Dr. Don W. Chapman, R.I.P.

Don%20Chapman.jpgLongtime Houstonian Dr. Don W. Chapman died last Thursday at the age of 90 (a Chronicle article is here). With Don’s passing, Houston has lost one of the extraordinary group of doctors who catapulted Houston’s Texas Medical Center into one of the premier medical centers in the world. I had the privilege of getting to know Dr. Chapman and his loving wife of 60 years (!), Mary Lou, through my father and mother, who were lifelong friends of the Chapmans.
As with my father, Don was a member of the groundbreaking generation of post-World War II doctors who embraced the optimistic view of therapeutic intervention in the practice of medicine, which was a fundamental change from the sense of therapeutic powerlessness that was widely taught to doctors prior to the post-WWII medical professors such as Don Chapman and Walter Kirkendall. We all take therapeutic intervention in medicine so much for granted these days that it is easy to overlook just how revolutionary this change was in the way medicine had been dispensed for decades and even centuries before Don and Walter’s special generation of teachers and researchers.
Don and my father completed their medical residencies together at the University of Iowa Medical School just in time for WWII. Don served in the war with great distinction as a Major in the Medical Corps of the U. S. Army and as the primary Cardiac Consultant for the European Theater while stationed at the 5th General Hospital and later the 98th General Hospital. Upon returning from the war, Don went on the faculty of Baylor College of Medicine and was one of the original ten Baylor faculty members who moved to Houston when Baylor moved to the Texas Medical Center location in 1944. Don and and the other Baylor faculty members at the time began operating in a fledging medical center that consisted of the new medical school and one 234-bed hospital.
Within two years of arriving in Houston, Don introduced cardiac catheterization to the Medical Center, which allowed Baylor faculty members and Methodist Hospital physicians to offer precise cardiovascular diagnosis and groundbreaking heart disease intervention for the first time. Under Don’s leadership, the Medical Center quickly became a pioneer in cardiovascular diagnostics and surgery as Don pioneered the use of a mechanical pump to circulate blood during open heart surgery, participated in one of the first coronary bypass operations in a Houston hospital and was a member of the team that researched and developed the initial mechanical heart implants. For good measure, Don in 1955 was one of the founding partners in Houston Cardiovascular Associates, which grew into one of the best cadiology private practices in Houston.
As director of Baylor’s Section of International Medicine, Don also became a leader in promoting cardiology education around the world by starting a program at Baylor that sends students to teaching centers around the world. Don served as a visiting professor and conducted seminars in numerous countries, including China, Columbia, Germany, South Africa, Guatemala, Switzerland, and Turkey. Not coincidentally, Texas Medical Center institutions now serve over 10,000 international patients annually.
Don was also a prolific researcher, authoring and contributing to more than 100 publications of medical literature. He received many professional honors, but the ones that he treasured the most were the ones he received for teaching, such as the Baylor Distinguished Faculty Award in 1978, 1981 and 1993 and the Outstanding Teacher Awards that he received from Baylor students in 1958 and 1962. In 1992, the Cain Foundation honored Don with the endowment of the Don W. Chapman, M.D. Chair of Cardiology at Baylor and, in 1993, the University of Iowa honored Don with that institution’s Distinguished Alumni Award.
Don’s contributions to Houston and the Medical Center were enormous. Today, 63 years after Don’s arrival in Houston, the Texas Medical Center is comprised of over 45 institutions (including 11 educational institutions and 15 hospitals and specialized patient care centers) that contain 6,500 patient beds and employ 75,000 people. Not only is the Medical Center now the largest employment center in Houston, Baylor College of Medicine is now widely acknowledged to be one of the best medical schools in the country.
How’s that for a professional legacy?
But Don’s remarkable professional accomplishments don’t provide the full measure of this man, who was a genuinely kind and warm human being. When my father at the age of 55 decided with my mother to move our large family (10 children!) to Houston from Iowa City at the beginning of 1972, Don and Mary Lou Chapman graciously welcomed us to Houston and took an active interest in the unwieldly Kirkendall clan. Don took a particular interest in me while I was a wayward undergraduate student in the early 1970’s and kept up with me as I worked my way through law school and became a part of the Houston legal community. I will never forget the wonderful impression that this successful man made on me in taking the time to express his genuine interest in what I was doing in my career. I was particularly touched by his phone call to me after my father’s sudden death in 1992 in which he told me how the eulogy that I delivered at the funeral had moved him to tears and how much he was going to miss his lifelong friend and colleague.
The memorial service for Don will be at 2:00 p.m. today in the sanctuary of the First Presbyterian Church, 5300 Main Street, in Houston’s Museum District just north of the Texas Medical Center. Immediately following the service, the family will receive friends during a reception in the church’s Fellowship Hall. In lieu of usual remembrances, contributions in memory of Don may be directed to the Memorial Garden, First Presbyterian Church, 5300 Main St., Houston, TX, 77004 or to Methodist Hospital Foundation Cardiology Department Research, 6565 Fannin St., Houston, TX, 77030.

