Chapter 04: The Impact of R. Lee Clark, MD and Richard martin, MD

Title

Chapter 04: The Impact of R. Lee Clark, MD and Richard martin, MD

Files

Loading...

Media is loading
 

Description

Dr. Ames begins this chapter explaining that R. Lee Clark knew many of the first surgeons he recruited to MD Anderson from his time in the Air Corps. Dr. Ames notes that this group functioned very harmoniously and reflected a type of personality, establishing come of the foundations of the culture of surgery at the institution. Next, he talks about Dr. Richard Martin, who was much less visible in the institution, but nonetheless had a great impact on the practice of surgery. Dr. Ames describes him as a "gentleman’s gentleman" who was innovative in multiple areas of practice. He tells the story of a controversial randomized trial to determine the relative value of limb amputation and limb salvage. He reflects on Dr. Martin as a teacher and mentor, and his habit of recruiting humble people, with further influence on the culture of surgery. Dr. Balch and Dr. Ames then discuss the importance of MD Anderson’s single plan, established by R. Lee Clark on the model of the Mayo Clinic to encourage collaboration for the benefit of patient care and innovation.

Identifier

AmesF_01_20190807_C04

Publication Date

8-7-2019

City

Houston, Texas

Topics Covered

Building the Institution; MD Anderson History; MD Anderson Snapshot; Leadership; On Leadership; Portraits; Multi-Disciplinary Approaches; The History of Health Care, Patient Care; Ethics

Transcript

Charles Balch, MD

But just checking with you, because my assumption is that Ed White, because he was there before any of them, was the titular chief of surgery because he ran the operating room and because he and Lee Clark had worked almost from the beginning.

Frederick Ames, MD

Well even before that, they came out of Randolph Field together.

Charles Balch, MD

I’m sure Felix Rutledge and Dick Jesse had no problem going directly to Lee Clark.

Tacey A. Rosolowski, PhD

Can I ask you to tell that story because I don’t know if it’s captured anywhere. Before the recorder went on you were telling me that story about how Lee Clark brought this group of men from his own military experience. Maybe you could tell that.

Frederick Ames, MD

Well as I remember it, but I think that’s been chronicled. Do you know that professor from Huntsville that wrote—?

Charles Balch, MD

Yes that is, Tacey, in the story that—I’ve forgotten the names but the chief of medicine.

Frederick Ames, MD

Cliffe Howe. I remember right where he lived.

Charles Balch, MD

They were all in the same baseball team at Wright Air Force, with Lee Clark. Then they all went off into different places, and Lee Clark, when he came from Mississippi, to MD Anderson, recruited them all back, because they were friends.

Frederick Ames, MD

I thought that came from Randolph Field.

Charles Balch, MD

Yeah, you’re right.

Frederick Ames, MD

One of the big—San Antonio, for years has been referred to as the mother in-law of the military. In those days there was no Air Force, there were only Army Air Corps, and that’s what these guys were in. Then after World War II, they developed the Air Force, and I don’t remember when that was, 1950 or whatever, but that’s the story I heard. I did know Cliffe Howe, a wonderful guy. He lived over there on Sunset and Kent, and he was best friends with a woman who lived across the street.

Charles Balch, MD

This was way before there was a specialty of medical oncology.

Frederick Ames, MD

He was a nice guy from New England as I remember. He would come in, lie down and take a nap on the couch in the surgeon’s lounge and wait for whoever to come around, and I got to know him pretty well. He was just a great guy, but there again, I was the junior person, either the fellow or the resident or a young faculty. It was also the same because the people, the very close-knit group who ran the place all knew each other.

Tacey A. Rosolowski, PhD

Who were the others that he brought, Lee Clark brought from Randolph Field?

Frederick Ames, MD

Those are the ones that I remember. Felix Rutledge, I don’t think came from there. He came later and I don’t know when.

