Title: The Lengthened Shadow of One Man

Contributor: James B. Wyngaarden

In his essay entitled, On Self-Reliance, Ralph Waldo Emerson famously asserts, "An institution is the lengthened shadow of one man." All of us in this room would likely agree that the Department of Medicine at Duke has become an institution and its lengthened shadow is that of Gene Stead, its chairman from 1946 to l965.

I would like to take a few minutes to describe some of my experiences growing up in Gene's department. I came to Duke as a young faculty member in 1956, after completing residency training in Boston and 5 years of biochemical research in New York and at the National Institutes of Health (NIH) in Bethesda.

Gene had been chairman at Duke for 10 years, and was placing his first departmental "graduates" in chairs in other institutions. Jack Myers had gone to Pittsburgh, Sam Martin to Florida, and within a year John Hickam would go to Indiana, and Jim Warren to University of Texas-Galveston and then to Ohio State. My first month at Duke was spent setting up a lab in the Bell Building, and easing back into clinical medicine. I worked in the Rheumatology Clinic with Bert Persons and Grace Kerby, and made teaching rounds observing Gene Stead, John Hickam, Jim Warren, and Frank Engel.

I had been exposed to some excellent clinical teachers at Michigan and the Massachusetts General Hospital, but I concluded that Gene Stead was the best bedside teacher I had encountered. I also observed that the Duke medical students were the best-trained students in physical diagnosis I had met, especially in cardiovascular diagnosis, which Gene personally taught them in the second year.

I then received my first rounding assignment at the Durham VA Hospital where Joe Greenfield was my intern. In those days we rounded three days per week, eleven months per year. Gene moved me around in assignments on Long Ward, Osler, Strudwick, the private side (Minot and Hanes), and the outpatient clinic (OPC). For a time I conducted clinical conferences at the VA every Tuesday noon, and in the OPC every Saturday morning. I also saw private patients one afternoon per week, and took my turn with occasional clinical-pathological conferences. Eventually, I became the regular Mon-Wed-Fri attending on Long Ward, opposite Gene who maintained the same schedule on Osler.

I first visited Duke on invitation of Philip Handler, Chairman of Biochemistry, in connection with an opening in his department that I did not take. But after accepting Gene's subsequent offer I was given a joint appointment in Biochemistry and for some years delivered the purine-pyrimidine-nucleotide-nucleic acid lectures to the freshman class. Phil led a faculty effort to introduce an elective year in the medical school curriculum for an intensive medical student research training program (RTP). He helped to secure funds for an additional wing on the Bell Building to house this program and the laboratories of the new faculty that it would require. Gene strongly supported this effort. In 1959, Phil asked me to become Director of the new program, and to help organize it, and publicize it among the students. I, of course, immediately consulted Gene about Phil's request. Gene asked me whether I would like to do this, and. I said I thought I would. One nanosecond later he said, "This is an experiment. We don't know whether it will be successful. If it is not, I don't want it said that the Department of Medicine didn't put its heart into it. From now on you will not receive any teaching assignments from my office. When you have time, you can ask to make teaching rounds or to see patients in the Private Diagnostic Clinic." And that's the way we proceeded for the next few years.

One day in the Bell Building I received a call from Bess Cebe. Gene had a visitor, a physician friend who was an executive in a pharmaceutical company, in the Baltimore area as I recall. He had asked to see me. We discussed the RTP and my latest research, and then he offered me a job. After he left I reflected on his visit, and thought to myself, "I wonder why Gene sent him over. Is he perhaps sending me a message?" So I went to talk with Gene and told him of the conversation and the job offer. I cautiously asked Gene, "Do you think this is something I should look into?" Gene's laconic reply was, "Jim, I would have thought you were good enough to make it in academic medicine." Having gotten the reassurance I sought, I returned to my lab in the Bell Building.

I believe the RTP turned out rather well. A number of student participants went on to highly successful careers in medical science or academic medicine. The experience of students who returned to the laboratory after an introductory clinical experience provided an insight that contributed to the major medical school curriculum revision that took place at Duke in 1963. In addition, the RTP eventually evolved into the MD-PhD program at Duke, one of the initial group of 3 such programs funded by the NIH.

In 1967, after serving for 2 years as Chairman of the Department of Medicine at the University of Pennsylvania, I was invited to return to Duke to succeed Gene, who against all entreaties insisted on retiring from the chairmanship at age 60. Duke was a better fit for me than Penn and I readily accepted. Some of my friends were concerned about my decision. There were contemporary examples of new chairmen taking positions in departments where the retiring chairman second guessed every decision, subverted initiatives, and made life miserable. These friends were worried about my going to a department and school where the retiring chairman had been such a dominant figure for so many years. But I knew Gene well enough to be certain that would not be a problem. When I arrived Gene stayed for one month to ease my transition. Then he and Evelyn departed for a one-year sabbatical in New York City "to get out of my way." (His words, not mine!) On returning, Gene insisted on having an office on the second floor of the Baker House, as far from the departmental office as possible, so his comings and goings would not routinely take him by my door. Gene kept busy with his activities in the Physician Assistant Program, and his computerized cardiovascular database, and continued regular teaching rounds with house staff and students. Only on rare occasions would he drop into my office. Perhaps once a year he would come and say, "Jim, there's a problem in the department you may not have heard about." In 90 seconds he would tell me what was on his mind. Then he would stand and say, "Do whatever you think you should do. Blessings on you. Bye," and he was out the door. In the 15 years of my chairmanship, Gene never once came back to ask me what I was doing about the matter he had identified.

Gene also had unanticipated absences from Duke. In the early 1970's, John Hickam died suddenly of a cerebral hemorrhage, leaving the Department of Medicine at Indiana in difficult straits. Gene was asked to step in to stabilize the department, which he did by spending 4-5 days per week in Indianapolis for about a year. Later, Michael DeBakey, Chief of Surgery at Baylor College of Medicine in Houston, and a long-time friend and admirer of Gene, was appointed Chancellor at that institution. DeBakey realized that the Department of Medicine was in need of revitalization and asked Gene to help him do it. Gene spent considerable time on this mission in Houston. Eventually, Henry McIntosh left Duke to become chairman of the department at Baylor, to which he recruited a number of Duke-trained people.

After leaving Duke in l982 to go to the NIH, I saw less of Gene. From time to time he was in Bethesda in an advisory capacity, as he had been off and on for years. During my time there Gene chaired the Board of Regents of the National Library of Medicine, and we got together on a few occasions. Since moving back to Durham in 1997, I have been a periodic guest in Gene and Evelyn's home at the lake, never ceasing to be amazed at the intellectual power and personal vigor he continues to bring to his analyses of medical education and the health care system. As we all know, Gene is a man of unique, pithy and contrarian views. In the essay, On Self-Reliance, that I cited earlier, Emerson also said, "Whoso would be a man must be a nonconformist." Thus Gene stands in a distinguished tradition.

In closing, I would like to say a personal word to you, Gene, and that is, "Thank you for all you did for me, and for all of us in this room, over so many years".