Chapter 05: Key Figures in Surgery in the Seventies through Early Nineties

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Chapter 05: Key Figures in Surgery in the Seventies through Early Nineties

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In this chapter, Dr. Ames provides his perspective on several key surgeons who had an impact on the culture and practice of surgery and surgical oncology: Charles McBride, Marvin Romsdahl, Everett Sugarbaker, David Ota, and Eva Singletary.

Identifier

AmesF_01_20190807_C05

Publication Date

8-8-2019

City

Houston, Texas

Topics Covered

Building the Institution; MD Anderson History; MD Anderson Snapshot; Portraits; Multi-Disciplinary Approaches; Discovery and Success

Disciplines

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

Transcript

Charles Balch, MD

Let me just go over a few more vignettes. Charlie McBride.

Frederick Ames, MD

Interesting fellow. He was a master of anatomic dissection, as was Dick Martin, as was Marion McMurtrey. Charlie would tell you, he would identify everything and he would tell you what was just the next thing we were going to see, and he was very smooth. He remembered everything and I don’t know that he remembered any more than anybody else, but he was a repository of all this information, and he remembered patients forever. Like the others, he was clinically very astute, and he would pick things up that others would miss clinically when examining a patient. I remember a lot about him because I operated with him a lot when I was his associate for a long time, and he shared a lot of things with me.

Charles Balch, MD

Do you want to mention about his haircut?

Frederick Ames, MD

He’d get one haircut a year.

Charles Balch, MD

In June.

Frederick Ames, MD

In June, and then he’d go off and here’s this guy, one of the most experienced skin cancer surgeons in the world, melanoma but also all the other stuff, and he would go get a lobster burn. He was from Nova Scotia, and they would go back home. He’d make his pilgrimage back home, and they’d go to the beach, and he would come back, and he would just --of all the people in the world. But he would, he’d get that one haircut a year. We joked about it, and he might have got one every six months, I don’t know, but in any event.

Tacey A. Rosolowski, PhD

That was the little eccentricity he allowed himself.

Charles Balch, MD

But now did Charlie give talks? My impression is, because of the fellows like you, like Ev Sugarbaker and others, they took the experience that was in the records and put them together and gave the presentations. Charlie himself was a clinical surgeon but my impression is he and Dick Martin did not have the inclination. They got the data there, but they didn’t extract the data and they didn’t personally give it, this was up to the fellows.

Frederick Ames, MD

And to some extent Jay Ballantine may have done that as well.

Charles Balch, MD

As part of their projects, yeah. Look, my point here historically is they are revered locally but they’re not known as well outside as they should be, because they weren’t visible academically.

Tacey A. Rosolowski, PhD

Right, and that’s sort of the next move, is how do we move from that excellence to research.

Charles Balch, MD

That’s one of the reasons to kind of raise that and describe their legacy.

Frederick Ames, MD

I learned so much from Charlie McBride and he was actually the one that worked very closely with Eleanor Montague, to bring back, to forge conservation surgery for the locally advanced with comprehensive radiation. The drawings and actually the manuscript on that --that was published, I probably still have it somewhere-- of the extended simple, that was Charlie McBride working with Eleanor Montague. So ironically, here’s somebody that did radical surgery for heaven sakes, but in fact he also had his other side. He was working closely with the radiation oncologists to do more effective regional control, which involved less surgery plus comprehensive radiation for the locally advanced, which is kind of easing in the back door. He was the one that did that.

Charles Balch, MD

I have four people I want to kind of get in before we finish. Marvin Romsdahl was recruited to be the chief of surgical research. That was his, in the records, his primary reason for coming here to set up a lab. How was he as a researcher, as a surgeon?

Frederick Ames, MD

I can’t tell you much of anything about Marvin’s research. I got to know him pretty well for various reasons. He was also a very quiet person and again, the program in those days was a one year clinical, and a separate year if you qualified for it and you wanted it, in research. He was among the first, if I remember, that was able to grow melanoma cells in a lab, because the fibroblasts would overgrow everything. I just heard the other people talking about that.

Charles Balch, MD

He did publish that. A lot of his publications were in melanoma.

