Perspective
Role Models
Some not-so-secret admirers pay tribute to those who influenced them.
A role model is by definition someone to emulate. What’s so intriguing about the concept is that a person becomes a role model only when someone claims him or her as such. The teacher is a role model to the student only if the student recognizes her as someone she admires. The father is a role model to the son if the son decides the father’s example is worth following. The role model emerges when the admirer sees him or her as such. A role model, like beauty, is in the eyes of the beholder.
We were struck by this idea as we read the following stories. We had asked readers of Minnesota Medicine to tell us about the person who most influenced their choice of career or lifestyle, encouraged them to do something they otherwise wouldn’t have had the courage to try, or displayed a passion or commitment that proved to be contagious. The stories they wrote reveal as much about the admirer as the person they admire.
We were inspired by their tributes. We hope you will be, too.
—the editors
Horacio Castillo
By Sandra Eliason, M.D.
I could not have guessed when I boarded the plane for Guatemala in January to explore the idea of my church, St. Michael’s Lutheran in Roseville, partnering with a church there that Horacio Castillo, the bishop of the Augustana Lutheran Church of Guatemala, would become a role model. The country seemed so far away and the concept of a sister church so ambiguous. I had no idea that the experience would influence the way I practice. But it has.
The bishop became my teacher. And his ideas about health and how to help people has permeated my thinking. While working in Mayan communities, where people had been displaced by civil war, Castillo has sought to not only heal war wounds but to raise the standard of living there. In his sister church model, each of the two churches helps set priorities and identify projects, which range from building communal kitchens to providing legal help to resolve land disputes. And each congregation invests in the project, giving members of the local church a stake in the project and those of the companion church a reason to return to Guatemala to build on previous successes.
In Guatemala, the indigenous people were victims of a 36-year civil war. More than 100,000 people were killed and another million were displaced—either taken to camps within their country or in southern Mexico. When the war ended in 1996, the poverty and inequality that were its primary cause remained. An estimated 80 percent of the population still lives in poverty, two-thirds in extreme poverty. The infant mortality and illiteracy rates are among the highest in the Western Hemisphere. Until recently, roads did not go to many of the Mayan communities; they were only accessible by foot paths.
The bishop has dedicated himself to working with the Mayan people through war, exile, and their return, always respecting their ways and culture. Because he is known and trusted, he is welcomed in villages where people are wary of outsiders. I was allowed to travel with him to some of these remote places. I have seen how small measures such as washing the foot of a man with cellulitis and educating him about foot care and the importance of wearing shoes in his dirt-floor house had a profound impact. The experiences reminded me of the importance of touch, education, caring, and reaching across the divide between patient and physician.
The bishop has shown me that in order to effect change in any community, you cannot impose it from the outside: You must walk with people to understand their needs, assets, perspectives, and culture, and then work together for change. I have tried to apply this approach as I work with patients, first seeking to understand them and then to “walk” with them on their journey to health.
Sandra Eliason is director of medical programs for the Center for Cross Cultural Health and practices at Fairview’s Andover Park urgent care clinic.
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Harley Racer, M.D.
By Richard K. Simmons, M.D.
I was getting out of the Air Force in the fall of 1958 and trying to decide whether I should do a residency when I met the Harley Racer. I had graduated from medical school and done an internship before doing my required time in the service; I thought it might be good to do a year of general medicine before applying for a residency position. After interviewing with several other physicians, I joined Harley at his small office in a Bloomington shopping center.
At that time, Bloomington was the youngest city in America. Young couples were moving in, buying homes, and starting families. We were really busy. By the second day, my schedule was full. I quickly realized why. Harley was sharing his patients with me. We were going to alternate call and coverage. Patients weren’t going to be his or mine, they were going to be ours. As a result, I was going to have the opportunity to learn how he thought and practiced from his notes in the chart as well as from his example.
I learned immediately that our patients loved and trusted him. And because he put his trust in me, they accepted me, too. He clearly enjoyed his relationships with them and their families. The unique thing about family medicine is that you get to know whole families over extended periods of time. And because of this, people look to you to be not only their doctor but also their friend and advisor. Harley knew this. Often, he’d save time at the end of the day for the patient or family he knew needed more than a quick visit. He’d listen and in a very gentle way counsel them, not telling them what to do but offering alternative approaches to their problems. Throughout my career, I’ve tried to do the same.
I learned from Harley that no doctor can be available to patients 24/7 but that some ways of providing coverage are better than others. One thing we did was alternate our visits with obstetrics patients so when it came time to deliver their babies, both of us knew the patient and she knew us. I also learned from him that if you were to command respect, you needed to perform at a high level. There was an attitude among some specialists in the early 1960s that general practitioners were third- or fourth-class citizens. He showed me that the way to counter this was by doing things well. By the 1970s, his reputation was such that he was asked to start a family practice department at what was then the St. Louis Park Clinic. Until then, the clinic had only employed specialists.