Tacey A. Rosolowski, PhD

Because I’m sure that choice—

Charles Balch, MD

I know that story. Felix was the only person that Lee Clark could get to come full-time. There was another person before him who said, I’m practicing at Hermann.

Frederick Ames, MD

That was probably Dean [Candice?] or maybe it was somebody else, I can’t remember.

Charles Balch, MD

I have that correspondence, but that was how Felix Rutledge got on.

Tacey A. Rosolowski, PhD

I’m sure that had a huge impact, you know these individuals.

Charles Balch, MD

And then Bill McComb was the first to be the first chief of surgery.

Frederick Ames, MD

Yes, I remember.

Charles Balch, MD

Who I think came because of Gilbert Fletcher.

Frederick Ames, MD

I would bet you’re right, but again that predates me, but I do remember the first night I was on call as a rotating resident, I’d stay in here.

[Redacted]

I remember I did one with Dr. Jesse. You put the patient to sleep, and I mean, you would biopsy it and you’d pack them and sometimes they would bleed to death just from the biopsy, and this woman did. [Redacted] Welcome to MD Anderson.

Tacey A. Rosolowski, PhD

Right. Well it’s the reality of your practice.

Frederick Ames, MD

I got to go down there and whoa, and I was a rotating resident. So you were asking me what drew me and what the drama can be sometimes. It’s as painful as you can imagine. But in any event, [Redacted] He was barely clinically active then. If I remember correctly, Helmut [Goepfert, MD; oral history interview] had just—

Charles Balch, MD

Yeah, because he came in 1951.

Frederick Ames, MD

Helmut had just come back from his residency I think, when I was—I know he was here. Maybe he came back when I was a fellow and he would look after Dr. McComb’s patients and so forth. It’s hard to remember exactly where I was. I’m pretty sure I was a rotating resident when I took care of Dr. McComb’s patient, but I don’t recall. There was so much harmony. That was Lee Clark’s style. If there was this harmony, you go to the top. If there’s harmony, you go to the top, and so I would assign him the credit personally, for what that’s worth.

Charles Balch, MD

It’s interesting, Bill McComb and Gilbert Fletcher had it out one time, because Gilbert had complained that there weren’t enough patients getting to radiation. So they had a meeting in Lee Clark’s office and the note was to Ed White, “Take care of this.”

Frederick Ames, MD

Yeah. And as I told you, whenever Ed White sent me anywhere on a mission, as a resident or a fellow or faculty, everybody understood where the message came from.

Charles Balch, MD

Before we get back into General Surgery, there was one person I wanted to ask you about who was here from the very beginning and that was Jay—

Frederick Ames, MD

Ballantine.

Charles Balch, MD

Jay [Alando] Ballantine and his wife Maria.

Frederick Ames, MD

I actually got to know them, I would say real well, more after the fact than while I was here.

Charles Balch, MD

He was one of the first surgeons that came on to the faculty in the early fifties.

Frederick Ames, MD

And he did everything in the beginning I think.

Charles Balch, MD

Yeah, you did.

Frederick Ames, MD

By the time I met him he was pure head and neck.

Charles Balch, MD

I think he came in, in either the late forties or early fifties.

Frederick Ames, MD

It was a long time ago and as I said, I got to know him and then I got to know Maria. She would call up here looking for him and he’d be doing some case that would take all day and half the night. She was socially very prominent, her two brothers were the Mitchell brothers.

[00:59:\28]

Charles Balch, MD

That was the connection, yes.

Frederick Ames, MD

You’ve heard of the Woodlands perhaps, and Mitchell Energy?

Charles Balch, MD

Yes, yeah.

Frederick Ames, MD

Okay. And then they had another brother called Christie Mitchell and he ran a honky-tonk down on the beach in Galveston, and these were Greek immigrants whose parents had come to Galveston, which was the major entry port, way back whenever. George or Johnny, I can’t remember which one, went to A&M and was a cadet commander or whatever.

Charles Balch, MD

But when you knew Jay Ballantine he was only head and neck.

