Chapter 03: Coming to the United States for Further Training
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Description
Here Dr. Levin describes the process of coming to the United States in 1966 for further training. Dr. Levin’s b brother, Nathan Levin, was already at Rush Saint Luke’s in Chicago, Illinois and he brought Dr. Levin’s name to the attention of a member of the administration to sponsor him as a resident. Dr. Levin emphasizes that came to the U.S. as an immigrant, not on a student visa. He describes many of the difficulties connected with that process. Dr. Levin first did a residency at Rush-Presbyterian-St. Luke’s Medical Center, then did another at Northwestern, where he worked at the Passavant Memorial Hospital on Chicago’s Gold Coast. Dr. Levin describes the differences between those wealthy patients and those he has served in South Africa and notes that he made efforts to see the real medical problems of Chicago through work in clinics.
Identifier
LevinB_01_20130207_C03
Publication Date
2-7-2013
City
Houston, Texas
Interview Session
Bernard Levin, MD, Oral History Interview, February 07, 2013
Topics Covered
The Interview Subject's Story - Professional Path Professional Path Influences from People and Life Experiences
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
Tacey Ann Rosolowski, PhD:
Can you tell me about how you made the decision and then went through the process of leaving that situation and coming to the US for further training?
Bernard Levin, MD:
As a medical student my brother was—while I was a medical student, my brother was a United States Public Health Service fellow in nephrology in Chicago at what was then called Rush -Presbyterian St. Luke’s Hospital. And his supervisor there was a South African whose name was Robert Kark. He was part of a large extended family of very distinguished physicians, some of whom made a huge mark in public health and prevention. So my brother identified my interest in leaving South Africa and studying internal medicine and possibly endocrinology, which was one of my interests, to the then section head of endocrinology at Rush -Presbyterian. His name was Ted Schwartz—Theodore B. Schwartz. He was a wonderful, bright human being who subsequently became the chairman of Medicine at Rush. So he, being somewhat politically liberal, agreed to sponsor me to come to the United States as a house officer, intern, and resident and then began a saga with the United States Department of Justice Immigration Service, because very few people had ever attempted to leave South Africa right after internship. It was an unknown pathway, and visas were hard to come by. And there were ridiculous rules, such as in Illinois, you couldn’t become a house officer there until you had completed your state board exams. But you couldn’t have completed your state board exams until you’d been a medical student there. So it was this circular issue. There was an examination which was given to all foreign graduates called ECFMG—Educational Council for Foreign Medical Graduates. It was given in Johannesburg, and it was a prerequisite. I remember my first exposure to this was that they sent an American to give the examination, and one of the components was the ability to recognize spoken words. And this woman had a very broad southern accent. And I remember scratching my head over words like bowel and bowl. I couldn’t understand what she was saying, because she had this broad accent, and basket and passable, I didn’t know what those words were. So I had trouble with some of that, but I got through and managed to get past the examination. But that was a prerequisite. Then lots and lots of correspondence with Ted Schwartz and his assistant—whose name I’ve forgotten—but who was a heroine in my eyes in those days. They were very patient with me and with the United Stated Department of Justice. Eventually, through various intercessions—I’m not sure by whom, but my brother in particular—I did eventually receive a visa to come to the United States as an immigrant, which is what I was seeking. I should make that clear. That was the hard part, not as an exchange student. Because it took so long, I came six months late. So I no longer was going to join the internship class, and I was too early for the resident class. They didn’t have an opening at Rush Presbyterian St. Luke’s. So Ted Schwartz arranged with a friend of his at Northwestern for me to do some months of internship there. So I actually spent three months at Northwest University Medical Center when I first came to Chicago as a medical intern. The specific hospital was called Passavant Hospital. It’s now been replaced by a more modern facility.
Tacey Ann Rosolowski, PhD:
How do you spell that?
Bernard Levin, MD:
P-A-S-S-A-V-A-N-T. And nothing could have been further from my prior experience. This was on the Gold Coast of Chicago with its rich patients. Most of them had nothing that in Johannesburg, where I did my training, which was called the Non-European hospital, would have qualified them even for an outpatient visit. Here they were in the hospital with what was what they thought were reasonably serious illnesses. I’m exaggerating a little, because I did happen to see some extraordinarily unusual and sick people during that three-month period. The chairman of Medicine then was also a very remarkable man called Ogelsby Paul, who came from Harvard and subsequently went back to Harvard. He was a very distinguished man. And he quickly let me know that I knew nothing when I arrived, so he told me.
Tacey Ann Rosolowski, PhD:
Was he right?
