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1987-10-22 Interview with Ben Eiseman, October 22, 1987 1987OH156 UKMC 74 01:38:44 UKMC001 University of Kentucky Medical Center Oral History Project Louie B. Nunn Center for Oral History, University of Kentucky Libraries Eiseman, Ben, 1917- -- Interviews University of Kentucky. Dept. of Surgery University of Kentucky. Medical Center -- History Physicians -- Salaries, etc. University of Kentucky. College of Medicine -- History Willard, William R., 1908 Surgeons Ben Eiseman; interviewee Richard C. Smoot; interviewer 1987OH156_UKMC74_Eiseman 1:|14(8)|29(5)|42(5)|68(9)|80(11)|92(10)|105(3)|122(14)|144(11)|175(7)|187(5)|199(11)|215(2)|225(9)|239(11)|255(6)|268(8)|283(12)|297(8)|325(3)|340(2)|351(13)|367(14)|381(9)|398(2)|412(6)|422(1)|434(11)|448(3)|459(10)|472(13)|486(7)|501(6)|535(7)|553(4)|565(9)|576(9)|590(4)|613(4)|630(8)|653(6)|665(2)|676(9)|699(5)|714(3)|726(2)|741(6)|755(7)|777(7)|790(9)|804(13)|816(8)|839(6)|852(14)|869(8)|877(9)|897(4)|915(9)|927(4)|942(7)|953(9)|965(7)|978(10)|993(4)|1006(13)|1033(1)|1045(9)|1061(3)|1075(12)|1094(5)|1103(12)|1118(12)|1131(2)|1140(6)|1154(1)|1173(2)|1185(9)|1194(10)|1211(3)|1227(4)|1255(9)|1271(1)|1308(12)|1322(5)|1336(5)|1348(1)|1360(8)|1379(12)|1390(1)|1402(9)|1422(5)|1444(1)|1455(4)|1482(9)|1497(4)|1514(10)|1524(6)|1538(4) audiotrans UKMCoh interview SMOOT: Dr. Eiseman, you were going to tell me about the departmental tie you are wearing today (laughs). EISEMAN: Yes, uh, not long after I came here, while this place was still a cornfield-- the hospital we are now sitting in, uh, I gathered the first thing to do was to gather a group of surgical faculty-- full-time faculty. And we got together with, uh, our full-time faculty and uh, and uh, we decided that we had to have some instant tradition. We had a new medical school and a new department, but the only way to, uh, to get this thing with a good esprit de corps with these young fellows, was to have instant tradition. So we did-- the first thing we did was uh, we had a-- we looked up the history of departments of surgery in Kentucky, and in Lexington. And uh, we found that Transylvania [University] had a uh, medical school here, and although it wasn't really the University of Kentucky, we sort of adopted it, uh, as our foster grandparent. And uh, the first thing-- one of the first things I did was to write a history of uh, the department of surgery at Transylvania. And you'll find in one of the journals an article that we wrote on the history of surgery. And the professor of surgery at that time, I won't belabor it, was a real character. And he and the professor of medicine, uh, got in an enormous argument-- I don't know whether you know about it, and they had a duel. And the professor of surgery was an irascible fellow, and he would stand outside, uh, in the springtime when this thing was-- when he challenged him, and he'd practice his pistol shooting, uh, outside the professor of medicine's office, (Smoot laughs) and it-- he was a pretty darn good shot. And he'd stand out there and bang away at the-- at the target in the few days before the, the duel was suppose to go on. And it totally unnerved the professor of medicine, who fled town. And uh, in his place the professor of OB-GYN, uh, fought the duel. They went up to-- across the, the county line, in Bourbon County, and uh, he winged him. Uh, but we wrote this whole story up about uh, the previous department of surgery, but then-- and you, you probably have a copy of that uh, that article that I wrote on this thing, but then we decided too we should have a department of surgery tie. Well about this time, uh, Bill Willard, who was the dean, uh, was holding the line that we could not uh, keep any of the money that we made. And we were making, as has been ever since, we were making most of the money for the school. So-- and I was always arguing that he-- we should have some return at least to our department, which I was never able to get. We were all straight salaried in those days. Didn't-- no matter what we brought in, we didn't get anything. So I designed this tie, and, and the tie as you'll see is uh, is uh, Kentucky blue-- a main Kentucky blue. SMOOT: Very good choice. (laughs) EISEMAN: And then, uh, there is a, two red lines in the middle, which is for surgery. And the green in the middle of that is the, uh, academic color of medicine-- of the hood. And then you'll notice that there are two gold bars on each side. And I-- and people would say, "Well, what's that for?" And I'd say, "That's all the money that we are putting into the department (both laugh) into the medical school." And every time I'd go by the dean, in the hall, wearing this tie-- or anyone of them, I'd hold this thing out like this, and he'd sort of cringe (both laugh), because I was always reminding him that this was-- this was the money we were pumping into the medical school and not getting back. SMOOT: Hmm. EISEMAN: Well you-- SMOOT: Beautiful story-- let me-- let me ask you some other stories. EISEMAN: Sure. SMOOT: I want to start with your story. Why don't you tell me a little bit about your own personal background, where you were born and raised, community you grew up in, and your educational background? EISEMAN: Well, I was born in St. Louis, Missouri in 1917. My mother was from New Orleans, uh, and my father was from St. Louis. And one grandfather fought on the North and one grandfather fought on the South during the Civil War, and so I turned out to be quite a Civil War buff, and still am. And uh, had uh-- subsequently, uh, parents were always in the military, and so that-- that got part of my interest in the military myself -- that was part of my tradition-- background. But uh, then I went to Yale undergraduate and majored in history at Yale, and only took uh, as much medi-- no, as much science as I had to take to get into medical school. Um, how I got into medical school I don't know, but I was accepted at Harvard and uh, uh and-- I don't think I'll go into that, there is kind of funny stories about it, but anyway I got into medical school at Harvard. Um, and uh, then uh, was an intern at the Massachusetts General Hospital in Boston. The uh, war came on and in those days there was never any question-- certainly not, uh, in my generation or certainly not at Harvard, uh you-- you know, that was your duty. We all-- and I went into the navy and uh, was assigned to the amphibious forces in the Marine Corps and uh, and was-- served variously in-- in the Mediterranean and in Normandy, and was a, a very junior medical officer. My job was to run across beaches and uh, take care of casualties as we got shot at and as we-- until we got it, uh-- the beach secured and uh, then the real doctors would take over. I was nothing much more than a glorified corpsman, but, uh-- and then went out to the Pacific and served with the amphibious forces and the Marines out there for a couple of years. And uh, then actually before-- as soon as the war was over was sent out to the Middle East again, and uh, uh, was in Egypt and married a girl that I'd met, uh, while-- while I was in England, before Normandy. Uh, two years later, uh-- well, it's sort of interesting maybe-- the reason I knew she was-- we had decided that we wanted to be married, but uh, the war was still going on full tilt and we'd made the Normandy landing-- looked like we were pretty solid there. And-- but I-- wan-- kept reading and worrying about the Pacific war, and she said, "You know, you don't think they can win that war out there without you, do you?" (Smoot laughs) And uh, so I knew that was probably the right girl for me, so I said, "You know, that's right." Uh, she said, "Well, you better go out there." So I went out to the Pacific-- volunteered to go out there, and was in the Marines out there. SMOOT: Is she English or an American? EISEMAN: Yeah, she's English. SMOOT: Okay. EISEMAN: She's here today. Uh, but uh, anyway then the war was over and I finished up my residency at Barnes Hospital in St. Louis, where I was from. And stayed on in full-time uh, surgery at Barnes Hospital, and rather quickly went out to Denver to be a chief of surgery at a very young age, just a couple of years out of residency, uh, at the Denver Veterans Hospital. And uh, on the full-time staff of the University of Cal-- Colorado. And uh, did a lot of research out there, did a lot of clinical surgery out there. And uh, they uh-- I guess there wasn't anybody else who'd take the job here, so they offered it to me, and I came here. Uh, I was a full professor of surgery out there, uh, and uh, Bill Willard asked me to come here. So that's really my background. SMOOT: He contacted you directly? EISEMAN: Yes. SMOOT: Okay. And-- you don't know how he had caught wind of your availability? EISEMAN: Well, I was president of the Society of University Surgeons, uh, by that time, and uh, and uh, that's sort of a target job. And uh, so I guess-- you know, it's sort of a short list, it's an old boys club-- who's-- who's up for chair and uh, and uh, I was on the short list. Uh, I could name you who's on the-- up for chairs now. It's the same-- there are a dozen, two dozen people that you sort of think of. SMOOT: Um-hm. How old were you? EISEMAN: Oh, Lord-- I don't know, I guess I was forty-three-- SMOOT: Okay EISEMAN: --or forty-four, something like that. SMOOT: Fairly young to be coming in as a chairman? EISEMAN: Oh, yeah-- little bit, but uh-- yeah, I was a little bit young, but not terribly. SMOOT: Um-hm. What was your impression of this place? This, this town? The institution that was, uh developing here? You came in what year-- 1960? EISEMAN: Yeah. SMOOT: Okay. EISEMAN: Uh no-- 50-- came in '53. I guess I first came down here in '52 and-- to look at it. And here was a, nothing but a glint in a few guys eyes. Uh, this was a, as I say, there was a little farmhouse over here, which is now the-- whatever that is -- cement structure over there-- SMOOT: Um-hm. The new, uh, Cancer Center. That was the Freeman House is the house you're thinking of I guess. EISEMAN: Okay. That was the name of the-- there was a little wooden farmhouse-- white farmhouse with green shutters (Smoot laughs), and we went in there-- and here was a guy, a long, lean, lanky, smiling sort of a fellow, who was the dean, who had some interesting ideas, uh, most of which I disagreed with. And then there was a dynamic fellow by the name of [Edmund] Pellegrino, who'd been down here a little ahead of me. And the only difference was that-- here was a guy that I totally disagreed with. (Smoot laughs) I disagreed with everything that-- I think Ed and I never agreed on anything except one thing. Uh, I've never-- I've never known a guy that I disagreed with on so many fundamental issues, that I admired so much. He uh, he was a wonderful guy with-- is a wonderful guy with great