Transcript: Tape 9

DATE: April 1, 1998
TAPE: Tape 9
INTERVIEWEE: Thomas Scully, M.D.
INTERVIEWER: Eileen Barker
PLACE: Dr. Scully's home, 1400 Ferris Lane in Reno
TRANSCRIPTIONIST: Teresa Garrison (Revised 2017, Haley Kovac)

---

Eileen Barker: Right now, okay, we're on the second tape.

Thomas Scully: Right. It's the first of April. Is it working?

EB: Yeah. It's working. And I will label this later.

TS: Well let me think, we were talking about Las Vegas impression. Well, when we first got there we were welcomed with open arms by friends as you know. And the practice started out fine, I had some interesting medical experiences I can tell you.

EB: Oh, I do want to hear those. What was the arrangement? You went there and you were working...

TS: On a salary.

EB: On a salary, within his office.

TS: I was only his salaried employee.

EB: Tony Carter?

TS: Tony Carter.

EB: So you didn't have to set up an office.

TS: Oh no, he had been practicing for two years there. He'd been there for two or three years, I don't exactly know how long.

EB: So the arrangement was a salary.

TS: He said, ‘You come in for a year, you work for a salary; at the end of the year's salary, we'll negotiate it and if it works out and we get along fine.' Well, at the end of nine months is was clear we weren't going to continue to work together. I wasn't paid very much.

EB: Was it a big practice?

TS: He was fairly busy, oh yeah. But we did do a lot of free work, and I give him credit for that and I did a lot of free work too. But what the hell, you can't say ‘no' and there was nobody else. But we first arrived, Celia went a couple of days early, I'm getting mustered out of the Air Force. So Celia goes with the two babies, Marty and Leslie and I keep the three older boys, they were three, five, and seven or whatever. And I keep them for a couple of days in a hotel while I'm waiting for all the papers to clear and to get my final paycheck. I get a night plane out of Dallas, a gambler's special, ‘cause that was the cheapest way I could get there, I sent Celia out commercial. So, the three boys and I get on this plane and we're flying and everyone on the plane at midnight or two in the morning are mostly men, smoking cigars, gambling and playing cards and all that. Some big guy nudges Peter and says ‘Where you going kid?' and Peter says [small voice to imitate Peter Scully] ‘I'm going to Las Vegas.' ‘Why you going there kid?' ‘I'm going there to live.' and he said ‘You mean people live in Las Vegas?' [both laugh]. Anyway, we arrive and Tony had put Celia up in a fairly mediocre motel on the Strip for a couple of days waiting for me to arrive. And she was, at that time, looking at houses we were going to rent for a year and thank God we did. We were going to rent for a year and not put any money down, we didn't have any money anyway. So she's there for a couple of days in a motel with Leslie and Marty, the two babies, before I show up. And we move into a house, our furniture shows up and we were right around the corner from Our Lady of Las Vegas Catholic Church, we got a nice place so the three older ones, who were in school, could walk to school. And right around the corner from that was the family of Armand Scully who was an orthopedic surgeon in Las Vegas, had been there a couple of years at the time.

EB: Same spelling?

TS: Same spelling, and probably is a distant relative, but neither of us had been able to make the exact connection, probably back in Ireland. At any rate, he had a bunch of kids in the Catholic school and we had some kids in Catholic school and we always used to laugh, one of the Scully kids would get into trouble we'd say ‘Well no, that's the other Scully. That's not ours.' [both laugh]

EB: What Order?

TS: They were Dominican and Father Kenny. And we met there a young priest Father Bob Simpson who is now the pastor up here in St. Albert's the Great. [EB: Oh] And married Leslie and John and we've been friendly with him for 30 some years. At any rate, we got into practice and I would guess initially until I started doing the clinic for Otto Ravenholt and then subsequently in spring of that year did I really begin to get an appreciation of the phony false plastic world of Las Vegas and the real life of the people, many of whom had very low-paying jobs, lived from hand-to-mouth, had very little security, the culinary union was very strong and was one of the few ways in which many employees could be reasonably satisfied that they'd get health insurance, but many people without health insurance.

