Reflection on 40 Years as a Cardiothoracic Surgeon

I am pleased to provide my reflections on what is now forty years of practicing cardiothoracic surgery.  In 1958, after graduating from the University of Alabama in Birmingham, I pursued surgery training under James D. Hardy in Jackson, Mississippi.  Jim Hardy would become my role model and life-long mentor and professional associate.  At the time, I was interested in general surgery but coming under the spell of Hardy mandated that I enter cardiothoracic surgery.  Watts Webb, who later chaired surgery at Tulane, was another role model on the University of Mississippi faculty.

 

I was extremely fortunate in being able to participate in the first successful human lung transplant on June 11, 1963, shortly before I completed my training.  I then spent two years as chief of the Thoracic Surgery section at the Walter Reed Army Institute of Research.  Following military service, I went to Lubbock, Texas in 1965, and participated in the founding of the Texas Tech University School of Medicine, and from 1970 until 1983, I directed the thoracic surgery division.  I was pleased to have the opportunity to initiate the open-heart program at Texas Tech and I participated in the founding of two other open-heart programs in Lubbock.  At the time, we were undermanned and overworked with the ever burgeoning increase in the number of coronary bypass operations. 

 

Although primarily pursuing the private practice of cardiothoracic surgery, I found time to participate in many activities of the new Texas Tech University School of Medicine including serving on its Foundation Board from the beginning.  I also found time to mentor students in an afternoon session one day a week.  In addition to some didactic instruction, they would make rounds with me and come to the operating room.  Several of these students ultimately entered cardiothoracic surgery following this clinical exposure.  I was able to assist the Texas Tech full-time faculty with the formation of the surgery residency.  In addition to rotating at the main teaching hospital of Texas Tech, general surgery residents also rotated through Methodist Hospital, the site of my practice of cardiothoracic surgery.  All of this experience whetted my appetite for academia and,  fortuitously in 1983, Jim Hardy offered me the opportunity to return as Professor of Surgery at the University of Mississippi Medical Center.  So, at the age of 51, I re-entered the academic world of surgery and plunged into the opportunity afforded me by Jim Hardy to teach residents and students.  Recall that I had been away from full-time academic employ for twenty years, so I had a lot to learn.  When I left in 1963, there were no women surgery residents and no minority students or residents at the University of Mississippi Medical Center.  However, twenty years later, both of these shortcomings had been remedied as Dr. Hardy had attracted a large number of women into the general surgery program as well as the thoracic surgery fellowship.  The number of female medical students had increased dramatically as did participation by minorities, especially African-Americans.

 

From 1983 until his retirement in 1988, I worked closely with Jim Hardy.  At the outset, he advised me to redirect my talents toward general thoracic and vascular surgery and to abstain from heart surgery, which I did following his advice. His rationale was that I could more smoothly advance academically if I excluded heart surgery rather than emphasizing it in my new career.  So, I redirected my surgical efforts toward teaching residents the nuances of the management of lung cancer, esophageal cancer and mediastinal tumors.  This proved to be very productive and led to a number of publications primarily with residents.  I was also able to do some meaningful research using the departmental flourescent activated cell sorter to demonstrate a particular type of B-cells that were prevalent in patients with advanced ARDS. 

 

As Dr. Hardy prepared to retire in 1988, he asked me to become Chief of Surgery at the adjacent G.V. “Sonny” Montgomery VA Medical Center, which I accepted on his recommendation.  Meanwhile, my new chair and compatriot, Robert S. Rhodes, was appointed James D. Hardy Professor and Chair of Surgery, and I greatly enjoyed this new relationship.  Bob and I worked together on many projects and several successful Residency Review Committee visits.  It was always a pleasure to work with Bob, and I did everything I could to expand the teaching of general thoracic surgery at the VA Medical Center.  During this time it was my pleasure to engage in productive clinical advances, particularly in the utilization of median sternotomy for advanced bilateral lung disease including multiple pulmonary metastases.  This proved to be quite effective and led to several interesting publications and doubtless engendered respect and enthusiasm for general thoracic surgery among the general surgery residents as well as the cardiothoracic surgery fellows. 