Changing history

Debakey050307.jpgThe NY Times’ medical reporter, Lawrence Altman, M.D., tells the story of how Houston’s famed heart surgeon Michael E. DeBakey changed the course of history by persuading the late Boris Yeltsin that he could survive heart bypass surgery after the Russian president had suffered a heart attack in the fall of 1996. The surgery saved Yeltsin’s life and allowed him to live for another decade.
Of course, there are some who would argue that Dr. DeBakey efforts did not change history for the better.

Thinking beyond the UH Medical School

TMC-arial.gifBlogHouston.net’s Kevin Whited notes this Chronicle/Todd Ackerman article about the University of Houston floating a proposed new Texas Medical Center-based medical school in a collaborative project with The Methodist Hospital and Cornell University’s Weill Medical School.
Unfortunately for UH, the proposal has zilch chance of floating for much more than a few minutes amidst the shark-infested waters of Texas educational politics. Heck, the political forces in Texas cannot even agree to provide adequate funding of UH’s uncriticizable goal of becoming the state’s third tier I research university. The University of Texas, Texas A&M University, and Baylor College of Medicine — Methodist’s former longtime partner — are just a few of the powerful political forces that would almost certainly line up against the UH-Methodist proposal.
Yet, the UH-Methodist proposal has merit, so here’s a proposed modification. Rather than start another medical school from scratch, let’s merge the University of Houston system with the Texas A&M system and have A&M expand its fledgling medical school into the Texas Medical Center from its current central Texas outpost. From a broader standpoint, the merger makes sense because it gives the A&M system something that it desperately needs — a major urban presence — while also giving UH something that it has always lacked — that is, access to adequate endowed capital. Such a merger would also provide A&M with the law school that it has always coveted and would greatly facilitate UH’s elevation into a tier I research institution, which is something that would substantially benefit the Houston area.
While the University of Texas would almost certainly oppose such a merger, perhaps a deal could be struck at the same time to merge the Texas Tech University system into the UT system while organizing the remainder of Texas’ non-affiliated public universities into a third university system for funding and administrative purposes. Such a structure would give Texas a similar structure to that of the reasonably successful California model, which has generated far more first rate, tier I research universities (10) than the current dysfunctional Texas system (2). Indeed, almost anything would be a huge improvement over the current Texas system, which allocates a disproportionate amount of endowed capital to the UT and A&M systems while starving the remainder of Texas’ public universities.
Make sense? You bet. Chances of happening? Probably not much. But just as UCLA and Cal-Berkeley co-exist productively in the same university system in California, UH and A&M could do the same in Texas. And just as two major university systems work side-by-side together to educate Californians, a similar structure would be a substantial improvement in the educational system of Texas.