EB: Did you join a medical staff somewhere?

TS: I was on the staff at Southern Nevada. I was also on the staff at Sunrise.

EB: You were probably still on temporary.

TS: Yes. And you had to go to the meetings and most of our patients would be at Southern Nevada because even then it wasn't like it is now. You can't even get across town in noontime. But in those days, it was still a bit of a problem. And of course, Women's Hospital was open at the time Quincy Fortier's Hospital that's now closed. So you go there for newborns, so we'd go to Sunrise and Southern Nevada and Women's for newborns, but most of our sick kids outside of the newborn period [inaudible] Southern Nevada. I thought that, I always have said that many of those single mothers who would bring their children were as good as mothers I've ever seen. They really cared about their kids, they paid their bills as I've said, often with cash, a lot of them had checks. But you'd say ‘Gee, I think your kid needs this, that, and the other thing.' And they'd do it. So, it was almost as though there were two separate worlds; there was the world of the Strip that we hardly ever went to, occasionally we'd go out to dinner or go to a show, but not very often, we had five kids. So, most of our social life was in the homes of the very physicians that we had met in Spain. They were the support system, particularly Harry Knudsen and Ted Jacobs, Jim Lum who's still there, just retired. And Jim, he was a radiology partner of Harry Knudsen had married a Spanish girl in Madrid, he was one of the officers who met and married a Spanish lady and brought her back. They had two children, one of their kids is now a physician and Celia had kept in touch with her. So our support system there when we first arrived was not family, but the pseudo-family of our friends from Madrid. And that was very supportive, we probably wouldn't have gone to Las Vegas had they'd not been there. But that was not enough, really, to keep us there. Friends apart, I didn't like private practice, I like taking care of patients, but not private practice.

EB: We were talking about the social conditions. These children, who came in, what paid for these kids? You didn't get paid for some of these.

TS: Oh gosh no. I'm sure the hospital wrote it off. In my private practice, yes, we got paid; I'm saying the indigent children we saw, the clinics we'd see a couple times a week and the patients who would be admitted to the hospital.

[cross-talk]

TS: There might have been a little county subsistence, but if anything, it probably went to the hospital to help pay for their bills and of course the county hospital would write off millions of dollars every year. And there were many physicians in Las Vegas who just refused because the county was such a mess and at the time politically and didn't pay any of their bills, they said ‘The heck with them. I'm not going to take care of those patients.' But if you were on the staff, you took care of them and you had two choices: you took care of the indigents, that was just your duty, or you quit, as many did, and go over to Sunrise, because Sunrise didn't take care of any indigents.

EB: What about the drug problems there? Did you see a lot of [inaudible]?

TS: No, no. No, not in 1966.

EB: No, not yet.

TS: Not yet.

EB: No crack babies? [inaudible]

TS: No, that wasn't much of a problem and there were no AIDS at the time. Remember, 1966, the Vietnam War is on, but we're ahead of the big influx of drugs; so, I don't recall seeing that sort of thing. I'm sure I saw a baby or two whose mother was drunk and the baby would be withdrawing. The most interesting infant I ever saw and I kept records of it was a so-called parabiotic twin syndrome where a mother delivered twins and their placentas had a common connected blood supply. So one of the twins came out seven or eight pounds all red and full of blood and the other one came out at about three pounds and all pale; and one had parasitized the blood supply of the other. And I had read about it, never saw it, but I saw this one.

EB: What's the chance of survival?

TS: Well, they both survived and they grew up. And I called Tony and we talked over the phone and he did some quick reading.

EB: What do you do?