Frederick Ames, MD

He was only head and neck.

Charles Balch, MD

Because by the time I came he’d retired.

Tacey A. Rosolowski, PhD

What kind of impact did he have on surgery?

Frederick Ames, MD

It’s hard to know. I really operated with him only a couple of times and he did everything.

Charles Balch, MD

He was a good surgeon.

Frederick Ames, MD

He was excellent, he was meticulous, he was slow, and he took care of some of the most demanding cases there were. In any event, he’d be doing one of these things and Maria would have a number of people that were going to the symphony or this or that, and she’d call the lounge and he’d be in there eating his fruits and his almonds and whatever else it was, “No, ma’am, I haven’t seen him.” She would call all around to the clinic, into the office, looking for him. Anyway, they sort of adopted me as someone they would ask to see their friends, which flattered me to no end. Their son in-law was a surgery fellow here a number of years ago, before you came, because Gil is only two or three years younger than I. In any event, I got to know them well and then my kids went to school where they were so deeply involved, at the Greek orthodox church over there. My kids went to Annunciation Orthodox School and she was a prime mover, she knew the women that had built the school, as you might well imagine. I saw her gosh, almost the year she passed away, at the age of 90-whatever, and we would visit at the various receptions and so forth. [Redacted]

Well, parenthetically, I asked Jesse if there was a spot in Head and Neck Surgery when I was finishing my fellowship and he made no secret with the fact that he was very fond of me and he said no, he actually didn’t have a position. [Redacted] There was another interesting turning point in my personal career, where something I longed for I didn’t get, and I’m so much the better off for.

Charles Balch, MD

Yes, a good story. So Fred, let’s go back to General Surgery. I just wanted to get, in our time, some vignettes about some of the people you worked with. Dick Martin.

Frederick Ames, MD

Oh gosh. First of all, the nicest person in the world, quiet, he was the gentleman’s gentleman.

Charles Balch, MD

Was Ed White kind of like that?

Frederick Ames, MD

Yes, and his first wife was dearly loved and she passed on a long time ago. I did not know her, my mother did. Ed White was born about the time my father and mother were, which would have been in the first ten years of the century, 1907 or ’08, sometime along in there, Dr. Hickey about ’14, Jay Ballantine, maybe 1920 or ’18, I can’t remember.

Charles Balch, MD

Let me pull you back to Dick Martin, to Richard Martin I mean.

Frederick Ames, MD

He was always Dr. Martin to me.

Charles Balch, MD

Okay.

Tacey A. Rosolowski, PhD

He was really well thought of. What were his special qualities as a surgeon?

Frederick Ames, MD

Well, he did things surgically that other people were afraid to do or couldn’t.

Tacey A. Rosolowski, PhD

Such as?

Charles Balch, MD

Sarcomas would be one example.

Frederick Ames, MD

Yeah, but that was nothing. He was doing formal right liver resection for metastatic colon cancer when it was not being done. We didn’t have ultrasound in those days and we didn’t have arteriography. You had to go in and figure out where the vessels were and figure out where the planes were. It was dangerous. Fred Eilber and I helped him do one and I remember the lady came back, brought us a box of cookies and Fred was thunderstruck that we were going to do a right hepatic lobectomy on this 70 year-old woman who had metastatic colon cancer[GJ1] . He said whoever heard anything like that? Well, it was coming to pass, which is kind of interesting because in those days, they weren’t quite ready to take on lumpectomy, but he was the master at hemipelvectomy.

Tacey A. Rosolowski, PhD

I was going to ask you about that because it seemed funny, you were telling that story in the context of conservatism versus innovation.

Frederick Ames, MD

Yes, ma’am, I acknowledge it.

Charles Balch, MD

This was a curious time where some surgeons were getting more radical and others were saying maybe we should do less surgery.

