More From UCLA

I began my career at UCLA as an outcast, a role with which I was actually quite comfortable. It defined pretty much my whole life. I was an outsider at Harvard; I was an outsider at Ohio State; and there was no reason for this to start out any differently. Everyone was uncertain of exactly what to expect. Gradually the residents and attendings
began to warm up. The first three months were actually tremendous fun. I was
running conferences, I was helping the residents with their clinic, and I was
doing surgery on my own patients with me making all the decisions, and yet there
was comfort in knowing that in the next room was someone there if I needed
help.

This cruised along for another month, and then things began to change.
More and more of the clinical staff began to question the necessity of a
fellowship in cosmetic surgery. They weren’t really sure why we needed one. I
was confused by that posture. There was a fellowship in microsurgery. There was
a fellowship in craniofacial surgery. There were even fellowships in hand
surgery.

Obviously I agreed with Dr. Miller that there should also be a fellowship in cosmetic surgery. This is why I was there. We, as plastic surgeons, were expected to do the best cosmetic surgery. It only seemed natural that we should be the best trained in it. Besides, there was certainly a lot of animosity over the fact that gynecologists had started
doing liposuction, ophthalmologists had started doing more eyelid surgery, and ENT
people actually began to call themselves facial plastic surgeons.

Many plastic surgeons felt that their area was being infringed upon and they resented it. My concern, however, was that their resentment was misdirected. Their frustration was not directed at those people whom they thought were infringing on their rights. Their anger did not motivate them to be better at it. They began to do the absolute incorrect
thing. They began to fight amongst themselves.

As is the case with most institutions, they crumble from within, not from without. Dr. Miller’s Aesthetic Fellowship became the first thing for the clinical faculty to attack.
They were more concerned that if they helped train too many people with more expertise
at cosmetic surgery than they had, then eventually they, in some manner, would
be below the standard of care. This was indeed a very short-sighted conclusion.

The clinical staff began to fabricate reasons for needing to dissolve the fellowship: It was too time-consuming. It required that the resident train too long (as if they cared
how long someone else had to train). They began to question whether the program
itself was economically feasible. Nonetheless, I was able to demonstrate that
the Aesthetic Fellowship had in fact earned more money than it had cost to pay me.
I compiled the lists of the surgeries I had performed, what revenue it brought
in, and compared that to what I was being paid. It wasn’t even close. UCLA was
coming out way ahead. Nonetheless, the idea that the clinical staff wanted to
dissolve the fellowship, less than six months into it actually began to chip
away at the enthusiasm with which I had begun the job. I was devastated that
the faculty was actually killing a program because it raised the standard of
care.

By the time May had rolled around, they had actually succeeded in undermining the program. Even though there was a resident who had signed up to follow me, you could tell that the program did not have much of a future. I resented that. My immediate reaction
was to isolate myself from this group.  I would prove to them that I was a better surgeon. I was determined to treat my patients better than any of them treated theirs.

I decided that once I started my practice, I would do my work and go home. I would limit my interaction with my so-called colleagues to the absolute minimum. I would as much as possible avoid the politics and petty jealousies. I knew to isolate myself from this group, my colleagues, was, career wise, not the smartest thing to do, but once again,
people had demonstrated to me that they were best avoided.  I refused to live the rest of my life looking over my shoulder watching to see which plastic surgeon would be the one to stick a knife in my back. And I knew being out there on my own meant sooner or
later one of them would. Look at what they’d done to Tim Miller and his program.

My decision to participate in a TV show was much more desperation, than inspiration. When I finished at UCLA, the hard question once again was whether to pursue a career in academic medicine or to go into private practice. In a sense, fate answered that for me.
Medicine was experiencing, from an economic standpoint, a drastic slowdown. As
a result, those people who had entered into academic positions, who normally would
have matriculated into private practice, were no longer doing so. They were
holding onto those jobs because they offered security.

I put a call into my former chairman, Dave Smith, to discuss my options. His first inclination was that I should look for an academic job. I considered a job at the University of Nebraska, the only opening available at the time, but a trip to Omaha in April,
with the temperature still a brisk minus fourteen degrees farenheight convinced
me this was not the place for cosmetic surgery. My other alternative of course was
to pursue a career in private practice. I was offered a position as an
associate of John Williams.

John was the premier plastic surgeon of his time. In a sense his career had defined cosmetic plastic surgery, particularly in southern California. I enjoyed the moments I spent talking with him.  He’d often reminisce about the good old days when celebrities or movie stars would come into his office, lay down $20,000 or $30,000, and ask him to fix them. In today’s world, from his perspective, that had changed drastically and was dead. The patients were now coming in telling him what they wanted him to do, describing how he should do it, demanding that they pay him less, and yet, at the same time, wanting him to take the responsibility for the outcome. Somehow this seemed backwards, just plain wrong.

In our very private conversations, he’d suggest that for the long term I consider doing other things. He thought that the future of plastic surgery was bleak. He just
thought that people were getting more selfish and mean and that the ‘good old
days’ of plastic surgery were gone. I chalked it up to progress, but now I
believe John was right. It was not sentiment on his part, it was observation.

John Williams believed my future lie in media. In particular, he appreciated the fact that I was able to explain very complicated medical issues in layman’s terms. Our office,
Aesthetica, was at 5757 Wilshire Boulevard in the same building that housed the
offices of the Screen Actors Guild. Across the street were the offices for E,
Entertainment Television.

Aesthetica, as an office, was beautiful. It was modern, tastefully done with soft pink colors, and a tremendous office staff that screamed success. John’s brother Jim had worked
with him at one time; in fact, they were twins. Jim’s practice, however, never
really took off to the extent of John’s practice, but it was obvious as to why.
No client was going to walk in off the street for plastic surgery and choose you, meaning any other doctor, knowing that John Williams was right next door.

Garth Fischer, who had finished at UC Irvine a couple of years earlier, had also taken a position as an associate with John. Garth proved helpful because of his insight into getting a practice started. He seemed comfortable at Aesthetica, and so I settled in and
began the task of creating a private practice.

Things went wonderfully well at first, as all the people who were waiting for me to complete training began having procedures done. But realistically, after you’d completed surgery on all your mother’s friends, it was now time to get going. The real game was now on.

In one conversation with John, we talked about how, in the past as a physician, you could go into a bank and get the funds needed to start a practice. In today’s world, that was clearly not going to happen. Many plastic surgeons, particularly the older ones, were
retiring because they were unable to make ends meet. In the long run, it just
wasn’t worth it for them to be spending money out of pocket to survive if they
weren’t producing the volume to replace that money.

I solved it by covering emergency rooms throughout the South Bay. I had received a call from Dr. Pearlman Hicks, down in Long Beach, California, whose wife unfortunately had developed breast cancer. After her death, he was looking for a way to spend more time with his children. I consented to cover his call schedule so that he would have more time
for his children, two boys.

And so, in addition to Aesthetica, I became a staff member at approximately 12 hospitals in the South Bay. At first it was almost comical. I would be at the emergency room at Long
Beach Memorial at 3 a.m. Friday/Saturday morning, and at the same time get a
call to sew up the face of an accident victim at Downey Hospital approximately
20 miles away. The weekends were spent driving from one hospital to the next,
sewing up lacerations, repairing hand fractures, and attending to accident
victims.

At first it was fun. After a few months, it became tedious, especially since you started to realize that the insurance companies were not only paying you 10-20¢ on the dollar, but many times not paying at all. I attempted to solve this problem by using an
independent billing service, International Medical Financials. I met its owner
and heard his pitch. They were representing hundreds of doctors. I believed that
the billing would be standardized and as such would be paid in a timely
fashion. Eight months went by before small checks started to trickle in.

Also by that time I was seeing patients in follow-up on Tuesday afternoons from 2 to 5 in the office of Dr. Hicks. It seemed unfair to ask some of these people who were general laborers to drive all the way to Beverly Hills. Since Dr. Hicks’ office was located near
the hospitals where these people had been seen, I thought it easier that I pick
a day and see them down there.  It worked fine at first and then became an economic issue. Dr. Hicks began billing me for a third of his office’s overhead but I didn’t have an office there. For the three hours once a week that I went there, I worked out of a nurse’s station
and basically saw only follow-ups; and even with that, I was paying his office
50% of the revenue.

That apparently wasn’t enough for him, and the bills for a third of his overhead kept coming.  I met with Dr. Hicks and explained to him that I did not have an office here.  I pointed out that I was working at his request so that he could spend time with his
children. Furthermore, we had never talked about me joining his practice or
paying him for a third of his overhead. Also, 100% of this money was insurance
money, and he was already in fact getting half of that.

But it was easy to understand why this was happening. Dr. Hicks was not just another plastic surgeon, he was my father’s brother and the truth of the matter was that we were never close. He also wanted to treat me like a nephew and not a colleague (as it suited him). As was standard for the profession, if you took on a new partner, you took out
a loan to pay him a salary until money started to come in. Dr. Hicks didn’t
want to do that for me. Apparently, he had done it for a previous partner who
had gone out on his own. I didn’t understand the connection.

