Transcript: Tape 6 Side A
DATE: March 30, 1998
TAPE: Tape 6
INTERVIEWEE: Thomas Scully, M.D.
INTERVIEWER: Eileen Barker
PLACE: Dr. Scully's home, 1400 Ferris Lane in Reno
TRANSCRIPTIONIST: Teresa Garrison (Revised 2016, Haley Kovac)
Thomas Scully: Alright, just see if it's working.
Eileen Barker: Yeah, it's working. Today is the 30th of March and we're going to be continuing on about medical school, Dr. Scully. I don't remember because I don't have the transcripts here, but if there's some duplication…
TS: Sure, we were talking about the second year of medical school when I didn't have any money, I hadn't joined the Air Force yet, and Celia and I wanted to get married. But in my second year I lived with a paraplegic in a hotel downtown, he was an English professor and I was his caretaker; he had a two-room in the hotel on the 13th or 14th floor. I lived with him, I had a day-bed in the front room, and I would get him up in the morning, take him down to breakfast, then I'd go to school at eight o'clock; then I'd come home in the evening and put him to bed after dinner. I'd have to bathe him and toilet him and shave him and do all those things either in the morning or the evening, whatever was most convenient, and then I would sit down to study. But as I was speaking the last time I was not doing very well in school at the time; I think we've covered this but just to repeat, I was really failing pharmacology. I was probably sleep-deprived and exhausted most of the time 'cause I was getting only a few hours of sleep every night and of course the care for this man was seven days a week. At any rate, at Christmas time of my sophomore year, Celia and I decided we were going to get married and I went to talk to my mother who, as you know from our previous conversations, was a widow, was left with seven children, I was the youngest. And finally I was in medical school and when I went to tell her that I was going to get married at the end of the second year, she almost had a stroke. And I can remember almost her words 'My God, if you wanted to kill me with a knife in my heart, you could not have been more dramatic' something to that effect.
EB: Somehow she picked up on Irish guilt.
TS: Yes, exactly.
Celia [in the background]: She said 'You could not have chosen a better way. If you wanted to kill me, you couldn't have chosen a better way. [EB: (laughing) I love it.]
TS: You could not have chosen a better way if you wanted to kill me; and then of course it went onto the next thing of 'The first thing that is going to happen is you're going to have a baby, you're going to drop out of medical school, you've worked yourself so hard for all these years through high school and college to become a doctor and you're going to have to drop out and you'll be driving a cab and you'll have kids to support and your future will be ruined.' I said, 'Yes, I understand all that's a possibility, but we're going to get married anyway.' I had already applied to and knew that the Air Force was going to start me in their program as of that July as a junior. So, I knew for the first time I was going to have enough money to get through school and I also knew Celia was willing to work.
EB: At this point, excuse me, was your mother contributing?
TS: No.
EB: …you did this on scholarships, she didn't…
TS: No, my sister.
EB: Your sister was helping you and your brother.
TS: Yes, my sister and my brother would send me a small check and, of course, was only for my freshman year; that's where that $2,000 came from. As we talked earlier, it was $1,000 tuition plus roughly $1,000 to live. And my sister who subsequently gave me a kidney transplant many years later, she sent me money, my brothers would send me small checks and I would work in the laboratory and make as much money as I could, I'd get a meal ticket, I would beg, borrow, and steal anyway I could. Then of course in my second year I was working for this paraplegic, so I got room and board from him and all I had to do was come up with the tuition. Well, I made tuition that summer driving a Pepsi-Cola truck; so, I made my tuition the second year by driving Pepsi-Cola all that previous summer and I made my room and board taking care of this man. And I was quite sure then that I would have money for my third and fourth year because the Air Force was going to take me on; and of course married to Celia, she was willing to work. Well, as it turned out I, in the spring, left that job with the English professor at the hotel downtown because I knew if I stayed I'd probably flunk out of school. In the mean time I got a horrendous case at Easter time, a horrendous case of infectious mononucleosis which Celia reminded me of after our last conversation and I was actually hospitalized for about a week. I had an enormously enlarged spleen, I had a high fever, I was very sick and that on top probably because I was exhausted, on top of that I was almost sure to flunk out of school. Celia and I have already planned to get married; I was facing the National Boards at the end of the second year. So it was a very stressful time, I do remember parenthetically that professor of medicine Dr. Beebe, who's still alive; last time I heard he's in his late 90's.
