Lessons in Creating a Rewarding Career

You have much to anticipate in your upcoming professional career with the likes of genomic medicine, regenerative medicine, and nanotechnology in the offing. I would like to be a fly on the wall 40 or 50 years into your careers to see if the extraordinary advances in medicine made in the last half-century are replicated. My guess is they will be even more extraordinary. To give you some perspective from my experience, I will share with you some aspects of medicine that I encountered at a similar stage as yours in my training. I graduated from Northwestern Medical School in 1953 at the age of 27. That occasion was further highlighted by my marriage to Barbara, who has survived living with a physician who for many of the past 61 years was more often than not away from home. We moved to Philadelphia so I could enter a 1-year rotating internship at the Philadelphia General Hospital, which was similar to The Houston Ben Taub Hospital. The Philadelphia General Hospital, affectionately called “old Blockley” by those who served there, no longer exists, nor do general rotating internships. The latter have been replaced by a “transitional year” for those physicians entering a nonmedical specialty. My marriage nearly floundered in the first month as my initial rotation was on a general surgical service. For each month, I was allowed one Wednesday afternoon and one Sunday off. Contrast that to the working hours trainees must adhere to today. As so often happened then for young physicians, I followed one of my role models, Dr. Thomas M. Durant, to Temple Medical School, where he was to become chairman of the Department of Medicine and also president of the American College of Physicians. The faculty at Temple Medical School Hospital was small and equally distributed between private practice physicians and full-time medical school physicians, all of whom were superb teachers. Penicillin, as a cure for streptococcal infections and a prevention for rheumatic fever, was well known, but there were literally hundreds of patients with rheumatic heart disease. At that time, there was a rheumatic heart disease hospital in Philadelphia to help care for them. In the 46 years since I’ve been in Houston, I may have seen one case of acute rheumatic fever from Louisiana and scattered cases of rheumatic heart disease from mostly south of the border. I spent 3 months at a tuberculosis sanatorium because tuberculosis was still very prominent. There I became proficient in producing pneumothorax and pneumoperitoneum as a form of treatment. Tuberculosis pericarditis was the most common form of pericarditis. My tuberculin skin test became positive when I was there. The most attractive part of that rotation was the monthly salary of $150 compared to the $50 I was paid at Temple. Remember, this was 60 years ago. Hypertension was treated medically with the rice diet and Smithwick splanchnicectomy (thoracic lumbar sympathectomy) operations, of which there were more than one.1 We became experts in physical diagnosis, because I knew that when we took the internal medicine board examination, the most common cause for failure was missing some significant physical finding. Examinations in those days were oral, and gamesmanship played a large role. My examination took place at King’s County Hospital in Brooklyn, and my examiner, well known for being a very tough examiner, entered the room where I was waiting and called my name, “Mr. Winters.” I learned that day not to take umbrage when being put down. As it turned out, the examiner and I hit it off right from the start, and I easily passed. I earned a Master’s degree in Medical Science during my residency, investigating new oral diabetic drugs that had just become available for study. At the end of my medical residency, I stayed on at Temple for 1 year as their first cardiology fellow. A year doesn’t sound like much in today’s timeframe, but at the time there was very little to learn. Electrocardiography, fluoroscopy, and chest X-rays were high on the list. A German physician, Hugo Roesler, was an expert in cardiac fluoroscopy and took pride in demonstrating his expertise. We spent hours perfecting our physical examination technique. Ballistocardiography became popular. And when I took my cardiology board examination in 1970, I was offered the option of interpreting electrocardiograms or ballistocardiograms. A myocardial infarction was treated by 6 weeks in bed, and the patient was not permitted to feed himself/herself the first week or two. Drugs available at the time included digitalis, morphine, nitroglycerin, oxygen, barbiturates, and an injectable form of mercuhydrin. There were no coronary care units; that concept came much later. Dr. George Burch at Tulane Medical School treated dilated cardiomyopathy with a year of bed rest. Among those who survived, a few actually improved. Patients with rheumatic heart disease and intractable peripheral edema frequently encountered “Southey tubes”—a small metal tube placed in the flesh of the lower extremities to drain fluid...a E D I T O R I A L