Chapter 03: On to a Fellowship in Boston and to Hematology
In this chapter, Dr. Freireich talks about moving to Boston and studying and practicing hematology, shares his observations on grant funding, talks about how success is defined in science and medicine, and talks about his wife.
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History of Science, Technology, and Medicine | Oncology | Oral History
Emil J Freireich, MD
I looked around the medical center. Don't forget, the world is Siam. There was Presbyterian Hospital, which is a private hospital. Presbyterian Hospital had a very famous clinic called the Rush Medical Clinic. It was a medical school. It shut down and became a teaching school, University of Illinois. It's now a medical school again; they resurrected it. At the time it was just a big, fancy private hospital where rich people from the suburbs went to get care. They had just recruited a very flamboyant new chairman of medicine from Boston. His name was Howard Armstrong. He was the messiah who was bringing the new medicine of Boston to Chicago, because in 1950 there was a scientific renaissance in medicine in Boston that was pioneered by a lot of people. Soma Weiss was one. They introduced physiology and science into medicine and began to develop treatment for diseases. It all came out of the war and the malaria program.
Dr. Armstrong had worked with Dr. E. J. Cohn on fractionating blood and developing a replacement for blood for the battlefield, and he had purified albumin. He was quite accomplished as a young man. He was probably only 40 or 45, and they made him chief of medicine to bring this new science to Chicago in Presbyterian Hospital. He was recruiting, so I walked into his office, and I said, "I've been at County for 18 months. I want to be a family doctor, but I've learned everything I can at County." But internal medicine is very complicated, and there's so always something new. EKGs had just been introduced and cardiology and renal function. They had just worked out GFR and creatinine clearance. I told him my medical school hadn't prepared me for the complexity of medicine, so I wanted to do some more medicine. So he said, "Fine," and he hired me. In a year I was the chief resident in the teaching service. I did very well, but I still wanted to be a family doctor.
As fates would have it, Dr. Armstrong got fired by the board. He was fired for a couple of reasons. The major reason was what he did to the house staff; that is, he created a teaching service like they have in Boston, which they've never had before, and the teaching service had its own practice, which came out of their clinic. These are free. It was called the Central Free Dispensary. He had created a teaching service where the patients were indigent, and it was run by the house staff, but not by County Hospital. It was run by the house staff, with teaching by the full-time faculty. He had recruited 2 full-time faculty members from Boston, so they had 3 professors. Those 3 guys were teaching on a full-time basis. When you make rounds with a private doctor, you're doing conventional apprentice medicine; that is, you just follow what they do, and you do it. If you say to Dr. Sippy, "Why do you stick a tube down his stomach every morning to get rid of the acid?" he says, "Look, Freireich, just do what you're told and shut up." The teaching service was very stimulating, but the consequence was they didn't have any house staff to work for the private doctors. They all gravitated to the teaching service, obviously. So the private doctors said, "Well, it's nice to have Dr. Armstrong, but what he's doing is interfering with our practice. We make the money. They're not making any money because they're all indigents." It was the MD Anderson thing all over again. So they fired Armstrong.
When he got fired, the hospital director called me in. This is early 1950. He said, "Freireich, you're the chief resident on the teaching service. You've attended on all the private services in the year and a half you've been here. You probably have learned everything you need to know." I was fired again. So I went to see Dr. Armstrong. I said, "I've been fired. What do I do?" He said, "Freireich, what do you want to be?" I said, "I want to be a family doctor." He said, "Well, I have heard from all your attendings." I remember Oglesby Paul, a very famous cardiologist. I loved cardiology, EKGs, and all that stuff. I loved neurology. I loved diabetes care with Roland Woodyatt. I loved cardiology with James B. Herrick, who discovered myocardial infarction. That all happened in my residency days, so I was really getting interested in medicine. They all thought I was great. I was a good resident, smart, I worked hard, and I took good care of my patients.
Dr. Armstrong said, "You know, this community is too provincial. You've got to go to Boston to learn the new medicine if you want to be a good doctor. You've got to go where the science is. You've got to learn that stuff. You're not going to learn it in Chicago." I said, "Okay. I'll go to Boston. What should I do in Boston?" He said, "Well, what do you know the least about?" I said, "Dr. Armstrong, I don't want to be offensive, but you've got a rotten hematology program. I mean, I don't understand these black and blue spots. Hematology is very complex, and there's all this turnover in red cell metabolism. I just don't understand it. So I think hematology is my weakness." He said, "Fine."