Reacting to the DeBakey surgery story

heart surgery.jpgThe reactions to last weekend’s fascinating story about the surgery to repair a dissecting aortic aneurysm in 97-year old Medical Center icon, Dr. Michael DeBakey, are as interesting as the story itself. The following are a few comments selected from letters to the NY Times regarding the story:

“Dr. Michael E. DeBakeyís surgery may have been a technical advance of heroic and dramatic proportions, but it was a setback for patientsí rights. Dr. DeBakey is the epitome of the informed patient, and a document evidently existed that said he did not want surgery for his disease.
Progressing into a coma as one dies is a normal part of the terminal stages of many illnesses. Directives exist to prevent such an incapacitated patient from becoming a victim of the grieving spouse or the frightened caregiver.
Because of Dr. DeBakeyís stature and publicity about his case, this surgery may decrease patientsí right to die in a manner they desire, an unfortunate result of a remarkable feat.”
Your article about Dr. Michael E. DeBakeyís aortic aneurysm operation was described as emblematic of the difficulties of end-of-life care, but it is as much or more emblematic of the difficulty patients encounter in having their wishes to forgo treatment respected. No one in the world had better capacity to refuse this operation than Dr. DeBakey, and he did.
. . .After the worldís best medical care, months in the hospital and a million dollars, Dr. DeBakey and his family had a happy outcome.
But for those thousands of ordinary patients who must struggle against family, church and state to refuse invasive, risky, experimental or simply unwanted care, it is not necessarily a happy ending.

“I wonder if Katrin DeBakey would have been so eager for her husbandís surgery if she had had to provide all the postoperative care herself as the rest of us have to do.
Almost any elderly patient with good insurance and an educated and younger spouse making decisions can get good high-tech surgery, but the system fails when the hospital dumps the patient back home on the spouse after only two days of postoperative hospital care.
In Mrs. DeBakeyís case, her husband received months of in-hospital intensive care, emergency care, more surgery, physical therapy and psychological support.
The rest of us caregivers would have long since passed the breaking point from dealing on our own with medical emergencies, unavailable doctors, no home nurses, no respite time and the psychiatric problems of many elderly male patients ó rage and depression.”
The article about Dr. Michael E. DeBakey illustrates many central issues that arise in determining types of care for gravely ill patients and whether to perform a risky but potentially lifesaving procedure.
The case exposes the standards of patient autonomy and informed consent ó foundational principles of ethical medicine ó to be impossible ideals. Even Dr. DeBakey, likely the person most thoroughly informed about the procedure, regretted his prior decision to forgo the surgery.
Another problem exposed by this case is the persistent misuse of the do-not-resuscitate order, interpreting it to signify more general wishes about less aggressive care instead of its actual, more restricted meaning: not resuscitating in the event of cardiac arrest

As one of the other letter-writers pointed out, the story also reflects that Dr. DeBakey is the consummate educator, using his experience to prompt consideration and discussion of important medical and ethical issues in caring for patients who are close to death. He is truly one of Houston’s treasures.

A patient of the surgery he created

heart surgery.jpgThis NY Sunday Times story by Lawrence K. Altman, MD reports that one of Houston’s greatest surgeons continues to be on the cutting edge of surgical and related medical issues even as he approaches 100 years of age:

In late afternoon last Dec. 31, Dr. Michael E. DeBakey, then 97, was alone at home in Houston in his study preparing a lecture when a sharp pain ripped through his upper chest and between his shoulder blades, then moved into his neck.
Dr. DeBakey, one of the most influential heart surgeons in history, assumed his heart would stop in a few seconds. [. . .]
But when his heart kept beating, Dr. DeBakey suspected that he was not having a heart attack. As he sat alone, he decided that a ballooning had probably weakened the aorta, the main artery leading from the heart, and that the inner lining of the artery had torn, known as a dissecting aortic aneurysm.
No one in the world was more qualified to make that diagnosis than Dr. DeBakey because, as a younger man, he devised the operation to repair such torn aortas, a condition virtually always fatal. The operation has been performed at least 10,000 times around the world and is among the most demanding for surgeons and patients.
Over the past 60 years, Dr. DeBakey has changed the way heart surgery is performed. He was one of the first to perform coronary bypass operations. He trained generations of surgeons at the Baylor College of Medicine; operated on more than 60,000 patients; and in 1996 was summoned to Moscow by Boris Yeltsin, then the president of Russia, to aid in his quintuple heart bypass operation.
Now Dr. DeBakey is making history in a different way ó as a patient. He was released from Methodist Hospital in Houston in September and is back at work. At 98, he is the oldest survivor of his own operation, proving that a healthy man of his age could endure it. [. . .]
But beyond the medical advances, Dr. DeBakeyís story is emblematic of the difficulties that often accompany care at the end of life. It is a story of debates over how far to go in treating someone so old, late-night disputes among specialists about what the patient would want, and risky decisions that, while still being argued over, clearly saved Dr. DeBakeyís life.
It is also a story of Dr. DeBakey himself, a strong-willed pioneer who at one point was willing to die, concedes he was at times in denial about how sick he was and is now plowing into life with as much zest and verve as ever.
But Dr. DeBakeyís rescue almost never happened.