EB: Do you remember his full name?
TS: Yeah, Dr. Beebe. Richard T. Beebe. B-E-E-B-E. B-E-E-B-E. Last time I heard from the alumni, he's still alive; and marvelous physician, chairman of the Department of Medicine. He came and saw me, and I remember they took me down stairs to the big auditorium and presented my case at grand rounds. He said to me and wrote it on my belly with a piece of tape, he said 'Don't let anybody palpate your abdomen' because the spleen was so enlarged that it would be relatively easy to rupture.
EB: My word.
TS: Anyway, I was quite ill. So, I have infectious mononucleosis, I get out of that; I left working for the English professor and I had about a couple of weeks 'til final exams. Well, true to form like my experience with German in Colgate, I bombed the pharmacology exam; and the professor called me in and I walked in and there were three of his assistants sitting there and I can give you their names if you want them and they said 'You are not going to pass pharmacology, but we understand from the dean…' Dean Wiggers who was a real good friend. '…We understand from the dean you've been ill, you missed some school, you were quite sick' as a matter of fact, one of them had come to the grand rounds where I was the subject of the discussion. In those days, we didn't know what infectious mononucleosis was; we just knew that it tended to affect young college and young people who usually were not getting enough sleep. At any rate, they said 'We'll make a deal with you. We're going to give you an oral exam next week and ask you some specific questions and then if you pass the National Boards Part I, all of it, including the pharmacology section; then we'll allow you to go on.' Now, the school, Albany, had made the decision early on, one of the first schools to accept the National Boards in the early 1950's. They just came out; the National Boards, as we now know them, only got started in the early 1950's. And many schools did not accept them and many states would not accept the National Board as a criterion for licensure; you had to take their state licensure. As a matter of fact, I came out to Nevada in 1956 and took the state licensure exam; be that as it may, at that time, Albany did require all of its students to pass Part I to go to the third year and to pass Part II to graduate. So I said 'Fine.' And I think this is repetition, but just to bring the story up to date; I then moved into a rooming house where a classmate by the name of Steve Sullivan was living. And Steve and I and some other students really studied day and night for, I don't know, about six weeks, I've forgotten. And the pressure was on, not only for all of us, but my going on was critical. We quizzed each other from morning 'til night and lo and behold, I passed the National Boards, I did rather well. I've got my grades some place; but I did okay and I did okay in pharmacology. Obviously, I knew enough pharmacology to pass a standardized national exam, the problem was I had been quite ill and fatigued and the departmental exam that they gave me, I just bombed it that day. Why? Who knows? My mind was all over the place. At any rate, I did pass the National Boards; the Boards were usually given around the 15th of June. I went home and I think I slept for two weeks, then Celia and I got married; we were married on June the 30th, 1956. And I think I had just received a day or two before or maybe it was just after we got back from our honeymoon, I don't remember, that I had passed the National Boards and got a telegram from the dean that I could return to school. So, it was a very touch-and-go sort of thing.
EB: On the infectious mono, I guess it has something to do with the immune system being depleted by lack of sleep?
TS: Well, I think that sets you up.
EB: How would you have gotten that, do you think?
TS: Oh gosh, who knows?
EB: What was the treatment then?
TS: The treatment was rest, nothing. There was no treatment.
EB: Nothing?
TS: No, and I think even today it's considered to be a viral disease.
EB: What are they doing now?
TS: Epstein-Barr Virus and I think today maybe it's also thought to be somehow related to this chronic fatigue syndrome they talk about today; in those days we didn't know what the Epstein-Barr Virus was. It apparently was later discovered, virology was just in its infancy in the 1950's; and at the time we just knew it was a disease, you went to bed, you slept, and all you did is sleep and drink a lot of fluids is what it amounted to.
EB: The Kiss of Death for a medical student.
TS: Yes, it was at the time; and it was right at the time where I was obviously on the edge with pharmacology. I had only a couple of months to go before the National Boards; I don't think my mind was working for weeks before that exam.
EB: How had you done in pharmacology up 'til that point?
TS: I did okay.
EB: 'Cause you would have had other exams.
TS: Yeah. They usually give an exam every couple of weeks or a month and I think I was doing okay. I never felt that I was going to flunk anything; I felt always more anxious about the first year of medical school whether I could compete and most medical students have that. I mean every first-year medical student, not all of them, not everyone, but many of first-year medical students have the anxiety about being able to compete with all these other bright people. But I had gotten through the first year okay, but I think what happened in the second year, as I was trying to make a buck; I was working overtime, I don't blame him, but I was working overtime as this man's caretaker and was physically exhausted.
