Transcript: Tape 6 Side B

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)

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Thomas Scully: I can also remember at the time, oh I think we got some lectures on dope addicts and they would tell us stories about opium dens in China or they'd tell us about…

Eileen Barker: Well you remember the musicians in New York in that era before your time and mine. What was it? Down in Harlem.

TS: Sure.

EB: All the musicians were known to take drugs.

TS: Probably using cocaine.

EB: What were they using?

TS: I don't really know. I guess they were probably using cocaine, maybe, I guess.

EB: But it wasn't a general thing, was it? It wasn't the way it is now; it's confined now, more or less to different groups.

TS: I think you're right; I'm not an expert on drug abuse.

EB: Trying to get the changes, I mean what it's like now.

TS: Alright, at that time we'd have a lecture or two on dope addicts and, I don't even think people knew about marijuana, I think it was mostly heroine and morphine; we never talked about doctors or nurses being addicted to drugs. Again, it was like alcoholism, it was considered an addiction of the down-and-out. Yes, we always heard stories about drummers and trumpeters and other musicians who would get high on something; now, what they were using, I don't know. Maybe it was cocaine, I really don't know. The only cocaine I ever heard about was in the ear, nose, and throat clinic when the otolaryngologist would spray the patient's nose with cocaine spray to deaden it; so they could go in and do whatever they were going to do. I don't recall that as being any significance and alcohol was a thing of the street, sure the drunk would come into the emergency room and vomit all over the place; and there would be some remarks made by the nurses and the residents. No awareness that alcohol permeated the society and certainly no, what we would now call, 'illicit drugs'. The LSD, cocaine, marijuana, morphine, heroine, all of that stuff got started in the early '60s and during the Vietnam War and a lot of Vietnam vets came back using that stuff.

EB: Well speaking of that, what about the vets hospital? When you went over there, what kind of patients did you… that would have been what? 11 years post-war?

TS: Yes. The war was over in '45, 10 years.

EB: Did you have for instance lung disease because the smoking during the Second World War?

TS: Yes, and that hasn't changed at all. The students still talk about the guy dying of emphysema with a cigarette in his hand and smoking with his ventilator on; now, they didn't have ventilators in those days, but they certainly would have these nasal oxygen. We also that time, would see a lot of older veterans who were still around from the First World War. I think some of the students used to think there was a conspiracy on the part of staff or the residents to assign some of the students to the older veteran who would start telling his story back at the turn of the century [laughing]; you'd have about a 50-year history.

EB: That was quite a systemic review, wasn't it?

TS: Yeah, exactly. You'd be sitting there and you had to do it in an hour and then write it up and someone would come by; you'd start maybe at one o'clock or 1:30 in the afternoon and some resident or faculty would get you together at four in the afternoon and you'd have to try to summarize 'Oh, this poor guy had a leg shot off in the First World War and had been gassed and then he had who knows what afterwards, and he smoked cigarettes and he drank.' His system review and his list of diagnosis is a mile long and as young students, we could no more sort through all of that.

EB: It's learning to be a good listener.

TS: It was a bimodal curve of people, World War I veterans and the new World War II. Now, 40 years later at this VA and most VA's, they're Vietnam and even the World War II veterans are dying off; 'cause they're in their 70's and 80's.

EB: Tell me about surgery at Albany Hospital, you said you had a hands-on experience.

TS: Not in surgery, I would say, in most of the others; certainly in medicine and pediatrics, OB, in the emergency room. In surgery, now maybe it was because I wasn't terribly interested and I didn't push myself and there were classmates who I know would push themselves and get to do things, they saw themselves as being surgeons. So, I think, I have to be honest, a lot of how a student remembers medical school was his or her own and my own, in my case, interests and how much I pushed myself one way or another. I was interested in pediatrics and in OB actually at the time and some others. So, I would volunteer for a lot of things, I would stay around later, I'd come in earlier, I'd offer my services and so the residents would always respond to that; as a matter of fact, I've told medical students for the last 20 years, 'One way to do well as a medical student, is to be willing to work, be willing to accept extra, volunteer, show enthusiasm; because you'll do fine and people will respect it and you may not be the smartest guy around.' So to be really honest, I was not terribly interested, excuse me, in surgery; and as a junior student, we were the low person on the totem pole; there were lots of others in line. So you really did have to push and to push to do more things, you really had to want to do it and I really wasn't that interested, so I didn't. I did alright, I passed the exams, I learned the material, I could answer the questions, I was good with the patients, I could take the histories and physicals; but to stand there for four hours holding what we used to call the 'idiot stick', I don't know what they call them today, but the retractors and couldn't see what was going on and the surgeon and the assistant surgeon and the chief resident and the assistant chief resident, there were four or five of them looking down into a little hole and the patient trying to do whatever they were going to do, was just of little or no interest.

