You have found an item located in the Kentuckiana Digital Library.
1986-05-19 Interview with John W. Greene, Jr., May 19, 1986 1986OH140 UKMC 43 01:12:31 UKMC001 University of Kentucky Medical Center Oral History Project Louie B. Nunn Center for Oral History, University of Kentucky Libraries Greene, John W. -- Interviews Social medicine University of Kentucky. Medical Center -- History Willard, William R., 1908- Medical education--Kentucky--Lexington--History University of Kentucky. Dept. of Obstetrics and Gynecology John W. Greene, Jr.; interviewee Richard C. Smoot; interviewer 1986OH140_UKMC43_Greene 1:|2(5)|20(7)|31(3)|41(6)|52(11)|63(13)|86(11)|102(7)|123(10)|136(12)|148(5)|163(10)|177(15)|190(8)|208(7)|229(15)|245(6)|255(10)|265(11)|280(2)|291(10)|302(9)|326(3)|341(14)|360(2)|370(7)|380(8)|392(1)|404(2)|415(10)|431(7)|444(13)|460(10)|475(7)|487(4)|496(9)|509(13)|522(5)|544(4)|557(2)|572(12)|591(4)|618(9)|629(7)|642(4)|660(8)|673(9)|688(13)|704(6)|721(5)|735(7)|752(4)|769(7)|780(12)|792(8)|809(3)|823(6)|836(2)|848(10)|865(11)|881(10)|896(13)|908(3)|921(6)|935(6)|948(14)|967(12)|986(2)|998(11)|1019(5)|1030(11)|1043(6)|1059(12) audiotrans UKMCoh interview GREENE: Um, I um, graduated from high school and then went into the Army in 1945. Of course, if you remember history, the-- we were being trained to go to war in Germany, and then Germany surrendered in April of '46, and then they trained us to go to fight the war in the Pacific, and island by island, we were gonna conquer Japan, then, I was in the service then, but then they dropped the bombs in August of '46-- SMOOT: Wasn't that '45? GREENE: '45--'45, that's right, that's right. That's right. You're a better historian than I am. SMOOT: (laughs) I'm supposed to be. GREENE: (laughs) It was a very interesting stage of my career. I was just a youngster out of high school at the time, and the United States uh, discharged--the Army, anyone that had any length of service or had seen action was almost automatically discharged as soon as the war was over, but it left the cadre of us to-- that they didn't know what to do with, so my story goes on that that they uh, felt they needed a group of engineers to rebuild Europe, and I was sent to Ohio State in an engineering program under the auspices of the Army and learned to be a civil engineer. That was from '40--somewhere in '45 to um, early, uh, '46, something like that, and then all of a sudden, as many government programs do, they abolished it one day and discharged us. (Smoot laughs) So, I had always wanted to be a physician and returned to Pittsburgh and went to the University of Pittsburgh for uh, really two and a half years. Graduated from the University of Pittsburgh in 1948 and then um, went to medical school. I was admitted to the University of Pennsylvania Medical School in Philadelphia in September of 48 and went to Medical School from '48 to 19--graduated in '52, June of '52 from the University of Pennsylvania. Then, stayed at the University of Pennsylvania for an internship and residency in obstetrics and gynecology. I did, after my residency, what you would now call a fellowship, from 1956 to '58 in endocrinology. They do--they didn't have it as formally organized as they do now, but then I was on the staff of the hospital of the University of Pennsylvania from um, 1956 until I came here in February of 1963, so for about six years I was a member of the faculty at the University of Pennsylvania College of Medicine, School of Medicine, there; and then Dr. Willard, who was uh, the organizer of this medical school, contacted me in the spring of 1962 and asked if I would be interested in coming to Lexington to head up their OB department. I was a young fellow, thirty-five years old at the time, and, uh, it never-- I never thought much about it 'cause all of my medical education had been at the University of Pennsylvania, and I was very happy there and doing very well. It was very interesting-- I never paid much attention to the letter he wrote me. I did politely answer it and sent a CV. Didn't hear anything from him, uh, and that was in May or April of 1962. Then in 19- and in July of '62, it was very interesting, I was invited to Texas to give a series of talk of a symposium there, and because of my love of tra-- train, I took the train from Philadelphia to Houston, Texas, and Dr. Willard went looking for me because he wanted to interview me, and he called my office in Philadelphia, and they said, "Well, he's in Houston, Texas," and he called Houston, and they said, "Oh, he left two days ago." Well when you're on the train in 1962, it took uh, two days to get from Houston, Texas to-- I was up here in Columbus, Ohio by then. So, he found me in Columbus, Ohio and asked me to come to Lexington to interview for the position, so we rented a car and uh, drove to Lexington and looked at what they were building here which was indeed very exciting. Of course, Dr. Willard was one of the greatest men I've ever met and still maintain a colleagueship with him, and, uh, then we talked a long--and he came to see me, and-- I visited here in July of '62, and then he came to see me in Philadelphia in a couple of weeks, and I very-- got very excited and interested in this but because of things in Philadelphia, I couldn't get away until February of '63, but we, I guess, signed a contract in September of '62 to become the first chairman of the Department of Obstetrics and Gynecology here at the Medical Center. SMOOT: Had you known Dr. Willard before? GREENE: No. SMOOT: How'd he caught wind of your name? GREENE: He got my name--Ed Pellegrino who was then chairman of medicine was visiting with a fellow by the name of Luther Brady, who was at the University of Pennsylvania, and Ed Pellegrino says, "Hey, we're looking for a chairman of OB." And he said, "Why don't you interview Jack Greene," so he gave my name to Dr. Willard, and Dr. Willard wrote to me, and that's how it came--that's how those things come about. SMOOT: Dr. Willard had made the initial contact with you? GREENE: Yes. Well, really Jack Githens, who was chairman of pediatrics at that time, uh, came to see me in Philad--I shouldn't leave that out--he came to see me in Philadelphia, just to see what I looked like and whether I had two heads or not, and, and uh, I guess that was even before they invited me to come here. Jack Githens paid a visit to Philadelphia. SMOOT: What were your impressions of the people that you were talking to? GREENE: Oh, people were and still are some of the finest people I've ever, uh, met. I mean, uh, it was--it's very exciting. It was a real group of scholars who were assembled here. Ed Pellegrino, William Willard, I said was one of the greatest men I ever had contact-- a few great men I've had contact with in my life, and he was one of them. Um, Ben Eiseman, chairman of surgery at that time. A lot of exciting things going on here. Dick Wittrup was the hospital administrator, Howard Bost had a lot of ideas about the delivery of health care, and it seemed very exciting to me. SMOOT: Why would you call Dr. Willard one of the great men that you've met? GREENE: Dr. Willard, I classify-- there's about four people that I figure were some of the greatest people I've been associated with. Uh, Dr. Willard is and was a scholar. He knew, uh, medicine. Dr. Willard was a very kind person. Have you met him? SMOOT: Yes. GREENE: Uh-hm, so you know what I'm talking about. SMOOT: Yeah. GREENE: He's a very thoughtful person. He was a very kind person. He was a very well educated man. Uh, he never made, um, uh--uh, he was kind in the respect that he, uh, he could