In my mind he was simply abusing our relationship. I made a number of attempts to create a working situation, but everywhere along the line, he was more of a hindrance than a help. He wanted me to do certain things as long as I remained subservient to him, but he didn’t want to do the things that helped a new partner develop a practice. I asked him
to talk with the guys at emergency rooms that were sending patients to their
friends when we were the on-call staff. He didn’t. He didn’t want to make waves
and so we suffered.

Perhaps too, he reminded me too much of my father.

Abandonment, by a parent is a tricky thing. As children, we resolve that things are the way they are and move on, but not without first burying a lot of hurt and anger deep inside that eats at us from time to time, and rots us from our core. Unfortunately, I thought I
had resolved it, but obviously I had not.

I do credit my father and a conversation we had at my grandmother’s funeral with
one profound epiphany: Sometimes you can’t get what you need from a parent
because it isn’t there. As a child, they never got it themselves.  People can’t give you what they do not have.

Sometimes, if you are to get from them the things that you need, you somehow have to help them get it first for themselves. You have to act as your own grandparent, and give your parent what they didn’t get as a child so that they, in turn, can pass it on to you.  That was my epiphany.

I decided to accept my father for who he is; to honestly find those things for which I could be proud; and speak to him about them. I resolved to tell him that I was proud of him for working at the VA hospital (Disabled American Veterans is one of my charities); and
especially that I was proud he had the guts to confront his addictions and
overcome them.

I resolved to be proud of him, so that he could be proud of me.

As a mentor, Tony simply did not have it.

UCLA

However, “the real game”, the game of life, was just beginning. I was also looking at what to do next. Do I go home to private practice? Do I continue on?
Having been accepted to the University of Michigan training program meant
that you would somehow go into academic medicine. No one said it, no one
brought it up. It was just something that was expected.

I looked through the possibilities and found that Dr. Tim Miller at UCLA School of Medicine was establishing a fellowship in aesthetic surgery.
I knew immediately that this was the program for me, and I discussed it
with Riley Reese who helped me to secure an application.

UCLA was slow in giving us a decision, and both Riley and I struggled with the wait. Oddly enough, it was Riley who could take it no more and he put in a call to UCLA to press the
issue. Riley is a southerner with a strong accent and a master of southernisms.
Waiting outside his office I could hear him screaming into the phone, “We need
a decision and we needed it now”. I was awarded the fellowship. I was to be the
first fellowship trained aesthetic surgeon to spend a year at a
university-sponsored program. “Wow!”

As I drove west along Interstate 10 toward Los Angeles, I was filled with excitement. There was tremendous anticipation in what I was about to do. I had just completed my residency in Plastic and Reconstructive Surgery at the University of Michigan, and I had completed
it with a bang. Dr. Smith, during our graduation ceremonies, had offered that
during the first year when he watched me do my work, he thought I “was the best
black resident he’d ever had”. However, at the graduation dinner, he offered
that Jan was in fact “not the best black resident he had ever had; he was in
fact the best resident he’d ever had”. That was a lot coming from him because
Smith wasn’t one to hand out compliments. He simply expected you to do better
than he expected.

Dr. Warren Garner, who was the youngest member of the staff, pulled me aside to reassure me that that was in no way a racial slur. Personally, I hadn’t taken it as that. I had taken it as nothing but positive. But that was Dr. Warren Garner. When you first met
Warren, you thought he was prissy and particular. It turned out after you’d
spent enough time with him that he was in fact quite prissy and particular, but
what lie below was a meticulous plastic surgeon who had the kindest heart of
any of us, myself included.

Warren always made sure, with an off-the-cuff statement here or there, that you knew you could be doing better; that there were certain things that were unacceptable and you needed to pay attention to detail. And no matter where he was when he ran into you, and no matter what was going on, he made sure that he gave you that dig, just to
remind you. But nonetheless, he was someone who you could always trust, you
knew where he was coming from, and ultimately he had your best interest at
hand.

And so my drive west was indeed exciting. It felt good to knowdeep inside that I was prepared, that I was good at what I had decided to do with my life. I also looked forward to seeing Steve Crisman, a friend from New York and visiting with his wife, Marielle Hemingway, and their daughters. Their house was a large “log cabin inspired” structure tucked neatly into a garden on a quiet street not far from the beach in Santa Monica. They had set aside a private guess wing and I had every thing I could possibly need. This
was better than I had lived over the past twelve years by a long shot. I’m not
sure I wanted to leave.

A close friend of Marielle’s was a very pretty, petite brunette girl named Courteney Cox, who was dating Michael Keaton at the time. I was really envious of him because this woman was, in addition to being beautiful, very smart and funny. It was wonderful to watch them, Marielle and Courteney, make fun of themselves, and other actors. They
didn’t take themselves too seriously which made them even more attractive.

I finally got the nerve to ask Courteney to lunch, and to my surprise she agreed. It was nothing romantic, I couldn’t be that lucky, but it was a time to sit in the sun and make friends in a place where I didn’t know too many people. Over lunch Courteney told me about a show she was working on, a show with an ensemble cast at Universal studios,
or somewhere. It sounded interesting but I really didn’t know enough about the
business to make sense of it. It was miles away from anything I had ever even
considered. I wished her luck with it, but I doubted she needed that from me. I
guess it eventually became successful. I was a little preoccupied with my own
life. After all, I needed something as basic as a place to live.

I settled on a condominium that sat on a hill on the east side of Pacific Coast Highway in Malibu. The complex, a gated community with a stoner for a guard, looked down on the famed “Colony” where all the movie stars lived, and then out onto the ocean. This apartment was perfectly located and a “stoner” for a guard provided the perfect
California welcome. For him life was easy, and that’s essentially how he
greeted everybody; no problem.

Just below was the shopping center at the “Colony” with a grocery store, custom shops, postal service, and a service station. The government buildings for Malibu City services were also just below, about half a mile south. Yes the complex was perfect and it offered everything I needed, at least so I thought.

The drive to UCLA took approximately 25 minutes each morning, and it was this drive that taught me something very interesting. Living at the extreme western part of the city is
probably not a good idea. During the first two months or so, I seemed to always
keep a headache. I couldn’t figure out why. Then one day it dawned on me. When
I went to work in the morning, the sun was in my face, and as I returned home
that evening, the sun was once again directly in my face. I resolved then to
live on the east side of the city and head west or when I’d finished the program,
return to the East Coast.

Regardless, there would be plenty of time to think about those things.  I
was now the Aesthetic Fellow in Plastic and Reconstructive Surgery at the UCLA
Medical Center, and I needed to get about the business at hand.

Orientation was confusing. It had never been done. I was the pioneer and the one setting the tone for the Fellowship. There were a lot of the details that were open and had to be defined by me. Dr. Miller’s office was in the newer outpatient surgery center at 200 UCLA
Medical Plaza. Across the street was the massive UCLA Medical Center, including
the Neuropsychological Hospital, the UCLA Hospital, the Children’s Hospital,
and various clinics. That was a maze that I wanted to avoid. And so, I tried as
much as possible to confine the workings of the Fellowship to 200 UCLA Medical
Plaza.

I began by first proceeding to the chairman’s office to get the prospectus for the year. That included the Division of Plastic Surgery anatomy sessions, the Saturday morning workshops, and the UCLA Division of Plastic and Reconstructive Surgery grand rounds
schedule. Once these were recorded, it was then time to arrange my schedule. I
wanted to allow myself as much time as possible to spend with the physicians
who would take part in the program, and the residents who I would help with
surgeries and clinics.

Tim and I sat down first and to the surprise, I think, of many in the department, we immediately hit it off. Tim was considered withdrawn and intellectual. I found him to be that, but I also found him to be warm and caring. I knew he had wanted this Fellowship to
succeed, and it was to that end that I dedicated myself.

The staff at UCLA was actually quite impressive. Dr. William Shaw, who was the chairman, had come from NYU and was quite famous for microsurgical techniques. Even more impressive was the casual clinical staff. They were the plastic and reconstructive surgeons in private practice in Beverly Hills and Santa Monica. This included Steve Hoefflin
who had been Michael Jackson’s surgeon, Jack Sheen who had written the book on
nose surgery, Henry Kawamoto who pretty much had defined craniofacial surgery
in America, and John Williams who in the early ‘60s had defined cosmetic
plastic surgery.

I loved John Williams. Despite of all his expertise, and literally all of his fame as a cosmetic surgeon, at seventy years of age he was more than willing to learn and try anything new. And that’s exactly the reason I went into plastic and reconstructive surgery. As a medical student, hearing plastic surgeons explain that this procedure was one they had never been done before was fascinating. They were, in fact, going to evaluate the
anatomy and devise an operation that specifically solved the needs of that
patient. I loved it. It wasn’t about learning operations and trying to mold the
patient to fit. It was about understanding the patient’s problems and devising
an operation that worked for them. It was perfect for me; it was perfect for
how I thought.

More From The University of Michigan

One of the biggest problems for any resident is getting everything done each day. There are people to see, things to read (to make sure that you were on top of patient care), and then there was the busy work, including the dictating of charts. It is the administrative work that would come back to haunt you. If you didn’t accomplish the paper work in a
timely fashion (like immediately) most hospitals, at least once a month,
printed a delinquency list for every one to see. Normally our posture was to
wait on this list and then, after having procrastinated as long as we could, be
forced to go down and complete them.