Bernard Levin, MD:
I’m sure he was right. But it was hard to get to the United States, and people had no knowledge whatsoever of conditions. People were amazed that I was familiar with modern appliances, that I spoke English, and that my family wasn’t in rags, and they were white. So it was very unusual to come from South Africa. Again, my brother—I owe him a lot—had paved the way, and there were his social circles and people who were very welcoming. And there were other South Africans at the time who had already emigrated at a later stage of their careers, so they were well established in Chicago at various institutions.
Tacey Ann Rosolowski, PhD:
That intercultural perspective, it’s a special state of mind. And you begin to make comparisons and maybe even feel a little like an alien, because you’re able to, and people around you aren’t making them. But that’s pretty striking to come from the kinds of clinical experiences you described when you were going through your training to come to the US and suddenly be plunged into what the wealthiest individuals considered to be dire medical need. So tell me more about where you landed. I mean, that was a three-month period, and then what?
Bernard Levin, MD:
Then I went to do my residency at Rush Presbyterian St. Luke’s Hospital. And I did a rotating medical residency with exposure to a variety of both private and full-time medical personnel teachers. And it was quite a rich medical experience. But, again, at a reasonably comfortable level—mostly whites—without any real exposure to the real medical problems of Chicago. But I was fortunate in that for one reason or another, I sought to diversify my experiences and spent several months working at a neighborhood health center called Mile Square Health Center, which was in one of the poorer areas of Chicago on the near West side, near what was then the Chicago Blackhawks ice hockey stadium——I’m not sure what the team name was but near the ice hockey stadium. It was a very poor area. And it was a federally funded neighborhood health center. And there I met some quite unusual, more senior medical personnel, all of whom in one way or another went on to do very interesting things in their careers. One of them, Milton Levine, and his wife, Charlotte, who had come from a mining area of West Virginia and had a lot of occupational health background. Another was Paul Knott. He was a black man who was recently from the Navy and subsequently became quite a successful medical and shipping entrepreneur. And Gordon Lang was a young nephrologist there who became quite a prominent dialysis mogul in Chicago. They were all quite interesting, and then there were others too. I was struck then by the severity of chronic illness amongst black people suffering with diabetes, hypertension, various forms of asthma, arthritis. And I was impressed with how little actually medical science had to offer.
Bernard Levin, MD:
I had, at some point, come to the conclusion that I was really no longer interested in endocrinology and had to face the fact that I had to tell my sponsor that I had decided to pursue another pathway. So after two years, I left to do what became a course in graduate studies at the University of Chicago where my mentor, Dr. Godfrey Getz, in what was in the Department of Pathology, applied for and received a United Stated Public Health Service general medical sciences fellowship to pursue graduate studies. I enrolled in various courses to improve my knowledge of science, mathematics, and calculus. Not all of which were entirely successful, but I did have one phenomenal set of courses in cell biology under a very gifted man called Hewson Swift, and his cell biology courses were remarkable. I also began to work in a lab under Dr. Godfrey Getz. I had written the fellowship application to study what I thought was going to be my area of interest, drug metabolism in the liver. By the time I received my fellowship, the work had all been done by another group. So Godfrey and I discussed alternatives, and he posed to me the challenge to learning something entirely new and different and working in a totally foreign system, which was yeast metabolism. Something of the challenge of learning something entirely new presented itself to me, and so I took on this new field of yeast metabolism.
Tacey Ann Rosolowski, PhD:
Why was that significant at the time?
Bernard Levin, MD:
Well, Godfrey had an idea that you could alter DNA in one yeast by what was called complementation—by exposing it to the DNA of another yeast. So you could alter the respiration of a yeast—of an incompetent yeast, a yeast that didn’t have an adequate respiratory system—by exposing the DNA of a yeast that did. That was a farseeing and important idea but it was impossible for me to achieve. So after a few months of this, we settled on a lesser project, which was to grow yeast cells that required fatty acids for their survival under a variety of conditions such that the mitochondria—which are the respiratory powerhouses of the cell which provides the cell with energy and respiratory ability—would be subjected to different types of fatty acid that would make the mitochondria behave abnormally and to study this under a variety of different conditions, different fatty acids, look at this biochemically and also under the electron microscope. And these fatty acids were known as trans unsaturated. Subsequently they became quite famous because of Mayor Bloomberg’s prohibition on having them in foods, because of what they can do inside cells and to arteries.. Cis fatty acids are floppy and are flexible. Trans unsaturated fats are rigid and clog up the works, clog up arteries and clog up mitochondria. And you could see these mitochondria under the electron microscope were stiff and were abnormal. And you could show the respiratory quotient was abnormal.
Tacey Ann Rosolowski, PhD:
What did they look like when they were stiff?