Frederick Ames, MD

But he wasn’t on the melanoma service actually. His research was melanoma but Charlie McBride and I and Ted were the melanoma service, once McMurtrey went off to full-time thoracic. Sarcoma was probably his major clinical focus and he too worked with Bob Lindberg on his 300 cases of extremities, sarcoma. He was a very soft-spoken person. He was not that assertive, that’s my choice of term, and I remember, I was doing a hemipelvectomy with him and Ev Sugarbaker had told me, I was sad by the way, to see that Ev had passed away, at a very young age.

Charles Balch, MD

Yes he has.

Frederick Ames, MD

His brother passed away at the same age.

Charles Balch, MD

David had passed away?

Frederick Ames, MD

Yeah, like two months ago.

Charles Balch, MD

I didn’t know that.

Frederick Ames, MD

I mean just out of nowhere. I’m sure it was cardiac. In any event, Ev said, “If you’re working with Marvin—” Who also had worked at the NCI, I believe, with Al Ketchum, and he said, “You can get to working with him but if you can get the instruments, he’ll let you run it with him unless you get in trouble.” So I was ready, and we were doing a hemipelvectomy --and I mean a full hemi-- and we were exposing the vessels, and he said, “Can you see that from over there?’ Thank you, Everett, and the rest is history. I finished the operation and obviously it was to his standard or he would have … But in any event, I remained friends with Marvin even after he was completely retired. He would come by and check his mail and sadly, he was killed at his—he had property up on Lake Livingston. Actually Ed White had a place up there. I think Jesse had a place up there, little bitty places on the water. He never built a house up there, I don’t think he did, but he was up there and he had a professional trimming trees, and one of the limbs fell on him. [Redacted] His then wife, who was one of the retired senior nurses, Virginia—

Charles Balch, MD

Okay, so David Ota.

Frederick Ames, MD

Well David, I knew in a different sense because actually he was—I believe David finished his residency at UT. He was one of Stan Dudrick’s residents. The one Stan brought down was --oh, heck you remember his name, retired-- anyway, to be his chief resident. But Dave Ota was his resident, rotated here and then was on the faculty. In those days, a number of the appointments to the faculty were what were called faculty associates, so they would be paired with a more senior faculty for a year or so and then elevated to full faculty, although they had full faculty privileges.

Charles Balch, MD

But David was not a fellow here, he was recruited directly into the faculty.

Frederick Ames, MD

That may be true.

Charles Balch, MD

I don’t know, I’m asking. We can look it up.

Frederick Ames, MD

You know, you’re probably right but I don’t know, you would need to look that up. He was around, and John Daley was another.

Charles Balch, MD

Yes.

Frederick Ames, MD

Who was the one—Bruce MacFadyen was the one that Stan brought down from Penn to be his chief resident.

Charles Balch, MD

Exactly.

Frederick Ames, MD

And I took care of all the fistula patients and the obstructions, because I was the TPN guy. Then Bruce was their guy and he wrote the paper. David was always more interested in GI than anything else, a very bright guy. He had done part of his residency, I think at Johns Hopkins.

Charles Balch, MD

Yes he had.

Frederick Ames, MD

I know he was big into the various nodal basin dissections for stomach cancer for whatever reason. A very bright guy, he lived less than a block away and his wife, Betty I think her name was?

Charles Balch, MD

[Redacted]

mean we’re talking—

Tacey A. Rosolowski, PhD

Where was Dr. Ota on the whole scale of conservatism versus innovation?

Frederick Ames, MD

He was young, which means he was impressionable.

Charles Balch, MD

He mainly did GI, so there wasn’t really the movement in sarcomas, melanomas, and breast cancer, and head and neck, where all the areas were.

Frederick Ames, MD

Right, and David was a GI guy to the core, in addition to which though, he was younger and not so set in his ways. As the years have rolled by, a lot of the eureka moments and the bright ideas for where to move next come from the younger people, as perhaps it should be, regrettably. I’m sorry that they’re coming up with stuff, but I’m very proud that I was able to be around while so many of the new ideas were being generated.