Smith called me in the office one day and said, “JR, I want you to do me a favor. I want you to go down to the record room and find out who’s responsible for the list of residents with delinquent charts. I want you to have him call you two days before he makes the list. And
then, those two days before the list comes out, I want you to go down to the
medical records office and dictate those charts.” I never appeared on that list
again. Smith’s point was this: learn to use the system, don’t let the system
use you.

One of the best things about training at Michigan was the camaraderie between the residents. The four of us virtually did everything together. We arrived at the hospital around 5:30 and we spent the whole day together until we left at 7:30 or 8 pm that night. We got to know each other very well. It was comforting to know that it wasn’t all just
happening to you.

One of the moments of clarity for me occurred when Dan #1, who was really from the year before, talked about his family. Dan, Ed, and Dan #2 were married. I was not. Personally I think that was a prerequisite to get into the plastic surgery program at the University of
Michigan and I somehow fell through the cracks. A married resident was a
committed resident without the distraction of nurses and female residents.

Dan#1 commented on how hard we were working. It was brutal to go through the day, having people who had certainly more knowledge and expertise than you pound on you for what you did not know. In a sense he was correct. No one ever seemed to support you for what you did know. The cup was always half empty.

All Dan#1 talked about during the day was his two small girls, approximately three and four years old. What he said was this, “No matter how bad his day was, when he got home, there were two little girls who thought he was the greatest thing in the world. No matter how down he was, when he hit that door he was a happier person because of them.” He
offered that he felt bad for those of us, meaning me, who didn’t have that
experience: those of us who got home at the end of the day and merely had to
confront that somehow that day you hadn’t measured up. You didn’t know all the
answers. You didn’t solve all the problems. And more than likely, you didn’t get
everything done that you wished you had gotten done.

That all changed when the next year of residents arrived. Noel Tenebaum was from New York, he was single; Steve Gitt was from Phoenix, he was single (though considering marriage) and then there was Jeff, Jeff  Wagner, who was
married andwho you could characterize as nothing more (or less) than Smith
cloned. It was clear that Jeff was going to be very successful as an academic
physician.

Noel and I hit it off immediately. In a sense, he became my family. Most of our time away from the hospital was spent together. We talked about life, we’d complain about the
workload, and we’d date nurses from the same nursing unit. That friendship has
lasted to this day, and even now I consider him family, more than just a
friend.

My second year of residency in plastic surgery at the University of Michigan began with one of the most frightening experiences I had had as a physician. A cute little six-year-old
boy, blond hair, blue eyes, and helpless, was brought into Mott’s Children’s
Hospital with meningitis. He had been an awesome hockey player but now he was
fighting for his young life. He arrived the day my chief residency year began
July 1, 1991. Dr. Smith assigned him to me, and it began a journey for both of
us that would change our lives forever.

Meningitis, an infection, either bacterial or viral, affects the membranes that cover the brain and spinal cord. Patients can present with headaches, stupor, and confusion, but it also can result in loss of integrity of the blood flow to different areas of the body,
particularly the extremities. We watched helplessly as the process progressed. Our
only recourse was to treat him expectantly chasing every complication that
resulted from his disease. I cried (along with his parents) as he began to lose
toes, his foot, and then his lower legs. Every day I needed to change his
bandages. It was difficult knowing that every day I was putting this kid
through excruciating pain. I felt so bad for his mother and father having to
watch this happen. Day in and day out, I’d round in the intensive care unit and
work on this kid for about an hour.

He did eventually get better and he did survive it, but the cost was the loss of his lower extremities. On the day that I finished my residency training at the University of Michigan, he was discharged home. His mother thanked me; we all hugged as they wheeled him to
the car. She made me a promise that we would stay in touch, to let me know from
time to time how he was doing. And she did.

A year later, after he had gone through extensive physical therapy, a company in San Diego had fashioned him some prostheses, above the knee leg attachments, to allow him to walk (and skate) once again. The Detroit Red Wings had heard of his fate and had adopted
him as their “mascot”. It was a wonderful thing to do.

I got a call from his mother. She needed a “favor”. During intermission at a Detroit Red Wings-Los Angeles Kings game, he was going to demonstrate his new legs by skating to center ice, a treat for any kid, but a triumph for him. She wanted to know if I could attend,
but more importantly, she wanted me waiting at center ice. I cried like a baby
in front of 20,000 screaming fans as he made his way toward me. I don’t think
I’ve ever been that happy. I still cry today every time I think of him, not so
much for his loss, but for his spirit and his willingness to fight on.

Michigan also provided me with one of the biggest non medical joys of my training career. My uncle, Terrell Burton, who had coached football at Michigan with Bo Schembechler for 20 years, was still affiliated with the team. Growing up I hadn’t been able to spend a
lot of time with him because they lived so far away, but my Aunt Sue and my
mother would speak all the time. Sue and Terrell were great and all about encouragement.
Sue always had a smile and the best thing you can say about Terrell was that he
was “a coach”. No matter when I got to see them, they were always loving and
always giving – well that is, except one weekend a year. Once a year, the
University of Michigan played Ohio State University in football. Terrell, who
knew I loved Ohio State football, would ride me for the whole week. I’d get
calls at the hospital, where he’d say, “Watch out for this play. We’re going to
do this to you on Saturday.”

But what Terrell did that was awesome was that he invited me and the entire plastic surgery division to the training facility where the University of Michigan football team prepared for games each week. There were lecture halls, with motivational slogans on the
walls, and indoor football fields. Let’s just say that this group of doctors
and nerds were literally in heaven. You could feel the history. You could feel
the excitement that went along with University of Michigan football. It was
simply great. We walked around the facility like a group of kids on a field
trip. I think Smith and Riley Reese enjoyed it more than the residents. Smith
summed it up by saying to Terrell, “My only hope is to build a plastic surgery
program the football team can be proud of”. I think he accomplished his goal,
but I don’t think any of us had as much fun in two years as we had that day.

My training career was winding down quickly. Two years had passed and I had yet to leave the hospital. Noel and I were now inseperable and had grown to be brothers and confidents. I knew that was a friendship that would last a lifetime and it has through children, living at different ends of the country, and divorces.

University of Michigan

The University of Michigan was simply awesome. Physicians learn most of what they need to know about being a doctor after medical school and formal training. That is a fact.

While medical school gives you a platform, it’s the interaction that you get from patients and other physicians that truly gives you your expertise. While there is a lot of information to be learned about the human body, the art of medicine really has to do with your investigative skills and your ability to put together a story. That transformation began for
me at Lenox Hill, but it happened at the University of Michigan.

I owe most of my development as a physician to two people:  David Smith, who was
chairman of the division of Plastic surgery at U of M, and Riley Reese, who was
his second in command. David Smith was from Indiana and his mannerisms and
background demonstrated that. Having grown up on the Ohio-Indiana border, I got
to know quite a number of people like David. He was smart, he was charming, and
his background had afforded him an opportunity to know who he was. That’s the
advantage of growing up in small town Midwest. You get time to define yourself.
Riley was from the South, and you could hear it in every Southernism he used to explain medicine. “KISS,” he would say all the time, “Keep It Simple, Stupid.”

Michigan was a tremendous learning experience for me. My education there changed my life. David Smith and Riley Reese taught me how to think, instead of what to think. That is a gift for which I will forever be grateful.

Here’s how it worked. Weekly, we had rounds where we discussed the patients on our service and their treatment. As the chief resident on a particular service, it was your job to present the cases to the attending staff, other residents, and medical students, while
Smith and Riley (and the other attendings) asked you questions about the care of a particular patient. It was not a friendly interchange.

Smith, regardless of how much information you had on a patient, knew how to probe, how to get to the question that you couldn’t answer. You never got away without realizing there was always more to do. It was embarrassing. Remember, you have medical students present, who you’re trying to impress as a good doctor and also trying to teach. To stand
there in front of the group and have Smith dissect you was painful.

Riley Reese, in his own way was just as smart, but he functioned to put you back together after Smith had dissected you. After one of these sessions, and laughing as hard as humanly possible, he said to me, “JR, why do you let David get you so flustered? You know more about the subject than he does.” And a lot of times I believe I did. But David Smith truly knew how to think, not what to think, and that gave him an advantage.  No matter what you had to say, there was always that next question that required an answer.

Interestingly, Smith really didn’t care what you chose to do for a patient (that is within reason and as long as the patient was safe). He really didn’t care how you went about caring for them. He knew you were an excellent doctor or you simply wouldn’t be there
in the first place. What Smith cared about most was that you knew why you were doing
it?  He required that you have at least five articles written in the plastic surgery literature that explained why you made the decision you made.

I soon learned very well how to think and as a result to be even more thorough with my patients. Clearly one of the greatest accomplishments in our time has been the computer. It gives us the ability to be experts by searching for information around the globe in an
instant. I would pull up obscure articles written in Russia, Romania, or France
and have them translated to English. I would then quote that study during one
of Smith’s sessions. The other residents would look at me in amazement. The
answer, though, wasn’t that I had done any more work, and certainly that I
didn’t have any more smarts than my colleages (those guys were amazing). The
answer was that I had learned the gift from Smith, and he in fact was a genius
at it.