integrity. And uh, he's the kind of fellow that's fun to work with. He's bright as can be; very well educated. And he and I hit it off immediately. And we hit it off by absolutely always taking the opposite point of view on everything. But when the issues came down, Ed and I got together and we said, "Now look--" uh, modestly, and neither one of us suffer from over modesty (Smoot laughs). Our egos are both pretty big. But uh, we said, "Look, we are going to be the controlling factors in this new medical school. If the Department of Medicine and Surgery-- Departments of Medicine and Department of Surgery thrive, the school's going to thrive. And that's going to depend on the two of us getting along together, and whom we recruit. Because as we recruit-- the people that uh, we're going to recruit, inevitably if they are going to respect us in any way, are going to take the same points of view as we do toward each other. And if we-- if I in surgery have a bunch of surgeons who are going to be snipping at the surg-- the medical people all the time and calling them "medical creeps" and other problems, then that'll be bad." So we said-- we made a little pact, we said, "We'll get together, and when we have differences of opinion-- important differences of opinion, we will settle it in a room with just the two of us. And when we come out we will speak with one voice." And for the seven years or whatever it was that we worked together, that always happened. And there was never any backbiting; there was never any, uh, second-guessing between the two of us. Although, in open conferences we were always at each other's throats -- and with a great sense of humor-- and Ed has a marvelous sense of humor. And, uh, we always were needling each other, but with respect. And uh, so it was an absolutely delightful arrangement between the two of us. SMOOT: This was-- was this understood by the other people in the room? EISEMAN: Well, not in the beginning, uh, but it soon became clear that we were good friends and that we were--uh, that this was-- it-- it's very much the tradition that had occurred in Boston, uh, between some of my chiefs. Only it was a little more leitmotif than it was perhaps in Boston, because it was a little bit more freewheeling here. But-- but uh, it certainly was understood that we had great respect for each other, uh, both personally and professionally. (coughs) They-- the school was founded with the idea that, uh, as you know-- that it was going to turn out family practitioners. It was clear to me that uh, no way was that going to be; what Bill Willard thought was going to happen, was going to happen. Because we were able to attract down here absolutely world-class young men. Uh, the first seven appointments I made all became chairman in their departments and divisions around the country, and now are the world known leaders. And so that these were really the brightest and the best on the scene, who came down for very much the same reason that I came here. They just found that this was a-- a frontier where they could, uh, carve out their own future. And if they had it and everybody-- these guys all had big egos--uh, that they knew they could make it, and uh, they did. But it was clear, to return to the theme, that with these people as the role models for the medical students, that a fair number of them were going to go into surgical specialties and medical specialties, et cetera. And I think the first-- something like twenty-eight, thirty percent of the class went into surgery-- the first class. You can look up that number, but it was an extraordinary percent. Well, you couldn't help it with uh, the people like [Frank] Spencer and [Rene] Menguy and [Benjamin] Rush and Charlie Wilson, and all these guys uh, who very, very shortly went off and became, uh, chairman in their own divisions. With people like that around, you couldn't miss. And the department at the time--I, I don't know, are you interested in how I organized the department? SMOOT: Yes sir. EISEMAN: The department at the time, uh, I organized in a, in an interesting way. It was clear to me that every one of these guys was smarter than I was and better than I was. And it's really true and it- - times have proven it. Uh, that all I had to do was to give them an area of assignment and then step back and step out of their way. So, I broke up departmental duties-- I've always been sort of interested in managerial techniques. I broke up departmental duties and I would say, "Now, uh, Dr. Spencer-- Frank, this year you take junior teaching and you take the operating room." And Charlie Wilson in neurosurgery, "You're head of the division of neurosurgery." And I got him straight out of his residency. Uh, he-- had made him chief of sur-- chief of neurosurgery, which uh, sort of confounded people. (Smoot laughs) And-- but he clearly was a winner. And I said, "Now, Charlie, uh, you take choice of interns and uh, you take the emergency department." And then-- so I created in this institution for the years that I was here-- and when Ward Griffen came I rotated him through the same system. They would have two things; they would have an administrative responsibility for the department and an administrative depart-- responsibility for the hospital. So by the time that any one of these people-- whether it was Ben Rush or Paul Weeks or Ken Walton, or any of the rest of these people who went on to be chairman, that by the time they'd been here for three or four years or five years, they had the complete knowledge of how to run a department. They ran-- as far as I know this has never really been done before or since, but the--uh, as a consequence, when Rene Menguy went up to be interviewed at the University of Chicago, uh, he could talk to them about, uh, how to, uh, budget a department, he could, uh-- about intern selection, about uh, promotion committees, uh, about uh, emergency departments, and this, that, and the other. But the spinoff was, I didn't have to do any work. So-- (Smoot laughs) SMOOT: That's a pretty good spinoff (laughs). EISEMAN: Well, it was a wonderful spinoff. And, and I--uh, it was kind of fun, because in the beginning people would say, uh, from other departments or the dean, uh, would say, uh, "Well, look, uh, you have, uh-- your representative at the promotions committee came out with this, uh, statement, uh, and uh, as-- and I want to check with you whether that's really the policy of the department of surgery." And I'd say, "Well, look there is no discussion. If that's what he said the, the policy of the department of surgery is, then that's the policy." "But, but maybe you want to change it?" I said, "If you want to ch-- if I want to change it, you'll never know." (Smoot laughs) Uh, in other words, that kind of policy only works if you back your men. Now what would happen, is the way we worked this was, it was understood that we would have -- in this very room after we got the hospital built -- in this very room we would sit around and uh, uh, we would say now-- oh, uh, let's say, uh, the men and the promotions since we brought that idea up. "Look, I'm serving on the promotions committee this year, and look this seems to be a substantive decision that's coming up. Now these are the pros and cons of the policy. I think this is what we ought to do." Then we'd kick it around within our department of this and as to what we thought our policy should be. Then it would go back to the man who was on that committee and he would state it. Now sometimes he would have to state it shooting from his hip, but our philosophy of this little band of brothers was enough so that even if he was shooting from the hip, the times when we really had any substantive differences were so seldom that, uh, it didn't make any difference. And if it did make any difference, we'd back the guy even if we didn't believe him. And it's a-- it's a-- was a wonderful policy, because as I say, I didn't have to do any work. SMOOT: Let me ask you about the -- not just the medical school and your own department-- the Medical Center. There was an overriding philosophy that Dr. Willard, uh, wanted to, uh, inject throughout the Medical Center-- EISEMAN: Right. SMOOT: --and Dr. Pellegrino was-- was very much involved with that, and supportive of that-- EISEMAN: Absol-- absolutely. SMOOT: --as well as any others. You were aware of this philosophy were you not, when you came here? EISEMAN: I was. SMOOT: And, uh, you didn't agree with it, did you? EISEMAN: No, I really didn't. Uh, I-- I just didn't think it would work. I didn't think that, uh-- I realize that there was a need for family medicine in the community, and I thought that the law of supply and demand was going to fill that. Uh, I was a, a Marxist in regards to economic determinism, if you will. And, although, not a Marxist, uh, in economic or political philosophy. But uh, I felt that a school like this, uh in this, uh, state-- it was going to be the same as, uh, uh, most other state schools. That we're going to turn out a number of doctors and uh, by self-select ion there are going to be some small town-- people who are brought up in small towns, who would come here. And the chances are that they would return to small towns. And that we would turn out a certain number of them, but uh, I didn't think we were going to turn out the family doctors anymore than the University of Iowa, or Nebraska, or Oregon, or anywhere else. The other part of it was-- that I didn't agree with, uh, was that I didn't know how-- and still don't know how to teach surgery to people who are going to be family doctors any more-- any differently than I know how to teach surgery at an undergraduate level to people who are going to turn out to be professors of surgery. I think you teach in the same way. So that in that regard, uh, I disagreed with Bill Willard. Uh, I also disagreed with him-- and used to bring up all the time this idea of um, of um, joint decisions on everything. Bill was a, a great one for democracy and maybe I was not so great on democracy. He uh, he would uh, get us all in there to make decisions about-- I remember one time a, a meeting down in the dean's office-- the epitome of it perhaps, to decide about the color of the dish-ware of the uh, you know, that you are going to serve the meals on. And we had some dietitian and some psychiatrist or psychologist or something, got up there and-- I've forgotten what his arguments were because I was-- my mind was somewhere else, and I was diddling and daddling at the time (Smoot laughs)-- about whether it was pink or blue or whatever. And then when it came time, they said, "Well, now we;re going to vote on that." And Ed Pellegrino had come up with this--he, he was all for this oneness business. And I said uh, "You know, I'm not going to vote on this. I don't know anymore about the color of, uh, chinaware than you guys do