Chapter 05: MD Anderson in the Sixties –A Culture of Innovation

Chapter 05: MD Anderson in the Sixties –A Culture of Innovation

Loading...

Media is loading
 

Description

In this chapter, Dr. Hill compares MD Anderson to Memorial Sloan-Kettering and the Mayo Clinic (Dr. Clark’s model for MD Anderson), noting that, at the time, MD Anderson could not replicate the cultures and traditions of these well-established services. Dr. Hill comments on Dr. Clark’s leadership style and vision and the innovative ideas he implemented at MD Anderson.

Identifier

HillCS_01_20120214_C05

Publication Date

2-14-2012

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - MD Anderson Past; MD Anderson Culture; Portraits; Building/Transforming the Institution; Multi-disciplinary Approaches; MD Anderson History; MD Anderson Snapshot

Transcript

Tacey Ann Rosolowski, PhD:

What were your impressions of MD Anderson during those first years that you were here? I mean, was it a good place to work? Were there frustrations?

C. Stratton Hill, MD:

Oh, it was fantastic. The thing that I thought about Memorial was this is highly organized. It’s well run. It’s a challenging atmosphere. Everybody at Memorial was—like Dr. Rawson—academically oriented. I remember one time— See, most of the people that were there when I was in clinical physiology were surgery residents, because it’s a big surgical hospital. That was going to be— And all the big names of surgery came from Memorial. Hayes Martin put head and neck cancer on the map. George Pack operated on Eva Peron. And let’s see, who else? Then you had (David) Karnofsky, who basically started chemotherapy. He was at Memorial. Who was the other guy? And then there was a guy named—oh, what was his name? He ran the Strang Cancer Prevention Clinic. I began to have people there at Memorial. [Redacted] Then Dr. Rawson came in a little bit later on, and I had written down all the stuff that I’d done. He didn’t say anything to me about it, but he agreed with everything and made a note that he agreed and everything. Then the guy that was in charge of that clinical physiology—because I was taking call with the medical people, and so he called me. His name was Parker Vanamee, and he said, “What in the world did you do over the weekend?” He says, “Dr. Rawson thinks everything you did was right, whatever it was.” And the other thing was this was a Jewish family, so this person had hypercalcemia. That was one of the things. I really went through all the mechanisms of what could cause hypercalcemia and so forth. This guy died about two o’clock in the morning. You don’t get autopsies on Jewish patients. I decided I was going to try to get an autopsy, and I said, “We can limit this autopsy just to the neck because we really want to see about the parathyroid glands, if we missed a parathyroid adenoma or something.” She granted me permission to do a limited autopsy on his neck, just to look at the parathyroid gland. Well, that was unheard of as far as Dr. Rawson was concerned, so that made a good impression. Several other times things came along that worked out where I insisted on some things that— I remember one time, down at Bellevue, I was— Of course, in those days, Bellevue still had direct current instead of alternating current, and you had to have all kinds of transformers if you wanted to do an EKG. And you had to do it yourself. I remember doing an EKG on a patient one time, and I thought “There’s something wrong with this thing.” I mean, there’s hardly any electrical current coming out of the little—the graphs were just—I thought “I think this guy has got pericardial effusion.” So I went and I said— I went to the Radiology Department, and the Radiology Department at Bellevue had been uncertified, it got so bad, so they had some guy from—I don’t know where he was from. I woke him up, and I said, “I want to take an x-ray and see if he’s got a pericardial effusion.” The guy, he says, “I’ll do it.” He goes in there, and he won’t let me come in. He comes out, and he says, “He doesn’t have pericardial effusion.” Well, we had a fluoroscopic room down in— Our part in the second division was the Cornell division, Bellevue, and I said, “We’ve got a fluoroscope down there. I’m going to call the GI resident. He’s the one that does the fluoroscopy.” I called him, and he came over. He lived down in— You remember Peter Cooper Village in Stuyvesant Town, down there at the Metropolitan Insurance Company, down south of 23rd Street and down almost to the Bowery? Anyway, he came over, and we looked in there. You couldn’t even see the heart moving, there was so much fluid around that heart, so we decided to go ahead and do a pericardiocentesis. Well, that kind of made an impression on several of the people, too, that I persisted in going through all that trouble to get that done. The person had cancer and had metastatic disease of the pericardium, but he got tremendous relief of his symptoms by taking off all that fluid and everything.

Tacey Ann Rosolowski, PhD:

How did the work situation compare at MD Anderson?

C. Stratton Hill, MD:

Well, see, Dr. Clark was trained at the Mayo Clinic. He went up there and brought down some of the people from the Mayo Clinic administration, and they basically set the clinic up as a model after the Mayo Clinic. So when I was running the clinic, he used to send me to the Mayo Clinic all the time. I mean, I knew that Mayo Clinic upside down and backwards and administratively, and it was fantastic.

Tacey Ann Rosolowski, PhD:

What was so good about it?