Bernard Levin, MD:
Like little tubes, little rigid tubes, as opposed to more filamentous. For a variety of reasons, I didn’t complete my PhD. There are a number of personal reasons that I won’t go into, but I didn’t complete my PhD and decided that due to my interest in liver disease that I would study gastroenterology and liver disease. The University of Chicago was a great place to do gastroenterology, because of its renowned head, Joseph B. Kirsner, who had agreed when Godfrey Getz approached him—agreed to accommodate me eventually in the training program. There was also a very formative person at the time who only spent a couple of years there and subsequently had a very illustrious career at Yale whose name was Henry Binder. And Henry took a liking to me and helped to persuade Dr. Kirsner that I should be accommodated in the training program. So I started out with working on Saturday mornings in the clinic as a volunteer to learn gastroenterology. And after I completed two or three years in the lab and doing graduate studies, I then became a full-time fellow in gastroenterology and joined the program, then completed that. So I had a lot of regret that I didn’t finish what I had really begun in graduate school. I benefitted enormously, but I felt that I had let Godfrey down in that I didn’t complete this. Subsequently, he and then another graduate student managed to amplify and complete the work, and an article iwas published in a prestigious journal of which I was a co-author.
Tacey Ann Rosolowski, PhD:
Would you choose to share why you didn’t complete the degree?
Bernard Levin, MD:
No. A lot of family problems at the time, which I think are best left out of this. It was a very stressful time. My mind was totally on other issues.
Tacey Ann Rosolowski, PhD:
Can I ask, did you anticipate that you would end up specializing in gastroenterology? Because you’ll see I even highlighted this pathology fellowship in blue and it just seemed like an interesting—how did you get there?
Bernard Levin, MD:
I was interested in liver disease. But it turned out that the University of Chicago actually, at the time, wasn’t strong in liver disease. It was kind of a mistake from that point of view. I was interested in liver disease but they only subsequently got someone—his name was James Boyer, who also went back to Yale as a very famous liver specialist—who only came quite late in my career of training in gastroenterology. So although I was interested in liver disease and saw the lab training and this drug metabolism as an avenue to understanding liver disease, it turned out that that actually wasn’t the case. I was also intrigued by the instrumentation of gastroenterology at that time, although it didn’t become my subsequent love at all. At the time I was interested in it and saw it as a fascinating way to understand the anatomical, biochemical, pathological processes.
Tacey Ann Rosolowski, PhD:
What was the instrument?
Bernard Levin, MD:
Endoscopy.
Tacey Ann Rosolowski, PhD:
Endoscopy.
Bernard Levin, MD:
And the University of Chicago—Rudolph Schindler had been there and was—of course, he had moved on by then—but he was an old-time gastroenterologist who helped to develop the science of endoscopy using what were then very primitive instruments, rigid instruments, semi-rigid instruments.
Tacey Ann Rosolowski, PhD:
Let me just—I actually neglected kind of getting dates along the way here. Let me just quickly run through them. Let’s see, you were in your medical internship at Northwestern from March ’66 to June ’66. And then the residency in internal medicine at Rush Presbyterian St. Luke’s from July ’66 to June of 1968. Then your fellowship period was 1968 to 1971. That was the special research fellowship in the Department of Pathology. And then when you were a clinical fellow in gastroenterology, that began in 1970, ‘71. So we’re talking about this period after residency, if you will, and endoscopic instrumentation. I talked with Sydney Wallace, who of course spoke a lot about the vitality of that period of time.
Bernard Levin, MD:
An amazing man, and you know, my wife’s boss.
Tacey Ann Rosolowski, PhD:
I didn’t realize that. I didn’t put that together.
Bernard Levin, MD:
Yes, he and Dodd recruited her.
Tacey Ann Rosolowski, PhD:
And your wife’s name for the record?
Bernard Levin, MD:
Is Ronelle DuBrow. She didn’t use my name. She useds her name as her professional name. And she was in the Department of Radiology for twenty-three years at MD Anderson and had a very important career there.
Tacey Ann Rosolowski, PhD:
So this interest in the instrumentation—
Bernard Levin, MD:
I saw gastroenterology, because in those days it was just the beginning of the science of endoscopy. Instruments were relatively primitive. And we had exposure to Kirsner’s very broad influence. We had exposure to Japanese endoscopers who came to teach us and also Brazilian cytologists, cytopathologists—a man called Joao Prolla from Porto Alegre, Brazil. And then the Japanese endoscopists came from Nagoya—Hattori and Kobayashi, very fine endoscopists. We were exposed to these people. Now, as a side, I was also at the time going through a variety of political exposures in Chicago in ’68.
Recommended Citation
Levin, Bernard MD and Rosolowski, Tacey A. PhD, "Chapter 03: Coming to the United States for Further Training" (2013). Interview Chapters. 1339.
https://openworks.mdanderson.org/mchv_interviewchapters/1339
Conditions Governing Access
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