EB: So, if somebody showed the interest in the surgeon or the chief resident.

TS: Oh yes, they get to do a lot, oh sure.

EB: They got to do it; it wasn't that it was not allowed.

TS: No, no, I would not say that. No, if it's probably like it is today, I don't know, you'd have to ask one of the surgeons. But the student who showed interest in something was willing to put out the extra effort, obviously did the reading, came prepared, stayed around, wasn't the first one dressed out of the doctor's lounge and out of there, didn't have other interests or other responsibilities; which certainly get all sorts of opportunities and of course, I know a number of my classmates ended up in surgery, they've done very well, had wonderful careers and I'm sure they would tell a different story in their oral history that 'I like surgery and I got to do a lot' and it was that sort of thing. Now, there still were a fair number of surgeons and I can remember a gynecologist particularly and several others who thought, notwithstanding the veterans after the Second World War, that for a medical student to be married and have kids and other obligations was crazy. They should be staying in the hospital, they should be essentially living there, they should be totally available at anyone's beck and call and that's the way you learned medicine; 'cause that's that way it used to be and we talked earlier that's what it meant to be a resident, you resided in the hospital. Well, as I showed you in our alumni of the 60 kids in my class, better than half of us were married by the time we were seniors, by the time we were juniors actually and a fair number of us had children and so there were other pulls; and so if you really weren't interested in a particular area, you'd do what you'd have to do to learn it or to get by, but it wasn't something that would consume your time, where as I can remember spending many a night in pediatrics and call Celia and say 'I'm not coming home, there's a sick baby here' and I'd stay there all night.

EB: Now, we're still talking about…

TS: Junior and senior year of medical school.

EB: One of the things, getting back to this hands-on…

TS: But surgery was not something I was interested in.

EB: Yeah. On this hands-on experience thing I was talking about, one of the things I had heard from medical students is that, one of the things they loved about the University of Nevada was being a small school and I guess 50 in a class, 50-60, isn't that what we had?

TS: Yeah. We had 48 for years.

EB: Yeah. Afforded them the opportunity to do things that their colleagues in other medical schools didn't get to do, ever…

TS: That's true.

EB: Those other students felt a great frustration, especially if it was an area that they were interested in.

TS: There's probably several, I can't think of all the reasons for that, but there are certainly several in our school that were not the case when I was in medical school and in these other big schools you're referring to. First of all, we had only 48 students; we divided them into small groups and they were spread both in Vegas and Reno. So there were very small groups of students with the faculty and the patients. Secondly, we did not, until recently and still don't have a large entourages of residents; medicine and surgery and OB, relatively small number of residents. So, there's enough patients to go around for our students to be able to do things; there's often one resident with two students and one attending and some patients. When I was at Albany, and many of the other big schools you were talking about, there were as many or more house officers, residents, as there were medical students and many of those residents had come from their own medical education not having had much experience so they wanted to get the experience. So, often times in the pecking order, it depends on how much experience the person ahead of you has had, as to how much he or she is willing to give up to you down the line, okay? So, it's a mixture of attitude of the school and its faculty, how many students in a group, how many residents in a group, and how many patients that group is taking care of.

EB: So, from that standpoint, medicine has not changed. Medical education has not changed a whole lot.

TS: No, it's just a matter of numbers.

EB: Same thing.

TS: Exactly, and often times it's serendipitous that you happen to be in a situation where there are few other students interested in your group, interested in what you're doing and a resident who's happy and a staff man who's happy to have you do things.

EB: So that could change within the same school, year-to-year.

TS: Oh, absolutely. It could and probably does, it probably does. I'm sure that our students are no different than we were 40 years ago in showing a particular interest in an area and being given more given freedom, more hands on because you show an interest and you're willing to do it; and the other areas, well, you get by with whatever is required of you. Now, the other thing that's important to recognize, I've experienced it myself later, but I'm sure many faculty, not only in medicine I'm sure it's the case in physics and English and who knows what, many faculty who liked to teach, want to be around students, but they also see themselves, their future, in these younger people. And so role modeling is very important to the student, but it also gives feedback to the faculty 'Here's someone who is interested in what I do, I'm going to give that person more time and attention than I might to another student, who might be a lot brighter, but doesn't show the same interest in who I am or what I do.'

EB: Just the old preceptor system.

TS: Of course, of course.