TS: Well, what we did was, did an exchange transfusion, took blood out of the big kid that had an oversupply of blood and put it into the little one who had an undersupply and was dying of edema. So both of them were at risk. The one that was in my mind the most was the baby with thalidomide in Spain with no arms, but this was a dramatic one. The other [inaudible], interesting, and I've often told medical students in medicine, ‘There are few times in pediatrics' not in medicine ‘in pediatrics there are few times where you can really say you saved a life.' Because a lot of it is you hoped that you don't get in the way and you hope what you do will support the child and most of the time children's diseases, as you know, are self-limited with the exception of maybe meningitis and leukemia. But there's not an awful lot of time where you can do dramatic things like surgeons do. I remember being in our office, in the morning we'd have morning and afternoon office hours, and a man came in with about a nine-year-old boy in his arms, came in and was frantic. There was nobody else in the waiting room, I hadn't started seeing patients yet, and yelled at the nurse and the receptionist that ‘There's something wrong with my child'. I was in the backroom and said ‘C'mon, bring him in.' so, I brought him in the examining room, and I put him down; I did a quick examination and he was very, very floppy and weak, he had no motion, he was alert and awake. And I said ‘What happened?' and he said ‘Well, we've been on a trip from back east and we woke up this morning and he couldn't move his legs and he couldn't stand. And we were out camping near the Grand Canyon and we drove into town, we left our campsite about, I don't know, an hour or so ago, we drove and got to the edge of the city and stopped' of course it was a small city at the time ‘stopped down the street and asked for the nearest doctor and they said ‘There's a pediatrician right up the street there.' So, I examined him, I now know what happened, but at the time I didn't know what was going on. So I said to the nurse ‘Get out a spinal tap tray, we're going to do a spinal tap on this kid. He's got Landry's ascending paralysis or Guillain-Barré or one of those things were sudden onset of a viral paralysis and I better do a spinal tap.' So, she got out the tray and I put on the gloves, I said ‘Turn him over.' And the father, I think, was helping and as he turned him over, I noticed a little black speck in the back of his neck.

EB: [mumbles] Probably a tick.

TS: A tick.

EB: [whispers] I thought of that.

TS: He had a tick in the base of his hair. I lit up a cigarette. Remember, I had not smoked since, and I said to the nurse ‘Do you have a cigarette?' So, you asked me did I ever smoked again, this was the only time I can remember. She said ‘Yeah.' ‘cause she did smoke, and we used to tell them ‘No smoking in front of the patients.' So they'd go out back and smoke. So, I lit up a cigarette, I cupped my hands and blew the smoke in and the tick backed off and I grabbed it with some tweezers and put it in a little bottle. Later, took it up to the laboratory and Bob Belliveau, for whom my son now works, who was the young pathologist at the time and he identified it as the dermacentor that causes tick paralysis. Well, I put the kid in the hospital within about three hours, he's got his leg strength back and within about four hours he was up and walking and in about five hours he was taking some fluids and walking around and feeling fine.

EB: Is that all you do?

TS: That's all you do.

EB: You don't give him anything?

TS: No, nothing to do. Once you remove the biting parts of the tick, the venom is no longer injected into the subject and the paralysis is instantaneous, but it also goes away.

EB: Where are these people from?

TS: This turns out to be a Ph.D. psychologist who taught at Columbia, I heard from him for years. And he had flown to Denver, he had rented a car. He might have had another child with him, there was no mother as I recall.

EB: So the child picked it up in the Rocky Mountains?

TS: Picked [inaudible] Rocky Mountains somewhere from Denver to the Grand Canyon, they'd been out camping, he went to bed that night, maybe got the tick who knows where. And this was classic tick paralysis. And, as I say, it was one of the few times where I can actually say, ‘I know I saved a life.', but I also then remembered Lew Barness who was my professor at Penn always told us, ‘cause I think there are some ticks in New England, he said ‘Whenever you see a child who has a sudden on-set of paralysis, always take off their clothes and look in their hair and look for a tick. It's usually in the mid-line'.

EB: Had you thought of that when you saw the paralysis. Or did you just, [TS: No.] as you turned him over to do the spinal tap you saw it?

TS: All I thought was ‘This kid's got something, I better do a spinal tap.'

EB: Being in Las Vegas, you wouldn't think of that.