EB: It's like having a baby.
TS: Yeah, and wasn't studying efficiently and so it all came together in the spring of '56; but turned out alright. I got through it, I passed my boards, they let me go on to the third year; and Celia and I got married and then the third and fourth year I blossomed. I was one of the better students, as I suggested to you earlier I won the prize in pediatrics at graduation as the Outstanding Senior. I was a runner-up for prizes in medicine and I did very well in my third year and fourth year.
EB: You fit the classic profile as I recall from the students that I got to know, when I was up there all through those years; having an awful time by the second year because by then the repetition of memorization, the didactic lectures that you had to sit through.
TS: Volumes of material.
EB: Everything was memorization and already by that point a lot of kids were running out of money and they were having to work. And pharmacology, as I remember, was the big complaint all the time because so much of it was memorizing charts and tables.
TS: Lot of detail, yeah. A lot of it doesn't have rhyme or reason.
EB: It doesn't hold together, it's like history. I remember history in school, when we were taught to remember dates without putting the story together. [TS: laughs] And I could bomb a history exam because I couldn't remember those darn dates unless it had a story.
TS: That was Celia's problem, she hated history; just memorization of dates. I've always looked at history as people's story and I find it interesting.
EB: If it's taught that way, but there again, it has to do with the professor.
TS: Well, you're right. You're right on, and I think part of my interest in trying to make our medical school here in Nevada in the '70s more clinically relevant, to use a trite phrase, was probably based on that experience. But we got back from our honeymoon, which Celia's father paid for, thank God. They gave us a week's trip to Bermuda, and I think I slept the whole time.
EB: That's a shame.
TS: All we did was just sleep [chuckles]. Got back, had a little apartment right down the street from the medical school, I was looking at the pictures in that yearbook over there and I can almost see the house that we lived in.
EB: You were telling me about the furniture.
TS: I could be at school in three or four minutes and Celia of course, first year we were there, she was secretary to the Dean of the nursing school. She had worked at the Rockefeller Institute in New York for two years out of college and was a very good secretary and very bright; and the Dean of the nursing school hired her until our first baby came, Peter. So, then all of a sudden I went from poverty and wondering if I was ever going to get through the second year or even be thrown out of school to that summer actually, having a paycheck every month from the Air Force. Celia getting a paycheck from the nursing school every month, doing quite well in the clinical arena and I was a good student; I mean, I was a good doctor model, I guess, medical student. So, things turned around in the third year and then the fourth year was quite good as well; so, as I think I said on another tape, we probably had more actual cash in the bank at the time we graduated from medical school then we had for the next, I don't know how many years after that because then kids started coming.
EB: How did your medical school years, not just the first two years but the next two after that, your junior and senior year; how do they differ from the way medicine is taught today?
TS: The contents different because the science has changed dramatically in 40 years. So, there's a lot more science and there's a lot more technological intervention; I mean, junior and senior students now participate in major surgical events and transplantation and things like MRI and all sorts of diagnostic tests. None of which were even thought of when I was in medical school. So, in terms of the science, the technology, and the content of medicine, it's changed dramatically during my 40 years. But what we did was essentially the same, you did histories and physicals and you made rounds and you talked about patients on a case-by-case basis it was a very Socratic method; there were many fewer lectures in the third and fourth year than in there were in the first two years. You'd have a lecture maybe once a week in some subject or another, but basically it was learning by doing. So, you'd be given assignments to read about your patients and you'd be assigned by usually the chief resident, a couple of patients on whatever rotation you're on; and it was your job to know everything you could know about those patients and keep the charts up and the notes. And then, of course, every morning or every other morning whenever the professor or someone would come around and make rounds, they'd quiz you on what was going on. So, there was a lot of show and tell, there was a lot of doing, a lot of hands-on, a lot of the Socratic questioning at the bedside about whatever your patients had; it was also very hospital-centered, there was very little outpatient, there was some, I don't want to say none. There was very little outpatient, we didn't go to doctor's offices the way they do now; you could in your senior year take some electives, but even most of the electives, I recall, were still in the hospital.
EB: Did they have hospital-based physicians there?
