Super Medicine
At the Texas Medical Center doctors can rebuild your heart, give you new limbs, treat your cancer, save your children from affliction, and maybe even bring you back from the dead.
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In 1943 the Anderson Foundation trustees persuaded the City of Houston to sell them a 134-acre plot of land south of Hermann Park, which was to form the bulk of the Medical Center’s grounds. Meanwhile the trustees, taking Bertner’s advice, began to look for a medical school and some general hospitals to join M. D. Anderson there. They approached UT’s Medical Branch at Galveston, but it wasn’t interested in moving to Houston. Then two of Freeman and Bates’ clients who were trustees of Baylor University mentioned the possibility of moving Baylor’s medical school to Houston from Dallas, where it was hopelessly embroiled in a battle with the private medical community. The Anderson trustees offered Baylor a site, a million dollars for a new building, and another million for research, and Baylor agreed to move. In exchange for free land and gifts of $500,000 from the foundation, other institutions signed up in rapid succession: UT’s new dental school; Methodist Hospital, which was abandoning an old downtown location; and a new Episcopal hospital, St. Luke’s. On the northern edge of the foundation’s property was Hermann Hospital, the leading private hospital in town, and the foundation offered it the same deal if it would build a new wing facing south on Medical Center land. By 1945, the Medical Center had two schools, a cancer hospital, and three general hospitals, and the trustees decided to create an organization to coordinate all the institutions’ activities. Texas Medical Center, Inc., was dedicated at a dinner for 650 at the Rice Hotel on February 28, 1946.
All these institutions are still at the core of the Medical Center, and the M. D. Anderson Foundation is still its most important financial angel. Over the years the foundation has given away $70 million, $35 million of it to institutions in the Medical Center, and has also increased its principal to $70 million. It has remained a very private organization, closely tied to Fulbright & Jaworski. Its current president, and probably the most powerful non-doctor at the Medical Center, is Leon Jaworski, who calls the Texas Medical Center “my chief outside interest.” The other trustees are Freeman, Hugh Q. Buck (another Fulbright & Jaworski partner), and A. G. McNeese (a former Fulbright & Jaworski lawyer who is now chairman of the Bank of the Southwest, a Fulbright & Jaworski client in which the Anderson Foundation is a major stockholder). They meet about once a month, usually over lunch at the Coronado Club, which, like Fulbright & Jaworski itself, is in the Bank of the Southwest building in downtown Houston. In addition to giving money away, the foundation lends it too — mostly to churches but also to friends. Both Jaworski and Buck have received personal loans from the foundation, which they promptly repaid when they became trustees, and the foundation’s list of outstanding loans now includes items like $1.5 million to the Houston law firm Bracewell & Patterson and $420,000 to Weingarten Markets Realty Company.
The Medical Center did not come into being only because of the Anderson Foundation, of course; as they say in medicine, it had a receptive culture to grow in. Houston in 1945 was a new, rich, unsophisticated town eager to get the grease out from under its fingernails. It had several dozen extremely wealthy citizens — the first generation of the oil rich, the Fondrens and Cullens and Sterlings — who were ready to turn their attention to good works and didn’t have the established network of charities that exists in, say, Philadelphia to exert a claim on their money. It was in a state whose government was rich and education-conscious, and a country whose government was rich and science-conscious. A medical center was the ideal focus for all these forces. It would be big and visible; it would benefit humanity; it would be a center of learning and technology; it would attract attention. All that was exactly what Houston wanted, and the Medical Center became the city’s central civic enterprise in a way that medicine is not in other major cities. It would come to dominate the city’s noncommercial life. It would become Houston’s glory and its redemption; it would be loud, rich, demanding of attention; it would, like Houston itself, get things done. The Chronicle summed up the city’s hopes for the medical center in a banner headline it ran in 1950: CITY GOES BIG LEAGUE WITH FAST-GROWING MED CENTER.
THE EMPIRE OF DR. DEBAKEY
Medical institutions can be created by lawyers and bankers and oilmen but they can be made famous only by doctors, and Texas Medical Center’s next stroke of good fortune was that it attracted some extraordinary ones. The first was Randolph Lee Clark, a big, barrel-chested surgeon, born in the Panhandle and trained in Virginia, Paris, and at the Mayo Clinic. In 1946 he signed on as the director and surgeon-in-chief of the M. D. Anderson Hospital. Clark was the first of what would become a migration of doctors from other cities to Houston and the Medical Center. What attracted him was what has always attracted people to Texas: big opportunities. In a way this is a euphemism for money, and in a way it isn’t. In Clark’s last year of private practice, 1941, he made $158,000; his starting salary at Anderson was $12,000. But the institution had a great deal of money and was brand-new, unformed. There would be plenty of facilities in Houston and no long years of waiting around for a brief turn at the helm. Those were Clark’s reasons for coming, and variations on them have been why hundreds of others have come since then. “People in the East,” he says, “were given a small, circumscribed territory. That’s why they left. Here in Texas your territory isn’t that limited.”