EB: Where you took on a student, the way people were trained. What? 100 years ago.

TS: Sure, in that sense. You want to be a good carpenter, get in here and I'll show you how to sew and hammer and we'll put together the furniture and we'll be happy together. So, a lot of it does have to do with a mutual respect, but also playing off one another; you identify with a mentor, you identify with a faculty member, you identify with a resident who you like, who you want to be like, who is the kind of person you want to be, you respond to that, he or she then responds to you.

EB: Guess it's just human nature that's it's still a one-on-one situation, in some areas.

TS: I think so, in terms of decision-making about what kind of a person or in this case, what kind of a physician you're going to be. There are people who say 'I never what to be like that person, I'd rather not be in medicine; but I really would love to be like that person.'

EB: Well, I won't mention what specialty this was, but I can remember students, you get to know them pretty well when they're sophomores, saying 'Oh this particular specialty' which I will not mention, 'that's all I want, that's all I want.' And when I would talk to them as seniors, because I generally wouldn't see them through junior and senior year, 'Well, I thought that this was the specialty you were going into and now you're going a totally different way.' And it had to do with that year down in Las Vegas, that elective in Las Vegas, they weren't going to be like that particular man.

TS: Now, there's no question and it's important, I think…

EB: It would turn their whole attitude away from that.

TS: And certainly important for administrators in a medical school, deans and chairmen to be acutely aware of this because lots of good students, not lots, some good students who ought to be in a particular area get turned off by one of these negative experiences or maybe only years later realize why they chose one field as opposed to another. I've often said to people asking about this, part of what I think medical school is about, is not only learning the vocabulary and seeing some role models and getting a flavor for what it is to care for patients, but it's also to sort through that which attracts you and that which repels you. So, at the end of the experience you can make a reasoned decision about where in this vast field are you going to end up; and where do you think you fit best and where you might make the best contribution.

EB: 'Contribution', that was the word that came to mind. We will be talking more of course about the curriculum when we get into our medical school section of this. Right now, we're getting into what formed your ideas because you had so many contributions to the program up at the University of Nevada. So, let's go back and talk a little more about your early medical school days or your junior and senior year. One other question I had about Albany College was when you were in surgery, 'cause I want to get a little bit about philosophy here versus medical training. If you had a woman in surgery who was in there and having, say, a D&C for bleeding [TS: Yes] and they would sometimes request tubal ligation because they had enough children and didn't want any more, was that done?

TS: I think that was, I don't know…

EB: Did you pay attention to that? I mean because this would be so against your religious beliefs, what I'm trying to get at here is the religious beliefs as opposed to the medical training. They sometimes are contradictory.

TS: Well, they are; sure.

EB: Many times they're contradictory, I should say.

TS: I'm sure that was done, but I can't honestly remember it ever being done at the time of the delivery of a baby. It may very well, if the woman made that choice and the gynecologist or the obstetrician would do it at some other time; he might do it in his office, I'm not sure. I know that we were told at the introductory lecture that we did not have to participate in a sterilization procedure or an abortion; I never saw one done actually that I'm aware of, now they probably were called D&C's…

EB: Yeah, I'm not talking about illegal abortions; I'm talking about therapeutic abortions.

TS: Now, I don't recall having that experience. Although, I do recall the issue of if you do not want to participate or you have some moral objections, all you need to do was to tell the attending and step out.

EB: I see. You weren't faced with that?

TS: That's a good question. No, I don't think I was. I only spent a month in obstetrics.

EB: But you decided against obstetrics, and I'm wondering if this had anything to do with…. [TS: No.] Or is it more of your love of pediatrics.

TS: That's a good question and I did do my obstetrics at a Catholic hospital, at the Brady Hospital.

EB: Who was that affiliated with, you started to tell me; the Brady Hospital.

TS: No idea, couldn't remember. I know there were nuns in the place and 'Brady' sounds Irish to me; there were nuns, but who ran it, I don't know. It was a place that we were assigned, and we may even been given the choice; I may have actually chosen Brady because it was a Catholic hospital. Subconsciously or even consciously, but I can't remember; I mean I don't know how I got assigned there or why I went there. I don't even know if I had a choice.

EB: But you weren't faced with this dilemma.

TS: No, I don't recall that. I probably would have been had I gone into obstetrics, but I didn't. I pretty much left Albany saying that pediatrics was probably the most interesting to me or maybe internal medicine. But as we said earlier since we only matched for an internship and almost all of those were rotating internships; most of us didn't have to make any final decision about what specialty we were going to go into until we were in our internship.

EB: That's another big change from today isn't it?