be decisive, but he was never abrupt or abrasive to anyone, and he gave things a great bit of thought, and one of his greatest attributes was always, "What do you think?" And, uh, because I was at the University-- the reason I, well--to give you an example of why I thought he was so great, um, the University of Pennsylvania was the original medical school in the United States and had been going for two hundred plus years, and they had a certain pattern of, of the way they did things, and I, and Dr. Willard would say, "How would you organize a Department of Obstetrics and Gynecology?" And I'd say--I would talk for about a half an hour, and he'd say, "Well now, if you came to Lexington, there's certain things we would want done a little differently. Uh, we are very interested in a full time staff." So, he was great in that he, he had a great sense of organization, a great way of putting forth his ideas and sort of bending you to his thought, a friendly persuasion sort of thing. Um, he was never, never in a hurry. He always seemed to have plenty of time to ask you what you thought and to uh, let you tell, let you listen to what he thought, and he knew everybody, and, uh, he could-- had tremendous memory. Well, we talked about that, and we, uh, we decided and so forth. And then, he did a tremendous amount of research. I can remember Murray Kinsman was dean of the University of Louisville in those years, and I can remember um, Dr. Willard spending a weekend or two talking to Murray Kinsman about the relationship with Louisville, then when I came here to visit, Dr. Willard said, "Let's drive over to, to Louisville. I have some business to transact over there. I would like you to meet the people in Louisville while I'm doing uh, my courtesy calls that I want to make." So, we drove over to Louisville one day. He took me to see the President of the University, Frank Dickey, and he did these things himself. He took time to do these things. Uh, he didn't delegate it to other people. The amount of time and effort and thought he gave to this, um, Medical Center, could never be-- I mean, you just can't--it was exceptional, and he just had his eye on the ball twenty-four hours a day, seven days a week. And there was another great person, his wife. She gave, uh, dinner parties. She taught Sunday school. She raised three children of her own, and have you met Adaline Willard? SMOOT: Yes. GREENE: Great, magnificent wo--as I said, and my three daughters went through her Sunday school classes at Second Presbyterian Church. She did a tremendous amount of entertaining with, uh, minimum cost. She would give dinner parties at their house for thirty people, and she would have it organized so that she would ask two or three of the wives to, to bring, uh, a covered dish, and then she would have a, uh, main course and then have, uh, several people serve it. It wasn't done with great uh, ceremony and pomp but done in a very comfortable style, to say nothing of the hours of work it takes to give a dinner party for thirty people, and then, even though the classes of medical students in those years in the range of thirty to fifty, she would have a class picnic. She would have a welcoming picnic. She would have a graduating picnic. She would have all these things. Just the sheer energy that goes--and-and Willard, he was the kind of dean that would walk in and talk to them any time. (laughs) I don't know how--and he was here all the time. He--he traveled worldwide, too, but yet he was--I can remember him coming in here one Labor Day. Uh, I was in a big hurry because they were having a family picnic at home, and he just happened to be wandering down the hall here about ten o'clock that morning, and we sat and talked for uh, an hour about how things were going, so he was around here all the time, always coming and saying "What's going on, what are your problems, what can I do for you?" And how the man had time to do that and still go to state legislature, be active in the American Association of Medical Colleges and things. He was just a great man. His memory of past events is terrific. His vision for the future of what medicine ought to be. He was just tremendous, and then he would disagree with them and say, "Well you know what? I think we ought to try to do such and such and so and so," and he had obviously given it a lot of thought. We had faculty meetings, every, or chair, not faculty meetings but chairman's meetings every Tuesday at noontime, and--and, um, every Tuesday down in the conference room off his office is uh, the, there were twelve to twenty of us, and the meetings began at twelve or twelve-fifteen, and frequently, they went til dinnertime, we broke for dinner, and then we came back at seven-thirty or eight and talk until ten or eleven and, uh, his ability to listen to everybody, and he would listen to everybody, and then Friday afternoon, there would be a memo on the desk of how the policy would be for next-- so, he was a dictator in that sense, but yet a great listener in the other on Tuesdays. SMOOT: Are those the two balls that a great administrator needs to be able to juggle? Be able to be a dictator sometimes and a good listener and-- and incorporate these-- GREENE: That's exactly what I'm saying. He had the ability to, uh, to listen to other people and to incorporate their thoughts but yet be a dictator when necessary. SMOOT: You talk about his persuasive ability-- GREENE: Uh-hm. SMOOT: --and you haven't said philosophy, but this is what you have been talking about. He would persuade you into thinking his way sometimes, perhaps because he had given great thought to-- GREENE: That's right. SMOOT: --the way this Medical Center should be constructed, the way it should be run, uh, all of the various people that should be brought in and how they should function within the institution. Uh, could you tell me a little bit about the specifics of that philosophy and how that may have been reflected, not only in the way you worked within the institution but also how the institution itself was structured? GREENE: Well, uh, I hope I answer it that would give you the information that you want. See, I was a youngster when I came here. I was thirty going on thirty-six--thiry-six, and while I'd had six years after my residency, I was a babe in the woods, but he--he liked that idea, while at the same time, he had been a man who had been in the administration of Yale Medical College, and then he was, what, Dean of Syracuse before he came here? SMOOT: That's right. GREENE: And so while a lot of us thought we knew how to do things the right way, and--and the old cliche of, well at our medical school we did it this way, he had thought through, and he was a very far, uh, ranging thinker, and, uh, he--he had some concept along with Bob Straus, uh, Howard Bost and so forth for the delivery of medical care, and, um, we all had our own specialized areas. The surgeons had theirs, I had mine, and medicine had their concept, and--and some of the concepts which they thought could be developed early on in the early sixties were very difficult to put into practice, because when you are dealing with multiple department chairman and other people, uh, some of these concepts of comprehensive care were very difficult to put into practice. He tried to persuade us to, uh, to do the, uh, to have comprehensive care. Now of course, funding was quite readily available in those days, and I can remember one of the things we failed at early on was there were, from the federal government, maternal and infant care projects, where they would finance, um, care for expectant