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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The one option residents at the Medical Center almost never consider is practicing in rural areas, although the main reason the state pours money into the Baylor and University of Texas medical schools is that rural Texas is underdoctored. UT is a state institution, but even at Baylor, the only private medical school in Texas, just 1.5 per cent of the operating budget comes from student fees. The theory of the Legislature has been that if the state needs doctors, the solution is to appropriate money to train more of them. But if they’re educated in a place like the Medical Center, the whole thrust of these new doctors’ training is that the successful doctor is one who does advanced, specialized work; a life prescribing minor antibiotics to the people of Texas seems to be a failure to fulfill one’s early promise. Because the demand for medicine in Houston is apparently limitless, there is every incentive to stay there.
As for Roxann Rokey, she is weary of being an intern. She thinks more and more about going into anesthesiology, a field that has regular hours. Young doctors increasingly want to be able to spend their evenings at home, pay enough attention to their children, and take weekends off. The life they’re exposed to in their years at the Medical Center is exciting, but they wonder whether the personal price is ultimately too high.
There’s one other thing the Baylor interns talk about a lot: what happened to three of their classmates. One intern died of heart failure. One shot himself in the head. A third, an aspiring surgeon, graduated from Baylor College of Medicine and went off to a prestigious surgery residency at Johns Hopkins. But at the end of his first year there he was asked not to come back and he returned to Baylor, severely depressed, to start over again as a surgical intern. One night he told his senior resident he was “going out for a Coke,” went to a lab, mixed a deadly solution of cocaine and lidocaine, and injected it straight into his heart.
WINNERS AND LOSERS
If there was a particular day when the Texas Medical Center came of age, it was April 4, 1969. On that day a man named Haskell Karp died on Denton Cooley’s operating table and Cooley brought him back to life by removing his heart and replacing it with a metal and plastic machine. For 63 hours the artificial heart kept Karp alive; in the meantime, Cooley and Mrs. Karp went on national television to make a plea for a new human heart for him. The TV appearance worked—a just-deceased young woman with an intact heart was flown down to Houston from Boston. Cooley transplanted her heart into Karp, who died twenty hours later.
The Karp episode brought the Medical Center’s fame to fever pitch—the place swarmed with reporters and cameramen—but it brought out other things as well. It shortly became apparent that the artificial heart Cooley had implanted was developed under a federal grant in DeBakey’s lab—Cooley may or may not have stolen the plans for the actual heart, but he certainly did lure away DeBakey’s artificial-heart researcher without telling DeBakey and flagrantly violated academic and governmental procedures. The episode led to a final, bitter split between Cooley and DeBakey that was symbolized by Cooley’s leaving the Baylor faculty and DeBakey’s later appearing in a malpractice suit brought by Mrs. Karp that concluded in 1972. It was now apparent that the Medical Center was not growing fast enough to keep everyone happy—that it was a place of intense rivalries and squabbling over space, equipment, and glory.
The artificial-heart incident was also the start of a period of concern about whether medicine ought to impose limits on itself. Six months earlier, the Medical Center had been the world’s most enthusiastic heart transplanter, a place with limitless faith in the practicability of advanced medicine. After the death of Karp the transplants quickly dwindled and people began to wonder whether it had all been worth it. For years there had been no distinction between what doctors could do to keep a patient alive and what they should do, but now a gap was opening up. Could the money spent on transplants be better spent on some other aspect of health? Was it better sometimes just to let people die?
It was during that time that the University of Texas set up its medical school in Houston, the Medical Center’s second. The new school was the biggest institutional addition to the Medical Center since the forties, and its early history has not been smooth. The Texas Medical Center isn’t a simple, ebullient place anymore. It can’t accommodate everyone’s ambitions. In the seventies, some of the people and institutions there have won, but some have had to lose.
By the mid-sixties, Hermann Hospital, the stately old dowager of the Medical Center that had decided to go private while all the other hospitals there were affiliating with Baylor, had fallen on hard times. The other major hospitals in the center—Methodist, St. Luke’s, and Anderson—each had a university affiliation; Hermann did not. Each of the others was strongly identified with one of the major chronic diseases that had, in the years since the conquering of polio, become the focal point of the nation’s medical attention—heart disease in the case of Methodist and St. Luke’s, cancer in the case of Anderson. Hermann was identified with no particular medical cause. The three other hospitals each had a charismatic surgeon-leader with whom they were identified in the public mind—DeBakey, Cooley, and Clark; Hermann had no such figure. The other hospitals had invested heavily in technology, had greatly expanded their facilities, had performed spectacular procedures, had mastered that most important of Medical Center arts, the art of getting publicity; Hermann had not. “Hermann fell further and further behind,” says one doctor who practices there. “It was literally and figuratively perched on the edge of the Texas Medical Center, ready to fall off.”