Frederick Ames, MD

Well of course Dr. Martin did a lot of breast surgery as well, and that was completely integrated with radiation oncology, and he, despite his VIP status, still took care of the locally advanced. The interesting thing about locally advanced is it crosses all socioeconomic barriers, because the rich old ladies from River Oaks and West Houston would hide theirs. [Redacted]

[GJ2]

Charles Balch, MD

Yes, I remember Joe Ainsworth.

Frederick Ames, MD

A friend of mine, so and so, [Redacted] We observed that. All the breast service did at that time. They weren’t getting mammograms and they would hide it, so there was an interesting paradox there. Dick Martin was heavily involved in also limb salvage, he was among the first that did it. Bob Lindberg was the guy that had over 300 cases of limb sarcoma, that he and largely Dick Martin, and a few of them, Charlie [Charles M.] McBride, and they fused a few of them as well.

Charles Balch, MD

Bob Lindberg was the radiation oncologist.

Frederick Ames, MD

You do excision radiation and save the limb, and the interesting thing is a couple of luminaries whom you know so very well, did a randomized trial of amputation versus excision and radiation, and Ted Copeland took them both to task in formal rounds.

Charles Balch, MD

Yeah. Whether that was ethical or not.

Frederick Ames, MD

Yeah and you know, to this day, those two people are still proud that they did the randomized trial. Ted Copeland said it can’t be justified, you know, in view of the 300 patients. In any event, it was kind of curious that here he was, and I think he may have been one of the first ones who would ease over and do some lumpectomies, but then he was getting very senior. Remember when you came, he was not very active at that time.

Charles Balch, MD

He finished his career helping his son across the street.

Frederick Ames, MD

He did and that was painful.

Charles Balch, MD

Yeah, I know. That’s another story.

Frederick Ames, MD

Another story for another day.

Charles Balch, MD

How was Dr. Martin as a teacher?

Frederick Ames, MD

He taught by example. He would show you what he was doing. But as much as I can remember, you paid serious attention to what he was doing, because he wasn’t giving you a step-by-step, what I’m doing now, look at this, look at that, look at the other, and yet, everyone looked at him—we all asked him to look after our mothers, what else do you say about that?

Charles Balch, MD

He was the surgeon’s surgeon.

Frederick Ames, MD

He was the epitome of the surgeon’s surgeon and that’s what I wanted to be.

Charles Balch, MD

Did he do the surgery, did he first assist?

Frederick Ames, MD

Yes he did, he did both, but remember we had the different classes then. We can go off the record and I can just grab some of that too.

Charles Balch, MD

Okay, we’ll do that later.

Frederick Ames, MD

He did both, but he was a master and it was painful because occasionally, they would have a fellow that was not up to the task. Later on, we had fellows who were political appointees and that was painful, and during your time here, you remember some of those.

Tacey A. Rosolowski, PhD

How did people handle that? How did Dick Martin handle that?

Frederick Ames, MD

It’s hard to know, because he was in his operating and I was in mine, but I heard some of the stories of a scrub—you know the scrub pad that you use on your Electrocardio unit being sewn into someone’s abdomen because he was letting—I mean and all that kind of thing, which I couldn’t tolerate. I was a favorite of some of the fellows and I was despised by others, and my impression is, my summation of that is I quickly sorted them out. I didn’t think some of them were up to the task and to this day, if you follow them in their careers—

Charles Balch, MD

You were right.

Frederick Ames, MD

I was right.

Charles Balch, MD

Yes sir. All right, so let me—

Frederick Ames, MD

A lot of people were not fond of me for that. Dick Martin, on the other hand, was very quiet, he was very genuinely—he never got ruffled. When he got brought in to try to salvage some patient who was on the operating table bleeding to death, he would do so quietly, I mean you can’t imagine how calm he was. I would get excited and accomplish the task, but Dick Martin would never get his feathers ruffled.

Charles Balch, MD

Did Dick Martin attend surgical meetings, SSO?

[01:12:-07]

Frederick Ames, MD

Yes.