mothers and their children, and the federal government would grant huge sums of money for prenatal care, hospitalization and, and so forth that complicated normal pregnancies. They also wanted the local doctors uh, in on that in that they would agree to what we, Dr. Willard and I wrote up, along with Dr. Howard Bost, a program and took it to the County Medical Society. Well, the County Medical Society was reluctant for us to accept federal money in those days, so that failed at that level, and as much as we tried to persuade the local doctors to go along with accepting federal money, they really didn't want to, so that, in a way, his and my persuasion failed. So that's one way to answer your question. Uh, I think it was amazing his, uh, his thinking of just the geography of this building that we're in. Its structure of a medical school, a dental school, a um, nursing school, an allied health school, uh, then a university hospital, all within, uh, within the geographic confines of one building. That was something quite, not necessarily unique to this place, but a lot of the concepts of having anatomy on the same floor with surgery and--so he persuaded all these people to try to get together and--and work, and I think he was fairly successful early on. SMOOT: Were there other comprehensive care methods or proposals that Dr. Willard had suggested that, uh, that failed or that you found as impracticable? Could you, uh, cite some specifics for me? GREENE: Well what happened, the way I see it, was that with the avalanche of technology, the family practitioner got into difficulty because while this school was uh, developed, and if you've already read the literature early on, about the school was developed to furnish more physicians for the state of Kentucky, particularly in the primary care area. We were hitting in the late fifties and early sixties, this tremendous advance in everything from antibiotic therapy to surgical techniques of heart surgery, thoracic surgery, uh, antibiotic therapy for infectious disease, so we had an avalanche of knowledge, uh, so that Dr-- while Dr. Willard wanted everything to focus on the primary family physician at comprehensive care, we ran in-- head on into how much that family doctor had to--how much knowledge he had to have to be able to function, so I think the thing--there was some-- someone made a failure in that, uh, let's face it, we're in an age of super-specialization. Uh, a doctor can't treat a heart attack and then go deliver a baby and take out an, app--uh, uh, an inflamed appendix. So, that's where, where we got. They didn't have a department of family practice in the early years, but the emphasis on the primary physician sort of failed because it's very hard to educate a man who can be all things to all people. And then when you get into the paramedical things, like social workers, uh, physician's assistants and uh things, uh, we came to crash on how much one can accomplish for the individual as to one, his acute problem, whether it be a brain tumor, acute appendicitis and all the other social factors that, uh, involved, and so the comprehensive care thing is--was very difficult to deliver, although I'm sure you've read his--uh, he was chairman of the committee on what the family doctor or family practitioner should be. It's all there, but the thing I saw failing there was the tremendous bundle of knowledge one needs to be effective as a general physician, just like in history. You're studying a certain era of a few years. (laughs) You know. SMOOT: Everything. GREENE: Same thing in medicine. SMOOT: Um-hm. You--you mentioned that the uh, maternal and infant care project was turned down by the Fayette County Medical Society. GREENE: He-- the way the federal government stated it, we didn't have to get their permission, but it was desired that we do before bringing in a big project. Dr. Willard was very sensitive to the doctors of the community and the state, and since they had voted that they didn't want it, he didn't feel it was-- that we should forge ahead with it. That was one of his ways of dealing with that. SMOOT: Is this a reflection of the fear--the fears of medical societies generally for any kind of government intervention-- GREENE: Exactly. SMOOT: In anything? Okay. Let me ask you a little bit more about the team, the original team of people here. You mentioned Howard Bost, the medical economist, and--and Bob Straus, medical sociologist-- GREENE: Roy Jarecky. SMOOT: Roy Jarecky, administrator. GREENE: One of the greatest--the contributions of Roy Jarecky to this Medical Center are second only to, uh, Willard in his, uh, he picked students, I mean, he didn't pick them all, but his influence of not only selecting the class but, uh, counseling them through, uh, well you just can't estimate what all that's worth. He was just a great man, too. So, Willard picked him, and he's still here. SMOOT: This institution was a spin off, it seems to me, from what I've learned over the past several months, a lot of innovations. They were trying to do some things differently. Uh, as I mentioned, you had Robert Straus, the Department of Behavioral Science-- GREENE: Uh-hm. SMOOT: --and, uh, you had some different ideas in terms of curriculum development in the College of Dentistry, uh, the so-called diagonal curriculum developed by Alvin Morris and his, his original staff, etc. There were several-- GREENE: Oh, Al Morris was another tremendous person that Willard picked to come here. He did great things over there. (laughs). SMOOT: Could you specify on some of the innovations here and your impressions of what was going on here and try to put it some sort of context for the region or country, uh. GREENE: Well, Dr. Willard, being a very sensitive man, uh, he picked some very sensitive people like Bob Straus and Roy Jarecky uh, to-- he saw, that as Willard did, the tremendous technology coming along, open heart surgery, antibiotics and all the things you could do to people, and you wouldn't have time to talk to them as to what you were doing to them, for them or about them, and I think his, his-- the behavioral science department was an effort to, uh, teach humanistic medicine and sensitize the student to the needs of the patient, and again, I'd emphasize you ran head on into the tremendous number of facts that one needs to, to deliver proper medical care and at the same time they had an emphasis to, in say behavioral science, uh, to teach the, uh, the individual to be sensitive to, uh, the patient, the client, the patient and his family and the interaction of the disease upon this. I should get into one other thing. The thing that this state doesn't really appreciate is what this Medical Center has really contributed to central and eastern Kentucky. Say, and this is all part of the humanistic approach to it, we still have a tremendous shortage of physicians in eastern Kentucky. The number of medical, social problems that this Medical Center has solved for this state have never been appreciated or recognized. The local newspaper has damned every little mistake w-- they have seldom praised us. But when I think of what this Medical Center has done, not only in the production of physicians, in the production of dentists, nurses, allied health people, the sensitization of the communities within three hundred miles of here, uh, to the health needs-- when I came here, cancer of the uterus and cervix was a prevalent disease. Tuberculosis, and this Medical Center was tremendously influential in eliminating the diseases, teaching the present doctors and the doctors--why, the outreach programs that