Chapter 04: Portraits of MD Anderson Surgeons in the Seventies-Eighties: Part II

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Chapter 04: Portraits of MD Anderson Surgeons in the Seventies-Eighties: Part II

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In this chapter, Dr. Copeland and Dr. Balch continue their review of excellent clinicians who were “under the radar” in the Department of Surgery in the seventies through eighties. Dr. Copeland begins with a discussion of Eva Singletary, MD, the first woman to join the surgical faculty (1986). He then discusses Dr. Frederick Ames, Dr. Charles McBride, Dr. Marvin Rhomsdahl, David Ota, Kim Jessup. Next, Dr. Copeland lists his roles with professional organizations while he was at MD Anderson. He also talks about his work furthering the careers of young faculty members.

Identifier

CopelandE_01_20190409_C04

Publication Date

4-9-2019

Publisher

The Historical Resources Center, The Research Medical Library, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

Overview; Portraits; MD Anderson History; MD Anderson Snapshot; Research; Collaborations; Building/Transforming the Institution; Multi-Disciplinary Approaches; Professional Practice; The Professional at Work; Gender, Race, Ethnicity, Religion; Leadership; On Leadership; Mentoring; On Mentoring

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 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 | Surgery

Transcript

[A discussion of technical difficulties has been removed to enhance readability]

Charles Balch, MD

Really? Let me go back for one other historical vignette about Eva Singletary, who you trained and who came here and ended up being a superstar.

Edward Copeland, MD

Eva, I think went to the medical at University of South Carolina.

Charles Balch, MD

That’s correct.

Edward Copeland, MD

She was a South Carolinian. Not only was she a South Carolinian, she was a coastal South Carolinian, and they have their own dialect over there. If you will recall, Eva could not pronounce lymph node, she pronounced it lymph “noag.”

Charles Balch, MD

Yes. And see Eva also grew up on a farm and she sometimes would tell us that she could do an orchiectomy on a cow just as well as any man.

Edward Copeland, MD

I’m sure she could and she was not necessarily talking about a cow.

Charles Balch, MD

I think she was telling us something.

Edward Copeland, MD

She was trained basically, by [Ed Woodward] and Ed was necessarily a tough taskmaster because you didn’t want to get on Ed’s bad side. They were all very, very technically skilled. In fact, there were two or three residents whom I inherited that I thought probably didn’t even need a chief residency, and they were much better trained than the UT Houston people were. I know when Tim Flynn joined me on the faculty, my group was thinking about having someone repeat a year and I said, he’s about as good as they were when I came through UT Houston. Flynn agreed and so I told my guys, “one of your jobs is to train the residents, so go train those whom you think may be lagging behind.”

Charles Balch, MD

Eva was a chief resident under you?

Edward Copeland, MD

I did my first operation with Eva Singletary. We debrided a guy with Fournier’s gangrene in the middle of the night and the next procedure I did at Florida was with Eva, I helped to do an abdominoperineal resection.

Charles Balch, MD

Any vignettes about Eva as a surgeon?

Edward Copeland, MD

Eva was excellent technically, no better than most of the other chief residents in Florida, but she was technically quite good and I’m sure when she got to the MD Anderson, her technical ability shone through, and that’s why she was asked to stay there.

Charles Balch, MD

I think it also would be fair that she was one of the first women to become a surgical oncology fellow at MD Anderson.

Edward Copeland, MD

I don’t know that for a fact but I don’t recall any surgical oncology fellows being women while I was there. [I did have women on my service who were chief residents at UT Houston, but no fellows.]

Charles Balch, MD

I don’t either.

Edward Copeland, MD

[I did have women on my service who were chief residents at UT Houston, but no fellows.]

Charles Balch, MD

Well, I know for a fact that—because I hired her in September, 1985, along with Raph Pollock [oral history interview], and she was the first women on the surgical faculty. I think we’re almost done. We’ve covered a very important time in the life of MD Anderson and it’s important for me because as you know, I came in 1985 and you are the best person, you and Fred Ames I think, and maybe John Daly, who we will talk to, about that important history and the growth of the department from 1975 to 1985.