Read the entire fascinating story, which includes Dr. DeBakey’s frank admissions that death seemed like a reasonable alternative to the pain he was enduring, that he initially declined the surgery because he would rather die than risk becoming an invalid and that he went into denial as his condition deteriorated. It is a fascinating story about facing death by a man whose legacy is saving lives.

Texas Children’s huge expansion

Texas Children's Hospital logo.jpgTexas Children’s Hospital — already the largest pediatric hospital in the country — announced a massive $1.5 billion expansion earlier this week that calls for 2 million square foot expansion, including construction of a maternity center, a neurological research institute and a satellite hospital in west Houston. Texas Children’s is one of the largest employers in the Medical Center and expects to create an additional 2,500-3,000 jobs in connection with the expansion. The Chronicle’s Todd Ackerman has story here.
Juxaposed between earlier posts here and here on the struggles of Baylor College of Medicine and the University of Texas Medical Branch to define their future in the troubled waters of America’s health care system, Texas Children’s bold expansion is a reminder of the strong influence that Houston’s Texas Medical Center and vibrant medical community will have on this key domestic policy and economic issues facing American society.

M.D. Andersen patients get a nice Friday surprise

MD Andersen.jpgThe University of Texas M.D. Andersen Cancer Center in Houston’s Texas Medical Center is one of the nation’s leading cancer hospitals and research centers. It is a place where difficult issues relating to life and death are confronted on a daily basis, yet the M.D. Andersen professionals work hard to encourage a culture of hope and optimism. It is truly one of Houston’s most remarkable places.
Sheryl Crow.jpgConsistent with that remarkable nature, look at who M.D. Andersen patients and workers were able to stumble across yesterday over the lunch hour:

On her way to Friday night’s concert in The Woodlands, Sheryl Crow made a detour for a smaller, kindred audience: women with breast cancer.
Six months after her own breast cancer made headlines, the Grammy-winning rocker stopped by the University of Texas M.D. Anderson Cancer Center to mingle with and play for patients and survivors of the disease.

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Baylor Med decides to go it alone