Clark built M. D. Anderson into one of the Big Three American cancer centers (the others are Sloan-Kettering and Roswell Park in New York) chiefly through two means: his enormous powers of persuasion and his penchant for thinking big. The most important recipient of his persuasive powers has been the Legislature, his most significant source of funds, where, in the words of one senator, “he brings a sack through every year and walks away with everything but the Capitol dome.” He is what is known in the trade as a medical statesman, which means that he can explain simply and forcefully what he needs money for, an ability most doctors lack. As for thinking big, his motto, framed on his office wall, is “Make no little plans,” and he likes to compare Houston today, in all seriousness, to Renaissance Florence. Now 72, Clark is an extremely active president emeritus of M. D. Anderson, having turned over the reins last year after getting seven consecutive extensions of the UT system’s mandatory retirement age. Part of his job now is developing a long-range plan for the hospital; he is presently trying to decide where it should turn its attention after (not if) it cures cancer.
In 1948, two years after Clark, Dr. Michael Ellis DeBakey arrived at the Texas Medical Center to take on the chairmanship of Baylor College of Medicine’s department of surgery. A druggist’s son from Lake Charles, Louisiana, he had practiced and taught in New Orleans under the tutelage of the most prominent doctor there, Alton Ochsner. A surgeon like Clark, and like Clark forty years old when he came to the Medical Center, DeBakey was looking for virgin territory, a place where he could do big things. His ambition, however, dwarfed Clark’s; while Clark wanted merely to build the world’s greatest cancer center, DeBakey wanted practically everything. He wanted to be the world’s greatest practicing surgeon. He wanted to build a great medical school and great hospitals around it. He wanted to be a national leader, perhaps the national leader, in the formulation of health policy, and the most prominent authority on all matters medical.
Perhaps as a result of his grander dreams, DeBakey became, much more than Clark, a figure of great complexity — certainly the most powerful man at the Texas Medical Center, arguably the most famous doctor in the world, but also a man capable of tremendous arrogance and unpleasantness, a man who won as many enemies as admirers, and who, in the end, seems for all his power and fame and great achievements curiously vulnerable in a way that Clark isn’t.
DeBakey began his surgical career at the Medical Center at Hermann, the grande dame of Houston hospitals and chief stronghold of the city’s community of private practitioners. He was immediately unpopular in the medical community. DeBakey is not like most private doctors. He achieved his eminence as a surgeon not just by having good hands — his hands are good, though nobody claims they’re in a different class from those of a dozen of his talented colleagues at the Medical Center — but also by doing more daring operations, and more operations, than anyone else, and by successfully promoting himself. He established what has become the tone of the Medical Center — big plans, fast growth, advanced surgery, lots of publicity. The Medical Center is full of monuments to DeBakey — a bust, a building, plaques. He has been written about, filmed, and photographed more than anyone else there. In 1966, when he performed the first implant of an artificial left ventricle, he invited a Life magazine photographer into the operating room and gave an interview to an ABC film crew upon emerging from the operation. It was natural that he and the private doctors wouldn’t get along. Medical societies still have official rules against publicity. They don’t like someone coming to town and overshadowing all their work. They don’t like professors at medical schools carrying on huge practices and using up a lot of hospital beds. In the fifties, Hermann broke its affiliation with Baylor and became once again a nonteaching hospital. DeBakey moved his base of operations to the less-established Methodist Hospital, two hundred yards away.
His specialty in those days, the early fifties, was vascular surgery — surgery on the blood vessels. He repaired vessels that were clogged with fatty material built up as a result of advancing years, high blood pressure, smoking, cholesterol intake, and genetic factors. A surgeon can cut open an occluded artery, take out the obstruction, and sew it back together; or he can bypass the obstruction by attaching to the vessel another channel through which the blood can flow around the blockage. DeBakey was a pioneer in these techniques. He was also a leader in developing operations to remedy a second form of vascular disease, aneurysms — sections of vascular wall that balloon out like weak spots on an overinflated inner tube. An aneurysm in a blood vessel is weaker than the healthy part of the vessel, and therefore in danger of bursting; the surgical remedy is to cut it out and sew the vessel back together, or to replace part of the vessel with new tubing. In surgery on both occlusions and aneurysms, DeBakey introduced the use of Dacron as an effective replacement for the human tissue of vascular walls. In all these cases the world of medicine generously credits DeBakey with great strides, and DeBakey credits himself even more generously. His book The Living Heart mentions his own contributions dozens of times, and mentions Denton Cooley not at all.
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