Harley went on to be involved with residency programs at Methodist Hospital and Hennepin County Medical Center, where he taught hundreds of young physicians. He showed me the benefits of teaching—you get as much as you give and you develop a huge network of colleagues. I followed in his footsteps and taught medical students and residents throughout my career. Mostly, Harley Racer showed me the joy of family medicine, and as a result, I had a wonderful career that lasted 35 years.
Richard K. Simmons, M.D., is a retired family physician who practiced in Bloomington.
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Ernie Ruiz, M.D.
By Louis Ling, M.D.
I knew I wanted to practice emergency medicine when I was in medical school, but I never did an actual rotation. So I didn’t match in emergency medicine, but I did do a rotating internship at Hennepin County Medical Center (HCMC). It was during my internship that I met Ernie Ruiz. We worked together in the ER, and when he learned that I was interested in emergency medicine, he was very helpful.
When I later applied to do an emergency medicine residency at the University of Chicago, he wrote a letter on my behalf. A couple of their faculty told me his letter was the reason I got in. At the time, I didn’t know that he was a leader and a pioneer in the field. You wouldn’t have guessed that because he was so humble.
When I finished my residency in 1984, Ernie hired me and I came back to HCMC. I realized he was someone I should look up to as a role model. But I don’t think he ever saw himself as that. He is soft-spoken, unassuming, and respectful of everyone. He just did what he thought was right. When he had suggestions, they always came out as that. I remember taking care of a man who was stabbed in the forearm. I wanted to sew up the fascia. Ernie suggested not doing that. I still did it. Of course, later on, he had more swelling and pressure inside the arm, which required us to open it back up. Then I realized that when Ernie made a suggestion, I should just do it.
He was constantly teaching, but he never talked down to you. He encouraged us to be the best that we could be and to give every patient every chance. I remember another patient who died under my care. Ernie was disappointed that I hadn’t been more aggressive and done a thoracotomy and given the patient every possible intervention. His teaching was also practical. One of his tips that I now pass along to residents is to sit down and have good lighting when doing a procedure or sewing up a laceration.
Another thing that was striking about Ernie was his curiosity. He always wondered if things could be done better and suggested research projects to answer questions that popped into his mind. And he was always willing to work with others in order to learn more. Now, when I see a patient and don’t know how to proceed, I’m happy to ask for advice.
Ernie worked harder than anyone else. Instead of giving out job assignments, he would ask people to volunteer for them. I knew that I had to volunteer for my share because if I didn’t, he would just take them on himself and not complain. I was on the faculty for two years before I discovered he was still taking trauma call in the middle of the night in addition to his emergency medicine shifts. He never mentioned that he was doing this until the day he announced that he was going to stop doing it.
In addition to creating the emergency medicine residency at HCMC, Ernie also formed the Society for Academic Emergency Medicine and helped create the Comprehensive Advanced Life Support course for rural Minnesota doctors and their teams. When he “retired” from HCMC, he started the emergency medicine program at the University of Minnesota. And when he retired from the university, he kept coming in to work. Today, Ernie still comes to conference on a regular basis. He’s still willing to teach, and he’s still willing to learn.
Louis Ling is a professor of emergency medicine and associate dean for graduate medical education at the University of Minnesota. He is also associate medical director for Hennepin County Medical Center.
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J.B. Friberg, M.D., and James K. Struve, M.D.
By Joel Thompson, M.D.
I consider two former partners, James Struve, M.D., and Joseph B. Friberg, M.D., to be my role models.
I joined James Struve in a two-man practice that served four clinic sites in the Twin Cities in 1978 and worked with him until 1982. During that time, Jim introduced me to the idea of offering care that addressed the needs of the whole person.
We worked together to implement an idea pioneered by Dr. Granger Westburg more than 30 years ago called the health planning conference. This was a method in which three professionals—a physician, nurse, and pastoral counselor—would meet with a patient to comprehensively evaluate their health status in all areas—mind, body, and spirit. In 20 minutes, we could establish the individual’s strengths and weaknesses and develop a plan for improving his or her health and preventing illness. We saw impressive outcomes. Patients reported that their stress was reduced, their marriages enhanced, and their chronic pains alleviated. One couple who had struggled with chronic infertility conceived within two months of their conference. Of course, one could dismiss such events as coincidences; but those coincidences were less the exception and more the rule. Because of Jim’s passion for this, we were doing 30 years ago what many in medicine now call for: offering integrated, interdisciplinary care.
Jim took his faith very seriously and was not in medicine for the money. In those days, we cared for all without concern about their ability to pay. Sadly, he reached a point when he could no longer keep his clinic open for lack of adequate compensation. Yet, his patients stayed with him, and he continues to work with many he’s known for 30-plus years, showing the same caring spirit he has always shown.
His compassionate care has been noticed by his colleagues who twice have selected him as one of the top family physicians in Minneapolis St. Paul Magazine’s annual Top Doctors listing. He was humble about this, saying he was selected only because he’d been around so long. His was a tough act to follow—and “follow” is the operative word, for he was always ahead of me, whether it was making rounds or attending to the details of running the clinic.