this place has, has conducted. See, Willard was all very sensitized to not only what the doctor had to know but what the community had to know about the doctor. And, it was that kind of feeling that we've never had proper recognition from, uh, the, the state. I think they just they've taken us for granted. "If we get a tough case, send it to the Medical Center, or if she's poor, send her--him or her--to the Medical Center." Well, uh, so we have solved a lot of medical problems. We have solved a lot of social problems, uh, for these people. Uh, and, uh, we have sensitized, not only the doctors in the state but the persons of the state to what the medical needs are. And, he was very powerful because he felt these needs, to where he would go to the frontier nursing services, spend a week down there. I did myself when I first came here. What did that do? That communita-cated to the medical community and the frontier nursing service what we were doing here, and I used to here, "Well the UK, the University of Kentucky Medical Center has set a certain standard of medical care, nursing care, dental care, uh, this kind of care," and, uh, Dr. Willard, just by his presence along with Bob Straus and all those other people, uh, did those things, so he--he sensitized the, uh, the people to not only their organic illnesses but their social needs. And, um, now you've got some other very important individuals whose pictures are hanging on the wall down here, uh, on the first floor. You got Burt Chambers who was really not active by the time I got here, but I got to know him. You had uh, Francis Massey, who just recently died who was, uh, Dr. Willard mobilized his ability. You had Cole-Coleman Johnston, um, then, who else's picture is down there. Oh, Edward Ray. I mean, you had all these people who were uh--and by, and Willard listened to all of these people as to what their thoughts were and so forth. That's those five, and there's four people plus his picture down there that were really tremendously helpful. SMOOT: Let me ask you a little bit more about this humanistic and community aspect of medicine-medical care emanating from the Medical Center here. Uh, one of the innovations ties back in with this innovative sort of question that I asked, uh, was the Department of Co--Community Medicine, Kurt Deuschle GREENE: Well, he's another great man, Kurt Deuschle, yeah. SMOOT: Uh, was his department and his, uh, concept of community care, uh, the primary driving force in this outreach, uh, to the community, or was this just one aspect of a total program headed by Dr. Willard, uh, to ensure an improvement of medical care for the people in the central and eastern regions of the state? GREENE: I'd answer that by saying Kurt Deuschle, his philosophy was, well he was primarily a teacher of medical students, so the way I saw his program was that he would assign-- he would get these medical students together and say, "Now, look. Um, we've got to go into a community and see, uh, a disease, or a social condition, uh, what-- what the condition--how--what the prevalence incidence and so forth is in the community, uh, what are the resources to take care of it," and so forth. He had a combination of both teaching a medical student to realize what problems were, how to solve the problems that were solvable and certain problems were not solvable, and then these youngsters would go out there and spend four to six to eight weeks, uh, evaluating, uh, the situation. Com-- I sat in on many of those conferences, and, um, the spin off from there was making the community realize what some of their problems were that they knew or didn't even know existed. They're very fascinating things. That kind of teaching is very expensive, because he assembled a group of people up there that were, oh, he must have had eight to twelve people in that department at one time that had tremendous teaching abilities as, as to what the health care needs of a community were. That takes a lot of time and money. SMOOT: Let me ask you about the influence of that department on the students; not only that department but also behavioral science. It seems that they were trying to give a more humanistic element to the physicians coming out of this institution. Uh, make them more socially conscious, perhaps would be a better way of putting it. Did they succeed? GREENE: Oh, I think they did. I--I don't think it--did they succeed? I think, uh, yes, they--they influenced a lot of other medical schools to--to do the same thing. Yeah, I think they--but you can't measure it. How do you measure that kind of success? SMOOT: It's arbitrary but-- GREENE: It's very arbitrary. Yeah, I think--I feel their absence, you know what I mean? We don't have it now. Bob Straus' department, um, see, Bob Straus and I did a lot of teaching early on. We had a course in human growth and development that we would take the concept of, uh, what a pregnancy meant to a family and then the what--we would take each stage after the child was born and would have a session that lasted a whole year on the stages, all the way from pregnancy, to birth, to adolescence, to middle age, to death and dying. Um, and I think that course, had a great impact on students. Hard to measure, but I saw a lot of other. They didn't have it with the University of Pennsylvania when I left there but when I went back to visit six years later they were doing it, so he came into some new things. Now whether we were the first, I don't think so, but, uh, I think that kind of thing is--is, is great, and, uh, again it takes time and along with time is money. You have to be able to finance those sorts of things. SMOOT: Are there any major problems that you saw when you came here that, uh, stuck out. Particularly impressed you? GREENE: The major problem that I saw, uh, when I came here was a tremendous number of people needing medical care that weren't getting it. Uh, because I came from Philadelphia where there was--there were medical facilities. Uh, if you were totally indigent, there was always Philadelphia General Hospital. Now while-- while it was not the Hyatt Regency, you would get good care there, and I came here, I could tell you story after story. We opened our obstetric-- obstetrical unit in July of '63 with the idea of just operating ten beds, uh, and within three months, we had thirty-seven patients a day, and I was just absolutely amazed at the total number of patients that needed a lot of doctor care. They had, and I don't, uh, know what the people did before, so that was a big problem. I--I've always told the story about a woman who came. Her son brought her in. She had a far advanced malignancy, and I said, she should be in the--she needs to undergo a course of radiation treatment, and I-I knew exactly what she needed, but we just physically didn't have the time or space to take care of--I told the son it would be six weeks before we could get her in the hospital and made arrangements for her, uh, to go to Cincinnati for her treatment. So, to answer your question, one of the--I wa- I was amazed because I had heard these stories where there shouldn't be a medical school in Lexington because there won't be enough patients for the medical students to see, and then we were inundated with some very serious, uh, medical problems that totally consumed our-- our time. Now, speaking from my own department, I was very fortunate in the early years with Jack-- Dr. Jack Drury, who came with me from the University of Pennsylvania and then Dr. Nick Lafoblus was our first resident who is now practicing in Bowling Green and us as a team, Dr. Patterson, Dr. Roddick, we