TS: Nope. But when I turned the kid over and saw this speck I said ‘Ah-ha', it rang bells. It's interesting how things you learn come back. Then of course, I sat down with the man in the hospital and he was forever grateful, he hugged and kissed me and they went on their way and he got on a plane and flew back and I got a letter from him and the kid was fine, he was about a 10 year old. And I still had a copy of the summary of the hospital record; I've kept some interesting summaries in there. One of the most dramatic moments in my life, then of course we sat and talked and he said ‘Yeah, we flew into Denver, we grabbed a car, we've been out camping for four days.' and by then of course Bob Belliveau calls me up from the lab and says ‘This is dermacentor andersoni's the tick that causes tick paralysis.' I said, ‘I know that. The kid's up walking around.' [laughs]

EB: Did you ever see any polio or was this all post-polio?

TS: No, it was post-polio. The last polio I saw was really in Albany as a medical student, the last big epidemic there was in 1950. As a matter of fact, I mentioned this in my hooding speech, I gave the hooding address last May to the students. And I looked it up at the time, I think the last polio epidemic in New York was around 1955 or '56 and I was a freshman or sophomore in medical school and I remember seeing a couple of kids in iron lungs.

EB: And nothing in Madrid?

TS: No, the polio vaccine was out then by what? '58? When I was a resident in...

EB: But these people in poor areas...

[cross-talk]

TS: But I didn't take care of many of the Spanish nationals, remember?

EB: Yeah.

TS: And I don't recall, maybe Lucas saw it at the local hospital. But, I don't recall ever seeing polio after. Now, we saw Guillian-Barré and other kinds of viral illnesses that mimic polio, but they're not due to the polio virus. And of course by the early ‘60s all kids were getting immunized for polio and then shortly thereafter they're all getting immunized for measles and that sort of thing. No, I didn't see that, but certainly that one and there are probably a few others. But most of the pediatric practice in Las Vegas was routine pediatrics, lots of behavioral problems, lots of ear infections.

EB: What about TNA's? Did you ever?

TS: No, never did a one. Never did a one in my whole life.

EB: You'd refer them to the EMT then?

TS: Yeah.

EB: What about your partner, did he?

TS: No. And I didn't do very many, I mean I didn't refer very many because they were [inaudible], most of them were unnecessary. Most tonsillectomies were unnecessary.

EB: Well, now. But then, I remember [cross-talk]. They were doing TNA's.

TS: I never did one. That was a money-making deal, I'm not criticizing them. But that's why it was dumb. The kids didn't need, they needed an occasional tonsillectomy; most of the time what they needed ears open and a tube put in. But besides, I was practicing pediatrics, so I had no trouble referring people.

EB: Did you have leukemia patients then?

TS: Yeah, uh-huh, had a couple of them. Couple of asthmatics, I don't recall in Las Vegas.

EB: What about malnutrition?

TS: Saw some undernourished kids, I'm not sure if I would call it malnutrition, but saw some in the Indian colony. That was where I was beginning to see child abuse, matter of fact I became aware of child abuse there.

EB: What did you do? That wasn't reportable the way it is now.

TS: No, matter of fact, child abuse laws didn't become reportable until the late ‘60s.

EB: What would you do?

TS: Well, what you did was you called the County Welfare Department if they were on welfare, sure. At the time, nothing was done, little was done.

EB: What if it was a private patient?

TS: Like most people, just ignore it or make up an excuse. I know that when I was a resident at the University of Pennsylvania and subsequently, I'm not sure about Madrid, but certainly Las Vegas, I saw kids with bruises and injuries and broken bones.

EB: That you couldn't explain.