Edward Copeland, MD

Exactly. Now Fred Ames [Division of Surgery interview] took over Dick Martin’s spot in being the go-to guy.

Charles Balch, MD

Clinically.

Edward Copeland, MD

Fred Ames likewise, was technically gifted.

Charles Balch, MD

Yes, and a utility player. Fred could operate anywhere.

Edward Copeland, MD

[Fred is a reflection of how he was trained at MDAH. As I told you, we rotated soft tissue with GI every 6 months to avoid boredom. So, he could do everything in the surgical oncology domain. Today, surgical oncologist focus on one body part, like breast, pancreas, etc. I guess this new system is best, but I would not have liked it At Florida, I did it all as well. As I got older and had more national responsibilities, I limited myself primarily to soft tissue malignancies. The last case I did, however, was a complicated enterocutaneous fistulae, a procedure that several other good surgeons had failed to rectify. In reality, Fred was probably your most valuable clinical faculty member.]

Charles Balch, MD

And he did that for the rest of his career.

Edward Copeland, MD

Let me tell you what impressed me with Fred Ames. Charlie McBride did a low anterior resection, and Charlie closed the perineal floor, and I have no idea why but he did. Of course, [the anastomosis is usually below the parietal, peritoneal floor so if the anastomosis leaks it is contained. If the contained abscess ruptures into the general peritoneal cavity, septic shock will often ensue.] And so Fred is making rounds one day before we went to the OR and a patient of Charlie’s --because Charlie and I shared a service, initially Charlie and I shared a service until John Daly joined and then John and I shared one. Charlie’s patient went into septic shock, and Fred stood there and took care of this guy and treated him like it was his own father for a lengthy period of time and saved his life, and I said right then, this guy is my guy. So I made sure that I kept up with Fred Ames. I made sure that Fred Ames got a fellowship, so I must have had some input into that. I made sure that Fred Ames joined the faculty because I’d beat him over the head if he ever thought about doing anything else. I’m likewise as proud of Fred Ames as I am of any other person [whom I participated in training].

Charles Balch, MD

And we talked about this when we were offline, if you could just repeat, for the record, Fred’s history and how he came to know you and to come to MD Anderson.

Edward Copeland, MD

Fred was a resident at the University of Texas Medical School at Galveston, and Jim Thompson became the chairman of surgery at Galveston. I think Ed Poth was the person who was chairman prior to that, and they were different people. Fred did not think he would enjoy his residency with Jim Thompson there, and he left after he got a residency program at St. Joseph’s Hospital in Houston, which is now the program that’s at Methodist Hospital, as a matter of fact.

Charles Balch, MD

And this was, I think because of the connection with John Stehlin.

Edward Copeland, MD

Yes, and John Stehlin is the person I’ve tried to think of. Marion McMurtrey came to the MD Anderson Hospital from Utah because John Stehlin had an electron microscope, and Matt came to run the Electron Microscope Research Facility.

Charles Balch, MD

John Stehlin was on the faculty at MD Anderson and then went to St. Joe’s in private practice.

Edward Copeland, MD

That’s correct and John Stehlin was doing lumpectomies and ancillary dissections, but he was not using post-op radiation therapy.

Charles Balch, MD

Let’s go back to Fred Ames.

Edward Copeland, MD

[Baylor and St. Joseph’s residents rotated through MDAH. In those days, the Residency Review Committee would allow a resident to spend an entire year at an affiliated hospital. Therefore, Fred spent his entire 4th year of residency at MDAH, much of which was on the McBride-Copeland service. Charlie and I were quite Impressed with him and I think Fred felt likewise. His military commitment was at Fort Campbell, Kentucky and he returned to MDAH for a fellowship, joined the faculty and the rest is history. I was especially pleased to have him return for multiple reasons, not the least of which, he shared the perfusion for melanoma patients with Charlie and me. This operation took about 4 hours and was boring in some parts. Charlie loved it—not me. So, I had an ulterior motive in Fred’s return!]

Charles Balch, MD

So Ted, could you give us some brief vignettes about a few other people I wanted to name. Charlie McBride.