about teaching surgery. And you don't know anything about teaching surgery (Smoot laughs) and I'm not going to listen to your votes about teaching surgery anymore than you should listen to my vote on chinaware." (Smoot laughs) Well, Ed Pellegrino and, and the rest of them sort of shook their heads-- well, they sort of put down, "He's an irascible old guy from surgery, and he's sort of different," but they did put up with me. SMOOT: Um-hm. EISEMAN: So--but, uh, now this was uh-- I-- I said this, uh, in camera with the, uh, dean and with the-- my fellow chairman. And uh, and uh, it was easy in those days-- it was a small group. Uh, we had the beauty of a small group with Jack Greene in uh, in obstetrics, and [Harold] Rosenbaum in radiology. And uh, um, we had a very loyal, uh, informal group who-- who meant a lot, and that's the beauty of a new school, of course. This is uh, before you get overly complex. Uh, we saw each other a lot, uh, we had lunch together, we uh, um, we rubbed elbows, we worried a lot together. Uh, we socialized a fair amount, not too much; much more with the community than -- the community surgeons, than uh, uh-- with whom we made wonderful, uh, contact. I don't know whether you want to talk about that at all. SMOOT: Yes, I would. (coughs) Because a town gown situation is, is often a problem with-- with a medical school. Uh, apparently, you-- at least worked on that. (laughs) EISEMAN: Well, indeed I did. And, um, this, of course, I was aware of, uh, and because I had been involved in it in St. Louis, and in Boston, and in-- and in Denver, and, and found out-- knew some of the, the problems and some of the solutions. So when I came down here, it became clear that there were some unique things here. One -- this area, because of Fred Rankin and uh-- and uh, others, uh, had a great tradition. There was Francis Massie, and Coley [Coleman] Johnston, and Brick Chambers and others, who had done an enormous amount to-- and Ralph Angelucci, had done an enormous amount to uh, get this um, medical school going, and-- and were looking forward with great anticipation to the department of surgery. So, uh, at the time we had no hospital, and I went over to St. Joe's [Joseph] and, and began to learn the people there, and we did our operations out at the narcotics hospital as well. And that was the only hospital we had at the time. It was kind of amusing there-- they had done nothing but small operations out there. And they said, uh-- I remember when, right after I got here, I said, "Well, we're going to do this patient who had obvious cholecystitis, cholelithiasis gallbladder disease." And (coughs) said, "Well, we'll operate on him Wednesday or whenever it was." He said, "Well, no we can't, uh, do, uh, gallbladders out here. Uh, we aren't able to do big operations like that because you may have to explore the common duct." Well, among other things I had operated in Thailand and other things at various times, and I knew what you could do, and I said, "Well, don't you worry, we'll just go ahead and do it anyway." Well, within three months of them telling that we couldn't do a gallbladder at the narcotics hospital, we did an open heart. (Smoot laughs) Ah, it sort of took them by storm, but to return to the problem of um, of the community doctors. It became clear that these were men of truly high personal integrity and quality. And I'm not just saying that to be kind, but these were southern gentlemen in the true tradi-- tradition. And uh, perhaps my New Orleans background, uh-- I recognized what they-- what their values were. And uh, they-- and I never tried to pull anything on them in any way, shape or form. I-- I always rem-- I got a, a small group as my, uh-- as my advisory group. And by this time I had recruited some of these young guys, and I remember over at St. Joe's one day, saying-- they asked me, we were perfectly above board about asking each other and discussing this in any way. And they asked me, um, "Now are these guys going to be, in essence-- or are these guys going to be in competition with me?" And I said, "Yes, they will." I said, uh, "There will be an occasional hernia that will be us taking over a private patient; taken over by me or by one of my full-time guys, or uh, a uh, um, fractured femur or anything else." But I said, "Let's just look at this." I said, "If I choose these guys one of two ways. I can either choose a, uh, a meek, nonproductive fellow whom you will all say, "Oh, that's great, he's no good. He won't be any competition." And I said, "In five years you will say, What the heck have these guys added?' nothing." Uh, I said, "Or I can choose real tigers," and by this time I had chosen a couple of them, "Who will come in here, who will take an occas-- occasional patient from you, but who will be so busy teaching and doing research, that they will be the equivalent of about a third-- at the most a third, of a new man coming to this town." So I said, "This is what it amounts to, for every guy here, you'll have a third to a fifth of a new man coming to this town. And they are going to be coming to this town anyway. Why not get somebody who is going to add luster to this city-- this town, and teach you something so that your practice will get better and bigger." And I said, "All you have to do is look at, uh, Michigan or any other-- Iowa City, or anything else. The, uh, there's a spinoff from a good department for those in practice here." So I got a-- and that, you know, I, uh-- I wasn't fooling them in any way, shape, or form. I was saying, "You bet, I'm going to get a patient that-- that might have come to you, but I won't get any money for it. It'll go into the dean's office, damn it." (Smoot laughs) And uh, and I reminded Willard of that. But, uh--but, uh-- so I got an advisory committee here. And in this room, um, I sat up an advisory committee of Francis Massie, who was the dean--a doy-- or the doyen of surgery in this community, and done enormous amount. And Coley Johnston, and Ralph Angelucci -- the neurosurgeon, and oh-- and uh, (coughs) then, I remember one of the guys who was just violent against it in the beginning, was a fellow named O. B. Murphy. So I said, "Okay, I've got four very strong--" and, uh, Ed Ray -- the urologist, so I had general surgery and I had the main specialties-- "And I'll choose-- I'll choose a guy who is absolutely violent against us, and I'll put him on my special advisory committee, and automatically will defang him." (Smoot laughs) And uh, so we had him in there, and bless his soul, within a few months he began to see, we'd have monthly meetings, we'd-- about five o'clock in the afternoon, within a few months of, of just laying our problems on the table, uh, he came around and was a wonderful supporter. Because he realized what we were trying to do. And there was never any Mickey Mouse; this wasn't--uh, this wasn't just window dressing. Because I've seen in other institutions before and since, that where you have an advisory committee, this and tha-- I'll always remember a time when I was sitting right here at the head of this long table, and it was a little bit longer in those days, um, we brought up-- I brought up something or other and I had, uh, these five guys -- the advisory committee and the four or five, uh, uh, senior members of our department, the oldest of whom was not-- probably not forty -- of Spencer, and Menguy, and Wilson, and Walton, and Rush, and these guys. And uh, I as the senior guy-- full-time at forty-five or whatever I was, and uh, we brought up some problem that was really a significant problem and was asking advice how we should do this. And uh, Francis who was sitting in the chair I am in now, said, "Well--" He said, "Uh, I--well we've discussed this-- I-- I'll tell you how I'm going to vote on this." He said, "I'm going to vote, uh-- I'm going to vote in favor of it. Now Coley what do you think?" And uh, Coley said, "Well, I'm going to vote in favor of Ralph on it." I said, "Wait a minute." I said uh, "Francis--" I put my arm-- hand on his arm right like this here, and I said, "Francis, uh, wait a minute." I said, "Let's get this straight." I said, "This isn't a democracy." (Smoot laughs) I said, uh, "There isn't going to be any voting in here, and if there--I, I'll know whether you are in favor of something or not in favor. You can say whether you are in favor or not." But I said, "There is not going to be any voting." I said, "There's just going to be one vote and that's going to be mine." And I said, "Right or wrong, this is going to be it." And I said, "Now, uh, let me get it straight. If I do something that's against what you, uh, recommend, I'm going to tell you why I did it against what you recommend and explain it to you in advance why I'm going to go against it. But there ain't going to be no voting." And there was, you know, Francis (Smoot laughs) was then about what I am now-- pretty-- about seventy I guess. And uh, I was some young punk there, and he looked at me like this, and his jaw fell down (Smoot laughs) and he slapped the table like this (hits table) and he said, "That's what we need around here!" (both laugh) And he told that story on me many times, and uh, it was, uh, you know, it was the way it was going to go. And uh-- and they were fiercely loyal to me-- and to us and to the department, uh, because uh, we lived up to what we said. We, you know, it would stupid to go against what they thought, uh-- because they kn-- most of the time, but there were sometimes when, uh, we went against them. And we kept our word that we would always telegraph-- and there would be no surprises. And we would be totally honest with them, and it worked marvelously. They were our greatest support; they were more supportive than was the dean or anybody else. SMOOT: Hmm. Let me ask you about, uh-- because you've made reference to it several times-- several times, but the uh, the physicians' practice plan-- the money. EISEMAN: Yeah. SMOOT: You had a real problem with the-- EISEMAN: Oh, yeah. Oh, yeah. SMOOT: --distribution system. My understanding is that it was distributed on a fairly equitable basis throughout the departments, even though certain departments-- especially your own-- EISEMAN: Yeah. SMOOT: --brought in most of the money-- EISEMAN: That's right. SMOOT: --and some departments generated virtually nothing. EISEMAN: That's right. SMOOT: Okay. Now you objected to that. EISEMAN: That's right. SMOOT: Could you go into that a little bit more in detail for me please? EISEMAN: Well, it was the, uh-- it was a, a uh-- that was, in essence, why I left here. Because I could see, uh, that if this continued--uh, you-- you've stated it very well. It was the full full-time system with no incentive, no uh, uh, difference of salaries, uh, of those who brought in a lot of money and those who did not. Whether they brought it in in private