TS: No. No, as a matter of fact, in those days almost all the patients in the hospital were either private patients of the faculty who carried on practices or the public patients, the welfare patients whether city or county patients who were cared for by the house staff, the residents. So, that hasn't changed very much, it was very much 'watch what's being done, have someone hold your hand while you did it'; but a lot of history taking, physical exams, learning the diagnostic skills, reading x-rays, and interpreting laboratory results. Antibiotics were the big thing at the time, surgery was pretty standard, but there were no intensive care units; there were no such thing as a pace-maker, there was no dialysis, although it was being experimented with at the time, but not as a routine. Dialysis, pace-makers, cardiac monitoring, all the technology of surgery most of that came since that time.
EB: Because that has come later.
TS: But the process was the same, the process of education was basically learn at the bedside watching others take care of their patients and emulating that.
EB: But this was a teaching hospital.
TS: Oh gosh yes. Oh yes. Sure, a big teaching hospital. But it was also, in a sense, it would be more like Washoe Medical Center in Reno than, let's say, the University of California at Moffitt. Because at University of California, Moffitt, you only get on that staff and bring patients to that hospital if you're a member of the faculty of the University of California, San Francisco. Here, you can be a member of our faculty and take your patients to Washoe, but there are lots of other doctors who take their patients to Washoe or St. Mary's who never go near a student or a resident, do no teaching. So, in that sense, Albany Medical College was more like Washoe Medical Center; it was a county hospital, but it had lots of private sectors to it, many people would bring their patients there, but they would not be assigned to a teaching staff. There would be no resident or student taking care of their patients; they'd take care of their patients like any other person. And then there'd be other patients in that hospital, maybe in the very next bed or the very next room that would be the patient of a professor, at least the students and the residents would participate in the care. So, it was a mixed bag. The V.A. which is across the street, we talked about last time, was very, very much part of the teaching at Albany. It was very much like the V.A. here, it was strictly for V.A., all of the patients were available to medical students; they had residents who took care of their patients as well as full-time attending V.A. staff just like they have here, but at the Albany Medical Center, no that was sort of a mixed. Now, what it's like now, I'm not really sure, I think it's pretty much a university hospital now.
EB: Say a faculty member of the medical staff had a private pay patient, could that patient then say 'I don't want medical students reviewing my chart.' Was it that kind of a thing? Or was everybody open?
TS: No, everyone was not open. No, absolutely not. No, and I can recall, there were patients of a professor, surgery for example, but in medicine as well; Dr. Beebe, I think, insisted pretty much that all of his faculty were going to make all of their patients available to all of the students and residents. But that wasn't the case across the board; obstetrics, or gynecology, and surgery there were cases there where the resident would say 'Now, you go see Mrs. Smith, patient of Dr. X, but you don't go see Mrs. Jones also a patient of Dr. X.' Now, what negotiation took place between that doctor and those patients, I haven't the slightest idea; but obviously it was apparent to us, as students, that some patients you went to see and they were willing to be seen. The patient had the right to say 'I don't want to be involved with a student.' But I never recall anyone ever throwing me out of their room; most of them were happy, as they are today. Many patients are very happy to have a student come in and sit and spend a half an hour talking to them, 'cause the students have plenty of time and most of the other people have no time. But I'm sure there was a distinction and it was a matter of the resident telling the student at the time which patients we were to pay attention to and which ones we would ignore.
EB: Was there a large indigent population there?
TS: Yeah, fairly good size.
EB: I remember Albany as having more of that kind of thing than a smaller town.
TS: Oh no, I think you're right.
EB: Because the factories would close down and the people would be out of work.
TS: And after the war many of those factories closed down and much of the garment industry, Gloversville and much of the rug industry which was in several rug factories. A lot of those, that stuff all moved south, much the way it did from New England, lot of the mills closed; and downtown Albany, I can recall, homeless on those streets.
EB: Yeah, where you wouldn't see it anywhere else, you would see it in New York City and Albany, I remember that.
TS: As a matter of fact, I noticed in the morning New York Times today, 40 years later, there's a big article about the apparent recovery of Troy, New York. Trying to recover which has been in a depression for 25 years. So much of the upper Hudson Valley lost a lot of its trade on the canal, on the river, all of that kind of commerce ended; the railroads went through there, but few jobs. No, I remember a lot of people living on the edge and a fair, I can't tell you the exact amount, certainly a fair amount of indigent population; and like many big city hospitals at the time, many people would come to the emergency room for everything. They didn't have a doctor, they'd come with a sore throat or whatever.