TS: Right, right.

EB: So, what's happening here is that there's a whole lot of things going on, a fund that you're building up in your mind about what you found that you would like to see changed in a medical education for students. Not that you knew you were going to be involved; that's what went in to making these changes.

TS: No, right, of course; and it was sort of like any other computer, it sat there for 30 years or 20 years, whatever.

EB: But that's what you drew on when you were setting up this curriculum.

TS: But I have to say to you, I didn't have any conscious awareness that all of what was going on in medical school would somehow later influence, first of all, my decision to get involved with the medical school and then later to get involved with curricular changes and that. No, I didn't think of any of that.

EB: How could you, at that point?

TS: Actually, I did not see myself going into academic medicine. I didn't have much of an interest in research and when I left medical school I knew I'd be in the Air Force for five years; 'cause I had to pay them back for the education I got from them and I figured 'Well, in five years, I'll just see what happens where the world is at that time.' I didn't leave medical school like some of my classmates saying 'I want to be professor of something, someday in a medical school. That's my goal.' No, my goal was to be a practicing physician.

EB: Sure, and you had to make money.

TS: I knew I was going to have kids.

EB: And you had to pay back some of these debts; of course, you didn't have very many at this point, you didn't have student loans.

TS: No, no. I borrowed time against the Air Force and I can remember talking to my own sons many years later and lots of other medical students about when these programs were still around: the Public Health Service, Army, Navy, Air Force as you know; you can join one of them and borrow time and payback time or you can go to the bank or borrow student loan and you pay back the money. Make the choice.

EB: That hasn't changed much either.

TS: No, there are a lot of different ways to skin the cat.

EB: Sure, to get through. So, you're going on to graduate.

TS: Yes, in 1958 in May, I think it was.

EB: May, '58.

TS: And I told you graduation surprised the hell out of me. When I came down the aisle, my wife and my mother and some other of my family members are waving this program at me and we didn't have it 'cause we were in line; and then when we sat down I picked it up and there on the back it had my name that I won the pediatric prize. 'Cause these were all handed out at graduation unbeknownst to any of the students they were all surprises.

EB: You were already thinking of pediatrics, you said that this had sort of influenced.

TS: Sure, had already been thinking about it; graduated on May 29, 1958.

EB: And you said that the hooding was different then, than it is now.

[Long pause]

TS: Exactly 60 graduates.

EB: 60?

TS: 60 graduates, I'm sorry.

EB: Were you hooded by…

TS: Conferring of the degrees and hooding was all done by the dean, Dean Wiggers.

EB: He did it for everyone.

TS: Yeah, we walked up on stage and we were presented with a diploma or maybe we had the hood put on first. The only time I ever saw it beforehand was when they took the picture for the book, but that was all fake, when we wore the same one; and the hooding was not like ours. We came in, there was the usual invocation, somebody gets up and gives a little talk, Dr. Mitchell was the dean at the University of Pennsylvania at the time he gave the commencement address; then we walked across the stage, somebody read out our name, the dean handed us a diploma and some assistant dean stuck the hood over our head, we walked down and sat down.

EB: Of the 60, how many were women? We've talked about this once before, I see one there.

TS: We had one. Bernice Shoobe, she went into pediatrics; and this guy, Marcus, I think went into urology. And I think, if my memory serves me, that's the only woman in our class.

EB: Out of 60, not much of a percentage is it?

TS: I can tell you in a minute by looking through here, but that was not uncommon in those days.

EB: Here's one.

TS: Here we go, Cenie Cafarelli; so that's two.

EB: That's two.

TS: That's it, the only two I see. Two out of 60, now it's what, almost 50%? And I don't think it was many more than that in previous years.

EB: And you happen to know what those two women specialized in?

TS: Bernice went into pediatrics, but I have no idea…

EB: It would be interesting wouldn't it? Because, traditionally, they stayed with the…

TS: Well, I've got the alumni journal I could look her up, if you want to know.

EB: Just curious, just a curiosity. We can look that up another time. So, May of '58, you graduated.

TS: That's it.

EB: Now, where did you go?

TS: I think we said last time I went to Westover Air Force base for about a week or 10 days. Celia and Peter went home to her mother's; we got out of our apartment. I went to Westover and I went through the usual physical and they taught us how to put on a uniform and did a few things; then I went home and I think we had two weeks at Celia's Mom's.

EB: Westover is where?