 

Having secretly harbored a desire to succeed Dr. Hardy as Chairman of Surgery at Mississippi, I continued to dream about the possibility of chairing an academic department.  In fact, from 1988 to 1990, I interviewed at several prestigious medical centers for the position of Chair of Surgery, but nothing worked out.  In June 1990, I chanced to see an ad in the Archives of Surgery for a faculty position with Dr. Will Sealy, interim Chair of Surgery at Mercer University.  I had always admired Dr. Sealy for his pioneering arrhythmia surgery at Duke and welcomed the opportunity to work with him in an academic environment.  Soon thereafter I came for an interview and ultimately accepted the position as Associate Chair and Associate Program Director.  My principal assignment was to begin preparation for a very important RRC visit that would soon occur.  This necessity led to my move to Macon in October 1990, rather than waiting to start at the beginning of the new academic year, so that I could immediately begin preparation for the RRC visit.  It turned out even under the aegis of Dr. Sealy the general surgery residency had been on probation for thirteen years, and the decisive RRC visit was pending.  In May 1991, I became Program Director and July 1, 1991, I was appointed the Chair of Surgery for the Mercer University School of Medicine Department of Surgery by Dean W. Douglas Skelton.  This was an opportunity I had relished for many years, and I was determined to make the most of it.  With the new tasks of Program Director and Chair of Surgery, I had a lot to learn.  However, my main thrust was to inculcate in residents the habit patterns of successful surgeons, and this I did by example.  It is always a pleasure to see residents respond to their mentor in a positive way.  With Dr. Sealy’s valuable assistance I completely redid the surgery residency program leaning heavily on the Halstedian principle of gradually progressive responsibility so that they would leave as well trained surgeons who could perform competently and independently.  Nothing is more pleasing for a surgical mentor than to see his residents perform well and excel on the In-Training Exams, Mock Orals and certification by the American Board of Surgery as well as their ability to compete successfully for various fellowships after completing their training in general surgery. 

 

The residency gained full approval in February 1992, and three years later, we obtained a full five-year approval, and this was repeated in 2001.  We anticipate our next RRC visit in February 2006.  It was my pleasure to work closely with Will Sealy for a full decade until his retirement in 2000 and his death in January 2001.  I certainly learned a great deal about training residents and about life values in general from my illustrious colleague and mentor.

 

For the past fifteen years I have fully enjoyed and welcomed the opportunities presented to me, both in mentoring students and training general surgery residents.  We have emerged as a highly successful surgery residency that continues to attract a large number of quality applicants for our program.  We continue to strive to work at improving the residency in every way possible.

 

So, after spending almost eighteen years in private practice with part-time academic responsibilities, I have spent the last twenty-two years in full-time academic employ.  Nothing has ever given me more pleasure personally and professionally than my current duties as Chairman and Program Director of the General Surgery residency of Mercer University School of Medicine.  I continue to persevere to improve both myself and the residents under my direction.

 

I have had three major fortuitous surprises in the past year.  First, I was elected First Vice-President of the Southern Surgical Association at the annual meeting in December 2004.  This was followed in February 2005 by being selected as the Alumnus of the Year by my alma mater, the University of Alabama School of Medicine.  To this was added in September 2005 the opportunity to become Dean of the Mercer University School of Medicine.  I currently serve as the Chair of Surgery and Program Director, as well as Dean.  Unfortunately, this new responsibility has proscribed continuing my career as an operating surgeon which I decry because I have always believed that a Chair of Surgery should be an actively operating surgeon.  Doubtless, my career as Chair of Surgery will come to an end within the next few years.  Meanwhile, I continue to enjoy my work.  I miss operating, but after forty years, it was time to hang it up.  I hate to see it come to an end, but nothing goes on forever.  It has been a wonderful forty years, and I would not take anything for having had the pleasure of the many opportunities presented to me over the past four decades.   

 

In looking over my career, I can think of no better way I could have spent my professional life nor have been so thoroughly rewarded for my efforts.  The opportunity to have young surgeons leave the residency well trained and independently competent is a joy for me and always has been.  Having participated in all phases of cardiothoracic surgery for a number of years, I can truthfully say that it is an exciting and demanding field and one from which participants gain a great deal of life-long happiness and satisfaction.