patients or whether they brought it in in research grants-- and each one of us were bringing in many, many thousands of dollars in research grants. And so-- so was medicine in that regard too. But medicine and surgery were bringing in a whole lot and-- and most of the other departments were not. But the main thing was uh, bringing in money from private patients. I could see, uh, near the end of my time-- and I fought this all the way along. Uh, I said, "We will never build a great school or a great department, uh, unless we have some sort of an incentive. There are a thousand different formulae, but the, uh-- it will never go unless we have--we'll never be able to keep anybody unless we have some sort of incentive, and we really won't be able in the future to, um, attract, uh, the quality of people that, uh, I've attracted now." By this time, uh-- as I was here for seven years. By the end of the fifth or sixth year it became clear that, uh, these guys were going to get wiped out. They were all going to go on to be chairman somewhere, which is exactly what I wanted them to be. But that I wouldn't be able to, uh, attract the same types of people for the second wave, uh, because our salaries, uh, were noncompetitive. And I can remember telling Bill, and telling Ed, and telling the rest of them, um, that "Uh, look, we are going to be-- and I won't name the school, but this place is-- if we continue on in this system, uh, this place is going to be like the University of "xxx," which uh, uh, is a "who's he?" institution." And I said, "I'm frankly not interested in uh, in uh, supervising a second-rate institution, uh, and uh, department." Um, and Bill, uh was committed to that principle-- Bill Willard, is committed to that principle, and uh, there was not any uh, Mickey Mouse about it, that's wha-- the guidelines. And, of course, most of the other department chairman were the same way; Ed among them, uh, because it was the have's versus the have not's. Well, okay, I wasn't going to be, uh-- I wasn't going to convince them. I certainly wasn't going to be, uh, try and undermine them, uh, and so I loved Colorado and the mountains, and they offered me a, a-- to come back, and I did. I went into the dean's office and he almost died. I told him I was going to leave. And he uh-- it was quite a shock. There wasn't-- there wasn't any-- I said, uh, "Bill," uh, I explained it, and I said, "Uh, there is no rancor or acrimony-- that uh, this is how it was going to be." And I didn't go in and tell him until I had already-- I wasn't going to threaten him-- until I had already accepted the job. And uh, then said, "Well, we'll work it out. You know, it'll be "x" months " I've forgotten what it was, and I remember he said, "Well, now whom shall we get as chairman?" And I said, "Well, he's sitting up there in uh, such and such a room." And uh, and it was tough because there was two or three others, uh, who were also-- who become chairman. And I said, uh, "Take Ward Griffen." And they did, and I think they did well with him. Now that's a very frank statement, but uh, uh-- and, of course, I think that I was right. SMOOT: You wouldn't have changed a thing? EISEMAN: No, because he-- that was his-- you know, he is a very, very honest guy. And uh, he was dedicated to a principle, and uh, it just happened we disagreed about it. SMOOT: Um-hm. EISEMAN: Uh, and uh, his other, uh, chairman uh, uh backed him in this regard, uh, and uh, to varying degrees, and uh, um-- SMOOT: Let me just throw something out, because it seems peculiar to me, and bu-- having talked with a variety of people, and having looked at the philosophical statement, and all these sorts of things. Most of the people that were brought in here really agreed with, with Dr. Willard-- at least the leadership in the early stages. They were on his side, philosophically. EISEMAN: Yes. SMOOT: You never did really side with him on a lot of philosophical points, and yet he brought you on board anyway. EISEMAN: Yep. SMOOT: Now, why is that? That doesn't make a lot of sense; that, that seems an incongruence. EISEMAN: Well, I--I-- it-- on the surface of it, it does seem incongruent. But Bill, um-- and, of course, then I can't tell, who can tell peoples' motives? I don't think he was fooled in any way, shape, or form as to uh, what kind of guy I was. Uh, but uh, in the same way that uh, any good administrator has to bring in-- now this is going be--seem, uh, boastful in some ways--can, can bring in a productive guy and say, "Look, this guy marches to a little different drum beat, and uh, I can tolerate him." Uh, I would guess that's what went through his mind. Oh, he had a whole lot of nice things that were said about me. I'd been acting dean at the medical school and I'd been through all the business. And, and I had a pretty good CV [curriculum vita] and at the national level I had this, that and the other. And-- but to answer your question, I-- I imagine he said, "Well, this guy's uh, not going to be the easiest one in the world to work with, but most surgeons aren't." And I-- I guess he, he took it on face value. SMOOT: Okay. EISEMAN: He certainly knew I wasn't a, uh, a machine man. Uh, nothing I had done before or certainly since, would suggest that I was. And, and we got along-- we always got along personally. He, uh-- I had great respect for Bill. Uh, I just disagreed with him. SMOOT: He was trying to do a lot of different kinds of things-- innovations. EISEMAN: Right. SMOOT: Uh, could you tell me a little bit about the innovations that he tried to uh-- he tried to start here, and-- and what you were doing, uh, innovative? EISEMAN: Well, let's start with his. Uh, and his innovations were that it should be a team approach, which I'm certain you've heard the-- the founding fathers, to coin the phrase now-- talk about. Everything was to be a team approach; everything was to be a joint decision, whether it was the color of the plates or--um, he brought up, uh, the problems of um-- he wanted us to bring up the team approach to teaching, which I thought was great to some degree. And I think that he made a, a great contribution to um, the team approach between clinical and non-clinical departments -- that was marvelous. Uh, we had uh, in-- Department of Surgery was here, and right down the hall was the Department of Medicine. Our research labs were right across the str--the hall here, and anatomy was right across the hall down the hall. Uh, we were in and out of each other's depart-- research labs all the time. I was on top of the biochemist [George] Schwert. Uh, and we were with them all the time, and uh, that can only happen with a dean who, who wants to have the team approach in that regard. (coughs) Um, we had uh, his idea of the team approach in mind-- veered-- I don't know why it comes to mind, but uh, I remember they wanted, uh-- Ed Pellegrino wanted to have a, uh, some sort of a combined ge-- grand rounds on uh-- on coarctation of the aorta. And uh, he wanted to have an embryologist describe the embryology, and the anatomist describe the anatomy, and the pathologist the pathology, and the radiologist the x-ray, et cetera, et cetera. And the psychiatrist-- what it would do to a patient who had coarctation and couldn't have an erection. And then the surgeon was suppose to come in and say how you just cut it out and hooked it up again. So this was, uh, sort of the-- I had heard enough- - I had heard this so many times, where there were twenty different guys who'd get up and give their little segment of a-- of a-- do you want me to quit a second? SMOOT: Yeah, could we pause a moment? EISEMAN: Yeah, sure. [Pause in recording.] EISEMAN: Well, I'd heard many presentations like this, that-- where it was all fragmented. And I thought "This is the wrong way," that "Medical students are going to get the wrong idea." They're going to think that a surgeon doesn't know anything except how to cut out the coarctation of the aorta. So I remember presenting this thing-- I was suppose to have the department of surgery presented. And we got up and I said, "Well now, the beginning of the discussion will be the department of surgery." So we got up and the surgeons presented the embryology, and they present-- and discussed the anatomy, and discussed the pathology, and discussed the radiology, and discussed the psychiatric aspects of it, and then discussed, uh sort of en passant, the, uh, the surgical treatment that you-- this is what you do, et cetera, and the results, et cetera. And-- but that sort of epitomised our difference of philosophy. Of course we would ask the-- then we went into the radiologist, now we have already described, uh, the notching of the ribs, but how often do you Dr. Rosenbloom, uh-- Rosenbaum--uh, uh, Harold, how often do you see coarct--? You've seen a lot of these, how often do you see them without notching of the ribs? You know, and-- and ask them for the subtle nuances of it. Uh, and uh, say in the pathol-- to the pathologist, "Well, how often do you have a, a uh, patent ductus with this? And what uh, uh-- how does the uh, the signs and symptoms correlate with what you find at autopsy, et cetera, et cetera? But our emphasis was-- was very different in this regard. And uh, Ed, bless his-- Pellegrino, bless his soul, understood that, and he would laugh and he'd-- you know, we-- we'd work that out. But it was a difference of an emphasis. But, uh, Bill felt that the team approach to, uh-- it wasn't called decision making in those days, but uh, it is now--uh, was the, uh, way you should go. I remember they, uh-- Ed went along with this-- and they said, "We must have a team approach to all clinical problems." So I said, "Okay, and uh, we'll have a team approach in medicine and psychiatry." And [Joseph] Parker was the head of psychiatry at that time -- so they had a, a team, and we would make team rounds. Now we'd get here far earlier than anybody else in the morning, and, you know, we'd be here at six o'clock and we'd make regular rounds. And then I remember the ultimate of this, we'd-- we would call the team together when we had a problem. And I remember one night-- oh, about two o'clock in the morning, we had a G.I. [gastrointestinal] bleeder-- upper G.I. bleeder who was vomiting blood. And I've forgotten how old he was-- a middle-age guy. And uh, I was on call-- we got in here and uh, here was a fellow who I knew perfectly well we had to operate on. I said, "Well, call Al Pateen." (Smoot laughs) And uh, so they said, "What do you mean?" I said, "Well, get the gastroenterologist, uh, get the radiologist, get the psychiatrist, get the--(both laugh) the, all these guys, you know, if they are a member of the team, they-- we certainly aren't going to make a decision without them here." So we-- they came in and, "Well, well, what's going on?" I said, "Well, we got a bad decision (Smoot laughs) here. We got