduced Dr. Haas who would make a presentation. And he said that Dr. Haas had been the catcher for the Alvin baseball team before he entered his—UCLA for his PhD and so on. I think he went to The University of Texas at Austin undergraduate. And when Dr. Haas took the podium to speak, he said it was lucky he’d been the catcher for the Alvin baseball team because he could handle all the foul tips that Hickey and Clark were sending his way, so this broke the faculty apart. But this was an attitude that I really liked. That the people never took themselves too seriously. They went back and forth, they argued things out, they talked things out, they settled things. Dr. Clark had instituted a system of planning conferences or meetings with surgeons, internists, and all the people involved with the care of the patient would meet together, and they’d come up with a plan for each patient. So you didn’t have these jurisdictional fights where one service or another would want the patient, and they didn’t—they froze out the others. I’ve seen that—it’s so destructive—in my years working in hospitals like the ones I trained in. That surgery wanted the GI bleeder, that medicine wanted the GI bleeder, who was going to get them, who? There’d be an argument over it, but none of that for Dr. Clark. Dr. Clark wanted a team thing, he didn’t want services arguing with each other about who got the patient and who made the money. He wanted the best thing for the patient. And that was the key at MD Anderson that impressed me so much. That the whole focus of what they were trying to achieve was for the good of their patients and their dedication to that good. It was just a very interesting time. But anyway, I took over at the rehab center, which had hired a group of people to staff it, but they needed a medical director to be in charge. And they’d had some problems out there with these, oh, factions, different people, without a central leadership, were trying to run things as they saw best from their departmental focus. And Dr. Clark said to me, “I want somebody to go out there with a little guts and run that place, and you go out and do that.” And Dr. Howe, who is a very colorful man, my immediate superior, the associate director of hospitals, said to me, “Seize control, do it by force of personality.” I remember him saying in his centurion tones, he said, “We’ll give you all the help we can, but you’re the man to do it.” So off I went, and I went out to the rehab center and held a staff meeting. In the staff meeting, I said, “Before, you had your own reporting relationships, but I’m here now, and I’m in charge, and everybody reports to me.” Well, that didn’t go over too well, but anyway, Dr. Howe, sitting next to me, he came out for the meeting, said, “Yes, you would—Dr. Gunn has told you the way we’re going to have it, and he’s here now to be available to you,” and so there I was. And they were a wonderful group of people they had hired, frankly. The nursing staff, Ms. [France Riebel?], Ms. [Gilbert?], Ms. [Delaney?], they were all very dedicated people to their patients, and I was very impressed with them. And the dietitians that they had, Ms. [Nozensky?], I remember, put together a teen club so that teenage patients, particularly those with missing limbs from Charcot, and so on, got together and had a little club where they did cookouts, and meals, and things like that, made life pleasant for them, and they had so many good ideas. I mean, I really just was amazed at how much strength they had to come up with all those ideas. And the social workers, Ms. [Stowell?], Mr. [Sines?], later [Russi Chiesa?], and others, they all were dedicated to the patient care very much and made a big difference. One of the problems is the rehab center accreditation. That was one of the first problems that we faced, and it had never been accredited, and so we looked at it as a rehabilitation center. And one of the first duties I had when I came there to the rehabilitation center was to evaluate how it was conceived of originally, how it was built to conform to that conception, and what its present status was. And so I took all the documents that I could find in files and went through them, and talked to the people out there. And it appeared that originally conceived, they hoped to transfer all