Tacey A. Rosolowski, PhD

It does sound like it was a pretty incredible time.

Frederick Ames, MD

It was, it was a neat ride, I’ve got to tell you.

Charles Balch, MD

One other person I wanted to get in was Eva Singletary, who I hired with Raph Pollock [oral history interview], in September 1985. You and I have that connection because she was trained by Ted Copeland.

Frederick Ames, MD

Yeah.

Charles Balch, MD

She was the first female to be recruited into surgery.

Frederick Ames, MD

In many respects, I was sort of—and she said so on a number of occasions, that I was in many respects her big brother, both in the hospital—

Charles Balch, MD

That’s why I wanted to ask you.

Frederick Ames, MD

And outside the hospital. She did the two-year fellowship. She came here and did melanoma research and took it upon her. She was a keen student, there was seldom anyone around who had as much intellectual horsepower as Eva Singletary.

Charles Balch, MD

I agree.

Frederick Ames, MD

She reviewed, I forget how many breast charts and how many melanoma charts, and put together all these databases, out of which, oh my gosh, I don’t know how many different things were mined. And then she came on the clinical service and she was actually an exceptional technician, and she also, I don’t know we got along. She would elbow me in the ribs and say, “What are you doing that for?” At the operating table. I helped her do a pancreas resection, I helped her do more than one Whipple. What are you putting that silly little stent in there for? Well, these little ureteral stents that I had learned on the urology service, that looks just right, we put that in the pancreatic duct and put that in with a chromic stitch and it will dissolve. I had a guy come back from Mexico one time and he had it in a jar, he passed it, something had fallen out of him, and he said, “What’s this?” I said, “Oh, that’s okay.”

Tacey A. Rosolowski, PhD

You don’t need to worry about that.

Frederick Ames, MD

It’s like your little kid swallowed a quarter and you strain all, you know. In any event, she was an exceptional technician, brighter than the Lord ever intended anybody to be. Eleanor Montague fell all over her, which is not surprising, because Eva was very, very deeply involved in breast. She was the head of the melanoma service before that, which she certainly deserved, and mined for a lot of academic recognition. But I don’t know, it looked to me like she had a greater fondness for breast, but you couldn’t tell it because she was so good at both and academically she was good at both. I do remember, we were invited to be on the faculty of the very first postgraduate course at the American College of Surgeons, in breast, and it was Kirby Bland and Ted Copeland, whoever they are, had just published a big book in which Eva and I had written parts, and we were invited to be on the faculty. I was paralyzed, because it was at the McCormick Center and I was staring out at over a thousand people. It was far and away the biggest postgraduate course that had ever been presented in one room, I was told, and I was lined up with Bernard Fisher and Ed Fisher, and all these luminaries, and I was just mortified. Eva was paired against the chief at Sloan Kettering, what’s her name?

Charles Balch, MD

Monica Morrow.

Frederick Ames, MD

Monica Morrow. They were going head to head on inflammatory breast cancer, and I remember you asked me you said, “Gosh, Fred...” You were worried about Eva’s presentation was going to be okay, and I said, “Trust me, she’s never been anywhere but first in the class, just rest easy.” She came out in a flaming red dress. This is inflammatory breast cancer and she’s a blonde, and this is October in Chicago at the McCormick Place, and you’ve got all these men in their trench coats, drab. You’re looking out at the audience, there are 1,100 people and she stands out, and Monica, for her part, was nicely dressed, I think, in black, and the two of them were just like two cats in a sack, which was not to Monica’s advantage. Raph told me about that later. Monica is always—I was very fond of her and was a friend of hers but she was then and is now, a tough customer. Eva’s presentation was just—she was swarmed when the meeting was over. I mean here’s this blonde in this red dress and surrounded by all these people in their raincoats, and then sadly, she had several health issues and she had some social issues as well. At the time of her death she had three conditions which she shared with me, any of which alone, much less in concert, could have taken her life. I stayed in touch with her up until the very end.