C. Stratton Hill, MD:

It was all organized based on the very best interest of the patient. Everything was geared to making it easy for the patient to get good care, and after several trips up there, I said, “Dr. Clark, the problem that we have is that we don’t have the discipline and the tradition of the Mayo Clinic.” The doctors are disciplined like crazy up there, and they make the rules, but they also enforce the rules, so they’ll give you anything you want, but you’ve got to take care of the patients. And taking care of the patients was from eight o’clock until noon and from one o’clock until five, or whatever it was in the clinic. Then they had two hospitals, St. Mary and—I forget what the name of the other one was that they ran. But each person was assigned so many new patients, and you can say, well, I’ve got this procedure to do or that procedure to do or this, that, and the other. You saw that patient, and so nobody ever even thought about not doing it. Then, also, they had a situation in which what we would call classified personnel were trained to do specific tasks, but they were trained by the Mayo Clinic. You couldn’t get a job anyplace else because you were just trained to do— If you were an x-ray technician, maybe all you ever did was x-rays of the skull. You became the world’s greatest expert on taking x-rays of the skull. But if you said you were an x-ray technician and went to work in the general hospital, they’d say, “Well, what do you do?” “Well, I take x-rays of the skull.” “Well, how about the arm?” “Oh, no, I can’t do that.” At the time, that was the thing that I thought—and I didn’t think you ever could get the tradition that they had because it was such a—I guess—a folklore with the Mayo brothers. They were so disciplined that you just did it, and you did it the Mayo Clinic way. They were for innovations, but you just couldn’t say, “Well, I’m going to do so and so.” You would have to go through the proper procedure. And at that time, they only had two big clinic buildings. They were huge, though, and they’d have things like they had no nurses at the Mayo Clinic. No nurses except in the emergency room. If you were doing a pelvic on a female, the doctor had to drape the patient. Now, they may have changed. I never knew that they changed, but with the liability and so forth and everybody accusing all this stuff— But they had a lot of funny things. Dr. (???) Plummer designed this building, and he designed it so that the halls in the clinic building did not go anywhere except that hall. They were all dead ends. They were spokes out like this, so if somebody was on that floor in that hall, they had business on that floor. You couldn’t say, “I’m on my way over to this place.” And then, of course, the lights—I don’t know whether you’ve been in the clinic at Anderson—they’re like they are at— In other words, there were about five lights. They had different colors. My color was amber, so they’d turn the amber light on, and it meant there was a patient for me in that room. The chart would be on the rack, right out front. That’s how you knew when there was somebody in the room, and up there—which I thought this was kind of interesting, because everybody realizes it’s hard to stay on schedules. If a patient— When you went into the room, you turned the light out so the nurse would know that you were in there or somebody was in there or there was nobody in that room, theoretically. But if the light was not turned off after an hour, it began blinking, so you’d know that that patient had been sitting in that room for an hour. They had things like that. They had kind of a Rube Goldberg distribution for their charts. You know what a Rube Goldberg is?

Tacey Ann Rosolowski, PhD:

No.

C. Stratton Hill, MD:

Well, I’m not surprised. I’ve run into that with medical students and residents and so forth. There was a cartoonist named Rube Goldberg, and it was always a process that had to be done, and you had an outcome over here. Well, up here would be a bird that ate a seed that when he pecked on it would do something over here that would set something else off that would set something else off that would set something up like that. Finally, whatever you were trying to get done would be done over there. A Rube Goldberg apparatus is a complicated—

Tacey Ann Rosolowski, PhD:

Kind of a domino effect.

C. Stratton Hill, MD:

Yeah, a domino effect. It’s not quite as simple as the domino effect. He’d have animals in there. A chicken would peck the corn, and then it’d do something to make a dog bark, and that would do something. Yeah, that dates me, because you used to have these cartoons that were Rube Goldberg. So they had a building that had all the records in it, and they had a guy that would put the records into a chute that would go down to where that thing should be. And when we were building the new clinic— Well, that was new at that time. You can’t even see that building now, practically. Dr. Clark got the idea that he was going to make a tube system—vacuum tube system—that would take these charts that we have in there. I don’t know how much they spent on that thing. It never worked a day, not once. Dr. Clark recommended a monorail for the medical center in the ‘40s.

Tacey Ann Rosolowski, PhD:

Yeah, I remember reading that in the Making Cancer History book. It’s really amazing, very visionary.

C. Stratton Hill, MD:

Oh, yeah, and he was for everything. Then we had another deal where you could write—I’ve forgotten what they called it—but I could write a message to another clinic. You turn this thing on, and you’d write it in the stylus, and that other clinic would write it out.

Tacey Ann Rosolowski, PhD:

And that really was adopted, or was that just—?

C. Stratton Hill, MD:

Oh, now that was adopted, but lots of times, what would be on that part of the paper where you were writing it only got half of it on the other— It wasn’t 100 percent.

Tacey Ann Rosolowski, PhD:

He was really concerned just about speed of communication.

C. Stratton Hill, MD:

Oh, he was concerned about everything like that, and he said to me “What I want you to do”—and he was interested in the thyroid too, very much so. Excuse me; I’m going to have to go to the little boy’s room. (audio pauses )

Conditions Governing Access

Redacted

Chapter 05: MD Anderson in the Sixties –A Culture of Innovation

Share

COinS