EB: Was there a psychiatric unit?
TS: Yes, they did have small in-patient unit, I remember it very well; 'cause it was always locked and it was always kind of eerie. But they also would send us, as we talked on the last tape, they'd send us down to one of the large state hospitals.
EB: We were going to look that up.
TS: I'll look that up, it's down the river. I can look it up.
EB: I was thinking it was called Mattawan.
TS: Well, I'm not sure what it was called.
EB: Let's turn this off for a second as we look that up.
[Tape turns off]
[Tape turns on again]
TS: Brady Maternity it's called.
EB: Okay, just to back up a little bit here; you said that there was a tuberculosis unit.
TS: Yes.
EB: Part of this hospital.
TS: Yes, it was actually detached. It was an old pavilion across the back of a parking lot.
EB: Like an old Quonset hut type thing?
TS: Well, no. It was a fairly big sized building.
EB: Really?
TS: Yeah, according to this, had 55 beds and they had active TB at the time and other pulmonary diseases; that's the only place I ever saw people with active TB. 'Cause then of course, the end of the isoniazid, INH, PAS, streptomycin all were coming on the market and tuberculosis was going to be a thing of the past; it's now recurred recently.
EB: That's what I understand.
TS: Basically, it was going to be a thing of the past due to the anti-tubercular drugs. But even when I started medical school in '54 through '58, there were still active patients, people would still go to Saranac Lake and I can recall seeing people had all sorts of surgical procedures on their chest. As a matter of fact, I tell this story because it's true; when INH and PAS and all those different drugs came out, the tuberculosis patients used to have to take really, I don't know how many, but all I can remember is wads of pills three or four or five times a day, vitamin pills, all sorts of pills. I always used to wonder 'How, in heaven's name, could you swallow all their pills?' 'Cause I have trouble swallowing one pill with a glass of water; and I remember a nurse showing a patient when I was there, or telling me at the same time, 'Have the patient put the pills in some apple sauce or some Jell-O or something and they'll slide down.' Well, fortunately I haven't had to take many pills in my life, but since my transplant, which was now 10 years ago; I take about 15 pills a day, I take two anti-rejection drugs and I take thyroid, I take a diuretic and I take hypertensive, I take a lot of different drugs and in the morning to this day, when I started doing this last 10 years, remembering what she taught me, I put my pills in a big scoop of apple sauce and I can swallow about 10 pills in one gulp, in apple sauce.
EB: Wow. That must have been great for your pediatric patients too, getting a pill into a child.
TS: Anyway, they did have a TB san, I forgot that, and I spent time there. And then I spent a lot of time at the Albany's Veterans Hospital and I did my OB, it was called the Brady Maternity Hospital, it was down the street from the Medical School, I don't know, maybe two miles.
EB: B-R-A-D-Y?
TS: Yeah. Brady Maternity, and it was a 70-bed hospital and delivered a lot of babies and I can recall that's where I delivered and participated in delivery of my first baby. I actually saw my own son being delivered in my senior year; but in my junior year that was the first place I ever delivered a baby.
EB: Did you actually participate and help with this delivery?
TS: Oh, yeah.
EB: A normal delivery.
TS: Yes, oh sure and they let us as juniors; if it was a normal delivery, the resident was there or the attending, usually the attending. They'd let you do the delivery so I had done a few in medical school, not a lot, not like they do today. But also attached, which was another important experience, attached to the Brady Hospital was what I would have called in those days a back ward; which had a whole bunch of abandoned infants who had hydrocephalus or other major birth defects and there was no place to put them and the families didn't take them home. In those days, they hadn't begun yet to put shunts into hydrocephalic babies, matter of fact, the shunting of hydrocephalic babies started while I was in my residency in Philadelphia couple of years later; but at that time it was shunting the ventricles of a hydrocephalic baby was just being done experimentally, I guess in animals initially. And that was the only place I saw hydrocephalic babies with enormous heads, enormous heads.
EB: What was their expectancy?
TS: Well, their life expectancy is very short, they'd usually get pneumonia and die, but they would stay there and some of them, of course, couldn't even be born alive in those days. So, the delivery of normal babies was the same, but that was the first place I recall, I had never been to a hospital for mentally retarded and I had never seen any. I remember a couple of kids in our home town when I was in grade school that we all knew something was wrong with them; and they were sort of seldom out playing with the kids, they were sort of kept at home. We found out later they were mentally retarded or had some disease of one kind or another; I had read about it of course, but I had never seen it.