to decide whether to operate on this guy." And uh, they said, "Well, what do you want with us?" "Well, you are a member of the team. We wouldn't think of making a decision like this without you." They said, "Well, come on!" I said (both laugh) well, that was sort of the death knell to the team approach. SMOOT: Yeah, I would think so. (both laugh) EISEMAN: Oh, so we-- and as a consequence we, uh-- we wo-worked extremely well with these guys. You'll see from our papers and publications at the time. We had a lot of problems that-- involved publications on psychosomatic problems. We had a lot of joint, uh, projects with our gastroenterologist colleagues, et cetera, et cetera. Uh, but it seemed to me that to contrive a team approach in a clinical setting was false, and ergo was not the way to teach. Now that was at a difference with some of the things that they, uh-- that I think that Bill felt, and then that Ed felt. SMOOT: Let me ask you about two specific programs that were considered innovative, uh, here. I don't know what your relationship was with these programs, but one was community medicine certainly. EISEMAN: Right. SMOOT: And the second one was the behavioral sciences. EISEMAN: Right. Community medicine was, without any question, uh, one of the strongest departments here. A very imaginative, wonderful guy-- uh, what's his name--? SMOOT: Kurt Deuschle. EISEMAN: Huh? Kurt Deuschle, who uh, uh, really was a self-starter. It's funny I don't-- haven't run across Kurt, but Kurt had an absolutely marvelous program that was enormously uh, uh, productive. And I'm sure in your various archives you have the details of it, but uh, we were very supportive of Kurt. Uh, we didn't happen to interface with him a great deal, but uh, um, that was one of the truly great programs around here. And an exciting department-- gosh, they had all sorts of wonderful ideas, and--uh, but we didn't happen to do as much with Kurt as we'd--as, uh-- just because community medicine and surgery don't usually. Uh, but we worked-- that was one of the truly great departments around here. I-- I don't have that much to add except to say it was damn good. Uh, the other one you asked about was--? SMOOT: Behavioral science. EISEMAN: Behavioral science-- well, uh, I'm trying to think how to put this. We always thought they were a little bit off the wall, but uh, they had a, an awful nice understanding guy-- kind of a chubby fellow, what's his name? Uh, who was uh--and not psychiatry, but uh-- not Parker, but uh-- because we-- but behavioral science we felt was a little bit, uh, overemphasized. I never thought that that was as high caliber as--as uh, most of the other departments. But they, uh-- the way psychologists will do, they sort of over-interpreted a lot of stuff. Uh, uh, where we did work with them was uh, in follow-ups. I'll never forget they-- they taught us a lot in this. And community medicine together with them-- I remember, for example, the shock that I had in this. Uh, um, one time the people in community medicine-- somebody -- I've forgotten who it was-- in Kurt Deuschle's department, came back and said, uh, "Do you remember Mrs. uh, so and so that you operated on?" and Frank Spencer and I had operated on. And I said, "Yeah, sure. We did a mitral [valve repair] on her." He said, "Well, do you know where she lives?" And I said, "Well, yeah, she lives in Eastern Kentucky somewhere." And we, "How did she do?" "Well, she did all right, and uh, and we sent her home. She was vastly improved." He said, "Do you know how she got home?" And I said, "No." And he said, "Well, I'll tell you." And he said, "They took her by car to the end of the road and then the road gave out. And there is a path up there, and they had to strap her in a chair and carry her-- she and her-- her sons and some of the neighbors had to carry her about two miles up the creek to her cabin." And uh, uh, well, that, uh-- we then-- that made a real impression. Uh, and from then on, uh, you know, it taught us, who, uh, as surgeons; we better be pretty careful. These guys aren't-- these people we're sending back aren't going back to the ordinary environment. And we worked with community medicine; we worked with behavioral science in this regard. So we interfaced with them where there were things interfacing. We were certainly uh, um, oh, paid homage to them in, in teaching us this. SMOOT: Um-hm. Yeah, I've heard a lot of uh, different, uh, descriptions of the hospital-- the clientele of the hospital. EISEMAN: Yeah. SMOOT: (coughs) That it was becoming really an indigent hospital for Eastern Kentucky. EISEMAN: Right. SMOOT: Is that accurate? EISEMAN: Uh, to some degree. Um, there was a--uh, first of all-- well, it, it became at the extremes. Uh, we weren't getting the ordinary middle-class people from around Lexington. They were still going to Central Baptist and St. Joe's, et cetera. Uh, we were getting some of the, the carriage trade from around here. Uh, we got some carriage trade from around the country too, uh, because our names began to get known and we'd get referrals from all over the country and indeed even all over the world. Uh, but, uh, increasingly as we got going and as community medicine got going, we had more rural Kentucky referrals. And uh, there were people, uh, which I imagine you still have, of, uh--any way where the whole family would park outside the door and, and they'd sort of look at you and say, "You better--bet-- nothing bad better happen to mom." (both laugh) And you'd think they are going to take you apart if it did, um, but sure it was true. And we had a lot of uh-- we had a lot of indigents from uh, Eastern Kentucky, et cetera. And we used to go up there and-- and uh, um, in the uh, miner's hospitals and other hospitals there, and, and do our-- our sort of postgraduate rounds a little bit up in there and, and try and get ourselves known for referrals. But uh, community medicine did the best job on-- on our rural referrals, um, in that regard. So it-- it-- by the time I was leaving there was more and more of that, uh, going on. We did not have a big emergency room; we were began to get it going, but Bill Mollett among others who was here with me at the time, um, uh, who subsequently became head of the V.A., um, and others really built the emergency room with Ward uh, after I left. We did not have a big emergency room then, which has subsequently added a great deal to this institution. SMOOT: Hmm. EISEMAN: But I-- I can't take responsibility or, or um, um, any credit-- it was a moderate emergency room, but I can't take credit for the good emergency room that came later. SMOOT: Um-hm. Are there any specific innovations you would point to within your own department? EISEMAN: Uh, well, of course, we did the first open heart surgery, uh in this area. We did the first liver profusions-- liver support in the world, uh, here. Uh, we, uh, did much of the original work on, uh-- on uh, uh, auxiliary liver, uh, assists. We uh, did some of the preliminary stuff on um, coronary artery surgery -- Frank Spencer uh, and with moderate assists from me-- not a great deal, did a great-- did the preliminary work on patch-grafting of coronary arteries in animals. Uh, we uh, of course, did the first uh, congenital uh, heart surgery in this area. A fellow named Paul Weeks, who was head of plastic surgery, did the uh-- it was a very innovative, new, uh, investigation of wound healing here-- right across the hall. Um, uh, every guy here was doing uh, innovative, uh, world-class uh, research -- it really was remarkable. SMOOT: I had one, uh, person say to me that this was probably the best department of surgery in the nation at the time you were here. Would you agree with that? EISEMAN: Well, said he modestly-- I think that's true. Uh, we had the-- all the societies uh, would uh-- came and met here and they kept all saying that this is where all the professors are going to come from. And we had people from all over the world coming here and visiting us. SMOOT: Do you remember specific countries? Uh, any particular group that was-- EISEMAN: Oh, gosh-- well, I still have them from uh-- well, I'll tell you; in Thailand recently--uh, I went around Thailand and there are seven provincial medical schools in Thailand. And the professors and chairman of the departments of surgery in those provincial medical schools-- I don't know whether all of them studied here or not, but certainly the majority of them had come here as fellows or in one form or another. Uh, the Lexington tradition in Thailand is enormous. Uh, the professor of surgery in uh, eastern, uh, uh, in eastern part of Indonesia--in, in Surabaya. Uh, the-- when I-- I was in Sidney a couple of weeks ago, and one of the professors of surgery in Germany-- in a West Germany came up. And he had-- he had uh, come here and worked in our laboratories, and uh-- so that uh, really all over the world. SMOOT: Hmm. What about within the United States? Were there lots of-- a lot of new schools were starting up in the 1960's. EISEMAN: Right. SMOOT: Do you remember any specifics, uh, about some of those people coming in? Uh, looking at your department, seeing what you were doing? How to set up their own departments? EISEMAN: Yeah, they um, uh-- we had the uh, Society of University Surgeons met here, uh, and so that all the professors came here. The Society of Clinical Surgery came here. Uh, the--we, uh, we took them out to some mill-- I've forgotten. This is sort of the creme de la creme of um, academic surgery. Uh, they all-- they all came here; uh, met here and would come here and talk to us. I can remember Dave Hume, uh, who was a professor of surgery at uh, University of uh-- Medical College of uh, Virginia, in um, Richmond, coming here and visiting us in the laboratories when we were doing some of the liver stuff. So it-- it was one of the hot departments in the-- in the world at the time, and it was fun. That's heady stuff, you know, that's good for the ego. And, of course, success builds success. We uh-- everybody was on national committees. And uh, of course, let's face it, money-- research money was easy to come by in those days. And so we were--our, my timing was right. Uh, it was a lot easier to do it than it would be now. SMOOT: Let me ask you about the quality of the students that you were given. Um, I'll put it that way-- tell-- tell me a little, little bit about the students. EISEMAN: Well, you know, I've-- I've worked and taught in private schools of Harvard and Washington University, which are the top tier of private schools where you-- the MCATs and IQs of the students are enormously high. And uh, I've taught-- I've had experience at the University of Colorado at two intervals and came here. Um, it's an old saw, everybody knows it-- that uh, the top ten percent of almost any medical school is about the same. Uh, whether you are talking