One characteristic that has never been associated with Dr. Michael DeBakey in all his 96 years is bewilderment. But the breakup between the medical school he built, Baylor College of Medicine, and the hospital he built, Methodist Hospital, and all it portends for medicine, in Houston and in America, has left him at a loss for words. The pioneer heart surgeon sits pensively in his sunny shrine of a conference room, its forest-green suede walls barely visible behind a veneer of framed photos, medals, and honors. Though he rarely operates, he still favors his royal-blue scrubs and spotless white scrub cap and coat, monogrammed, in cursive, with his initials. His regal head and ferocious eyebrows still reference the man who, as the world’s most famous surgeon, could outglower just about anyone. But now he drags his long, beautiful fingers across his pale, furrowed brow, as if palpating for his own thoughts. He no longer barks orders; his Southern drawl is soft as a pillow. He takes a steaming cup of coffee but does not drink from it. He studies the floor, ponders. “I don’t understand it,” he says, finally, “it” being the end of the partnership of the medical school and its teaching hospital and the abysmal absence of any successful peace initiative.
DeBakey lost his first wife in 1972 and a son last October, but as tragic as those losses were, he now faces another that must be almost as painful: the end of everything he created in the past half century, which was nothing less than the best medicine Texas had to offer. For more than fifty years Baylor and Methodist coexisted in a mutually beneficial if not always happy marriage that brought out the best in both. Baylor had the intellectual firepower; it ranked in the top ten U.S. medical schools in research funding from the National Institutes of Health and thirteenth in the U.S. News and World Report list of top medical schools. Methodist, in turn, possessed spectacular wealth, which paid for innovation after innovation for the hospital and the school. Banners hanging in its lobby attest to its “Best Hospital” rating in at least nine categories in U.S. News and other publications. Baylor and Methodist both have always hungered to be the best, which is why the unraveling of the relationship is so heartbreaking, not only for DeBakey but also for Houston’s elite, for whom the idea of Texas medical institutions’ ranking alongside Yale and Massachusetts General really matters. The split threatens not just DeBakey’s legacy but the futures of Baylor and Methodist, along with Houston’s eminence as an international medical center and all the economic and psychological benefits that accompany such success.
All of DeBakey’s efforts couldn’t stop the breakup. He wrote imploring letters to members on both boards: “I am writing about a matter of the utmost importance—it may, indeed, even constitute a crisis. . . .” At meetings he beseeched his colleagues to make peace, soon, before they lost everything. “I’m hesitant to take on the role of Cassandra,” he would say. But no one heard him, and nothing was done. Maybe they didn’t understand the history, DeBakey thinks. Maybe they don’t understand the stakes.
His coffee is cold, and his hands, cradling the cup, are helpless to warm it. “Maybe,” he says, with a half smile, “they don’t know who Cassandra was.”
BAYLOR COLLEGE of Medicine sits stolidly in the center of the harried, purposeful congestion of the Texas Medical Center, about five miles south of downtown. The main building is a sand-colored, low-rise art deco structure that has been refurbished. Inside it looks like any good school that’s too busy teaching to fix itself up: a low-ceilinged, somewhat dingy warren of offices, classrooms, and conference halls. A slick, sun-washed addition named after DeBakey contains an impressive glass wall dedicated to Baylor’s donors and not one place to sit down. Baylor’s educational mission is aggressively conspicuous, with people in white coats and scrubs striding intently past tatty bulletin boards and posters for lectures with titles like “Beyond the Double Helix.”
Methodist Hospital sits a couple of blocks away, a mini—medical center itself, with eight imposing interconnected buildings devoted to various specialties, many bearing the names of great Houston oil families. Its valet parking entrance can be hard to find in all the hubbub. So too its emergency entrance, which detractors in the medical center insist is intentional, the better to dissuade charity cases. The main lobby resembles that of a grand hotel: An enormous atrium allows the fountain below to sparkle in the sunlight, and a sprawling concierge desk of sable-stained wood welcomes those with the wherewithal to pay. Benefactor Ella Fondren’s Boehm birds nest in a display case, and a pianist plays show tunes on a grand piano. There is even a Starbucks, just down the hall from the food court. Surrounding the lobby—on the floors above, in the basement below, down halls that stretch, seemingly, for miles—is some of the most cutting-edge health care equipment on the planet.
Baylor and Methodist should have been a marriage made in heaven, and for the better part of the past fifty years—until last April, when the Baylor board voted to end the partnership and affiliate with St. Luke’s hospital instead—it was. There were always issues, as there are in any marriage, but only in recent years did they turn bitter, making unavoidable the first split in American history between a medical school and its teaching hospital. As is often the case in a divorce, there is no single cause of the breakup. But two major factors stand out, one that is common to all of American medicine and one that is unique to Houston.
The nationwide issue is the shrinking of medicine’s profit pie. Doctors and hospitals get their money from two sources—insurance companies and the government—and both have dried up in recent years, the insurance industry by imposing managed care and the government by limiting Medicare and Medicaid reimbursements. Both actions