TS: It's in Massachusetts, someplace. And then, somewhere around the last week of June, I got on a plane and I flew, it was propeller in those days, I flew to El Paso; where I'd been assigned as an intern at the William Beaumont Army Hospital, even though I was an Air Force office. Since the Air Force had no internships they assigned us to Army hospitals. So I was one of a handful of Air Force officers, who showed up and joined a bunch of Army lieutenants and we were the intern core there. I don't know maybe 30 of us or so.

EB: So you were a lieutenant.

TS: Lieutenant, William Beaumont Army Hospital at El Paso, Texas.

EB: And you had one child.

TS: One child, Peter; he was born in October of '57, so he was about seven, eight months old when we graduated.

EB: So, how long were you at El Paso?

TS: We were there for a year and Chris was born the next October. So, Peter was one-year-old when Chris came along.

EB: So this was October '58?

TS: Yeah, and I was doing my internship there; like most internships in those days, or most all of them, it was a rotating internship. So it was, in a way, a repetition at a higher level I guess of responsibility of medicine, surgery, OB, pediatrics, obstetrics and so we went through that all over again; but now you'd be down every third night and you'd take care of the patients.

EB: Now, who were you taking care of there? They were all military.

TS: Almost all Army and Air Force military.

EB: Civilian dependents?

TS: Yes, civilian dependents. So it was a big Army base there, Fort Bliss, and then there was a big Air Force base Biggs Air Force base. Bliss and Biggs and all of their soldiers and airmen would come to Beaumont for their emergency room and medical care; and of course you've been in west Texas, half of west Texas is one big military establishment. At the time it was a missile school, I don't know what is over there. So, our clientele, our patients I should say, were military; many of whom were healthy, a lot of accidents and then a lot of dependents. So, the obstetrics, all of the babies were being born there including one of my own, Christopher, was born there. Pediatrics was all the dependent kids and surgery was relatively small. Although, El Paso, like many other southwestern towns, had a large retired population and retired military were permitted to go to a military hospital. So, the funniest story I remember, which is true. I was so sleepy one night. I was on the emergency room and you'd be on for the usual 24-hours on; and about four o'clock in the morning some older man, obviously retired, came in and the sergeant at the desk called me, and I was sleeping in the back room. So I came out and he was sitting in there and he was obviously having a lot of abdominal pain, probably had an ulcer, I've forgotten exactly what he had. I looked at the bottom of the page and I saw 'retired' and I said 'Well Lieutenant, I think you've got an ulcer, and you probably ought to go to the clinic tomorrow morning.' And he looked up at me and he said 'Son, that's Lieutenant General.' [Both laugh]

EB: So after you got out of the stockade, what did you do?

TS: He laughed and I laughed and I said 'Oh, I'm sorry, sir.' And he said 'That's alright, you're half asleep.' I said 'Yeah, I am. I didn't read the whole thing, I saw 'lieutenant'.' [Scully continues to laugh]

EB: Was that what your internship and residency was like? Was it that sleep deprivation attitude that we've heard so much about?

TS: I think the internship was. 'Cause you were on call, I've forgotten, every third night; but residency, no, I think residency was not quite that bad. There were nights where I would stay up all night long and I can recall one night when I made a terrible mistake, now we're getting ahead of ourselves, I'm sure I made a mistake 'cause I was not thinking. But internship, I recall it as more of a problem; I was always tired in my internship 'cause we did put in long hours and my residency was not quite as bad, but we can talk about that later. So, anyway, we spent a year there, we liked El Paso and it was important to us because later on when the time came to get out of the service and Celia and I wanted to make a decision. We made a conscious decision that there was no reason to go back east; we loved the southwest, we liked the dry climate, we liked the desert. So when the opportunity later came to go, we thought about going to El Paso, I thought about going to Santa Fe, Albuquerque. I had visited a number of places, looked at jobs later on; 10 years later, ended up of course in Las Vegas. But El Paso was important to us, as New Yorkers, 'cause it was the first time either of us had ever seen much of anything west of the Hudson River and never saw anything called 'desert' or 'purple mountains majesty'. The first time I ever saw 'purple mountains majesty' was in El Paso, it's called the Pass to the North; El Paso is the Pass to the North through these mountains and the mountains were gorgeous and a beautiful summer evening and it was cool with the breeze. So, that's when we decided we're going to end up somewhere in the west, it was a fitting start as we'll talk about later, but eventually we ended up in Nevada. [EB: Interesting.] And my father-in-law never understood why we ended up out west; I mean why didn't we just come back to New York and make money like all the other doctors?

EB: Well, what I would like to do is stop now.

TS: Sure.

EB: Because I have questions about El Paso and can we start tomorrow and talk about El Paso?

TS: Oh sure, sure.

EB: Let's end now.

[End]