the University of Kentucky or, or Harvard or Hopkins or Stanford or whatever, they're, you know, great achievers. And we had that top ten percent here. Uh, by and large there were good old boys, but the thing that's really great about it is that uh, the uh, students-- you could motivate these students to, uh-- the ones that I know best, of course, were the ones that-- that went into surgery. Um, uh, I just was an hour or two ago was talking to a student-- to a resident here, chief resident here, who uh, has gone with a man named Dick Furman. I don't know whether you know-- well, you must read his book. His book-- he's a graduate of our program here. And his book is called, uh, To Be a Surgeon. And he's in practice in Boone, North Carolina. And he-- this book is about being a resident at the University of Kentucky. And uh, (coughs) it's uh, very flattering about-- he doesn't use our names, he gives us pseudonyms-- I've forgotten what he called me, but he-- you could-- anybody who knows the place can spot this was Spencer, and this was Menguy, and this was Eiseman, and this was Wilson, et cetera. And uh, I didn't know he was a writer at the time. I knew he was a sensitive fellow. And uh, he came here and uh, we put him through. He was a wonderful guy and he's now in practice over there. But here's a resident now who went to this fellow, Dick Furman, uh, and that's his role model--uh, Dick Furman. And Dick Furman and-- he is going to uh, join Dick Furman when he goes in practice. And as I told him at lunch-- he asked me the question, "What is the most, uh, satisfying thing that you've done?" You're an old guy -- he didn't say that, but you're about had it, and he said, "What's the most satisfying thing that uh, you've done?" I said, "Well, that's easy." I said, "That's the people that we turned out." I said, "That's the thing that academicians do that uh, non-academicians can't do. That-- we don't-- we aren't any better in surgery, we aren't any better at anything else, but we turn out people." I said, "As a matter of fact, you're my grandson because Dick Furman is my professional son, and he in turn has turned you on." And uh, I said, "That's the thing that's-- that's greatest." And-- and we had some of that. Uh, we had-- to show you another thing-- one time sitting in this office right next door, a guy came in and uh, he said-- he came down here and, and, from Columbia P&S [College of Physicians and Surgeons], and he said, uh, "I'd like to uh, look over-- I want to be an intern. Uh, I'm an intern applicant and I'd like to look over your program." Fine-- we had them coming from all over the country, uh, to look at these things, and we cranked him through, and he came back and he said, "Well, I like what I see." Well, I thought "That's very nice of you." Uh, he said, "I'd like to spend a couple of more days here." Well, that was unique. And uh, he said, "I like it enough, I-- I want to see whether I'm going to put my time in." I said, "Well, tell me young fellow--" I didn't say young fellow because I wasn't much older than he, but I said, "Tell me about yourself." Well, he said he'd gone in the Marine Corps when the Korean War came out, and he hadn't quite graduated from college at the time, and he became a tail gunner. And he, uh, came back and he had gotten his uh-- afterwards he went straight into college and he finished college in about two and half years. And he, uh-- never having graduated from high school. And uh, he then got himself a degree in systems analysis-- this new thing and he-- at UCLA, and he went to P&S and he was a parachute jumper and a flyer and a this, that and the other. And anyway we took him in the program and he was a unique fellow. And he came in in the middle of his second year and he said-- said, "Boss, I want to talk to you for about a half hour." I said, "Alright, Storey" I said, "You--uh, what is it?" He said, "Well, hold your hat." He said, "I want to be an astronaut." (Smoot laughs) And I said, "What?" He said, "Yeah," I said, "You mean one of those guys that--" -- by this-- at this time there is nobody in the, uh-- except maybe-- I've forgotten whether Glenn had gone up or not. I said, "One of those guys maybe who will go on to the moon?" He said, "No-- no." He said, "Long after that." And this was way before anybody had gone to the moon. This was about 1960, I guess-- maybe '61. And uh, he said, "No, after that." Well, this was Storey Musgrave, and we'd talked a long time. And I remember-- even remember the odds. He said-- he says, "About one in seventeen hundred." And we sat down and figured out how he could up his odds. And he had a master's degree, and as you probably know, he's become-- he got a Ph.D. in physiology here and he's gone on to be a-- flown twice and been mission commander and all that kind of stuff. But that was sort of the-- the way things went in those days. SMOOT: Everything was falling in place? EISEMAN: Yeah. SMOOT: Well, what about that--(coughs) that-- you have ten percent that's on top. EISEMAN: Oh, yeah. SMOOT: Let's-- let's go on down the tier, if you will. EISEMAN: Well, we had the usual foul balls that you have everywhere. SMOOT: Um-hm. EISEMAN: Uh, no more. Uh, we had some that were really pretty funny, but the-- well, maybe the behavioral sciences will--uh, maybe this will illustrate a little bit about how we were at odds with the behavioral scientists. Um, we had a guy here-- we won't use his name-- who we thought was crazy--uh, a medical student. He wasn't stupid, but he was crazy. And uh, so we said, "Look, this guy's crazy and he must, uh, not be allowed to go through medical school." And the behavioral scientists said, "No, no, no, you don't understand," and they gave us some far-out explanation. "And we can-- we think if we can work with him, that we can get him around." And uh, we said, "Well, alright," he was about third year then, "Um, okay, you work with him, but I think he's crazy." We all thought he was crazy, and that he'd be a very, very dangerous doctor. And uh, so we went over and over and along with this, and we uh-- I don't know -- I've forgotten what we did, we had him reprieved or something like that. And finally they had to lock the guy up. I mean it was perfectly clear, but it was the difference between those of us who were clinicians dealing with sick people, uh, and who knew that uh, a clinician we turned out-- didn't make any difference whether he was a surgeon or a family doctor-- whatever, it had to be a stable individual. And the--and the behavioral science people who felt that this was a professional challenge, uh, to see if they couldn't take a crazy guy and make him uncrazy, (Smoot laughs) and uh, so that we had the usual problems that uh-- that uh, come up there. SMOOT: Um-hm. EISEMAN: The middle group is probably very much like the middle group I just made rounds with now. They were good solid, good old boys and uh, they're-- that's where the real difference between uh, say a University of Kentucky or a University of Colorado or University of Oregon or University of Florida or anywhere else, uh, differs from the Harvard, Hopkins, Stanford, uh, Washington University, uh, um, et cetera. And they differed then and they still differ, but they are good solid guys. They make good solid doctors, which is fine -- that's the mission of a medical school. SMOOT: The students obviously were very much influenced by you and enjoyed your classes and your lectures. Uh, did the students at all influence you? EISEMAN: Oh, sure. That's an interesting question, I never really thought of it. Uh, sure, it was very much an interaction affair, but then the next question would be, how? Uh, (coughs) they gave me a real insight, of course, into the area. And I used to go back off in this area and see where they came from and being a Civil War buff, visited all the battlefields. And uh, they gave me uh, an insight-- let me say-- I'm trying to think if they gave me an insight into-- any different than the University of Colorado, because Colorado and Kentucky in many ways are similar, and the middle portions of the class are very similar. Uh, so that other than regional--um, I'm not sure how they did, uh, except giving me information-- gave me a love of the area. Uh, but how did they influence me personally or professionally, I'm not certain I can give you a good answer. SMOOT: Okay. What makes uh, a good surgeon? What are the ingredients? EISEMAN: Ingredients of a practicing clinical surgeon? SMOOT: Just-- that's right. EISEMAN: Not an academic-- not a professor? SMOOT: You can draw the difference for me too, if you would. EISEMAN: Okay, the uh, uh-- the first thing, he's got to be bright. He's got to, uh-- that's no different than any other physician. Uh, he, uh, has to be-- he has to be enormously goal oriented, because you have to work so damned hard -- he's got to be willing to, to work hard. Uh, he's got to be able to put-- this sounds trite, but it's true, he's got to be able to put his own, uh-- his own wishes and desires, uh, to put them right behind himself. More so than most specialties, because uh, he has to be ab-- he, he, must be both physically and emotionally able after having worked a hard day and finished a hard case half the night, to get another one. So he must be physically and emotionally ready, and then he must be strong. He must be, uh, durable, uh, so that he can do that. But more important than anything I guess, he must be uh, willing to, to have decision making under uncertainty-- in the current jargon. Uh, the surgeon must be able to work with less than all the data that he, uh, would like to have and make a decision, and be bool-- use boolean logic, which uh, means yes or no, because the decisions a surgeons make, uh, are usually yes or no. Uh, that's perhaps why I like to get into the algorithm business and decision trees, because, uh, you either operate or you don't operate. We just saw a case-- you either do a colostomy or you don't do a colostomy. SMOOT: A binary proposition. EISEMAN: Right. It's a binary-- binary decisions. And he must-- he must think along those lines. And-- and, of course, it feeds on himself-- on itself. Uh, you-- at first you must be able to do it without going crazy in doing it, uh, because you are going to make mistakes some time and you can't let that-- you can't let that destroy you, uh, and it tends to--uh, down the years it tends to, and it's accumulative too. Uh, so that uh, you have to be able to live with decis-- wrong decisions. And you have to be honest, because you have to, uh-- your-- if your decisions are buried-- I don't mean buried-- if they're hidden -- uh, because of the connotation of burying -- but if-- if the decisions of a psychiatrist are long--uh, takes a long time to, to show itself- The decisions of a surgeon usually show up right away. He must be able to, uh, take responsibility