Edward Copeland, MD

[I have told you about Charlie already. He trained at the Royal Victoria Hospital in Montreal. As Charlie would say “the Royal Vic” as if it was a bit of Heaven. Yes, he came to study liver transplantation but never did so. He got one hair cut a year. So he was a bit “grisly” in the winter and had a crew cut in the summer. For some reason, Charlie was enamored with closing the abdominal cavity with cat gut. He had the highest abdominal hernia rate and, it seemed, among the faculty members. I think this technique was taught him at “The Vic”. In morbidity conference, we would try to change his mind about this closure technique but were never successful during my tenure at MDAH. Once Charlie got a technique in his mind, it remained there. Fortunately, his other techniques were fine, in fact, some were better and changed our minds.]

Charles Balch, MD

On thing I recall is Charlie McBride was incredibly traditional. Once he locked in to a routine, he never changed.

Edward Copeland, MD

He didn’t, but he was a very good surgeon, and as I say, the first Patey modified radical I ever saw, Charlie did. He taught me how to do them, [I have written several technique papers on this procedure and the extended simple mastectomy, which he not only taught me but also showed the value of the procedure to prevent ipsilateral arm edema. Another idiosyncrasy of his was to invert the distal ileum into the colon after a right colectomy. Charlie’s thought process was that since the inverted ileum acted as a physiologic valve that prevented reflux of bacteria back into the ileum, doing so would prevent bacterial overgrowth into the ileum which, in itself, would preserve ileal absorption of needed nutrients such as vitamin B12. In the dog lab, I attempted to prove Charlie’s theory, but was unable to do so. The dog ileum is naturally contaminated with bacteria. I could, however, show that the valve worked by using nanometrics before and after the operation. Fluid was prevented from refluxing into the ileum. So the operation worked as a replacement for the ileocecal valve but the practicality of it was never proven by me. I learned a lot from Charlie, some useful and some not so useful.] He got a haircut once a year.

Charles Balch, MD

In June.

Edward Copeland, MD

He got a haircut in June and then it grew and grew and grew and grew. He always was well groomed but he had lengthy hair by the end of the year. [Laughs.]

Charles Balch, MD

Down to his shoulders.

Tacey A. Rosolowski, PhD

Oh, that’s funny.

Charles Balch, MD

So, how about Marvin Romsdahl?

Edward Copeland, MD

[I have talked a bit about Marvin Romsdahl earlier, but will repeat a bit of the narrative here. He came to the MDAH from the University of Illinois to receive a PhD in immunology. He had trained at the Research and Education Hospital, the name given to the hospital used by the University of Illinois. From a surgical oncology standpoint, it was a lot like the University of Pennsylvania, as I have said before. So Marvin had a good background in contemporary surgical oncology. He, too, was pressed into clinical service when the operative volume of the MDAH became overwhelming. If I was to be constructively critical of Marvin, I would say that he was too much of a gentleman—too nice. Were he to hesitate on a simple decision like the volume of colon to remove for a colon cancer, the fellow could take over the case and Marvin would become the first assistant. Now this example may only apply to me. I was already a technically accomplished surgeon from my year spent in Viet Nam doing battlefield surgery. So, I think if you looked beneath the surface, you would find that Marvin’s real interest was in basic science, yet he was an accomplished surgeon.]

Charles Balch, MD

So, how about David Ota.

Edward Copeland, MD

David Ota came to us at the University of Texas, I think from Johns Hopkins, to do a year of fellowship with Stan Dudrick and me, in the study of the effects of TPN. We talked him into finishing his residency at the University of Texas and obviously he rotated through on my service like John Daly did. [In the laboratory, he used a rat hepatoma model to study the differential difference in the way a well-differentiated hepatoma metabolized nutrients compared to the normal liver. He showed that in this model, TPN had no effect on the growth and metabolism on the hepatoma, it was functioning maximally and not stimulated to increase metabolic pathways when presented with TPN. Likewise, the normal liver functioned no differently when TPN was presented. This experimental model helped to show that TPN had no effect on a tumor and was available for use by the host. David was invited to join the MDAH faculty and continued his metabolic studies. He later took over the leadership of the American College of Surgeons Oncology Group ((ACOSOG), funded by the NIH to do multiple clinical studies in oncology. In fact, when the funding almost failed, David rescued the projects.]