photo_tmc_aerial2002.jpgThe Houston professional community and the Medical Center was abuzz yesterday with Baylor College of Medicine’s announcement late this week that the school will construct a new teaching hospital in the Texas Medical Center and end its recent affiliation with St. Luke’s Episcopal Hospital as its primary teaching hospital. This move comes only a couple of years after Baylor (which has no affiliation with Baylor University in Waco) terminated its longstanding with the Methodist Hospital as its primary teaching facility (previous posts here), a relationship that was as storied as the Medical Center itself. As usual, the Chronicle’s Todd Ackerman — who has done a superlative job in covering the Baylor-Methodist split and the changing nature of Baylor within the Medical Center — has this excellent report on the development.
Baylor’s new hospital will resolve Baylor’s increasing concern over being the nation’s only top-20 medical school that does not own a hospital or whose department chairs do not head the key medical departments at an affiliated teaching hospital. The announcement is really not a surprise as there have been rumors for the past six months or so that Baylor-St. Luke’s partnership was on the rocks. Although the two institutions entered into merger negotiations shortly after they entered into the teaching hospital affiliation, those negotiations didn’t go anywhere as St. Luke’s staked a vision of providing medical services in new hospitals throughout the far-flung Houston metropolitan area. The straw that broke the camel’s back was St. Luke’s dragging its feet in making Baylor department chairs the head of the hospital’s parallel medical departments.
The demise of Baylor’s relationships with both Methodist and St. Luke’s is a reflection of the difficulties involved in sustaining long-term business and professional relationships in the face of the fast-changing world of American health care finance. When those pressures overwhelm a productive relationship such as the one that Baylor and Methodist long-enjoyed, the risk increases that a decline in the quality of medical care will be the ultimate result, which is a risk that should concern all of us. On the other hand, Baylor is presenting an ambitious plan for maintaining its position as one of the top medical schools in the country, and more competition between outstanding hospital facilities in one of the nation’s top medical centers could well generate even better medical care and research. How it turns out will reflect much in regard to the direction of the American health-care finance system and the challenges of training physicians within that changing system.

Houston’s gift to Botswana

bradshaw_lrg.jpgMajor W. Bradshaw has long been one of the talented physician-teachers that makes Houston Texas Medical Center such a fascinating place. Dr. Bradshaw came to Houston and the Baylor College of Medicine as an Assistant Professor of Medicine in 1972 to ramrod Baylor’s development of expertise in microbiology and immunology. An outstanding teacher, Dr. Bradshaw was promoted to Dean of Education in 1996 and to Senior Vice-President and Dean of Medical Education in 2004. Now, while most contemporaries are planning their retirement, the Chronicle’s Leigh Hopper reports that Dr. Bradshaw has other things in mind:

[After 30 years at Baylor], Bradshaw is making an unusual career move.
He’s heading to Botswana, a country in sub-Saharan Africa that is roughly the size of Texas.
Baylor is expected to announce this week that Bradshaw has accepted a job as interim founding dean at University of Botswana’s medical school, the first such school in a country with one of the world’s worst HIV rates. Next month, he and his wife move to Gaborone, Botswana’s capital, leaving their home, their children and grandchildren for at least a year.
“It’s pretty remarkable for (the University of Botswana) to have the sitting dean of education for the No. 10 medical school in the United States to all the sudden be their new founding dean,” said Baylor College of Medicine President Peter Traber. “That’s quite a recruitment.”

Dr. Bradshaw’s appointment is part of Baylor’s affiliation agreement with the University of Botswana, which is starting the country’s first medical school to address Botswana’s critical health needs, including a high percentage of the population that is infected with the HIV virus. Under the leadership of Baylor pediatric professor Mark Kline, Baylor has already opened a treatment center for HIV-infected children in Botswana in 2003 as a part of Baylor’s International Pediatric AIDS Initiative. What better legacy for a teacher such as Bradshaw — who has had a major influence on one of America’s finest medical schools — than to contribute his talents to the creation of a medical teaching institution in a part of the world that needs it the most. Just another example of the magnificent influence that the professionals of Houston’s remarkable Texas Medical Center are having throughout the world.

The Medical Center philanthropist

dan duncan3.jpgTodd Ackerman does a fine job covering the Texas Medical Center for the Chronicle and, in this Sunday Chronicle article, profiles Dan Duncan (previous posts here), chairman of Houston-based Enterprise Products Partners, LP and the leading philanthropist to Houston’s famed Texas Medical Center.
Duncan’s life is a quintessential Houston success story, a hard-working, self-made man who started his first company with $10,000 and a trailer-truck and, after working for a small independent oil and gas company, started Enterprise in 1968 and built it into a $15 billion company that is one of the two largest companies in the nation that transports natural gas between exploration and end-use. As Ackerman’s profile points out, that task has not always been easy — such as during the mid-1980’s when the bottom fell out of the natural gas market — but Duncan perservered and was ultimately rewarded for his vision and hard work. Couldn’t happen to a nicer fellow.