Chapter 21: Expanding MD Anderson’s Reputation

Chapter 21: Expanding MD Anderson’s Reputation

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Description

Dr. Hill begins this chapter by explaining why so many ENT cancers were referred to MD Anderson to have the successful, less disfiguring surgeries for people “who were supposed to be dead.” (He vividly describes the process of “walking a flap [of skin]” to perform reconstructive surgery.) He recalls that MD Anderson’s reputation was secured via non-surgical interventions of radio- and chemotherapy, and compares it to the more surgical focus of Memorial Sloan-Kettering. He also illustrates Dr. Clark’s “political moxie… that doctors in general don’t have” –a key factor in MD Anderson achieving prominence. Dr. Hill next returns to his own work on thyroid cancer, offering two specific cases in which he and other MD Anderson physicians were better able to diagnose cancer than others. He talks again about how he started up studies of families.

Identifier

HillCS_04_20120228_C021

Publication Date

2-28-2012

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; MD Anderson History; Portraits; Patients; The Business of MD Anderson; The MD Anderson Brand, Reputation; The Researcher; The Clinician

Transcript

Tacey Ann Rosolowski, PhD:

You had mentioned something a little earlier I just wanted to go back to because you were saying at the beginning, the hospice movement didn’t want to have doctors involved, and then you started to talk about how there were certain things they didn’t understand about the progress of the disease. I was wondering if you could elaborate.

C. Stratton Hill, MD:

Oh, yeah. See, one of the areas where we got a lot of referrals because nobody knew how to take care of them would be cancers of the head and neck. The last thing that an ENT doctor wanted was to take care of a patient who had cancer of the tonsil or the tongue or any part of the head or neck outside of the brain.

Tacey Ann Rosolowski, PhD:

Why was that?

C. Stratton Hill, MD:

Well, you’ve got a bunch of kids in your office with tonsillitis, and you get a guy coming in with a big tumor on their face or something like that and sitting there in the waiting room waiting to be seen, and these kids and all the mothers and everybody there looking at this guy with all his horrible tumors, that was not too good for business. Then you get into— See, we brought Dr. Bill—what is his name? The head and neck guy. I mentioned him before. He came from Memorial, and nobody did head and neck here. Dr. Clark had to send a guy to Memorial to get him to learn how to do head and neck surgery. He came here and worked at Anderson, and he realized what a lucrative practice he could have. He left and set up his own practice. I don’t think Dr. Clark ever spoke to that guy again. Bill McComb. He was the first guy here. At that time, he did radical surgery. Then to do repairs, do plastic surgery, at that time, you had to walk a flap. If you wanted some tissue, you had to walk a flap maybe from the abdomen, and what that means is that they would prepare like a roll of skin. They’d make an incision, say, that long, maybe almost a foot long, and they would take the skin off, separate it from the abdomen, and then they would cut if off here but leave this on down here, and that gave us blood supply to this flap that you separated. They’d just tack that on to hold that flap in place, otherwise it would just be flapping around. Then they would sew that skin together underneath. They could pull that skin together. Then they’d wait about— Well, actually, they would sew both ends together, so you’d have a flap that was like a tube. You wanted to move that from here to here, so you had it hooked here, and it hooked there. Then after about two or three weeks, you’d cut this loose here and pull it over here and then you would let this blood supply—

Tacey Ann Rosolowski, PhD:

So you attach it on the chest.

C. Stratton Hill, MD:

The chest and let that grow for two or three weeks, and the blood supply would be from both sides. But then you cut this off, and then you flap it up here. It may take six months to walk that flap up there. If you’ve got somebody in your office that is sitting there with a big roll of skin hanging down, they don’t want that either. I mean, the doctors don’t want that in their office, and we had a problem. At Anderson, when I was running the clinic our clinics looked like—I think I told you—looked like feed lots. I mean, it was just packed with people. Well, a guy would be here from Aberdeen, and he’s getting this defect in his face—half of his face might be gone. He’s getting that repaired. Well, he has to stay in a hotel or motel, and if you’re going to go in the dining room of a hotel with a flap of skin right there, you looked like you were from outer space. People, they could either sit in their room at the hotel/motel, or they could come to Anderson and sit in the waiting room and visit with people, so we had a whole bunch of people just sitting around just visiting and so forth. Your waiting room had a lot of people.

Tacey Ann Rosolowski, PhD:

And just to clarify, you knew this was going on. You knew people were basically using it as a place to socialize, and that was okay with you, and you didn’t monitor that or throw people out.