The University of Michigan took three plastic surgery residents per year. That meant that there were a total of six of us in a two-year program. However, the year before I arrived in Ann Arbor there had been only two. Dan, who started the program with us and had
been the selection the year before, had taken a year off to do research. This
guy was brilliant. (I comment on that because we, the plastic surgery
residents, worked much harder than most residents in heart surgery. I can’t
imagine how hard it was the previous year for the two guys ahead of us.) The
most grueling day each week was Smith’s clinic. Smith saw about 100 people that
day. When you did his clinic, you had to see them all. Therefore, you saw 45
people in the morning prior to lunch and 55 afterwards.

Smith also taught me an important key about how you treat patients. Having to see 45 patients in about three hours meant that you didn’t get to spend a lot of time with them, but you clearly had to make them feel that way. And so in my interactions with patients, I
learned to do a few things:  1) I always sit down and never stand by the door; 2) regardless of what the patient has to say or I have to say, I always wait until the patient has completely finished and I allow for that awkward pause that occurs when people are done and we’re just sitting there staring at each other; 3) I never look at my watch, and I
always look the patient in the face; and 4) finally, you never touch the
doorknob until you’re ready to leave the room. That way, no matter how much
time you spent with the patient, there was completeness. That gave the patient
the impression they had had enough time to say what they needed to say.

Managing people was Dr. Smith’s forte, and he was a master at it. The greatest recollection I have of him was sitting in his office one day when his wife called. Dr. Smith had two sons,
both in their early teens. That day Nancy had called, not really to ask for any
help, but to release some of the stress that accompanies raising two boys. You
could hear her through the phone. Her speech was pressured, going on and on,
not pausing between sentences, and certainly not pausing between paragraphs. On
and on she went without taking a breath.  After about three minutes of this, Smith calmly spoke into the phone and said, “Nancy, just tell me what you want me to do and I’ll do it.” Wham. There was complete silence at the other end of the phone. There’s not much you can say to that. You could feel her calm down. You could feel her get control.  I thought, “Wow, that’s one to keep for the ages.” If you do whatever someone else wishes (that is of course within reason), there’s not much more to add.

More From OSU-College of Medicine, Lenox Hill and U of M

A few months after being discharged from the Cardiac Intensive Care Unit, I returned to the wards on the cardiology service. As luck, or fate, would have it, my first patient was a
42-year-old football coach from a small town in Ohio who had developed a
cardiomyopathy. Over the next 30 days, because I was the medical student assigned to him, I saw him every day. I watched, helplessly, as this vibrant young man took on approximately 200 pounds of water and literally drown in his own body fluids.

That was the reason for Dr. Unverferth’s concern for me: when the heart isn’t an effective pump, fluid backs up in the lungs until the patient finally drowns. Most people with a viral cardiomyopathy don’t survive.

In a sense, I became the poster child for people with that disease. Before I graduated, periodically, Dr. Unverferth would come around the ward, collect me, and take me back to the cardiac intensive care unit. He was determined to show his patients that you
could survive that disease.

I just enjoyed being with him, and I loved the physiology of cardiology. I actually ended up doing research the Cardiology Department. Along with Dr. Stephen Schaal, I authored apaper, coordinating the electrical activity of the heart with MUGA Scans and Vector Cardiographs.

(As an aside, just to put things in proper perspective, does anybody believe that I,
as a physician, am not honed in to heart disease? Does anyone really believe
that Donda West’s cardiac status wasn’t evaluated as her niece and the press
tried to suggest? I still cringe at idiocy of that magnitude. Clearly Harvey
Levin didn’t have the conversation with me he lied to Larry King about.)

Nevertheless, despite my history, I took to surgery immediately. I was exactly where I was supposed to be. The chairman of the department at OSU was Larry Carey, and he was a tough bastard whom I loved. He seemed always to be looking at me, checking, making sure I got it andwas doing the right thing. No matter how tough he was being, he would
give me that smile that kind of said, “You get it? There is no room for error here.”

I was interested in neurosurgery at the time, and in my next rotation spent a lot of time with the neurosurgical residents. They were all extremely nerdy, but they were a great group of guys who loved what they were doing. They spent pretty much all their time at the
hospital. I talked seriously with Dr. Hunt, who was the chairman of
neurosurgery, while on that rotation. He candidly told me that he thought I was
a whole lot more like Larry Carey than I was like Bill Hunt. That was a big
lesson. Awareness is a very important thing in life, particularly self-awareness.
A lot of times we walk through our days in a fog, reacting rather than
proacting. We don’t really think about what it is that we do, or where our
talents might best be used. We fall into things rather than work toward them.
We do it and think about it later. What Bill Hunt had shown me was that it’s important
to take a look at yourself, be honest with about whom you are and make an
informed decision about who you want to be.

I chose Lenox Hill Hospital in New York City for my general surgery residency. The interview sold me completely. I met Felicien Steichen, who was chairman of the department of surgery at Lenox Hill Hospital, the New York Medical College affiliate at the
time and later the Cornell University affiliate and that was all it took. He
was French, Belgian actually, and I immediately took to him. He just seemed to
get it, and with his credentials, just being around him was a godsend.

There were a number of things that I liked about Lenox Hill Hospital, but the most important was, its residency program paid the highest salary in the country. I also liked the fact that all the big time Park Avenue surgeons brought their patients there. I knew
I wanted to learn surgery from the best, and the old German hospital had a list
of the best surgeons in New York City.

Lenox Hill Hospital however, had a pyramid program, and that was the most frightening part about it. There were twelve surgical interns that would be reduced each year so that at graduation five years later there would be only two. You had to perform every moment of everyday. There was no room for error. You had approximately 60 masters, because
there were 60 general surgeons on staff, and you knew every second of every day
one of them was watching you. You had to perform every moment of every day, or
fear alienating one of those surgeons who could vote against you returning the
following year to the program. If you didn’t return, you had a hard time
finding a place somewhere else. Each of those programs had already taken in the
general surgery residents they expected to matriculate through the system. New
guys weren’t being brought in to be chief resident from the outside.

I was closest to Dr. Doug Heyman. Most of the interns and residents were afraid of him. In a sense, he was intimidating, but it was really his desire to make certain that the treatment of his patients was perfect that drove him. There was no, absolutely no, margin for error with him. He wanted no excuses and he expected you to do the correct things for his
patienys without having to be told to do so. If he had to tell you then it was
too late. And so I did exactly what Dr. Heyman expected of me and I believe it
was him who championed my matriculation through the system.

Of particular fun for me was the fact that he had a young daughter, Alexa, who in a sense gave me back some humanity and broke up the monotomy of being a surgical resident. Lenox Hill Hospital’s general surgery program required you to be on call every other night
and every other weekend for five straight years. There wasn’t a lot of personal
time. On Saturdays, your day off, you’d meet the attendings at the hospital and
go on rounds. That generally would last until around noon.

Dr. Heyman used Saturday to spend with his daughter and there were times when he would bring her to the hospital with the intention of spending the remainder of day with her. In surgery though, the best laid plans can often go wrong with no help whatsoever from those involved. If he got tied up, this eight-year-old and I would have lunch.

I attended her Bat Mitzvah. It was both joyous and sad. I listened as my little friend recited the scriptures she was required to memorize. Her words made me sad. Maybe it was that she was growing up and I had lost my friend, or maybe it was just because I wanted
everyone to believe, as I believe: that we were all one. Where we grew up and
what problems the planet threw at us defined our culture, but ultimately I
wanted to believe as always, that we were one. Our relationship changed after
that and that is perhaps as it should be. She was growing up and it was time
for even me to see that. Nothing in life, it would seem, is permanent.

Dr. Steichen, the chairman of surgery, had developed squamous cell carcinoma of the throat and required operation. This affected his voice and his ability to speak, but not his
spirit. I resented the other attendings for plotting against him behind his
back. They suggested that he no longer was able to be chairman because of the
raspiness of his voice. Ultimately it was because they all wanted his job. The
person most adamant about him not being physically able to perform his duties was
the guy who had, in fact, done his surgery. That was my first lesson about
jealousy amongst doctors. Unfortunately, that pattern of jealousy has shown
through no matter where I’ve been. It’s a part of medicine and life that I have
come to hate. But it is a part of medicine and life that seems to always be there.

Lenox Hill Hospital eventually put out a search for a new chairman. And lo and behold, those attendings, which would undermine Dr. Steichen, learned the lesson of their lives: “Be careful what you wish for – you might get it”.

Dr. M. Michael Eisenberg arrived on the scene at Lenox Hill Hospital and his first order of business was to demonstrate to everyone that he was in fact in charge. He didn’t need to be
here, he chose it. By far they had gotten something much worse than they had
gotten rid of.

The most frightening moment for me and the most telling moment about Dr. Eisenberg happened before I even had an opportunity to meet him. I was attending a conference in Brooklyn, and a doctor, who I had never met, came up to me and said, “I hear Dr. Eisenberg’s with you guys now. Man, that guy’s a bastard.”