assembled uh, about seven, eight, uh, faculty and residence staff that took care of--to answer your prob--directly, the biggest problem I saw was the great need for sophisticated medical care in this area. Uh, not that there wasn't good, uh, sophisticated medical care, but the number of people requiring it was unbelievable. SMOOT: Did you find this, p- uh, particularly bad in terms of coming from Pittsburgh, Philadelphia. You'd been in major urban centers. Did you find that the problems were unique or special for our rural population coming in from eastern Kentucky? GREENE: No, I don't think they were unique or unusual. They were just a lot of them (laughs). I mean we saw this in Philadelphia. We had cancer of the cervix, we had complicated pregnancies and so forth. We just had more people to take care of than they had here. SMOOT: Tell me a little bit about the nuts and bolts of this department. You came in as chairman. GREENE: Uh-hm. SMOOT: What was it like setting up a department, uh, what were the specifics of setting up the department here, what did you have to do, what did you have to deal with and how did it fit in with what Dr. Willard had wanted you to do. GREENE: Well the biggest problem I had in setting up this department, by the time they got to me, I guess they were sort of hard up and they were-- took anyone they could get. (Smoot laughs) Um, everybody else that I saw who came here had time to plan a curriculum and so forth. You see, I came in February of '63, and there was already a class of third year medical students. The day I got, I go-- I pulled into town on a Thursday afternoon, and they wanted me to start a series of lectures the following Monday because the third year students had had no OB-GYN, and, um, so, uh, the nuts of bolts of it were I took the curriculum from the University of Pennsylvania and put it in effect here. And, I didn't have time to write up all of the objectives and basic uh, goals that one would like to do in a new school. Jack Drury came with me from the University of Pennsylvania, and it was the two of us for about, and then Nick Lafloblus came four months later, and it was really the three of us that sort of put it together. Uh, the term I would use: we hit the ground running. We didn't have much time--so what I did was brought a University of Pennsylvania curriculum here, and then, uh, now there were some people that in those days who did great things for me. Carl Delobar, who is still here today. He knew about all the finances of everything, and I didn't know anything about that. Carl just-- he said, "Well, I'll take care of buying that desk and these chairs, and I'll get you that-- all those things that you're not gonna think about," so Carl was just a mastermind at expediting that sort of thing. We need a conference table and all those things, he did. And if we needed a projector to show slides, he took care of all of those things. He's another unsung hero around here. He, uh, just knew everything about everything from money to policy. So, the nuts and bolts were such that, uh, we, and, well then we started a clinic as soon as I got here. I got here in February, and we needed some patients for the medical students, and, uh, we used to have a Thursday afternoon clinic in OB-GYN. Again, the numbers of patients that showed up to be taken care of was really more than um, we needed. (laughs) SMOOT: What did you think of the quality of students that were brought into the institution when you came here? GREENE: Oh, wonderful group of people. SMOOT: You didn't find any major discrepancies in their--in their educational background from say that of the students at the University of Pennsylvania? GREENE: Um, the people that were first in their class here at the University of Kentucky would have been first in their class at the University of Pennsylvania. Uh, there was a, uh--there wasn't much mediocrity there, I can remember-- wellI kept in touch with a lot of those people. I knew them all. There were only thirty-two some odd people in the first class. There were one or two questionable poor students, but they would have been poor students at the University of Pennsylvania, too, and, um, it was a smaller class. You know, there was a 135, 140 students at Penn when I left there, and there was only thirty-some here, so I got to know them pretty well. But no, I--um, people like Roy Jarecky picked that class along with Bill Willard, and I wouldn't put them down. I think they were all great, and we worked them really hard, and they got a pretty good education. SMOOT: You think that the level and quality of the students that has come in since then have been maintained? GREENE: Sure. SMOOT: Let's pause a moment. [Pause in recording.] SMOOT: University Hospital had just-- GREENE: Well let me finish about the students-- SMOOT: Beg your pardon. Go ahead. GREENE: The-- I was on the admissions committee at the University of Pennsylvania for the three years. I was a young bright star at the University of Pennsylvania, so they picked me to be on the admissions committee. The committee at the University of Pennsylvania consisted of five people, two from the basic sciences, two from the clinical departments, I was one of them, and the associate dean, Bill Kennedy. We uh, were an Ivy League school that interviewed students from the other Ivy League schools, uh, Penn, Columbia, Harvard, Yale, uh, then Halliford and Princeton. Um, we had some very, uh, poor students in those classes at Penn. (laughs) Uh, I don't think that-- so what I'm saying is that I wouldn't put down Kentucky student at all. The people that were selected to get into these classes were quite able. They would have passed at the University of Pennsylvania courses just as they passed, and just because we are supposedly Kentucky in a rural state, I--I didn't figure-feel that--every class had a few failures--failures of personality or failures of intellectual ability, but that is gonna happen whether you're at Harvard, Yale, Princeton or-- Harvard, Yale, whatever. Some of the college preparation of the students perhaps wasn't optimal in that there, uh--I, I talked to students who had never been out of the state, never been to Cincinnati. I talked to one student who grew up in Louisville, and had, this was his first venture out of Louisville (laughs). So, they weren't worldly oriented. On the other hand, there were some students who had been all over the world. Um, the biggest difference between the student that came here and the student at an Ivy League college was his, his depth of experience wasn't as great, but his intellectual ability, I had no problems with. SMOOT: I was going to ask you a little bit about University Hospital, which had just opened in '62, as a matter fact. GREENE: Yeah, they opened in April of '62 with twenty-some beds or so. SMOOT: What was your impression of the facility and then the way it was administered? Of course, you already mentioned that you think Richard Wittrup was a fine administrator. GREENE: Uh, I think Dick had a lot of-- Dick was a great, uh, crea-- he wasn't, I wouldn't say a fine administrator when it came to the day to day running-- SMOOT: Uh-hm. GREENE: --of things. Dick, uh, was a conceptualizer of the way things ought to run. The way things run are a little different from the way he thought they should run. (laughs) Uh, and I could be a little bit severe and say I'm not so sure Dick liked doctors, MDs. I think there was a little hostility there. Um, the physical facility was amazing to me. What a beautiful building it was because I came from the old University of