C. Stratton Hill, MD:

Nothing. This was great, as far as we were concerned. That gave them support. It’s like AA. Nobody in this town did anything like that. Now you don’t have to do that anymore. They’ve got different ways of doing things, so you don’t have to worry about those flaps. Or you might see that occasionally, but not much. That was one of the first things that we did, that Anderson did, and then people got to see the results. They’d say, “Wait a minute. Hey, those people are supposed to be dead.” Then we got Gilbert Fletcher. We talked about him, I think, the radiation guy, and of course, his work began to be noted. He was getting comparable results to the radical surgery that Memorial was doing. And John Stehlin was getting comparable results with the perfusions, and that was salvaging the lower extremities so people could walk. So that got around. Then John Stehlin realized that he was doing more of that than anything and he could make a lot more money, so he left Anderson and set up shop. He set up in all the hospitals, but he couldn’t manage that, and he ended up in St. Joseph. He must be 90. He’s out of it. There’s no Stehlin Clinic anymore, I don’t think. Gilbert Fletcher, it’s interesting. Bill McComb was a radiotherapist before he was a surgeon, so he and McComb got along real well, whereas Hayes Martin, up in New York, was a surgeon, so anybody that had a head and neck surgery was surgerized in Memorial. Bill McComb and Gilbert Fletcher treated a lot of these internal tumors of the sinuses and so forth with radiation therapy, and Gilbert Fletcher was the leading radiotherapist in the world. They got tremendous results and less disfiguring, and they began to radiate carcinoma of the larynx. At Memorial you got your larynx out, and you were no longer able to speak or had one of those mechanical voices with a synthesizer. You’d sound like a foghorn. So that began to bring people to MD Anderson. We had that, and we had the—the head and neck people, the gynecologist, and both of those were reinforced with radiotherapy, so Anderson made a big reputation on those two things. Then you brought in the chemotherapist, and that pretty much put Anderson in the forefront. And about that time, that’s when the Rockefellers got interested in what was going on down at MD Anderson. I remember being in meetings with Laurence Rockefeller because I was running the clinic. He was down here studying what Dr. Clark had set up. We were a close-staffed hospital. We didn’t practice anywhere else but at MD Anderson, and nobody but us could practice at MD Anderson. And at Memorial, the goal for the doctors up there was to get in with somebody who was— The doctors at Memorial, the way that medicine was practiced in those days was that it was strictly a private practice. But then you had guys like Hayes Martin and George Pack. And what was that breast surgeon’s name? I’ve forgotten, but that was only a categorical hospital to practically run. You had all of those TB hospitals, but that was a public health situation. Those guys had their offices on Park Avenue, and they used Memorial Hospital. Not many hospitals want cancer doctors to use their hospital because they use an inordinate amount of resources. For instance, we had this Dr. (???) Brunswick who was at Memorial, and he was German, obviously, with that name. He fit the category of the image of oppression, that I’m-going-to-cut-you-in-two. We used to say that he did hemi-humanectomies. (laughs) And some of those residents— He thought potassium was a poison, and of course, it is if it’s used in a certain way. But he wouldn’t let his residents give patients potassium. That’s crazy. They’d have to come back after making rounds with him and give the potassium to the patients, and they would tell me— I knew all the surgeons up there, and they would say he had a butcher-knife-type of thing that had a cautery on it. He’d cut half the liver in two and let it bleed, and he would use 20 and 30 units of blood. You’re not going to get a little community hospital to let one doctor use up all the blood. No way. So they get out there, and they can’t practice that way. They shouldn’t be practicing that way anyway. Of course, that never caught on.

Tacey Ann Rosolowski, PhD:

But it gives cancer physicians a real reputation.

C. Stratton Hill, MD:

Oh, yeah, but I think Dr. Clark was smart enough to realize that people wanted to get rid of their cancer but not at all costs, in term of the quality of life that they had. He wanted it to go as far as possible, but if there was another way, like a limb-salvage-type of operation or something like that, he was all for exploring that and other means of therapy. He was not— They were not ideologues like the surgeons at Memorial Hospital, a strictly surgical hospital. So that was the thing that gave— That was a window of opportunity for Anderson to step into that, and Clark was pretty persuasive. They used to publish— I don’t know whether they still do or not. I don’t think— They might have. They called it the yearbook of so and so, the Yearbook of Cancer, the Yearbook of Urology, and it was a company that did that. Clark pulled off the coup of having the Yearbook of Cancer written by the people at MD Anderson. That was a good move. He had insights like that, and I guess you could say that’s somewhat of a political moxie that he had that doctors in general don’t have. We can step in at this point, and this is a good place to get attention, and so that’s what he did. And then because he brought this guy that was the radiation person in there— And they developed the cobalt machine here, then he focused on isotopes, so that’s the reason we were the earliest people that had radioactive iodine in the whole Southwest. It’s the reason we got the reputation in thyroid diseases. We could do scans and stuff like that that nobody else could do. And then of course, people gradually got trained in that and came and did it and we did all kinds of things with— Memorial was called Memorial Hospital for Cancer and Allied Diseases, and boy, that term allied was broadly interpreted. We had everything you could think of, practically, at Memorial in New York that was kind of a low incidence of rare disease. We had a bunch of them, so that’s what I found so fascinating about being in a cancer hospital, and that’s the same way with us. Then we got down here and we get into hereditary diseases, and people began to write about the association of one tumor to the next. Then we were doing all this followup. Then we found, well, wait a minute. We’ve got this person that had that tumor that’s got this one, and so we made the association. We were one of the first to really write with extensive experience in those different areas, particularly medullary carcinoma of the thyroid.

Tacey Ann Rosolowski, PhD:

And what was an associated cancer with that?