Charles Balch, MD

American College of Surgeons. He was not very visible though.

Frederick Ames, MD

No. He was known in the SSO because of so many people who knew him, and he had trained quite a few. Of course he went to the Texas Surgical [Society] all the time. He was a very humble, quiet, reserved person.

Charles Balch, MD

I think those are good words, those are my memories.

Tacey A. Rosolowski, PhD

Was that kind of—you know, as your talking, I’m thinking there must have been a very different sense of how a surgeon built a career at that time, like what do you need to do. Am I right in picking that up?

Frederick Ames, MD

Well, the story I remember about Dr. Martin, he did his surgical training in Galveston, although he’s from the Northeast. I guess Edgar Poth was the chair then, I’m not sure he was, that goes back so far.

Tacey A. Rosolowski, PhD

Let me ask the question a different way, because I don’t want to take us down one of those terrible rabbit holes, I mean because what I wanted to get at was here we have this generation of individuals, as you said, clinicians that are kind of really under the radar, I mean they’re excellent, but they don’t have a lot of visibility and that of course is having an impact on how MD Anderson is perceived.

Frederick Ames, MD

The brief vignette, the story that I remember was Dr. Martin finished his training but didn’t have a license in Texas. He wanted to stay in Texas --and again, this is hearsay from somebody born in the year I was born, remembering back a long time ago-- they said, if you’ll go up to MD Anderson and work with Dr. Clark for whatever period of time, you can get a license.

Tacey A. Rosolowski, PhD

Oh, interesting.

Charles Balch, MD

Part of my impression, let me just go over that, is the culture here that started with Lee Clark and Ed White, was they recruited like minded people in terms of attitude and personality. It was a contrast to people across the street, you know with the Michael DeBakey/Denton Cooley, who were big personalities, but there was a lot of turnover underneath them. Here, the culture was recruiting likeminded people, and if you were going to survive and be a leader, there’s a consistency among people. Look at Felix Rutledge, he was just like that also.

Frederick Ames, MD

I got to know Dr. Rutledge, because he would invite me to do combined procedures with him.

Charles Balch, MD

He was a short but very humble man, but he was a giant in the field.

Frederick Ames, MD

Oh yeah, but there again, Dr. Martin --now it’s coming back to me-- he came here to work with Dr. Clark. But you’re right, obviously, Dr. Clark liked him and saw in him what he was looking for, and he was invited to stay, and a lot of the early cases were done by Clark and Dr. Martin together.

Charles Balch, MD

And you see, Tacey, this goes back to one other thing that I think is fundamental to this and the vision of Lee Clark is there’s only been one practice plan. I can tell you, having worked in other places, that the financial barrier between departments can really interfere with the ability to give multidisciplinary care. But Lee Clark started from the beginning, with one practice plan, so there was no financial reason that you didn’t mind doing less surgery and giving the patient radiation therapy, because you’re all contributing to the same practice plan.

Frederick Ames, MD

I was told that upfront, not by Dr. Clark, but it was painfully obvious. I was also told, and I suppose it’s true and someone could find out, that he went and spent a good part of year, six months or maybe even a year, at the Mayo Clinic, seeing how they did things.

Charles Balch, MD

He did. My point is that I think one of the reasons that multidisciplinary care evolved here before it did in other places, goes back to his leadership and how he set up the organization and the people that he recruited to be leaders. I think we’re hearing a common theme about culture, personality. There’s no outliers of one person dominating over another, other than Lee Clark.

Frederick Ames, MD

It was clear that multidisciplinary care was the way and the truth, and that was how it was to be practiced, and every disease site was organized that way. We wound up in little fiefdoms, and you remember it took a while to get a disease site collection in one center because we didn’t want to lose our identity and there were some good reasons for that. But in terms of multidisciplinary care, that was the way it was practiced from the beginning as far as I know and the plan had a lot to do with that.

Chapter 04: The Impact of R. Lee Clark, MD and Richard martin, MD

Share

COinS