TS: And we'd accept whatever the cock-and-bull story was that was given to us, you know, he fell off a chair. Now we know that's nonsense, babies don't break their legs falling off a couch and they don't squash their skull, that's all inflicted. But really, until the child abuse laws went in that first required reporting, but secondly gave immunity for good faith reporting, physicians like, and it was our duty at the time and I admit that. I was actually in the Air Force, I think in 1965 and I can look this up. I know it was 1965 because I went to the Academy of Pediatrics meetings as an officer, still in the military, in Philadelphia. And I went and I listened to the first talk given by Kempe, Henry Kempe, who was professor and chairman of the Department of Pediatrics in Denver, Colorado, University of Colorado; gave the talk that shook the world. And he coined the phrase ‘The Battered-Child Syndrome', he gave that talk, showed slides and the place was silent; and I bet you every pediatrician in the room said, ‘I've seen kids like that.'

EB: Mm-hmm.

TS: And it was because of Kempe, Henry Kempe's talking about it, and shortly thereafter State legislatures getting on the bandwagon and putting in laws saying ‘We got to report this. We got to stop this, he showed evidence. It's clear.' And I know there were kids I saw as a resident in the Emergency Room and probably in Las Vegas. Well, not Las Vegas, because by the time I got to Las Vegas, matter of fact, I think Nevada was one of the first to put in its reporting laws and the legislature, to its credit, may have put in those laws in around '66 or '67, I'd have to look that up. So there was at least a mechanism to report it, but nothing like now. No, that was all the doing of Henry Kempe, he was the one that brought to the attention and he gave that talk in Philadelphia; it was then published, I don't know where, JAMA or some place. And then, of course, so called ‘Epidemic of Child Abuse' came out of the woodwork, well that was nonsense, it had always been there.

EB: Sure.

TS: But it had been ignored, it had been not dealt with.

EB: You were restricted too. [TS: Of course] When you think about it.

TS: Yeah, you couldn't falsely accuse somebody. And there was very little investigation or ways to know. The radiologists were just learning how to read the x-rays to show that there were multiple problems. And the Welfare Department and Child Protective Services, sure they could intervene if some kid was murdered, got shot, a gun. But the common abuse, I shouldn't say ‘common', the most common form of physical abuse was ignored and sexual abuse wasn't even talked about then for another 10 years or so. Sexual abuse came even much later and the first big episode of that was Papoose Palace thing here in Reno in the early ‘80s.

EB: Had to be a combination of reluctance, one, to admit it was there.

TS: One was denial, the other was ‘I don't want to get involved'. And that's an attitude in medicine or pediatrics even today.

[cross-talk]

EB: That was a real step in the right direction.

TS: Right, but that was not the case in 1965 and ‘6 and '67.

EB: Tell me, before we finish this, because I think we have a lot more to talk about on that. ‘Cause this is a time in medicine here in Nevada that's very interesting to people. Even though, it isn't that long ago, but when you think of the changes between 1966 and 1998.

TS: Yes, 32 years. Oh, big changes, not only just the medical, big changes in the way medicine's practiced.

EB: And because Las Vegas has grown so much.

TS: Oh yes, absolutely.

EB: I mean a whole change of scene down there. Did you see Baby Bottle Syndrome?

TS: Yeah, I'm not sure I recognized it at the time, but I always was taught and always advised mothers not to prop bottles or use them as pacifiers, primarily because it was known to be associated with an increased incidents of ear infections. But also we, later, then realized, obviously from the dentists, having sugar and garbage in your mouth all the time, your teeth rotted.

EB: That's where I first heard about it. And interestingly enough the parallel between the Baby Bottle Syndrome in Reno as opposed to Baby Bottle Syndrome in Las Vegas, was brought out as being much more prevalent down there because of the casinos and the people who had to work. It wasn't as common for mothers to work here in Reno in those days, if you'll remember.

TS: Oh yes, right. You're right.

EB: It was more in Las Vegas.

TS: Large percentage of my private practice were working single mothers.

EB: Now, I'm just talking about Nevada medicine.

TS: Yeah, sure, sure.

EB: Mothers didn't work, they were home when they're kids came home from school, but with the infants they took care of them themselves.

TS: We can talk some more about that or quit or pick it up on the next time around.

EB: Well, let's quit. And we'll end this right here.

[End]