 I thought “that must really be true, because this person doesn’t know me from Adam. Dr. Eisenberg and I could be the best of friends. For him to say that publically without
knowing me meant that he must really believe his assessment, was also passionate about it, and didn’t care who knew it.

Dr. Eisenberg, though, was not as bad as people tried to paint him. He was, however, as big a bastard as they had suggested. He seemed uncomfortable around people. There was warmth lacking that I believe as surgeons we all have to have, and yet he had none. Perhaps he had spent way too much time as an administrator. Perhaps it was his predicament. He had taken over a job where there were residents in place, that he had no part in choosing. He was running a ship that he had not taken to sea, and I think he
was determined to put his stamp on Lenox Hill Hospital. The problem was his
skills didn’t fit that. He had a very hard time being friendly or winning
people to his way of thinking. I tried as much as possible to establish a
relationship with him, but it never seemed to take. You just could not trust
that he was genuine, and any display of warmth on his part would quickly be
followed by a coldness that would give you chills.

I chose, during my fourth year of residency, to apply to plastic surgery programs without going through Dr. Eisenberg. All of the programs required a letter from your chairman. I chose Dr. Steichen to write that letter, rather than Eisenberg. He believed that to be a slap in the face (which it was) and whatever chance we had of even being cordial went away
with that; but I saw a letter that he had written for my co-chief resident, Dr. Morad Tavalalli.

Morad was an Iranian national who had studied in London and the U.S.  He had this
awesome British accent. Morad worked as hard as anybody, and all Eisenberg
could say about him was he had a great speaking voice. My slap to his face was
in retaliation.

And so I went about my application process without him. And lo, and behold, the University of Michigan accepted me. That was perhaps the biggest coup to this day in my medical career. The program at the University of Michigan was one of the best in the
nation, and had a very proud history of medicine, including the Mayo brothers.

I had also interviewed at Wright State University in Dayton, Ohio. My intention was and always has been to one day return home to Middletown. Somehow I just never got around to it. I believe that my life is somehow less for that, but my hope is that I will get around to
it before it’s too late.

The Ohio State University-College of Medicine

I was very excited about my prospects at OSU. Everyone I had interviewed with at the Ohio State University-College of Medicine had been very gracious and helpful. I was particularly impressed by a plastic surgeon, Dr. Robert Ruberg. He asked the right questions about where I wanted to be. He demonstrated that if I made the choice of Ohio
State, he would certainly be there to help. He was concerned about my family
and asked about my mother. He was concerned about me. He was there trying to
help me make a decision, not exclude me. I loved him from the start.

Ohio State took in a large number of medical students. There were about 160 my year. Of that, approximately 30 of us went into the independent study program. I chose the independent study program because it just seemed to be civilized. I couldn’t see me wasting time in lecture discussion classes having my mind roam as I sat there for hours. Independent study was much more suited to me. I could sit down with a very good book in a very quiet place and get it done.

The course workload was divided into modules. Modules were comprised of the material that needed to be learned in that particular subject. You progressed through the module at your own speed. When you had completed a module, you took an exam. If you passed the exam, you progressed to the next module. If you didn’t, then you had to see the professor
who wrote it. And frankly, that was something you never ever wanted to do.

The independent study program was run by Dr. Michael Altman, an internist, but the real backbones of the program were two women, Dee Eskin and Jodi Skinner, the administrators.

Dee was strictly “business” and expected you to do your best. In a sense she was a “mother figure”. She made sure that it got done. Jodi was simply our fantasy. She was about the same age as all of us and we all really looked at her as, hopefully, the next girl friend, and not the program administrator. She didn’t even know any of us were alive. It was hysterical, but it was how it was. They were the administrators with whom you interacted. The goal became to impress Jodi by passing all your tests. If you failed, she’d have to tell you those horrible words, “You need to see the professor.” No one wanted that.

The other students in the independent study program were, in fact, pretty “independent” themselves. Most were incredibly smart. Many already had advanced degrees. There were a couple of dentists, a pharmacist, and two engineers. Most were older, some of them
married, and so it just worked for their lives based on where they were at the
time.

My favorite subject was anatomy, and two of my favorite people were our anatomy instructors, both women. Martha Sucheston taught embryology, and Peg Hines taught gross anatomy. The part of anatomy that intrigued me most was embryology. Getting a look at how we develop amazed me. That anybody – and I mean anybody – was born normal was the exception, not he rule. There were so many things that could go wrong all along the way. I just marveled at that stuff. Imagine two microscopic cells
developing into a total person. The transformation was simply awesome.

About eight months into the program, and about a year before I was to complete the independent study program and head for the clinical wards at Ohio State Hospitals, I began to feel ill. I experienced a lot of chest pain and after having had a number of
episodes with associated nausea and dizziness, I decided to talk to one of my
instructors about it.

Of course, I went straight to Peg Hines one of my anatomy professors. I couldn’t pinpoint for you why it was her or why she took an interest in me. We were so different, but the fact is I liked her and trusted her judgment. She referred me to a cardiologist, Dr.
Donald Unverferth. She chose him because our backgrounds were similar, though
his was clearly more impressive than mine.

Donald Unverferth had grown up in Dayton, Ohio about 20 miles north of Middletown. He had played football at Ohio State, and in actuality had played quarterback during some of the glory years of Woody Hayes. Unverferth had been drafted by Vince Lombardi of the Green Bay Packers and chose not to go into the NFL. He chose to be a doctor. He was
impressive. He was 6’4” tall, still about 210 pounds, prematurely gray hair but
still looking all the part of the athlete. All the secretaries and all the
nurses loved him. It was amazing to watch them all swoon as he walked by,
oblivious to all of it. He simply loved taking care of people. I envied him
that. He was just so happy to be doing it. The process was his reward.

Donald ordered a lot of tests to examine my heart. It was all very confusing for me. I knew what each test was for but I was confused as to why he always seemed so solemn and serious. I had been referred to him because we were kindred spirits, but I couldn’t help but
feel some sadness when he was around, as if there was always something he
wasn’t telling me. I finally got my answer.

One day he came to me looking more serious than usual. We sat down, and he began to talk about what he thought was going on. His concern was not only the Wenckebach block (that had been discovered a few years earlier when I interviewed for the Naval Academy), but that I had developed a cardiomyopathy. My heart was getting larger and larger over time, becoming a more ineffective pump, and the heart rhythms were now becoming increasingly erratic.

He was worried and so I became worried too.

I also became incredibly sad and even angry following that conversation. Why was this happening to me?  I’m the athlete here. I’m the one running every day. I’m the one lifting weights. I’m the one eating right. And yet here I am, 24 years old, and essentially dying of heart disease.

Dr. Unverferth decided to place me in the hospital to run more tests. The first was an electrophysiology study, a very interesting (and new) test to undergo. I was completely awake for the entire process. Electrodes were placed in my groin and right arm through veins and pushed into my heart under x-ray guidance. Different medicines were infused
to stimulate my heart and the electrodes recorded the different rhythms. Part
of the test is diagnostic and part is therapeutic. The goal was to discover
what medicines serve to make the heart a more effective pump.

The cardiologists discovered that I had an ectopic focus of tissue near my sinoatrial node (another set of pacemaker tissue) and that this was most likely the reason for the Wenckebach block. In other words, there were two distinct set of cells fighting to control
the electrical activity, and hence the beating, of my heart. No wonder I had
become conscious of my heartbeat, something most of us never even think about.

The cardiomyopathy was viral in nature, and an echovirus was cultured. I spent the next 42 days in the cardiac intensive care unit. While the cardiologist figured out what medicines would make my heart a more effective pump, they also wanted to see my symptoms disappear. At the end of those 42 days, I was on Hydralazine, a vasodilator,
Digoxin to help the pump by increasing contractility, and Inderal to slow down
my heart rate.

The medicines initially made me a zombie. Oddly enough, one of the side effects of Inderal was to make me confused and it became more difficult to study. The hydralazine simply gave me the worst headache I had ever experienced (and it was constant). As a result I
took some time off from school. I spent the next few months at home resting in
bed, but eventually I did get my strength back. I came to understand that that
was a miracle. Most patients with a cardiomyopathy simply die.

I devoted myself to health and over the following three or four months became a gym rat. I execised constantly, in fact too much. A short time later, I began to experience
problems with my right knee and subsequently saw another Unverferth, Donald’s
brother, Jack.

Jack was the orthopedic surgeon in Columbus-he was team physician for the Ohio State Buckeyes- and it was funny to watch them joke with each other. They used me as a ball to play with. Donald showed up at the operation on my knee, a lateral meniscectomy, and was always present at my follow-up appointments. He didn’t have to do that, but it was always great to see his face.

Donald always suggested that I never go into surgery because I wasn’t quite dumb enough. Jack would always laugh and say that’s exactly why I should go into surgery, because I’m not quite dumb enough to be an internist.  They loved each other. I envied them that also.

The saddest conversation I’ve ever had with my mother came after her conversation with Dr. Unverferth. His fear was that this heart disease was progressive. He thought I’d be lucky to get to 44 years of age.