C. Stratton Hill, MD:

There were two of them, the pheochromocytoma, and that’s a tumor of the adrenal medulla, and then the parathyroid carcinoma.

Tacey Ann Rosolowski, PhD:

Yeah, I think you mentioned that in one of our sessions. Yeah, I do remember that.

C. Stratton Hill, MD:

As a matter of fact, I used Andy von Eschenbach, who was head of the FDA, and he’s an Anderson graduate, so to speak. He was the one I would refer the pheochromocytomas to because that was in the area of the kidney, so I thought he was the best surgeon for something like that. We began to study those things from an epidemiological point of view. And one time there was another surgeon in Houston that fancied himself as a thyroid surgeon, and he was. His name was Henry Glass, and he was a little bitty guy. He had to stand on a stool in the operating room. In our studying, we made contact—or I had these two girls that were working for me, and they made contact, and they said, “Dr. Hill, they tell me that they’re operating on their cousin over in the diagnostic hospital right now.” And I said, “Are you sure?” And she said, “Yes.” “Find out who it is.” It was Henry Glass, and he was operating on the thyroid. So I knew him, and I called over, and I said, “Do you mind if we come over?” He said, “No, come on.” We went over there, and I said, “The first thing I want to do is look at the anesthesia chart. I want to see what the blood pressure is doing.” (phone ringing)

Tacey Ann Rosolowski, PhD:

Oh, dear. I forgot to turn off my phone. Pardon me. Oh, dear. I will turn it off now. There we go.

C. Stratton Hill, MD:

We went over there, and I said, “Let me see the anesthesia record.” The anesthesiologist was there. Wide swings and that was the blood pressure. I said, “This patient has got pheochromocytoma.” He said, “Oh, in these surgeries we have wide swings,” and I said, “You don’t have wide swings like that.” Anyway, he was about finished with the operation, and I never convinced the guy, the anesthesiologist, this was a patient with pheochromocytoma. The patient recovered and went home. I called him, and I said, “That woman had pheochromocytoma. She’s got it.” “Oh, I think that was just stress of the operation and everything.” I said, “Well, do you mind if we follow up on it?” He said, “No, go ahead.” I think he didn’t want to operate on it. I don’t know whether he thought that was beyond him or whatever, so we brought her in, did the studies, and she had a pheochromocytoma.

Tacey Ann Rosolowski, PhD:

She did.

C. Stratton Hill, MD:

And we operated on her. We learned the hard way that we could better demonstrate those by doing a venogram rather than an arteriogram to demonstrate the pheochromocytoma. Because right after I got there to MD Anderson, before we really knew all of this, we had a case in which this woman had an operation on her thyroid, had the same thing, and then for some reason we did an arteriogram on her. She had bilateral pheochromocytomas, and the guy on call that night, he thought, since she’d recently had a thyroid operation, that she had a thyroid crisis and treated her for that, and she died. At autopsy, we showed these huge bilateral pheochromocytomas.

Tacey Ann Rosolowski, PhD:

What happened as a result of those findings? Did it become kind of standard to look for these other cancers?

C. Stratton Hill, MD:

Oh, yeah. Then we got the calcitonin marker. So you got the calcitonin marker, and you can look at that. Then of course, I’m pretty sure they’re still studying those families, the Falticzek family, because they produce them. It’s autosomal dominance, so somebody is going to have it in every generation. Now they can pick them up early. But that was the story of sort of how we got into the familial studies, and we brought people from all over the country. We had a grant. I remember one time we had one patient who was a relative from California, and we said, “Hey, you might have this problem. We can put you in the hospital, and it won’t cost you anything.” The guy was saving money for the thyroid operation. Well, he decided that he would come to Houston. On his way, he stopped by Las Vegas, and he won a pot of money. Then he comes to Houston, and all of his treatment didn’t cost him a penny because he was on our grant. But he stopped there and won—I’ve forgotten how much it was. It was a pot of money. He used the money he was going to spend on having his operation for his time in Las Vegas. And the other side of that was a family we had from Arkansas who had a brother who was in the army, a career army guy, and we said, “Tell your brother that they can work him up in the service and so forth. He might have a medical discharge.” But anyway, he could get treated. Well, I think he was afraid. He didn’t want to be discharged from the army, and he was afraid that if they found something they’d discharge him, so he did not do that. He retired from the army, and he did have it. He came to Anderson. This was after I was no longer doing the thyroid and had he come to Anderson—I mean—had he been treated, and if they’d kept him in the service, he would have been retired, and under those circumstances, you pay no taxes on your income from when you’re medically discharged from the army, so he would have had all that without having to pay any taxes. Now, whether or not he— He was a non-commissioned officer. If he was already a master sergeant, the only thing that he could have done would have been to accumulate time to increase his pension. But anyway, he didn’t do it. There were consequences like that. I remember one time I had this family from Arkansas, the same family. A little woman who was—you’d be a giant compared to her. I mean, she wasn’t real short, but she was small-boned. She was in the cafeteria one time, and at that time, everybody ate together. I was going through the line coming out, and she comes up to me, and she was choking. I put my tray down and did the Heimlich maneuver and popped out the food but broke every rib in her body. We had to put her in the hospital with broken ribs.

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