EB: Did you find this particularly difficult?
TS: Yes. It was, and it made an impression on me, 'cause I ended up in pediatrics. So, then subsequently I began to see and work with all sorts of developmental disabilities. But that was the first place…
EB: Now, let me ask you something that goes along with your religious training; your idea about abortion, I'm sure, was formed through your high school years.
TS: Yes, oh yes.
EB: And college years because of your Roman Catholicism. Can you detect prior to birth, it is detectable.
TS: Oh sure, it is now.
EB: So, it wasn't then?
TS: Well, maybe if they got an x-ray, which you didn't do too often of a pregnant woman, but if she was particularly large you might get an x-ray and see the bones of a very large head. The main problem is that this would confront the physician at the time of birth and all of a sudden you can't deliver the baby's head or the baby has come out breach and he's delivered the breach which is the legs and the buttocks and the chest and can't get the head out.
EB: Would these babies be born by caesarian then?
TS: Some would be.
EB: What was the hospital attitude about these children, did they perform abortions?
TS: Not at this place. 'Cause this was connected to one of the religious orders, can't tell you which one.
EB: Oh, you mean Brady.
TS: The Brady, not the medical school.
EB: But wasn't this a part of the Albany-?
TS: No, it was a separate maternity hospital down the street.
EB: Oh so Albany did not have its own maternity ward section?
TS: It did, oh yes. You could be assigned to obstetrics at Albany.
EB: I see.
TS: You could be assigned to obstetrics over at Ellis Hospital in Schenectady or you could be assigned to the Brady Maternity Hospital. So, it was mostly by the flip of the coin or some sort of assignment, I don't really know how it worked, but you would get your OB at one of the three places; 'cause there would be, as we said earlier, attending physicians who were members of the faculty who would deliver their babies at one or more of these places.
EB: So, what was the attitude at Albany Hospital? If a mother presented with…
TS: I don't think there was any abortions being done at that time. I think they were, first of all, considered illegal Roe vs. Wade was still another 15 years away and I think at that time, the principle of double-effect even in the Catholic Hospital was 'you did whatever you could to extract that baby, trying to save both lives; but if the baby died, you were trying to preserve the mother's life' often times if they knew in advance they had a hydrocephalic baby which could not be delivered vaginally, they would do a caesarean section. Then there was the whole problem in those days many physicians, which we now consider inappropriate, but in those days many physicians would advise the parents, the mother who gave birth to a disabled, handicapped infant of one kind or another (Down's syndrome, traditionally, 'cause that could be diagnosed frequently at birth, babies with hydrocephalus, babies with spina bifida, where there is an opening in the bottom of their spine, a variety of those) just encouraged the mother to not even take the child home from the hospital and leave them in the hospital. And they would be kept clean and they'd be fed, but nothing more.
EB: So they were just warehoused until-.
TS: Oh sure, and in many state institutions. Hell, when I got to Nevada in 1966, I was working in Las Vegas at the time, and the governor, Paul Laxalt, asked Otto Ravenholt the Health Officer down there if he'd come up and look at this old hospital in Sparks for the mentally retarded; and to advise him and subsequently Michael O'Callahan, when Mike became governor, advise him on doing something about that hospital. And I can remember going into that hospital in 1966 in Sparks and there were two floors and you'd walk into an enormous room and there were, I don't know, 10, 15, 20 children with all sorts of disabilities, all retarded, and lying on mattresses on the floor; and warehousing is probably a very good word, that's not the way it's done now. And I can remember that room at the Brady Hospital, it's probably no longer there, and it was in the back of the hospital some place; all I can remember is going down a hallway and there'd be these cribs, whole bunch of cribs lined up, and most of them were babies with hydrocephalus and there were probably others, I can't even remember, but it made an enormous impression on me at the time. I can remember discussing it with my sister; Celia and I have always talked about everything, I always told her everything about my professional life, but I remember discussing with my sister and she sent to me a book by a Catholic priest by the name of Kelly, I think it's Kelly, could have been Murphy, it's probably Kelly. And she had already gotten out of the convent, she was out of the convent by then and she was working as a secretary at Fordham University and it was a book on medical ethics, Catholic medical ethics, I may even have it here. And that was the first time I ever did any serious reading about difficult medical decisions. Abortion wasn't even talked about in those days, it was just considered verboten, but issues of the care of the mentally handicapped, and I've forgotten all the other issues in there, and so that sort of lay in the back of my mind. I guess 20 or 30 years later when Celia and I got around to writing a book on medical ethics, a lot of that stuff reminded me; but I hadn't thought of that 'til I opened this today and you had started asking me about where we got our education. Back to your first question you asked, there was a section at the Albany hospital, was a psychiatric section attached to the hospital, I remember that. It was locked and it was usually for acute, I guess you'd call it almost incarceration of the psychotic patient who was a danger to himself or herself or to others; and I can remember there were several locked rooms within that locked ward. And we would go in there and one of the professors, the psychiatry who was taking care of the patients, would talk to us; but I recall it as a more frightening and disturbing experience than a learning experience, and I also remember later, as I told you, we were talking about what we thought was Matteawan, it was probably just a visit we made down there.