For all those reasons, the trustees of Hermann, the last bastion of private medicine, decided in the mid-sixties it was time to affiliate with a medical school. Ideally, such an affiliation would not be with Baylor, because Hermann needed a major infusion of money, people, and excitement, and becoming Baylor’s third-string teaching hospital wouldn’t accomplish that. So what Hermann began to push for was the establishment of a brand-new medical school by the University of Texas, with Hermann as its centerpiece.
In the meantime, the University of Texas system had undertaken a study of the state’s medical resources, showing Texas to be severely underdoctored. There were 267,000 doctors in the U.S., but only 11,000 in Texas. One result of the study was that its primary author, Dr. Charles LeMaistre, was catapulted from a professorship in Dallas to the chancellorship of the UT system (he later fell from that eminence and became Lee Clark’s successor as president of M.D. Anderson Hospital). Another result was that, in the 1969 session, the Legislature appropriated $10 million for the establishment of a University of Texas Medical School at Houston, to be affiliated with and physically joined to Hermann Hospital—part of a $49 million package intended to double the number of medical students in the state. Baylor College of Medicine originally had qualms about the establishment of a new medical school in its own back yard, but the university placated it by agreeing that the new school would not tamper with Baylor’s hospital affiliations or steal its faculty. In that same session of the Legislature—whether coincidentally or not is the subject of some disagreement today—Baylor agreed to increase its class size from 84 to 168 in return for a grant from the state for every student who was from Texas. Today that brings Baylor $20,000 per Texas student per year in state funds.
In 1970 the new medical school in Houston hired its first dean, Dr. Cheves Smythe, who had been the number-two man at the Association of American Medical Colleges. Smythe is a witty and charming man through whose veins courses the bluest of South Carolina blood, a career academic doctor raised in Charleston and educated at a New England prep school, Yale, and Harvard Medical School—which is to say that he could not count among his virtues having a great deal in common with the private doctors of Hermann Hospital, Houston, Texas.
The university put up an impressive new building and Smythe built up a faculty from scratch, but from the beginning there were troubles with the private doctors. Suddenly the chiefs of service at Hermann were the newly arrived UT department chairmen, out-of-towners who believed in using patients for teaching. The Hermann doctors didn’t like a bunch of interns and residents crowding into their patients’ rooms to hear little lectures on pathology. Private patients at Hermann were accustomed to being treated with an accommodating, understanding touch, not to being put on display for doctors in training. Most of all, Hermann doctors, like most other physicians, had been trained to believe that their relationships with their patients were almost holy and certainly inviolable. The doctor assumed the burden of total responsibility for the patient’s survival. In return he got total control over the patient’s medical treatment. Nothing—and certainly not medical students—was supposed to get in the way of that.
These were the general complaints; there were specific ones too. Old familiar schedules were changed at Hermann. New nurses were brought on. Comfortable routines were upset. There were renovations of the hospital that meant a temporary reduction in the number of beds and difficulties getting patients admitted. Worst of all, the new department of medicine decreed that all orders on patients should normally be written by residents and not by the patients’ own doctors, a policy that was disastrously unpopular and was dropped after a year and a half.
All the doctors’ bitterness culminated in a meeting in 1971 over the composition of the hospital’s executive committee. UT professors had a solid majority on the committee, and the private doctors wanted to increase their representation. They lost—the composition of the committee remained unchanged—and the doctors realized that their hospital had irrevocably slipped from their grasp.
A few months later two longtime private practitioners at Hermann, Dr. Henry Glass and Dr. Thane Sponsel, got together with about twenty of their friends and decided things had gone too far at Hermann Hospital. It was time to leave and start a hospital of their own. “We just felt there was a need for an acute/general-care hospital where patient care was the primary thing,” says Sponsel today. “There wasn’t a hospital left over there where you could practice medicine.” With money raised by selling limited and general partnerships and taking out bank loans, the doctors bought three blocks of land just across Hermann Park from the Medical Center and built Park Plaza Hospital, which opened for business in April 1975 and is now, with four hundred beds, the largest privately owned, for-profit hospital in the United States.
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