Charles Balch, MD

One of the things I remember, just to bring out in this history, is when I came it was the Department of General Surgery and within a few years, we changed this to the Department of Surgical Oncology and then set up the sections within those, and you were the first chief of the breast section. I wanted Eva to have a title, because I was trying to be a champion of women having leadership roles. So even though she wasn’t as active, she had the pedigree to justify being the first chief of the melanoma section, and that was the first time that a woman had been given a titled role in a surgery department in the history of MD Anderson.

Frederick Ames, MD

She was almost, except for Nylene Eckles and Marga Sinclair, who was the plastic surgeon, I’m struggling to think if there were any other women, there may have been.

Charles Balch, MD

But Eva is one who is a heroine for me because she literally broke glass ceilings.

Frederick Ames, MD

Oh she did.

Charles Balch, MD

Not only locally but nationally, she was the first president of the Society of Surgical Oncology.

Frederick Ames, MD

She was.

Charles Balch, MD

There was hardly anything you would ask Eva to do that she wouldn’t do very well.

Frederick Ames, MD

She was very efficient with her time.

Charles Balch, MD

But she was also very innovative. We did the first skin sparing mastectomy that she pushed, and she was the one, with Gabe Hortobagyi, who came to me and said we need to form a breast center so that patients don’t have to traipse all over the hospital, remember, and then we eliminated Station 80.

Frederick Ames, MD

We started doing skin sparing, and it was interesting because Eva was a Tuesday/Thursday surgeon and I, a Monday/Wednesday/Friday, and we would be saving skin, which was novel at the time. Trust me, nobody was doing that, and we were being criticized unmercifully for it and we were doing it so the reconstruction was a little bit better. And we were doing immediate reconstruction and we were being criticized for that unmercifully. I would get to the OR and the nurses would say hey, you won’t believe what Dr. Singletary did yesterday. So that back and forth went on all the time, so if I did something that was half a step forward, she learned about it the next day.

Charles Balch, MD

She was very innovative.

Frederick Ames, MD

And not to be outdone, here she would come again. We did everything in sync and of course the nurses adored her, you have no idea. I used to take care of many of the nurses—

Charles Balch, MD

Would you say charming is a good word for Eva, her personality?

Frederick Ames, MD

Oh for sure, but she took a lot of my patients away from me. I mean she was the favorite of many of the anesthesiologists and the nurses, and then out in West Houston, all the college educated women who would get together and network.

Charles Balch, MD

She and Gabe Hortobagyi kind of grew up together. They really became the centerpiece of the breast center.

Frederick Ames, MD

They did.

Tacey A. Rosolowski, PhD

Yeah, I’ve gotten a trail on that.

Charles Balch, MD

And that’s not to take anything away from you, Fred. Eva was gravitating to be the full-time breast surgeon.

Frederick Ames, MD

She was.

Charles Balch, MD

Surgical oncologist.

Tacey A. Rosolowski, PhD

And a powerful combination, I mean someone who has those kinds of communication and interpersonal skills to be doing this innovative work.

Frederick Ames, MD

And a woman, who was that bright and who could get up before a thousand people and embarrass some of the others on the podium.

Charles Balch, MD

MD Anderson raised a lot of money around Eva Singletary.

Tacey A. Rosolowski, PhD

Those are leadership qualities.

Frederick Ames, MD

Well they were. Oh gosh, I was thinking about something else. George Blumenschein and Eleanor Montague adore her, but she earned it.

Tacey A. Rosolowski, PhD

For sure.

Frederick Ames, MD

I mean she, good grief, at her zenith, she was the most in-demand surgeon. I can recall going up to her offices, because I had been called, from the president’s office, that I had to see somebody, and I’d say gosh no I can’t, you know it’s the Christmas holidays. I’m going on a deer hunt, or this or that. Eva is leaving town and I’d walk in front of her office and she screamed, “You’ve got to see this one!” Why? [Redacted]

Charles Balch, MD

I remember her.

Frederick Ames, MD

—she said, “You’ve got to take this one.” So anyway, I’m glad I did because she’s charming and we’re very good friends now. But in any event, Eva was, she was special.

Tacey A. Rosolowski, PhD

We’re almost at time folks.

Chapter 05: Key Figures in Surgery in the Seventies through Early Nineties

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