Pennsylvania, that the building was fifty years old, a decrepit old building where you'd put six people in one room and call that a semi-private accommodation, and then you came here, and they did have some four-bedded rooms, but the, the, the building itself was a beautiful thing, and there-- Dick's concepts, Dick Wittrup along with Sue Kearns, who was director of nursing, and Barbara Bates who ran the uh, the adult medical service, their concept on how things should go were, were, uh, were quite good, but they had difficulty in the day to day operation, and the-- the other problem they ran head-in on were the inundation of the numbers of patients. They had some very interesting concepts, I'm sure, on the fifth floor, 5-North, they had a quote "motel arrangement" up there. Have you heard about that? Yeah? Well, it was a great thing with the idea of a person coming from 100 miles, didn't have to be in the hospital but needed a series of tests run, they could live up there on the fifth floor. Well, we doctors began admitting sick people there when they didn't have the nursing staff to, to take care of anybody. You might as well been at the Campbell House or the Imperial Inn, uh, in those days. Uh, we put some sick people. We doctors made those mistakes, and of course Wittrup and Sue Kearns had trouble controlling this, but we were--we knew everything, and, uh, but the physical facility of the building was great, and again, I can't have anything but praise to say for what they organized and got going in those years. SMOOT: Uh-huh. What about outreach problems in OB-GYN? You talked that you did go out with Dr. Willard and with others along the state. Uh, did you go out to Morehead? Did you go down to Hazard, uh, these places, and conduct clinics? Uh-- GREENE: I never was much for conducting clinics elsewhere like some of the other departments. The history of our department is that we have had, uh, for a long time, for about five years, we were at Harlan, Kentucky. SMOOT: Uh-hm. GREENE: With medical students from about 1964 to 1971 or '72. We had a medical student residency rotation at Harlan. Uh, we had medical student resident rotation at, uh, Morehead. We had one at Bowling Green. We had one at Madisonville. We had, um, all of these outreach things where we would send both on a regular basis and then intermittent basis at these places, Morehead, Harlan, Madisonville, Frontier Nursing Service at certain times. Uh, then we contracted, and the main reason we contracted, there was so much to do right here in Lexington, that I couldn't find the time or the, uh, faculty that had the ability to do outreach programs. SMOOT: Hm. You mentioned that, um, one of the goals of this institution was to put physicians in eastern Kentucky where they were desperately needed and that we still need physicians in the-- GREENE: Terrible need out there. Tremendous need. SMOOT: There's been a lot of graduates from this institution. Why haven't we fulfilled the need to put those people in eastern Kentucky? GREENE: Um, well I like to brag about my own department. We've now graduated as of June '85, seventy-five residents in obstetrics and gynecology, and fifty-two are still in the state of Kentucky. Unfortunately, they're not--there's only about three or four of them in eastern Kentucky, namely Ashland. Uh, why haven't we done it? Well, all you have to do is read Harry Caudill's book, Night Comes to the Cumberlands. SMOOT: Okay. Uh, what has been your impression of support given by the state of Kentucky to this institution? GREENE: Well, the state of Kentucky hasn't made the commitment to this University, and I mean not just College of Medicine or Medical Center, I mean total University, uh, as say North Carolina did to their educational institutions, or Illinois did to theirs or California, my goodness, look at California, cordant. And it was just recently brought to my memory that I had totally forgotten, it was a disastrous period in when 1970 they took the University of Louisville and Northern Kentucky into the state system without any funding to do it. And I had forgotten about that. And if you want excellence in anything, you have to put not only money into it but effort into it. So the state of Kentucky didn't make the commitment to education, uh, like the state of North Carolina or California or New York did to their educational systems. SMOOT: You think that they are trying to move in that direction now? GREENE: I hear it, but I, uh, I, it concerns me. SMOOT: You'll see it- you'll believe it when you see it? GREENE: Mm, well, I don't mean to--I'm not a cynical person. I think it's amazing what the people that are here now, both in administration and in the faculty, have been able to accomplish with the amount of money they were given. You know, I have nothing but the greatest praise for Singletary, Bosomworth, and those guys that have kept going. This place is- Other medical schools are-- and medical centers and universities have become--I don't feel this is a second rate institution. No, I'm very proud of this place, and, uh, look what they would have done if they had been better financed. My goodness gracious. SMOOT: What about support from the federal government? Do you think that the support from the federal government has been adequate for the Medical Center? GREENE: I don't really know. I'm, I'm not, uh, I'm not educated along- -I've kept up with obstetrics and gynecology, but I haven't kept up with finances that much. I think that, uh, the federal government certainly poured a lot of money into capitation grants for medical student educations, so, but I- I'm ignorant in that. SMOOT: You really addressed this, uh, throughout I think, but, uh, I'd like for you to evaluate the, uh, impact of the Medical Center on the community of Fayette County, within central Kentucky and eastern Kentucky. GREENE: Well, I don't know what more I can say that, than I think we are appreciated in many areas, and the way I see the appreciation is: how do they do it at the University? I mean, we have set a certain standard, that there is not a week goes by that somebody doesn't call up here and say, "Uh, would you send us how-- your protocol for such and such and so and so." So, I think we have set a standard that people have recognized. I've seen this in another way. When, uh, I first came here, it took two to three years for the community to find out who I was. Then I began to get patients that were going, that had been regulars of the Mayo Clinic, the Cleveland Clinic, the, um, Johns Hopkins. There was a whole group of people. Then the, uh, Lexington Clinic was sort of a branch of the Mayo Clinic, and so they had--there were a lot of people. So, I began, and our department began seeing a group of people that were regulars of the Mayo Clinic or Johns Hopkins. They began coming here. Every once in a while, I'll hear of some prominent person going to Houston. Wendell Ford had his operation for his aneurysm at Houston, but when Governor Brown needed surgery, they came here, and she had her babies here. Uh, just--I could name a whole list, but I would be-- the reason I could mention the Brown's is that was all in the newspaper, but there has been a very long list of prominent local people that no longer go to Houston or Rochester, Mayo Clinic and so forth and now. So that's one big impact it's had, we've been recognized as people-- as a place where not just for the indigent, but there's a standard of care that's equal, that's unequaled in other places, or equaled in other places. So that, to me, has been a big impact. The dental school has had a tremendous