Sadly, Dr. Unverferth himself, who was born on exactly the same day as I (April 21) died a couple of years later at the age of 44.  He had developed a brain tumor. On the day I received that news, I simply cried. The world was worse for it. I felt sorry for us all.

More From Hurlbut 45

As I began to write this  post, I hesitated. Why were things I was now sharing important to the story? I began to feel as if I might be rambling. I took a step back and thought long and hard about it.

 These things became important to me because of how the press handled it. This all started with the death of Donda West following her surgery. Yet here’s the catch. There is not one instance, one report, that says, let alone document, that the doctor did anything wrong. The city attorney reviewed it, other doctors reviewed it, the medical Board of California reviewed it, lawyers reviewed it and so did the press. The fact was, and is, that her surgery and care were all within the standard of care (frankly better than most).

That is why this case never went to court. But here is the question to ask, if Conrad Murray is negligent in the death of Michael Jackson, why isn’t the nurse “with an advanced degree” that abandoned Donda West the morning after surgery, with her helpless and having taken narcotics for pain, not negligent?

This documentation of who I am is necessary to keep the story on point. The press, particularly TMZ had nothing; they couldn’t attack the message, so they went after the messenger.

We were all sad, and mad, about Donda West. It shouldn’t have happened. But it happened at home because the nurse with an advanced degree, her nephew, had abandoned her. The press, the city attorney, the Medical Board of California, and everyone else interested should have been looking there.

The story is taking the turn it is taking because it makes no sense to continue unless we, now that we have heard the press’s take, take a look at the facts of who I am.

I needed to look inside, to remember who I was. Constant hammering in the press, particularly when it is wrong, exacts quite a burden. I was tired and more importantly I was tired of the people I loved being hurt by the inaccuracies.

In order to begin the healing, in order to get my life back, I had to turn inward to remember who I was.

I remembered my time at Harvard and my opportunity to play basketball as an alternative to the loss of football. I was blessed. The greatest reward in playing was the camaraderie I established with the upper classman. The pertinent lesson was a confirmation of my mother’s wisdom: stay in the game, which is the game of life.

Harvard’s varsity basketball team was quite impressive when I arrived, much more so than us on the freshman team. They boasted six high school all-Americans including James Brown, who is now a sports commentator for Fox and CBS, Floyd Lewis from Washington DC, Tony Jenkins from Detroit, and Marshall Sanders, who was from the South. More
importantly, they took the time to mentor those of us who were black on the freshman team.

As a group, they, the upper classmen, were a lot more socially conscious than we were. I loved just hanging around and listening to them talk. JB had a sense of spirituality and conscious that gave a little sense to the world. He helped keep the Harvard experience in perspective. I suspect you could sum it up by saying that they, unlike us, had value processed in the early 60’s and were indeed socially conscious.

Ray and I continued to grow closer as friends and to do those things that college kids do. What was hilarious was how hard we worked at trying to do nothing. I was pre-med and Ray was studying economics and business. At the start of the second semester Ray came running into our dorm room very excited. “Jan,” he said, “I’ve got the course for us:  Statistics. They’re actually doing multiplication.” Thinking that we had found the ultimate “gut” course, we both signed up for statistics that semester. The course began with combinations and permutations and in fact Ray was correct, it was a gut (to start with). But then the course advanced into chi square and other analysis. I remember
laughing hysterically as we were both completely lost. We made it through that
course, but so much for guts and so much for listening to RaySwagg. From then
on, we decided it was just better that we study the courses we needed to
graduate.

It was at that time that I also met S. Alan Counter, Ph.D. He was the young black biology professor from Tennessee. He became my mentor. He was good looking. He was smart. And his wife was absolutely beautiful.

Dr. Counter took me under his wing and it was from him that I became interested in neurobiology. By that time, I had decided to major in psychology with an emphasis on neurobiological systems. My first research project was with him studying the hearing systems in katydids and crickets. (Don’t laugh – they’re very interesting.)

Crickets have large front legs and their hearing systems are actually in their knees. They make noise by rubbing the feathers together on their back. What we studied was “lateral inhibition”.

If you’ve ever heard yourself on a tape recorder, the one thing that you notice is that it doesn’t really sound like you. Your hearing system dampens (blocks out) your own voice when you talk so that you don’t directly stimulate yourself. It is in fact a very protective
device. We were studying how much noise the crickets were making as compared to
how much they heard.

That was a good time for me. I felt connected to him and it helped me psychologically to move on, to move away from football and more into studying medicine.

Ray and I made friends with Ernie Carter and Barry Lee, both of whom were pre-med. They had also been in the program I had attended in New York City the summer before coming to Harvard. That was really the beauty of the program. It gave you friendships and a support system on arrival to Cambridge. We decided, that for sophomore year, we would set up a rooming group together, but that was our second disappointment. Harvard was incorporating Radcliffe into the system at that time and it meant that a number of us would have to live at the Radcliffe dorms rather than at Harvard. It was unfortunate because, I, as the first name listed, was considered an athlete. That was one of the factors considered in moving people to Radcliffe. Besides, none of us were legacies, and the houses like Elliot, Leverett, or Adams were not in our future.

I believe it’s fair to say that during that time I went from a small town hick, who really didn’t know that much about the world, to learning about kids from places like Washington DC, New York City, San Francisco, California, and places in Europe I had never even heard of. Each of us brought our own culture and experiences to the Harvard
experience. That was also one of the benefits of Harvard and one that shouldn’t be taken lightly. The first snow in Boston that year brought out the freshmen from Southern California. They were wearing shorts to enjoy the snow. We considered them crazy and they never served to disappoint us.

The first truly white friend I made at Harvard was George Vaughn. George was from San Antonio, Texas. George and I spent a lot of time getting to know each other and challenging our belief systems and prejudices. George’s family owned lumber yards in Texas. They were also part owners of the San Antonio Spurs.

George gave me the greatest compliment that anyone could have given me at the time. A friend of his from South Dakota was also at Harvard. His friend was required to write a paper on race relations, and George suggested that he sit down with me. I thought that
was fantastic. He believed enough in me, and cared enough about who I was as a person to suggest that I might be able to offer some insight. I’d like to think I did, although I never learned what grade his friend received, or whether what I did have to say made it to print. I loved being the authority though.

During the time that I did research with Dr. Counter, I also took a leave of absence for six months to really decide what I wanted to do. I certainly wanted to go to medical school,
but my interaction with him really opened my eyes to solving problems. There was a real consideration on my part to pursue a Ph.D. in biology. I opted for medicine. I was concerned that I had begun to isolate myself much too much.

Once again, the words of Thoreau came to me: “…I wished to live deliberately, to front only the essential facts of life, and see if I could not learn what it had to teach, and not, when I came to die, discover that I had not lived…and, if it proved to be mean, why then to get the
whole and genuine meanness of it, and publish its meanness to the world; or if it were sublime, to know it by experience….”

Even though I thought I had been hurt enough by life and people, I still desperately needed them. One of the consequences of being “parentified” is the need to define yourself based on what you do for others. That, for all intense and purposes, defined me. In
spite of my firm grasp of individualism, experience had defined my need for the
approval by others.

The only choice for me ultimately, was medical school. The only choice for medical school was Ohio State University-College of Medicine.  I had interviewed at Cincinnati and at Case Western Reserve, but the one turnoff for me was how important the interviewers at these institutions thought they were. I found them condescending. My attitude was, “Dude, I’m about to graduate from Harvard and trust me, no matter how you slice it, either one of you academically will be a step down.” My purpose wasn’t to minimize either of them. Frankly either would have been an excellent choice. But there is also something in me that had resolved a long time ago that I don’t want to be anywhere where people
don’t want me. In Middletown, it was why I stopped playing golf. The only place
to play was the private club, oddly enough not to far from our house, but blacks weren’t welcomed there, and I didn’t pursue it. In that instance, I guess I had opted out of the game.

At least Ohio State was happy that I considered them. More importantly, I was happy to be going home.

My Code

The other “great discovery” of my life as a freshman at Harvard College was Henry David Thoreau. Walden Pond and “On the Duty of Civil Disobedience” was required reading in the freshman literature course I chose to take. For the first time in my life (for the Harvard experience offered a lot of firsts) I was literally in a conversation with a like mind who was not a football coach. I couldn’t believe this man had written these things some 130
years before. They clearly spoke to me.

I didn’t read his writings, I engulfed them. They became a part of me. Remembering the entire text became my mission. I carried ‘Walden” with me at all times. It became my bible. I began to survey my world for little glimpses of God and the nature of things. It was
a period of profound spiritual growth for me, my freshman year at Harvard.

I once stopped in a public restroom in the Boston Commons. And while I am not particularly enthralled by the musings of philosophers on bathroom walls, this one touched me, and has stuck with me for more than forty years: “I wish I was what I
wished I was, when I wished I was where I am now.” Pure poetry, and with a message we can all appreciate. But life is like that, I have come to believe. God speaks to all of us, all the time.