Charles Balch, MD

And Kim Jessup?

Edward Copeland, MD

[I met Kim Jessup when I was an external reviewer of a NIH funded CORE grant at Northwestern Medical School. Kim was one of the representatives from the NIH. He was spending his two-year commitment to the military in this capacity. He had finished three years of residence at Cornell. I was impressed with Kim and at breaks would recruit him to come to UT Houston to finish his reside. I was successful and brought him to Houston. Once again, he rotated through my service at MDAH. By this time fatty acid requirements could be given by vein rather than having to apply safflower oil to the skin of a patient. There was some concern that some of the contents of the fat solution could be detrimental to the immune system, obviously a disadvantage to a cancer patient. Through an elaborate series of experiments, Kim demonstrated that the fat solution available at the time had no deleterious effect of the cancer patient, but rather had a salutary effect by providing the essential fatty acids, linoleic and linolenic acid. He, too, had the fellowship at MDAH and joined the faculty.]

[To this day, I use Kim as a model for persistence. He was turned down multiple times by the NIH for a RO1 grant to study the immune effects of colon cancer. The grant was eventually funded. He didn’t give up!]

[As a side note, but an important one, I can claim credit for several eventual faculty members of the MDAH. We have just discussed Kim Jessup and David Ota, We can add to that list John Daly, also from UT Medical School and Eva Singletary, Lee Ellis, and Eddie Abdallo from Florida. Likewise, your current chief of the liver tumor service, Nic Vautey had his original faculty appointment after finishing at Memorial Sloan Kettering with me at Florida.]

Charles Balch, MD

That’s a good story.

Edward Copeland, MD

Eight times, eight times, and [Kim] got his R01.

Charles Balch, MD

Could we just talk for a second, during the time you were at MD Anderson, was that during the time that you were president of the SSO?

Edward Copeland, MD

[No, I was the 13th President of the Association for Academic Surgeons in 1979. It was the young, young Turks society at the time and had not joined with the Society of University Surgeons SUS)), as is the case today. It was established for those young academic surgeons who had not yet reached the status to be considered candidates for membership in the SUS.]

Charles Balch, MD

It’s interesting. So I came after you as president of the AAS.

Edward Copeland, MD

[ ]

Charles Balch, MD

I think Ev Sugarbaker was around our time also.

Edward Copeland, MD

Yes, Everett Sugarbaker [Secretary when I was President.. As I mentioned earlier, Everett was one of these individuals who took a fellowship early on to become an academic surgical oncologist. He went to the University of Miami to work with AL Ketchum. After Al either retired or died, Everett had a large practice of surgical oncology at Cedars-Sinai. Everett never became President of the AAS, because he was now considered a private practitioner. I disagreed with this decision, but was out-voted by the Executive Committee because the members thought it set a bad precedent. The key to the success of the AAS is the person in the position of Secretary because the entire Association is run through this office. I thought Everett had done the work and deserved to be President regardless of his position in life.]

Charles Balch, MD

When I came right after that, I think around 1982 and just for the record, the Association for Academic Surgeons was the organizations of the young academic surgeons, the assistant professor young Turks.

Edward Copeland, MD

[Yes, the term I used was young, young Turks. The majority of us who were President went on, like you, to have productive careers. The President of this organization, at the time, was nominated from the floor and voted upon. So he/she was not put forward by a nominating committee usually selected by the previous president, as occurs today.]

Charles Balch, MD

The Society of University Surgeons was the midlevel.

Edward Copeland, MD

[ ].

Charles Balch, MD

So, Suzanne Klimberg, what is your relationship with her?

Edward Copeland, MD

I trained her at Florida.

Charles Balch, MD

Yes, and so that’s another Florida connection. You know that Suzanne now is at UTMB.