for those decisions if he is going to be any good-- you said a good surgeon. He must be honest with himself. Um, he uh, he must be technically adept, he must like to do surgery. Uh, well, that's the physical parts. He uh, he--that's-- he must be curious. Uh, he must be, uh, uh, skeptical, uh, because our decisions are, are grave decisions and uh-- I was just thinking of the rounds I made with a student who asked about a certain drug and uh-- and I said, "You know, I don't think that's probably going to pan out." And somebody quoted me a lot of numbers. I said, "Yeah"-- a lot of papers and things-- I said, "Yeah, but I just don't really believe those." And so a good surgeon must be appropriately skeptical, but not negative. That's a pretty long list. SMOOT: Yes it is. But it takes all those things you think really-- EISEMAN: To be a good surgeon-- to be uh--he he must-- the other thing is, he must uh, uh, and he must uh, be compassionate because uh, he's got to understand that his decisions are awful decisions. Uh, I've often said that, oh, you know, giving a student a lic-- graduating him is really equivalent to giving him a license. And that's sort of a license to carry a gun because you can do a lot of harm, but to give-- to make a, a young person a surgeon and qualify him as a surgeon, is to give him an automatic weapon. Because uh, you know, a psychiatrist who takes care of ten patients, uh, or a hun-- fifty patients or something, uh, over the years. Uh, a surgeon, uh, has an automatic weapon; he can do awful damage if he-- if he's wrong, and he's got to realize that. And we deal with-- we deal with very cruel diseases. Uh, whether it's cancer or trauma or, you know, brain dead people or far advanced diseases of this that and the other, and you've got to--he's got to, um, weigh the um, the uh, patient's quality of life, uh, in his decisions. SMOOT: Hmm. What about a professor of surgery? An academic surgeon? What different qualities-- EISEMAN: He's got to be all of the above, (Smoot laughs) uh, plus emphasis on curious. I-- I happen to believe that uh-- time am I going to have to talk-- SMOOT: I'm watching it-- EISEMAN: Okay SMOOT: I have to stop at least about five till four. (laughs) EISEMAN: (coughs) I'm not sure I can go that long, but let's see-- he's got to be curious because I don't think you can be a good teacher unless you're doing research. Uh, I think that uh, that's why, you look at a department of surgery and see if they are doing research, because the teachers have to be curious and, and uh, critical, um, and if they are curious and critical then they are going to want to solve some problems. You've heard me discussing-- just before we started here, about how to solve two or three of the-- or a problem that we brought up in just a ho-hum case. Um, so that I think he has to do--my, in my opinion, he has to do research. He has to know how to do research -- he has to have done research -- he has to know how to write. Repeat, he has to know how to write. He has to know how to talk. Uh, he uh, has to be a judge of individuals, because-- let's, let's assume for the moment that uh, I did a few things right in this institution. Uh, what did I do right? The only real thing I did right was to choose seven, ten, fifteen staff, and an awful lot of residents who have turned out very well. So that you could say-- and I didn't do much else. Uh, you have to be able to be, uh-- have to choose people right-- properly. And then you have to have enough confidence in yourself to give them their head. Uh, the uh-- that's perhaps the hardest for some people. If you are lazy, such as myself, uh, it isn't the hardest. But I've seen a lot of people fail on that; I've seen some guys a lot smarter than I am, who uh, are afraid to have strong people around them. You know, that's the same as any other managerial technique. That's-- it's no different than head of IBM or General Motors or Joe's Hardware down the street. So that you have to be a good manager with all that implies-- organized, uh, disciplined, um, understanding of the people you're working with. But then the other thing that if you want to be a-- the best academic surgeons that I know, are interested in turning out-- influencing the, uh-- influencing the personal and professional lives of the people they're teaching. SMOOT: You set up the internship and residency programs here-- EISEMAN: Here--uh, in surgery. SMOOT: Yes. EISEMAN: Sure-- yeah. SMOOT: Okay. Do you remember your first students? EISEMAN: Oh, gosh, yeah. SMOOT: Could you tell me a little bit about them and the influence that you had on them and where they've gone and what they're doing? EISEMAN: Well-- SMOOT: If you can-- EISEMAN: Uh, just the ones last night of-- Bill Offutt, who is an ophthalmologist, uh, here in town. Herman Playforth, uh, uh, cardiac surgeon here in town. Dave Richardson, professor of surgery at Louisville, on and on and on. Uh, they're-- some of them are, are professors, some of them are associate professors, some of them equally as good are practicing in Boone, North Carolina-- respected people in the community -- uh, the respected, uh, surgeon in the community, and that's not to say that a guy-- Dick Furman, uh, or Bill Offutt or somebody is uh, any lesser achievement than Dave Richardson, who-- who uh, will go on and be uh, a professor of surgery somewhere-- I mean will be chairman of a department. They just chose different paths, uh, you know-- paths, grass and the woods; and one took one path and one the other. Uh, but uh, sure-- they're-- that's what's most fun of all at the college, is to come up and somebody will say, "Well, Dr. Eiseman, you don't remember me, but I was in your first class and et cetera, et cetera." Well, that's what's really gives you the kicks. SMOOT: Let me ask you a few other questions about your relationship with other parts of the Medical Center. EISEMAN: Yeah. SMOOT: Uh, first of all, dentistry has its own surgery. EISEMAN: Yeah. SMOOT: Uh, what was your relationship there? EISEMAN: Well, we had a fellow-- what is his name? He's a wonderful guy-- came from Alabama. He uh-- a great administrator, uh, and a good enough dentist so that I would let him be my dentist, (Smoot laughs)- -uh, a great fellow. Uh, um, you know, he, he came within a philosophy again, the same philosophy-- and I'm sure Bill Willard, uh, chose him, uh, of one of-- SMOOT: I know who-- I know who you are referring to and I can't think of his name at the moment. EISEMAN: I--anyway, he's a good man and uh, we got along very well with him, but they had, uh-- at that school it was called the school of surg-- of medicine and dentistry, I believe. And anyway whether that was it or not, that was the theme of it here. And uh, we worked I remember in bone healing and, uh, osteogenesis and this sort of thing with them, uh, but when it came to-- and-- and we were supportive of their oral surgery, uh, people, uh, but there was no Mickey Mouse about who was going to do-- the head of the next surgery. Uh, when we, uh, talked-- we helped them choose an oral surgeon. Uh, when it came time to--um, to divvy up the problems of let's say-- could I have a little-- could you get that coffee? SMOOT: Sure. EISEMAN: I'm wired to this thing. I won't be able to get around to it. Can you get it? SMOOT: Sure. EISEMAN: I'm going to have to do a little voice rest, because I'm going to have to give a-- SMOOT: We can stop for a moment. Do you want me to turn this off? EISEMAN: No. No. SMOOT: Okay. EISEMAN: That's all right. I'll have to get some of that, but before-- I think I'm going to quit in a-- in a little bit of time here. SMOOT: Okay. EISEMAN: (coughs) Because I don't want to go hoarse while giving this lecture. SMOOT: Oh, no. No, not at all. EISEMAN: Is that going now? SMOOT: Yes, sir. It's on. EISEMAN: Okay. Um, we worked well with them. Um, we decided, I remember when we had problems of uh, who should take care of fractured jaws and who should do the laryngectomies and who should-- where there are areas of conflict between specialties. And uh, we sat down with them and said, "Well, now look, um, you want to do the busted teeth." "Yeah." "Well, does-- do you-- Ben Rush was interested in-- in head and neck surgery-- well, you want--?" No, he's not interested in that. "Okay, well all of those will go to the oral surgeon or the dentist." "Now how about, uh, mandibular fracture?" Yes, they want that. The plastic surgeons wanted some, the-- everybody. "Well, alright, we'll set up, uh, that will go one, one, one, one. Uh, now the laryngectomies, uh-- the dentists, are you?" No, they're not interested in that. "So, uh, we'll have zero for you in that." And uh, it worked out well, of course, part of it was-- let's face it, it wasn't any brilliance on my part. Part of it was that when we decided those formally, there were no patients -- number one. So we were divvying up something that didn't ex- exist. And number two -- it didn't make any difference whether they took care of a fractured mandible or whether plastic surgery or general surgery did, as far as money's concerned. Now I'm certain that if they got fifty percent of the fees for something or other, that uh, they'd get it instead of us, it wouldn't of been so easy. So that's one of the benefits of Bill's full full-time system. SMOOT: Let me ask you about the, uh, relationship with nursing. Because I know that uh, the nurses were trying to instill a, a new philosophy within their own right to professionalize, uh, nursing, uh, a bit more. And that seems to have created some conflicts in a variety of areas. Uh, Did that create any problems for you? EISEMAN: Much less so than it does now. Nurses uh, in those days were relatively-- around here at least, were relatively naive. They were still interested in getting sick people well. Uh, we had-- I can't remember any serious conflicts whatsoever, uh, with the nurses, uh, here. Uh, they were good hard-working young women, by and large all women then. Um, and uh, they were--uh, there were enough of them, they were good hard-working girls, by and large, uh, where we didn't have problems. I would say that, uh, the problems have become much worse since then as far as I am concerned. Now you can't get nurses who are interested in anything but, uh, being administrators, and they've-- they've priced themselves-- I don't mean just in money, but they've--uh, in their professionalism is all in managerial techniques, et cetera, and they're-- become, by and large, no damn good at taking care of sick patients. So that, uh--a- and I think we are up against a real crisis, uh, at the moment, but that's not what we are talking about. In the days that I was here, the nurses that came in here were, uh, young women who uh, who were really interested in taking care of sick people, and, and they did a good job. And, of course, those were the