In the summer of 1972, I wrote the following before heading off to Harvard College:

“The good life is one that is inspired by love and guided by knowledge. As a man, I was placed here on this planet by God and my purpose is to succeed. I was not meant to be led; I was not meant to fail. This place, in which I find myself, is not merely Earth,
but a battleground, one in which my only enemy is my own laziness. I will work
hard, save my money (a part of everything I earn is mine to keep), and invest
only in those things of which I have first hand knowledge. I will engage in
charities that make the world better for children. Above all, I will have
malice for none, and charity for all.”

That was it; that’s my code, my mantra, and I wrote it on a 3×5 card and placed it
in my wallet. I would take it out periodically to remind me of who I was and
who I wanted to be. And I wanted to be successful, and kind, and contribute to
the community in which I eventually settled.

The writings of Thoreau took my mantra (and my beliefs) to a higher level. In a sense I became obsessed with self-sufficiency and his teachings and views on everything, from politics to the way a man should live his life. Three things happened my freshman year that changed m life for the better: I was denied a chance to play football because of heart disease; I met Laura Murphy who taught me about love and freedom; and I began to read Henry David Thoreau, who defined my philosophy.

The loss of football I was able to overcome through pure tenacity. I was finally
granted the opportunity to play after having tortured everybody involved. Gradually,
like the death of a loved one, I let it go. Over the ensuing two years I watched as the greater part of my life – up until then– slowly evaporated away, much like morning dew. Football had been one of the reasons I chose to attend Harvard. At that time there were no Black quarterbacks in the NFL and the “rap” was that they were not smart enough to play the position. My goal was to prove them wrong. I never got the chance, and that is perhaps where the lesson is to be found: accentuate the positive, don’t focus on disproving a negative.

Laura was a chemical reaction, and that was all there was to it. I never had a
chance. I loved her immediately, but somehow, life got in the way.There was
never going to be anyone else. But much like football, over the ensuing two
years, Laura and I slowly drifted apart too.

Henry, though, was here to stay. As I read Walden, every word became a part of me. I
knew immediately I wanted to be a philosopher. I wanted to teach men how to
think, not what to think. I was mesmerized by his clarity, and his conviction.
“The finest qualities of our nature, like the bloom on fruits, can be preserved
only by the most delicate handling. Yet we do not treat ourselves, nor one
another, thus tenderly … Public opinion is a weak tyrant compared with our own
private opinion. What a man thinks of himself, that it is which determines, or
rather indicates his fate”.

Little did I know –forty years later – that would be the quote, and those would be the
words, that held it together for me under an onslaught of negative press? God does indeed give us what we need, when we need it.

In 1975, I read Ayn Rand’s address given to the graduating class of the United States Military Academy at West Point on March 6, 1974. Her goal was to describe how philosophy – which was being pushed aside in most college curricula – was an integral part of man’s everyday existence, and that the question was not the choice to have a philosophy, but rather which philosophy to have. The choice was simply whether your philosophy was conscious and logical and therefore based on reason, or rather it was unconscious and irrational and based on mysticism.

“Most men,” she wrote, “spend their days struggling to evade three questions, the
answers to which underlie man’s every thought, feeling, and action, whether he
is consciously aware of it or not: Where am I? How do I know it? What should I
do?”

Philosophy is the study of the fundamental nature of existence, of man, and of man’s relationship to existence. As such, philosophy is composed of five essential parts:
metaphysics and epistemology are the essentials. Metaphysics is concerned with
the nature of existence, and epistemology studies the theory of knowledge and,
more importantly, addresses the question of “How do I know it?” From these two
essentials one can then progress to ethics, or morality (a code of values),
politics (how men treat other men), and aesthetics (art).

I was quick to grasp the concept of epistemology, and for my mind, there could be no
substitute for reason, logic, and rationality. Metaphysics, however, was a most difficult one for me to grasp largely because it forced me to challenge a few concepts – which growing up in southwestern Ohio – you just didn’t question.

Metaphysically, the issue is this:

Is consciousness primary, or is existence primary? Was the world created by a
supreme being, or is the world the result of the evolution of natural laws
requiring no supreme being for its existence. The idea that consciousness, or a
conscious, is fundamental suggests that the universe is the product of a divine
(or human) consciousness. Man therefore gains knowledge by introspection
(looking inward).
The opposite, the idea of the primacy of existence, means that the
universe (nature) exists independent of consciousness. Man therefore gains
knowledge by extrospection (looking outward).

I was born and raised in southwestern Ohio, the Bible belt. The notion of existence
without God creating it was something you just didn’t entertain. The accepted
view was not that life was in God’s hands, it was the only view. For much of my
life, I depended on divine intervention to get me through, as did everyone else
around me.

But even with that, there was always this nagging belief, that something’s just not
right here, something’s missing. It wasn’t faith though. I am firmly grounded
in the notion of GOD. It was more a need for it to make sense. My mother would
often say, “Make peace with God,” and my reply would be, “We have never
quarreled.” But in reality, we have been quarreling all along. I went along
with the status quo – first as a Junior Deacon at Mount Zion Baptist Church –
basically because, at the time, I was too young to fight back.
Later it was out of necessity because it seemed so fruitless to resist. You
weren’t going to get an open dialogue from active minds, so no real discussion
was ever going to take place. For my grandmothers, my other support group, it
had been their way of life and that, their beliefs, certainly weren’t changing
at this point.

I have resolved it simply as this: why could both theories not be correct? I can easily imagine a God who created man over a period of time, which in the context of the existence of the universe, is merely a blink of an eye.

Basketball, Unconditional Love, and Freedom

At the end of the football season, I joined the freshman basketball team. I had shown up late for “tryouts”. Football season did not end until two weeks into the basketball season. Coach Harvey, a man I immediately liked and respected, gave me a shot. He first discussed it with the team and, through consensus, I was then allowed to participate in drills with the otherplayers. After a week of practice, Coach Harvey called us all together and announced that I had made the team. The rest of the guys cheered; it felt good to belong to something, it felt good to belong to a team. That was something my football experience had taken from me, a feeling of belonging; it had distanced me from everyone else.

I wasn’t particularly good; at least I think it’s fair to say that I wasn’t a basketball player. I was an athlete, but not a basketball player. I didn’t look like one; I didn’t carry myself like one; and despite the fact that I was a better athlete, I didn’t play like one. I was a football player, period.I hadn’t played basketball in high school, and I lacked a smoothness that signified a level of comfort with the game, a smoothness I imagined all the “real” basketball players had. I played the whole year as a swingman and was assigned to guard the other team’s best scorer. I was certainly quick enough, and determined enough, to play good defense. I  was never going to be a scorer.

In the winter of 1972, an article written by Daniel Patrick Moynihan appeared in the New York Times magazine. It was a commentary on campus life at Harvard. In particular, the liberal Senator, through a photo taken in the Freshman Union during lunch time, had commented on the self-imposed segregation on the part of Black students. Many of the
upper-class black students took offense to the implications, and rightly so.
The photo showed a group of students who were black eating lunch together, but
didn’t show the climate throughout the rest of the cafeteria. It was a snapshot
taken out of context. And so a meeting was held at the Harvard-Radcliffe
African-American Cultural Center to discuss strategy and to submit a
response. No one wanted to be portrayed as not embracing the Harvard experience;
too many people across America had fought to get us there.

I was standing on the front porch of the building prior to the meeting. Coming our way, walking on the side walk as if she owned it, was her, the girl I was going to marry. She was about five foot-five inches tall, with olive skin and black hair cropped very short. She was wearing a blue dress with white polka dots. Her legs were curved and strong and she
sort of skipped along. There was a confidence in her stride, and an air of
aristocracy about her. Everything about her said sassy. “Is this the Harvard-Radcliffe
Afro-American Cultural Center?” she asked matter-of- factly. Her voice was
strong, full of life, with a kind of hoarse squeak that suggested she would
break out into laughter at any moment. (She was mocking us I was sure.)

One of the upper-classmen on the porch answered “yes”.

I, for my part, just couldn’t stop looking at her. She bounced up on the porch pretty much ignoring us all. Someone, and it wasn’t me, got up enough courage to speak directly to her, “Hi, I’m Keith; what’s your name?

“Laura… Laura Murphy”.

“Oh my God”, I thought. It is the girl I’m going to marry.

“You’re Laura Murphy” I said. “Steve told me I should look you up. I’m
Jan”. We shook hands. I was gone. (Prior to coming to Harvard, as I had noted earlier, I had spent part of the summer in New York City at Columbia in a preparatory program for minority students entering “Ivy League” colleges. It was designed to get you up-to-snuff in physics, calculus, and chemistry prior to throwing you to the dogs. Steve was a guy from Baltimore, Maryland, in the program who I had befriended, and he had told me all about this girl he knew, who would be going to Wellesley College, and more importantly, that I should look her up. I always suspected that he somehow was in love with her-and it was easy to see why-but that it never worked out for him. Right then, this
Laura Murphy, seemed so much more mature than I remembered Steve, or me for
that matter.)

“So you’re Jan” she said almost slyly. “I knew I’d run into you sooner or later”.

“Oh… really?” I responded somewhat tongue in cheek, somewhat flirtatious, but clearly interested in anything this woman had to say. It’s true, “she had me from hello”.