Edward Copeland, MD

I know that, yes. Suzanne was offered the opportunity to be the chief of the breast service, and this is a little known fact, of the breast service at Memorial Sloan Kettering. [ ] [I encouraged her to do so. As you know, Suzanne has the capacity to “to think outside the box”, exampled by her studies on reverse lymphatic mapping of the axilla for breast cancer. She had young children and a husband whose family settled Little Rock, Arkansas. Likewise, her value to the University of Arkansas was well recognized by the institution. She elected not to be a candidate. I did all I could do to convince her to remain a candidate. I told her if she had that job “her picture would soon be on the cover of Time Magazine”!! Now several years later, her family situation does allow for her to “spread her wings”. She, too, was President of the AAS.]

Charles Balch, MD

Yes.

Edward Copeland, MD

[ ]

Charles Balch, MD

[ ]

Edward Copeland, MD

[ ]

Charles Balch, MD

[ ]

Edward Copeland, MD

[ ]

Charles Balch, MD

[ ]

Edward Copeland, MD

[ ]

Charles Balch, MD

[ ]

Edward Copeland, MD

[ ]

Charles Balch, MD

So Ted, do you recall, or can we put on the record, relationships of MD Anderson with other groups in the Texas Medical Center, notably UT Houston, which you were part of but uniquely so, Methodist in Luke’s.

Edward Copeland, MD

Unique is the right word. [I was in the position to explain the actions of UT Medical School to MDAH and just as easily do the opposite, and I would hope to the benefit of both institutions. Also, I became reasonably well known for the work with TPN in cancer patients. Both institutions could claim me, and I claimed both institutions.]

Charles Balch, MD

Now that’s okay, let’s just continue with what we have because I’m almost finished, but I wanted to get some broader thoughts about when I came. There was a continued one-year resident from St. Joe’s, there were occasional people from UT Houston. I suspect, from what you said before and my knowledge of Bob Hickey, that Bob --he was not very keen about UT Houston relationships. But Frank Moody got me to join the faculty there as the vice chair, so we could resurrect that relationship. Then we had occasional people from Methodist.

Edward Copeland, MD

[Residents rotated through MDAH from Baylor and St. Joseph’s before there was a UT Medical School. Once I was on the MDAH faculty, UT residents began to rotate. With time, my service only had UT residents, a chief and an intern. The relationship between UT Medical School and the MDAH was not great at the beginning. From my vantage point, as a young Assistant Professor, I would attribute this less than warm relationship to the first Dean of the medical school rather than to Lee Clark. As I have already indicated, Bob Hickey certainly had ambivalent feelings about the relationship between the two schools. The Baylor residents rotated after their rotation with Dr. DeBakey and I would characterize their posture as using the MDAH as a place to “rest”. Remember for the first year or two, I had fellows not residents. Bruce MacFayden came from the University of Pennsylvania to finish his residency. He spent his entire chief year on my service, something impossible to do today. You mentioned the number of TPN manuscripts that contain Bruce’s name. I needed his help to establish the TPN service. The technique had to be proven useful, not harmful, initially. And Bruce gets full credit for helping accomplish this status. ]

[You noticed that I did not have the best relationship with Bob Hickey some of the time. Since Bruce had spent an entire year at MDAH with me, and effectively as a fellow, I asked Bob if Bruce could join me as a faculty member. He refused, saying as he did for John Daly, he needed a fellowship. Bruce refused and stayed the medical school. Fortunately, the fellows from other institutions were willing to help out with the TPN duties and their names appear on the early papers published on the subject.]

Charles Balch, MD

[ ]

Edward Copeland, MD

[ ]

Charles Balch, MD

So was Stan Dudrick then, the first chair?

Edward Copeland, MD

Stan Dudrick was the first chair of the medical school, yes.

Charles Balch, MD

And then Frank Moody was the second chair.

Edward Copeland, MD

He was the second chair.

Charles Balch, MD

Just one other historical vignette. Frank Moody started out at UAB and my first three cholecystectomies were done on the blue surgical service led by Frank Moody.

Edward Copeland, MD

[I have great respect for Frank Moody who was chief resident at Cornell when I was taking an elective rotation in the dog lab. The only other person in the dog lab was Frank working on his experiments with gastric secretion. I was especially impressed that a chief resident could find the time to work, by himself, in the dog lab.]

Chapter 04: Portraits of MD Anderson Surgeons in the Seventies-Eighties: Part II

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