the rehabilitation functions from the main hospital over to the rehab center, and this had never occurred because of the practical problems. It was about a 15- or 20-minute bus ride from the main hospital, and getting patients—there was regular bus service, a little bus they had purchased, okay, made daily round trips all day. Dr. Clark wanted a gypsy service as he called it where taxi or a taxi would, more or less, keep circulating, picking people up and dropping them off at the rehab center. But rehab patients, we did have a very up-to-date, very beautiful facility with a whirlpool bath, all sorts of weight-training facilities, I mean everything it had in it. And we had a physical therapist there, [Marla Dark?] and then [Mernette?], very, very capable people and who could handle the people in the rehab center, oh, very, very completely down there. To step back a minute, among the other staff we had, at the time, was the head of the rehabilitation section, I think, or department. I’m not sure what it was, Dr. Raul Villanueva. Now, he was a very qualified physical medicine specialist, a PM&R specialist, physiatrist. He had various assistants work from Dr. Pedro Guana, among others, and he had really pioneered a lot of very, very important treatments to rehabilitate cancer patients. One of the most important—I’d like to just digress a second, most important was one of the side effects of some chemotherapy that were used that were given intravenously was the destruction of the vessels and necrosis of the area around it, particularly in the forearms where the CVs, the intravenous lines had been placed. And Dr. Villanueva pioneered many of the treatments to try to deal with that, to try to restore use to the arms where—that it had been injured and damaged by the extravasion [sic] of fluids from the vessels into the tissues surrounding it. And he had accomplished an awful lot in that field. Later, Dr. ""Sam"" Raad, who became the head of infectious diseases, discovered methods of inserting intravenous catheters that—through central venous methods and using certain materials that avoided a lot of infections and problems that the prior methods had caused. But anyway, Dr. Villanueva was a pioneer in physical therapy, and he was at the rehabilitation center a certain number of times a week, but of course, his main focus was the main hospital where the patients needed service in the wards and floors. And so the rehab center had never really taken off as a rehab center should. And when they looked at what it would take to make it into an accredited rehabilitation center, it seemed very difficult to achieve because of the expense that would be involved. Now, Dr. Clark, when I first came to MD Anderson, had a plan to make me a rehabilitation specialist, and he sent me to New York where I spent time with Dr. Herbert Dietz at Memorial Hospital. He was the head of rehabilitation. He was a surgeon who learned the trade when he was no longer going to carry out surgery. And also, I spent time at the Rusk Institute with Dr. Howard Rusk learning the principles of rehabilitation medicine. I was never a rehabilitation specialist, so, I was an internist by training, and that was my specialty, so I never became a rehab specialist as such. But one of the things that Dr. Dietz alerted me to in that is that rehab isn’t just physical rehab. You have to consider rehab from a broader perspective, and that is, it takes a lot of different things to rehab a patient. I’ll give you an example of what I’m talking about. Yes, physical medicine and rehabilitation is important, but remember, the patient has pain, and controlling pain is important, and so pain control is part of rehab. Nutrition, how important is nutrition for recovering patients? Some of these treatments and some of the surgeries are debilitating. It’s very difficult to eat heartily after you’ve had some of these things that need to be done to cure you from cancer, so how does nutrition handle it? Luckily, we had very leading experts around, Dr. Stan Dudrick and Teddy Copeland were experts in hyperalimentation. They were at the medical school, but they also had a role at MD Anderson. At MD Anderson, we had people who knew a lot about nutrition. And that nutrition, another thing, colonoscopy or colono, uh— F1 Colostomy?