EB: Not even sure that's it.
TS: Well, whatever it was. Frankly, I went there and I said 'Oh.' It had a terrible shock.
EB: Psychiatry was not for you.
TS: No and it had a terrible shock effect on many of us. Which was too bad because it certainly was not what we would now call 'modern psychiatry'; it was really the institutionalization of the mentally retarded and the mentally disturbed.
EB: The way we have all heard about Bellevue Hospital, dungeon type things that occurred.
TS: Yeah, like One Flew Over the Cuckoo's Nest. But that's all changed, that's all changed.
EB: Did they do electric shock treatment there at all?
TS: Yes. As a matter of fact, I witnessed that and I also think I witnessed…
EB: Did you have an opinion about that as being efficacious?
TS: No, no I really didn't. Psychiatry was a very small part, I recall, of our curriculum or at least it had a very small impact on me; which was too bad because when I later got into pediatrics, I recognized how important behavioral sciences were to the care of children, raising children, education of children, and I certainly am a big supporter of behavioral sciences in all aspects of medicine. But classic psychiatry as taught in those days, unfortunately seemed to the student at least, to be the care of the psychotic patient and the extremely neurotic; but we didn't see it as part of everybody's illness having a behavioral component and that it was important to be attuned to people's feelings and all the other things. There's a picture of an artificial kidney, it was research being done; so that was when I was in medical school, the artificial kidney was a big enormous thing, filled that room and had absolutely nothing to do with what modern dialysis is like, isn't kind of interesting?
EB: Now, getting back to the psychiatry, let me ask you one more question about that. You, of course, didn't have the acute psychotic patient who came in because they were on some kind of a drug trip. You didn't have that drug problem then, right?
TS: Very little, very little. No, you certainly had the alcoholic.
EB: The kids who come in on LSD, that kind of thing.
TS: No, that was something later; we're talking 1957-58 when I was a junior and senior was working in those. No, that was much later; that was really a part of the Vietnam era, more of the mid-'60s to late '60s. So, I never saw that, but what you did see of course was the homeless and you certainly saw the alcoholic going through DT's; and I think unlike my knowledge about it today where we know alcoholism is a pervasive addiction throughout our society, both male and female, all race, all creed, all color, all income levels. But my impression at the time, because of this narrow view in medical school, which was a hospital-based, emergency-based kind of thing, was that alcoholism was the falling down street drunk, homeless.
EB: That was the drug of choice wasn't it?
TS: Sure. But we didn't know that large numbers of doctors and lawyers and everybody else were also alcoholics; they just managed to control it enough to get to work on time. And I can recall, a nameless, but stories about one particular surgeon and a couple of other members of our faculty who, at the end of the day, would get a couple of the students to go out to the local bar and drink with them and obviously they fit all the criteria in today's world of being an alcoholic. So, we now know that alcoholism affects everybody, but that time, no. So, in many ways too, part of my experience when I got to here and was a part of my wanting to see our medical school be more clinically oriented, earlier in the game, not all hospital-based, in doctor's offices, in clinics, throughout the community so the medical student could get a much more accurate picture of what disease was like and not just a hospital, emergency room or high-tech kind of a picture of what the world was like. That was the distorted view, now I certainly left medical school with some distorted views about psychiatric illness, about alcoholism. No, we didn't see the kinds of drugs you're talking about; I don't think they were even on the market. As I told you earlier, when Celia worked at the Rockefeller in '55-'56 before we got married; one of the people she worked for was actually doing experimental work on LSD with animals and wrote papers on how it was disorienting to animals, but later….
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