impact on--on, on dentistry. SMOOT: Could you evaluate the specific medical programs and departments here? That's an arbitrary question once again. GREENE: Yeah, that's a tough one. Don't ask me to get into grading other, uh (laughs) people. SMOOT: Okay. (laughs) Have you been involved with, uh, specific medical organizations such as the AMA or the KMA, Fayette County Medical Society? GREENE: Yeah, I've been chairman of the Maternal Mortality Committee for the state of Kentucky since 1968. I've been on the, uh, that's about the--I've been president of the Kentucky Medic--er, president of the Kentucky OB-GYN Society. I've been active in their politics over the years. I haven't been very active in the Fayette County Medical Society, uh, because my activities at the national level, uh, uh were great. I was on the residency review committee for obstetrics and gynecology for six years. I was on the National Board of Medical Examiners for five years. I was associate editor of the Green Journal, the Obstetrics and Gynecal--all those volumes up there, I did for eight yea--six-eight year. And when you get involved at the national level at that thing, it's--it's a very time consuming thing, so; and every other department has an equal number of people that had done things at the national level. SMOOT: Then that would bring me to ask, uh, and again, you--you've expressed your opinion, but I would, I'd be interested in the impression of your colleagues on a national level towards this institution. GREENE: Uh, the impression of my colleagues? I think this has been regarded as a, still a new medical school but much more successful one than say Arkansas, Mississippi, Georgia. Even I think, uh, perhaps a little more successful than Florida. Florida started about the same time we did at Gainesville, but as I travel around, uh, I think my colleagues admire this place and the way we have maintained some standards here that perhaps some other schools, uh, in other states; I mentioned Arkansas, they've had a lot of trouble there. Missouri got spread too thin between Columbia and Kansas City. Um, and uh, Arizona, I don't think has done as well. I think we are highly regarded--well I can say in our own department, Jack Van Nagell, John Van Nagell, has been a recipient of American Cancer Society Fellowship, uh, Collie Galleon received one or two such things recently, so, uh, the American Cancer Society as the-- and the NIH isn't going to give you those awards unless they think the institution has the facility and the peoples to do it. SMOOT: You mentioned that you've also been involved with medical politics, at least the Kentucky OB-GYN Society. GREENE: Uh-hm. SMOOT: Uh, could you tell me a little bit about the difficulties that you face there, the, the issues that you've had to deal with, in that capacity. GREENE: Well, uh, I always felt we had a pretty good relationships with the, the doctors in the state. The original fear that we would steal their patients has been converted from fear of stealing our patients and then to, at the present time, "Are you going to be able to take our complicated people?" Cause we have had some times over the last ten years when we haven't been able to take all the referrals that the local and regional physicians would like us, so that, that's been something that we handled at the Kentucky OB-GYN Society, both in conjunction with this school and Louisville. Now of course the big issue in the last four years has been malpractice in Obstetrics and Gynec-- I mean, that's totally consuming their um, their time at every one of our meetings (laughs) politically because of mal--The malpractices thing is, is, is a real big issue, particularly in obstetrics. Knock on wood, [knocks on wood] we have never had a big suit here in this department, but the day will come when one of those things will come along. SMOOT: Do you have any suggestion on how to deal with that? I mean I know that something that's, that's causing a lot of consternation among various groups throughout the United States. How do you see it--? GREENE: Well, it's not only in medicine, but it's in, uh, local city governments can't get--I think you-- there's got to be a better definition about what's, uh, really a mistake, what's a happenstance, from, separated from what's really malpractice. I mean, if I neglect you or if I were to cause you physical harm, that's a crime. But if, uh, I make a mistake that day either because of I'm tired or I'm just not thinking, that's human error, and uh, that's gonna happen to every one of us. Uh, so I think there's got to be something worked out, whether your mayor of a city government or chairman of an OB Department, that you've gotta learn how--there's gotta to be something worked out to compensate people for mishaps to them but yet not these tremendous instant millionaires that we've made out of some people. SMOOT: Uh-hm. What about the maternal mortality group that you've work with and-- GREENE: Well that's been a very fascinating story, too. I think we've had some impact in a silent sort of way because when I first joined that committee in 1963 to '64-- the way that committee works is, uh, there's a long history on it, but each state organized one, and the way that committee works is a group of twenty-some doctors that meet twice a year, uh, to evaluate every maternal death that occurred in the previous year or six months. Dr. John Petry, P-E-T-R-Y, out of Louisville has, uh, garnered those statistics for twenty-five plus years, and in 1964 and '65 when I first began attending those meetings, Kentucky had thirty-five to forty maternal deaths a year. Maternal deaths. In the last five meetings we've had over the last two and a half years, there's been less than ten deaths. So, the committee has had an impact in that when we would find there was a problem, we would get a hold of the doctor and say, "Look, here." Now there was a time when every month I wrote one of those cases up, and it was published in the Kentucky Medical Journal. We sort of got away from that seven or eight years ago because of the malpractice thing coming, but I just recently begun writing some of them and publishing them. There were three in the last three issues of the KMA journal, uh, written in a proper manner so that litigation, but, but I think that committee, not because of me, but I've been chairman of it, but just because it's continued to meet and exist has had an impact on maternal care and-- cause we-- the meetings is not necessarily a closed meeting, anyone can come. We've have had some that are just breakfast meetings and some others that have been meetings of the whole Kentucky OB-GYN Society, where there'd be a hundred people there. SMOOT: Where do you think medical education and health care is going, specifically in Kentucky, but you have to put it in a national context again. You've seen the rise of, of private hospitals, like Humana, uh, that some would characterize as the old proprietary hospital coming back as a different sort of animal altogether, too. And, I--and I think of the, uh, relationship that the University of Louisville's Hospital has with private corporations running, administering their hospital because of the costs involved. GREENE: Uh-hm. SMOOT: Uh, a-are these the kind of things that the UK Medical Center is going to have to be concerned with? And what are the major concerns as you see them aside from what you've already enumerated, uh, for this institution and how it functions within the Commonwealth? GREENE: Well as I look at, or hear the statistics for this University Hospital, financially they seem