Albert E. Gunn, MD:

Colostomies, that was a part of rehab because so many surgeries left the patient, particularly abdominal surgery, with a colostomy. How could we rehabilitate the colostomy patient? You see all the different things that went into rehab outside of just—social work of course, how do we integrate the patient back into society? And an area which I was especially interested, [and maybe lapse?] into talking about in a sec, but return to work. How do we get the cancer patient back to work at the job that they can do, and they were trained for, and know how to do? And that’s the things that I was alerted to up in New York for the training that Dr. Clark sent me to. So when I got back to MD Anderson, I knew that we had to look at all of that as part of the comprehensive rehabilitation approach. Anyway, I’ll make a long story bearable as Dr. Hickey was fond of saying. The rehab center was accredited as a residential care facility. This was to be an interim step to a more complete accreditation, but it also required a lot of things to be done to—so it met the standards that were required for that. Now, from my standpoint, the medical director was required to be a member of all the standing committees at MD Anderson Hospital. So I was appointed to the executive committee of the medical staff, I was appointed to the research committee, to the—then because of certain—I was a lawyer and a doctor—I was appointed to the surveillance committee. It was the original institutional review board, which became very, very important over time at MD Anderson. And it gave me a real vantage point to see the institution and its workings from many different viewpoints. The rehab center moved along. One of the things that I thought was very good was before patients came, the rehab center essentially became a residential care facility, but it did have a rehabilitation focus. And the center point of that start with maxillofacial rehabilitation. I forgot to mention that in my comprehensive, but the center of maxillofacial rehabilitation was in the rehabilitation center. They had a maxillofacial suite, and there we had a genius, one of the geniuses of MD Anderson [were?] Dr. Ariadesa Udugama. He had a slogan, “Everybody has a right to look human.” And all the radical surgeries that were done on people’s faces, and head and neck with surgeries to remove very extensive cancers, he was determined to make those people get back into society and back to being loved by their families. The war wounds had alerted people to how maxillofacial rehabilitation could work. I know that many people suffered many wounds because of explosions and so forth of munitions in war, and there’d be much surgery and so forth. But Dr. Udugama was a master of improvisation. He took patients who had had radical surgeries on their face and head area, and he was able to build out of composite materials, prostheses and things that he figured out a million different ways to put together back on the face and make the person look like they had. He was a tremendous artist. And the rehab center, one of the—it's about was we were constantly having delegations, like from Japan, to come and see his work. The rehab center would be—we’d have to entertain some group of doctors. I think there was a club named after him in Japan, the Ariadesa Udugama Club that he was such—considered such a genius. He was kind enough to write a chapter in my book, Cancer Rehabilitation, and I’m sure that it sold many different copies because he was such a world-known person. Unfortunately, he was lost to maxillofacial prosthodontist when he became a dermatologist. I admitted him to medical school later on, I was the dean of admissions, he was worthy of admissions. I didn’t want to, but I had to. He applied, and he had these credentials, and he was interviewed, and they favorably thought of him. But anyway, while he worked in the medical suite, it was a center of interest and turned—put—and really put—help us put it on the map. And he came up with many ideas for all the patients in the rehabilitation center. For instance, screening them for a variety of dental problems and looking into whether they could be—receive some sort of restorative care for other than surgeries and so on. So he was a very ambitious and a very brilliant person, and I was so lucky to be associated with him when talking about the people at the rehab center that made it go. But one of the things I noticed about the rehab center was academia. We didn’t have a academic atmosphere there because if—MD Anderson did have an academic atmosphere because of the faculty ranks, we were all given faculty ranks. I was very pleased when I came, when Dr. Clark said to me, “We’re going to make you an associate professor.” And Dr. Hickey chimed in immediately, he said, “No, you can’t be an associate professor. You can be an assistant professor, but you have to write 10 papers and be board certified,” and I was appointed under those conditions. But anyway, I was pleased with the academic quality of MD Anderson. It was a part of The University of Texas, and its official name was The University of Texas Cancer Center. Originally, it was called the MD Anderson, something and Tumor Institute—Hospital and Tumor Institute, but it was changed to the Cancer Center. But anyway, so I went over to the medical school for Grand Rounds, and they asked for volunteers to teach medical students physical diagnosis. And where I went to medical school in Ireland, they very much emphasized physical diagnosis, and so I felt very comfortable in volunteering. And that meant we would have students coming over to the medical—from the medical school to the rehabilitation center, examining the patients and learning how to do it properly and report on the patients as you would have in a medical facility, a medical school facility. And so off came these students, and I think they changed the atmosphere. The staff at the rehab center liked it, they liked to be part of it. The patients liked it because of the attention they were getting from all these young people that were taking very detailed histories and examining them, and we had lovely facilities for everybody to use, and so the thing was successful. And personally speaking, it led to an invitation by the medical school to take over the course. My students were so enthusiastic about their experience at the rehab center that the medical school took note, and Dr. Tuttle called me and said, “We’ll have you take over the rehab—you take over the physical diagnosis course at the medical school.” And that was the start of my experience with the medical school, but anyway, that was one of the things I think that that gave the rehab center an atmosphere of investigation. Research was something we needed to develop further. Anyway, I was—my—did you want to have—to ask me some questions now? I’ve been talking so much. 

Recommended Citation

Gunn, Albert E. JD, MD and Sáenz, Allison PhD, "Chapter 02: Developing a Rehabilitation Clinic and a Rehabilitation Specialist" (2024). Interview Chapters. 1607.
https://openworks.mdanderson.org/mchv_interviewchapters/1607

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