He wrote me 3 letters to the 3 most famous hematologists in the United States of America: William Dameshek, founder of the journal Blood and the first formal hematologist; Joseph F. Ross, who was the first hematologist to do metabolic studies. You see, in 1950, we didn't know that proteins had a life span, red cells had a life span, and white cells had a lifespan. All that turnover business was a product of the war, because we had radioisotopes. Dr. Ross was a pioneer of radioisotopes. And he sent me to the third guy, whose name I can't remember. I think it was Israel or something. I had 3 letters of reference.I took everything I owned and threw it in my car. I had a 1946 Oldsmobile. That was the first postwar automobile. I drove off to Boston, interviewed with the 3 guys, and they all offered me a job. The only problem is this was 1950. Nobody paid residents or house staff; you worked for nothing. But Dr. Ross had just gotten a new grant from the Atomic Energy Commission to study red cell metabolism with radio iron, and he offered me a job that paid $3,000 a year. That was big money, so it was an easy choice. Dameshek was very famous, but I went with Joe Ross, and I began working.
Lesley Brunet, MA
Was it the money or the position?
Emil J Freireich, MD
It was just the money. I would've rather gone with Dameshek, but I couldn't live. He didn't pay his house staff. It was very competitive, and I had nothing to live on. I had no relatives or friends in Boston. I didn't get any money from my mother, and my sister was also poor. I had no money—zero. I had to live on my own resources. I could have gotten a part-time job, but I wanted to devote myself to my research. I'm a hick from the country, the small town of Chicago, and here I am in the big metropolis of Boston. It was money.
I went to work with Joe Ross. That turned out to be a very exciting period. I worked on a very exciting project, my first research ever. Up until then, I was strictly a trainee. The project I worked on was the mechanism of anemia in rheumatoid arthritis. It turned out that there was a paradigm that was created by Maxwell Wintrobe, who is the author of the first textbook of hematology in the world. He was the authority on the mechanisms of anemia. We did some very innovative things with rheumatoid arthritis. Then another fellow in the lab, Aaron Miller, and I got the idea of doing some experiments with a dog, which would nail the problem, and these turned out to be tremendously successful experiments.
My first research projects were enormously successful. There is what's called regular science. Regular science is what you do when you write a grant, you get funded, and you do it. Regular science is all very predictable. Here's this amount of knowledge. If you want to find out if this amount of knowledge will take you a step further, you do the following. There are only 3 possible things you can do, you write it down, you have the facts—that's regular science. But discovering something is a whole different process. Discovering something is tackling a problem that you have no idea what the outcome is going to be. You never get funded for a grant. If you write down, "I want to cure leukemia," the study section will say, "Fishing expedition." You won't get a nickel. It's one of the problems with the way we fund research now. Young people are trained to do what everybody else does. It's like the military, but they're not challenged to think.
It's been established by formal study of scientists who are successful that the secret to a successful career in science and innovation is to hit a home run the first time at the plate, because if you face a number of defeats, you immediately recede into the mode of doing what everybody else is doing, which is regular science. You get funded, you get promoted, and everything is fine. There is no controversy, and you never have to fight a battle. But if you hit a home run, if you discover something, 2 things happen. The first is that you become controversial, because if you discover something and you're young, this is bad. How come all the experts didn't know that? That's what happened to my first discovery.
We made a breakthrough discovery in the mechanism of anemia infection, but it conflicted with the Wintrobe conclusions. Wintrobe had written 15 consecutive papers on the mechanism of anemia infection. We had proven that the formulated thing was false, and we knew how it happened. We wrote this paper, and it was rejected by the journals, of course. Innovation is always rejected. So we had controversy. How do we get this paper published? I must admit, without Joe Ross's backing, we never would have gotten published. Dr. Ross wrote to the editor and said, "I've gone over this data, I know it's correct. I don't care what Dr. Wintrobe says, and I think it should be published." He was in the Association of American Physicians. He was a famous guy, so we got it published.
At this point, I'm still a fellow. I hadn't gotten a staff position anywhere. I'm still learning. But I realized then that there is enormous reward in discovering something. You can't be admired. It's really a thrill to discover something. It's one of the high points of human intellectual activity, to discover something no one else knows. I hit this home run, but it's still controversial. I'm working my tail off, and I'm a fellow at Mass Memorial.
I should tell you about my wife, Haroldine "Deanie" Cunningham Freireich, who's very important to me right now. We've been married 48 years. She was the head nurse at the clinic in Chicago. When I moved to Boston, all alone, working my head off, and no money and no entertainment, she came to visit, and I took her to the lab. While we were touring the hospital to show her how important I was, someone broke into my car and took all of her luggage. She didn't have her tickets or anything. So to make a long story short, she stayed in Boston, we got married, and we've been together ever since. She's very important in my life. We had 4 children. She's made me acceptable to the world; otherwise, I'd be unacceptable.
So here I am, working my head off. I still want to be a family doctor. I'm just doing research because that was the job they told me to do. I'm learning hematology, and I'm really learning it. I took my boards in internal medicine then, because I figured you can be a family doctor, but if I have boards in medicine, I can charge more. So I took my board exam, and William Castle examined me. He's one of the giants of American hematology. What a man. I still quote him every day. There I was in the Mecca of all new science, and I was learning science. I was excited. That was in 1953.
Freireich, Emil J. MD and Brunet, Lesley W., "Chapter 03: On to a Fellowship in Boston and to Hematology" (2001). Interview Chapters. 151.
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