early days in the intensive care units and uh-- and just as they are now, the ICU nurses are, are something else -- they are tremendous. So that, no, we had uh, little conflict there; they were increasing professionalism in that, uh, they were quite appropriately, uh getting more interested in disease processes and certainly the emotional reaction of patients. But uh, there was no threat-- no real conflict that I remember, uh, in those days, because they--they, they did their jobs-- the job that we wanted and as far as we were concerned, and did it better because they did have this area of professionalism than they have now-- I--uh, now-- I don't, can't answer for here, but all-- everywhere else in the country, that, uh, their professionalism is not the same professionalism that-- that we're looking for. So in those days it was good-- we had good rapport with them. [Pause in recording.] SMOOT: Dr. Eiseman, let me ask you about uh, experimental animals. Was there any problem with that in the community here? Uh, a lot of people have uh, brought that up. It seems like a cyclical sort of thing on a national level really, where people worry about, uh, animals being abused or misused and that sort of thing. EISEMAN: Well, that's funny you should bring that up because I hadn't thought about it in a long time, but I remember what I did. Our department-- the people and myself included, uh, were very much, uh-- we had to have experimental surgery. And I didn't choose a guy to come here unless he was an experimentalist as well as a surgeon. So a hundred percent of my staff were doing experiments, and were doing experiments almost a hundred percent-- maybe a hundred-- with animals. And this was brought up as a problem-- and I can remember right after I came here-- I don't know how soon, but within a few weeks, I went down to the Fayette County Animal-- whatever it's called, and said, "Look, we are not going to do anything that you don't know about. And you give us a list of the people of-- that you want on your inspection committee." And we had, uh, an animal facility right down the hall from here. And I said, "I'm going to give this to the veterinarian who is in charge of that-- of uh, that animal facility, and anytime, unannounced, you are welcome to come and see what we are doing. And uh-- because we have nothing to hide, and you come with us--" and I've forgotten the fellow's name who was in charge of that, but um, I said, uh, "We, we'll-- you come and ask us now what our policies are going to be, this that and the other, and uh, we will tell you. And we will work them out with you, and uh--" I'm not sure I said that, but I said, "These are what they're going to be." And uh--(coughs) "But if you give us the names of the people you want on your inspection committee--" sort of like the I.G. -- the inspector general in the Navy and Marine Corps and the Army. I said, uh "You spot-- sight visit us-- spot visit us anytime you want." Well, this really defused it and uh, they'd come in a couple of times. And there would almost always--uh, every morning, every afternoon there'd be some full-time guy working down here and operating in there and uh, and doing research-- in the uh, in the animal area. And uh, you know, this is the kind of policy that we talked out in our department. And uh, you know, they'd come a few times in the first few months and they'd-- every once in awhile for the next six months, and maybe once a year thereafter, but uh, we never had any problems with it, while I was here. SMOOT: Um-hm. EISEMAN: Now those days were easier. I-- I don't say that the same things that would have happened-- that happened then could uh, solve the questions now, because it's much more sophisticated human rights and animal rights things and all this. I was lucky; I hit it at the right time. SMOOT: Um-hm. (coughs) Did you ever have any questions about their use of cadavers? EISEMAN: No, we didn't have uh-- we didn't, uh, actually-- no, the answer is no. The--that wasn't in my-- SMOOT: That would have been something earlier-- EISEMAN: I mean that was in-- would of been with anatomy, and-- SMOOT: Okay. EISEMAN: --and uh, I didn't personally have anything to do with it. SMOOT: Did you ever have any relations with the University of Louisville's department of surgery? EISEMAN: Yeah, uh, I did. Uh, when I first came here--uh, use this discreetly, but when I came here, there was a fellow named uh, Rudy Norr, who was the head of surgery at Louisville. And it was a very weak school, and it was a very weak department, in those days. And I might add, now, it's far from it. It's an excellent department of surgery, a superb-- I won't say just excellent. It's a-- it's a really, uh, Hiram Polk has come here long since. But I went over to Rudy and uh-- before I took the job, asked him about the job here-- and potential. And uh, I promised him at that time, that I would not raid his department because it was so weak. Uh, I had been here-- I've forgotten, a few months-- and the guy came over to me from Louisville. He called me up and said, Could I come and speak to me? "Yeah, sure." I'd known him-- he was a young guy. He'd graduated from Hopkins and finished his residency at Hopkins -- was a very bright fellow. And he'd gone-- he was from Louisville, and he, uh, went back there. And he was the bright star of Louisville. He came over and he said, "I want to come with you." I said, "I can't take you," and he was crushed. I said, "I can't take you because-- I'd love to, but I promised Rudy that I wouldn't take you." He said-- I said, "What-what's the trouble there?" Well, he said, "I want to go into pediatric surgery and uh, Rudy has told me that uh-- that there is no future in pediatric surgery. Academically there is no future in it; it's just a variant of general surgery and there is no future." And he said, "What do you think of that?" I said, "Listen, Alex," I said, "You're a winner -- you're gonna, you're gonna be great. I don't care whether you go into colon or rectal surgery, or ENT [ear, nose and throat], or pediatric surgery -- you are going to be a winner. And if you want to go into pediatric surgery, you go into pediatric surgery. And I wish to God I could, uh, take you here, but I promised to Rudy Norr that I wouldn't do it." SMOOT: Was this a personal choice, by the way? That you would not raid their department? EISEMAN: Yeah. Oh-- SMOOT: Just a personal choice? EISEMAN: Oh, this is just me and Rudy. SMOOT: Okay. EISEMAN: Rudy and I. SMOOT: Okay. EISEMAN: Uh, because uh, it was-- I wanted to get along with Rudy and the University of Louisville, and I did. But if I'd gone in there and taken this guy away, uh, it would of automatically been bad. So, I said, uh, "Pursue what you're gonna do." And he said, "Well, I guess the best thing to do is to go back to Hopkins." And I said, "Well, I guess it is." And that's Alex Haller, who is now professor and chairman of pediatric surgery, and the leading pediatric surgeon, I guess in the United States. Uh, you know, this-- but he was clearly a winner. But that--uh, Louisville was woefully weak then. SMOOT: And it seems to me that uh, really if-- if it had been a, a policy or if somebody had decided to do this, really this school could have destroyed the University of Louisville. By taking out their best people and who-- who would go there? EISEMAN: I think that's right and I'd take my hat off to Bill Willard, uh, uh, that he did not want to do that. Uh, he--uh, he made school policy in this regard and uh-- and I, and I think that's true. SMOOT: I'm going to ask you one broad sweeping question because I know I'm-- EISEMAN: Yeah. SMOOT: --taking up a lot of your time and uh, and I appreciate it, but since you studied history, uh, you've heard the questions that I've asked. Uh, have I missed anything? Are there certain questions regarding the history of the development of this institution, your department in particular, or any other thing that you think should be addressed, uh, as sort of a summation? EISEMAN: I'd only say one other thing. I'd say why. Why did this place blossom? And to some degree, why did it have a less than blossoming period? Uh, it-- as a historian, uh, why was this, uh, sort of Periclean Athens, or Florentine Medieval era? Or, or Saxony in the middle of the, the seventeenth century--uh, eighteenth century? Uh, or Elizabethan London? What-- why was this a golden period? Uh, because it was -- it was a very exciting environment. Now there are a lot of things that go with it-- people. There was, uh, money-- not from here, but from NIH [National Institutes of Health], an-and the other things that go along with it. Because it was a--it was a golden period, certainly in surgery it was. Uh, and I take a little bit-- not very much credit for that. The uh, the only real credit I can take for it is the people I brought here. But the-- why does a school blossom and be on the cutting edge of so many things. Whether it's community medicine or-- or uh, interdepartmental activities between basic and clinical sciences, et cetera, et cetera-- and surgery, this that and the other. And why does it wax and wane-- it happens here, it happens, the University of Colorado, it happens at Harvard -- although, uh, Harvard and Stanford and et cetera, usually have so many reserves that uh, it doesn't-- the swings aren't-- the Dow doesn't go from (Smoot laughs) 2700 to 1900; uh, it swings from, uh, 2700 to 2500. Uh, but in a thin-- thinly traded institution like the University of Kentucky, uh, the swings are greater. I think the term in the stock market is a beta potential. SMOOT: Okay. (laughs) EISEMAN: Uh, in economics-- in other words, it is a, a thinner issue and uh, therefore, uh, outside influences make it swing further. I've never thought of that analogy, but you, you are free to use it. SMOOT: Thank you (laughs). Thank you for all of your, uh, sharing it with me today. EISEMAN: It was fun. SMOOT: I really appreciate it. It was very informative and enjoyable. EISEMAN: Well, thank you. SMOOT: I hope it was for you too. EISEMAN: How much of it, uh, is at variance with what you've heard, uh, before? SMOOT: Shall I turn this off? EISEMAN: Yeah. SMOOT: Okay. [End of interview.] Dr. Ben Eiseman was Professor of Surgery and Chairman of the Department of Surgery (1961-1967) at the University of Kentucky College of Medicine. In this interview, Eisemen discusses the department of surgery and his unique structuring of responsibilities. He also details his disagreements with Dr. Willard over the direction of the Medical Center, in particular, his disagreement with almost everyone regarding the lack of a payment incentive program at the Medical Center. He also discusses in detail the qualities which make a good surgeon, academic, and manager. In addition, Eiseman shares some anecdotal stories about the Medical Center. insert here