to be doing fairly well. I mean, I'll- - ten years ago when I attended those board meetings, I, I thought the hospital was going to close next month. But I don't hear that these days. So, uh, Frank Butler and his group seemed to have done a pretty bang-up job of getting the finances in order around here. I'm not exactly sure how they've done it, but they've done it, and you can't argue with success. Um, I'm very bullish on the future of American Medicine, just like the stock market that has practically doubled in the last two years, I think the, the sophistication in medical care is going to double, and people will pay for good care. People will buy Jaguars and Mercedes, and they-- they'll find a way to do it. Um, it's gonna cost more money, but so is a Mercedes or Jaguars, but I see plenty of them out there (laughs). SMOOT: Well, let me ask you, though, about the folks that really can't afford Mercedes or Jaguars. Uh-- GREENE: Uh, they seem to get around. SMOOT: Okay. GREENE: No one's really being denied medical care today. I mean if you don't have a penny in the world-- now, I hear the gloom and doom people saying that the system is gonna break, well, but I don't see that. I, there's-- when I see people paying fourteen million, ten million dollars for a horse, there's, there's gonna be a, they are going to find money to finance this care, and what's changed, what used to be just to do a little minor procedure, they'd admit you to the hospital three days before. Now, they do it as an outpatient procedure. Why? Because our laboratory work is so much faster and better. Our anesthesia is totally different. Our, um, uh, thinking about disease, and we, we've become pretty sophisticated on how we deliver some of the care. So to do a little simple gynecologic procedure, we used to have to admit you two days before, and now we can do all the work within an hour of the time of the operation and get you out within six hours, you know? And that would be opportune-- so what I'm saying is, uh, it-- I don't see the day that we're gonna say, uh, we can't take care of you 'cause you can't pay for it. Uh, Americans are so ingenious, they'll find a way to pay for it. SMOOT: The administration, of course, of the medical center has changed from that of Dr. Willard to that of Pete Bosomworth. GREENE: Uh-hm. SMOOT: What has been your impression of the administration under Dr. Bosomworth? GREENE: Um, Pete's had a tremendous-- Pete's a very kind, thoughtful gentleman, very much like Dr. Willard. Uh, and he ran into this terrible problem that I said happened in 1970. See, Willard essentially left in 1970, stayed on until '72 or so. But remember what happened in 1970, Otis Singletary reminds us of this all the time. Is that they brought Louisville into the system, and they brought Northern Kentucky into it, so they diluted it. Uh, Bosomworth has held together, and as I walk around--every time I walk across that bridge into the--I look at the new building I'm walking into. I look at the new nursing building. I look into the educational building. I look at the uh, pharmacy building that's just being completed. I see the Markey Center. I look out here, and they're always tearing down something and putting something up. So, you can't argue with success. They, they-they cry the blues all the time about not having any money, but my God, we're all here, and a lot of people getting taken care of, and I don't go to clinical board meetings and hearing about closing the University Hospital. So, you can't argue too much about that, can you? SMOOT: Are there any points, uh, that I have not covered regarding the history of this institution that you think I should ask or address, or that you may be able to help me with? GREENE: I don't know, we've been talking here for an hour and a half. I might think about that tomorrow morning when I'm waking up, but. SMOOT: Okay. Will you let me know? GREENE: Yeah. SMOOT: Are there are any points you think--you would like to add or anecdotes that you would like to add, uh, that you have not already commented on? GREENE: Um, oh I'm--I'm very proud of my own department, as I say; there are four people that left my own department to be chairman at other departments. Bill Roddick left to be chairman at the University of Southern Illinois, Preston Diltz is now chairman at the University of Michigan. Jack Drury is the chairmen of the medical college of Ohio in Toledo. Steve Zwerick was chairman, or, at the University of Massachusetts until recently. Uh, so we've had some good people here. Uh, I think, uh, anecdotally, I think that we have made a tremendous contribution, Obstetrics and Gynecology has to the area, the central Kentucky area and the eastern Kentuc-- I wish we could get doctors to go to Hazard, Harlan, Whitesburg and all of those towns that are sorely in need of, of medical care, the need for more physicians out there is just a-- I had a man, Dr. uh, Becknell sitting in that chair from Manchester, and uh, he's seventy-five years old, and he told me he delivered a baby at four o'clock this morning and didn't--and he begged me to take one of his people and give them a month or two of OB experience here. I've been saying no to him, no to him, so he made a trip up here to, from Manchester and said, wouldn't I please let this man spend a month or two here, and I said, "I've got too many students already." (laughs) So, but, uh, when a man comes to you, seventy-five years old and, and, uh, still doing everything from obstetrics to dermatology, you can't say no to him. You gotta help him. So, uh, I'm very optimistic; well I don't know what else to say except we've had a tremendous impact, just as University of Kentucky has. It seems like we spend more time belittling ourselves than we do appreciating what we have. Unfortunately, the local newspaper, um, has not helped us. SMOOT: Is there a reason that you can see for that? GREENE: Oh, I think it's journalism essentially. It's-it's, it's a-it's a-- I remember one year we had a woman that had a very far advanced cancer, and, uh, she died while waiting to be seen, and the newspaper picked this up, you know, a woman dies in the waiting room at UK while no doctor would see her. Well, a very sad situation, but why capitalize on that? They've never talked about the, the thousands of patients that were successfully treated, but that- was a sensational story. She died in the waiting room, waiting to be seen, and that's. (sighs) SMOOT: Is there is anything else you'd like to add? GREENE: I don't think so, right. Unless I can think of it--well what a great time. I'm almost twenty--uh, see I came here in '63, and I'm in my 24th year here, and that's a great life. SMOOT: Let me thank you on behalf of the Medical Center and the Library-- GREENE: Sure. SMOOT: --for spending time with me. [End of interview.] 1 Dr. Jack W. Greene (Director of the Department of Obstetrics and Gynecology, 1963-1990) discusses his experience as a physician, going to school at the University of Pennsylvania, and becoming the director of the OB department at UK. He explains the greatness of Dr. Willard, and the unique contributions he made to the Medical Center. Green attributes the Medical Center's success to its founding at the same time as a rapid advancement in medicine. He mentions other great contributors, and their specific contributions to the Medical Center's success. He also discusses the lack of recognition for the contributions the Medical Center has made to Lexington and Kentucky. He lastly discusses the transitional nature of medical care and the future of medical care in America. insert here