That meeting may, or may not, have been successful in arriving at a plan to confront the Senator’s take. To be honest I don’t remember. All I could see-mostly out of the corner of my eye- and all I could hear, was Laura Murphy. I walked her to the bus in Harvard Square that evening after the meeting. I had never connected to another human being as completely as I did then. It was beyond chemistry. There was a complete collapse of any ego boundary I might have had and literally we, Laura Murphy and I, were one.

I had not loved anything or anyone in my life as much as I came to recognize my love for Laura. She was smart, politically active, beautiful, sophisticated and all those other things
that boys from small Midwestern steel towns hope to find in a woman someday. She
was that princess that every fairy tale assures us is waiting at the end of our desires. At the worst moment in my life, the loss of football to congenital heart disease, she had arrived. There was a GOD.

We became inseparable. Every Friday evening at around six o’clock the bus from Wellesley College would arrive in Harvard Square and I would be there to greet it. I’d also be the last
one to wave good bye to it at 2:00 am when it left.

I know for me at that time, there were two women in my life: Laura Murphy, and everybody else.

Laura, and my relationship with her, taught me what I believe now, some forty years later, to be the most important aspect of my belief system: that fundamental to a man’s life and
mankind’s existence is but two things, love and freedom.

Love is that which connects us to everything else. It is what gives purpose to life. Love builds, creates, molds, and develops. It is what gives us everything we have. Love is “the raw energy that drives the engine of human experience.”

Most of us have experienced “conditional love”, an idea that is based in fear. I’ll love you, but only if you love me back. It began insidiously with our parents. We experienced their
love when we did the things that they believed we should do. We came to want in
ourselves that which they wanted for us. The flip side though was that we feared that love might be taken away if we did not please them. Their love, and our assessment of it, was conditional.

Laura showed me the shear power of unconditional love, that is, love without fear. I never imagined in my wildest dreams that it would ever change. It didn’t, and it hasn’t. But Laura also taught me the importance of freedom.

I am not speaking of freedom in a poetic sense. I am not talking about freedom from want, or freedom from the fears that are present in every life. I am talking about the importance of the freedom from compulsion in the life of a human being: the realization that a
man’s mind can only work effectively when he is free to make decisions based on
rational considerations, and reality; a freedom, where one is not forced to behave, or think, a certain way by circumstances or forces outside himself.

The last game of the freshman basketball season was played against Dartmouth. We played at Harvard’s Indoor Athletic Building, the IAB. Laura attended the game as usual, but much more pertinent was that she had a girlfriend who was one of the trainers for the Dartmouth squad. There were going to be parties after the game and I expected that she
was going to hang out with me. I saw her after the game and she informed me that she was going to spend some time with her girl friend. She did, but that also meant spending time with a group of her girlfriend’s friends, which meant the Dartmouth freshman basketball team and that was all men. I was jealous, period.

We, I and some of my friends from the Harvard basketball team, ran into this group in Harvard square. My eyes went directly to Laura’s eyes. Pain, I am sure registered all over my face. I felt betrayed, or at the very least left out. I didn’t say a word, and a look
of embarrassment was all I got back from her in return.

I returned to my room to examine my feelings.The chaos inside of me was new and the hurt, though real, seemed not to have a cause. I didn’t know what I was hurt about. I didn’t know why I hurt. I just knew that to feel this way had to mean that something, somewhere, was drastically wrong. It was…with me.

My melancholy was interrupted by a knock on the door and as I swung it open there stood Laura. To this day I am still amazed at how a woman can make a pair of jeans, a bulky sweater, and fisherman’s cap look so darn good. Standing there was the most beautiful woman I had ever seen. She glowed and now it was my turn to feel embarrassed. I
simply hugged her and held on for life.

“Jan”, she said almost apologetically, “ I don’t want you to think I’m not with you, because I am, but I have to be free to make choices, to spend time with my friends if I choose…and
I have to  feel like I am free to do that.” Her message rang loud and clear. “I have to feel like I make the choice to be with you, not that it’s my responsibility or duty.”

She was right you know and I knew it. People often put it in political terms but it all comes down to the same thing. We all know at our core that we don’t function well when forced to do anything. Love and freedom was my message from God carried by Laura Murphy.

My freshman year at Harvard, in retrospect, is still one of the happiest times of my life (although I must confess to not knowing it at the time). The world opened up for me, and I discovered truths that never even occur to kids from small towns like Middletown, Ohio. Laura and I grew stronger as a result of that incident. I got to understand her a great deal better and I learned a lot about myself, and life. I credit her with igniting introspection in me, with starting my real spiritual journey of self discovery.

More From Hurlbut 45

My first task the following morning was t0 find the football stadium. Ralph Goldston, the black coach on Harvard’s staff, had come to my house in Middletown, Ohio, recruiting. I liked him and appreciated their interest in me. This also served as a source of comfort.  Football had been my life, my anchor, up until now, and I was happy and excited about joining Harvard’s team. I felt comfortable with him and he was my contact at Harvard. This triumphant walk to the stadium was filled with expectation.

I walked through campus, through “The Yard”, out onto “The Square” down Boylston Street, across the Charles River to the stadium almost floating. It was effortless. For all the uncertainty that lie before me, football was one constant I was comfortable with. These guys would surely be kindred spirits.

Soldier’s Field was everything I had hoped for. It was a monstrous structure of gray cement that looked as if it had been there forever. It was like the Roman Colliseum. I stared through the fence just imagining the heroics I would have in there while seventy thousand people cheered. I was in the right place and this felt good.

In the building adjacent to the stadium, a sign on the door directed me to enter. It was a low one story brick building that was dark and damp; I found the locker room immediately. There were four or five trainers, talking and a few guys standing around in shorts, but none of the behemoths I expected to see. It was college, and I expected 300 pound tackles.

I was directed to where I needed to go for a physical exam. I stripped down to my underwear and began to follow the signs. I desperately needed to see Goldston, to see a familiar face, but no such luck.

Listening to my heart, the doctor immediately noted the irregular heartbeat. I explained that I had just had a physical. I had been nominated to the Naval Academy and they had discovered that I had a Wenckebach heart block.  His facial expression changed drastically. He was uncomfortable with that information. My chart was kicked “upstairs”.

He completed the exam though and after I was dressed he pulled me aside, “Look”, he said, “I’m not saying you won’t be able to play, but I am going to have you see a specialist before I’ll clear you.”

But I didn’t get the chance to see a specialist. Upon my return to the locker room the next day, the decision had already been made. I would not play football. In a flash my world
collapsed. I had never even remotely imagined it, not playing football. It was
too absurd to even entertain. I was caught completely off guard. I was
devastated. The rug had literally been pulled from under my feet. I was lost
and I was alone. I wandered up and down Massachusetts Avenue for the remainder of the day. I didn’t even mention it to RaySwagg.

I spent the next few days just wandering around Harvard Square. I didn’t call my mom either. I didn’t know what I would say. With each day, though, I became more determined
to play. I returned to the doctor and requested a specialist. He gave me a list
of cardiologists at Harvard Medical School and I called them all trying to get
the earliest appointment.

It took a number of weeks and more than a few examinations before the doctor consented to let me play. I was so out of it I couldn’t even remember his name. I didn’t hear him. I only wanted to hear him say I could play and so that’s all I listened for. And so
approximately six weeks late, I joined the freshman football team.
Unfortunately for me, by that time, people had already secured positions. Depth
charts were completed and the players had settled into their routines. I
started at the back of the quarterbacks and moved up quickly, but it became
apparent that I was not going to move up to the starting job. It had nothing to
do with ability, nor did it have anything to do with the players in front of me.
I just think the coach believed he was protecting me. I was allowed to
participate enough to keep me quiet, but not enough to get to where I wanted to
be, and worst yet, I had no advocate.

Goldstone was working with the varsity players and took no time to mentor me. It was as if we had never met and although it did not consciously register at the time, subconsciously it registered as another time when a black man had deserted me when I needed him most.

The joy that I had known since I was six years old, the joy I had as a football player was gone. I continued to participate but I could feel I was never going to get the shot I knew I wanted, and perhaps deserved. The head trainer, a man in his seventies, pulled me aside
one afternoon and began a dialogue. “Just call me Joe” he said.

Joe had seen a lot of Harvard football and had been there through four or five coaching changes. “I want you to spend some time with me” he said. “I’ve had a lot of players become orthopedic surgeons, and with your medical problems, maybe that’s the way for you. I know it hurts now but anytime life closes a door, it opens up a window. Maybe, just
maybe, your destiny lies somewhere else.”

It wasn’t a matter of maybe; whether I chose it or not, that was where it was going to be, somewhere else. Many times in life choices really aren’t choices; sometimes your preference isn’t really an option.

But, it wasn’t all bad. Life never is. A lesson my mother tried to instill was the notion that “you can’t always control what is going on, but you can control your reaction to it”. My
immediate reaction was to close down, to retreat inside-clearly a remnant from
my childhood. Yet my epiphany was this: about 90% of what goes on in anybody’s
life is good and about 10% is bad. If you want to make yourself miserable, just
focus on the 10% that is bad and ignore the 90% that is good.

I chose to focus on the good-which soon became a habit- and  immersed myself in campus life.

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