Over the years, Jim has challenged me to consider what role faith and faith communities should play in health and healing in today’s society. Because the Christian and Jewish communities have been central to the establishment of many hospitals throughout this country and because faith has inspired many members of those communities to enter into the nursing and medical professions, this is an extremely important question, especially now when so many lack access to health care. We continue to explore questions about faith and practice and seek ways to encourage the Christian community to meet the challenges these questions pose.
Joseph B. Friberg allowed me to experience what it was like to work in a small, independent family practice that had been caring for families for three generations. I joined him in that two-man practice in 1984 and practiced with him for the next seven years. Our practice had a rural feel but a downtown Minneapolis location. We had the unique experience of being able to offer seamless patient care, from clinic to hospital to extended care to nursing home, all within walking distance of our office, which was across the street from Metropolitan Medical Center. His patients showed a loyalty that was without equal. I recall one of them stating, “He grows sweeter every day!”—again, a tough act to follow.
At first, I was frustrated that virtually every one of my patients admitted to the hospital had Dr. Friberg listed as their attending physician. But with time, it seemed appropriate, as I came to realize that I owed my practice to him. Without his introduction to his large patient population (more than 4,000 families before the insurance wars began), I would never have been able to work in such a delightful environment.
In that setting, I came to understand that family practice is the best way to care for patients and families, and I would not exchange that experience for anything. We did everything—from obstetrics to medicine to surgical assisting. We cared for our hospitalized patients whether they were on the general, ICU, CCU, or surgical wards. I doubt future generations of physicians will ever experience such breadth of care.
Dr. Friberg allowed me to mature as a physician, delegating to me ever more responsibility for the business aspects of the practice as well as the more difficult patients as the years went by. When we later worked together in a larger group, he showed me how a physician could effectively practice well beyond age 65. He knew his limits and asked for help when he approached them, but he always followed through, making sure his patients got “the best.” He was a man of unimpeachable integrity who loved his patients as he believed the Lord loved them—without reservation.
If he had a fault, it was erring on the side of kindness, not wanting anyone to suffer when he felt he could do something about it. Money was almost never a consideration in his practice. I wouldn’t be surprised if during his 60-year practice he gave away more care than some give (and charge for) during their whole career. I will forever be honored to have been the second name on our office door.
Joel Thompson now works in rural emergency rooms in northern Wisconsin and Minnesota. He is also writing a book on the health care industry.
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Carolyn Clancy, M.D.
By Barbara Yawn, M.D.
I first met Carolyn Clancy about 15 years ago when she was the division director of primary care for the Agency for Health Care Policy and Research. At the time, I was chair of the American Academy of Family Physicians’ task force on research and their commission on health policy and research. We were advocating for more training and opportunities for primary care researchers. Dr. Clancy, who is a general internist, is an advocate for primary care and primary care research in a world that is specialty-oriented. When I first met her, most people were talking about the importance of subspecialists and their spectacular activities of saving people’s lives. She was able to articulate the perspective that in primary care, we don’t save one life at a time, we do preventive care that saves thousands of lives or at least prevents thousands of premature deaths. She was able to change what people considered cutting-edge health care from the latest imaging tool or test to the everyday work with patients and communities to help them improve their health.
Because of her ability to do that, specialty physicians respect and are willing to listen to her. That’s not an easy thing for a woman general internist to do, or for a woman family physician to do, for that matter. She makes sure that specialists realize they are valued by those of us in primary care and reminds them of the important roles we play in our patients’ lives.
One of Dr. Clancy’s talents is taking someone’s idea and handing it back to them in a way that broadens their horizon. For example, she recently published the article “Primary Care: Too Important to Fail?” in the Annals of Internal Medicine. Rather than whining that no one respects us or no one is reimbursing us, she takes a positive approach and says, “We’re going to act on this, and we’re going to do something about it,” and then presents recommendations. Just the title made me think about the issue in a different way.
I’ve tried to do that with medical students, residents, and young physicians who come to me with an idea of what they would like to study. They frequently have a point that they want to prove, and I try to help them look at it more broadly. She taught me how to do that.
Since I’ve known her, Dr. Clancy has encouraged me to continue working to make sure primary care physicians are recognized as the basis of our health care system. Specialists and subspecialists are important collaborators in the comanagement of selected patients; but they do not serve as medical homes for most patients, nor should they. Her example keeps me saying yes to serving as the primary care representative on national and international panels that are developing resources and guidelines for primary care. It also keeps me mentoring young primary care researchers.
Barbara Yawn is director of research at Olmsted Medical Center in Rochester and an adjunct professor of family and community health at the University of Minnesota.
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John Mantica, M.D.
By Daniel J. Wilson, M.D.
Many of us have seen The Lion King in theaters or on stage and been reminded of the circle of life. Over the years, I’ve found that the circle extends to medicine, too.
Few of us are fortunate enough to have a second father who looks after our growth and development. I was lucky to find Dr. John Mantica, who had a profound influence on my becoming a physician and was a major force in guiding my career development. Dr. John was a family practitioner in Steubenville, Ohio, and he was my physician when I was growing up in the 1950s and ’60s.
He was the team doctor for our high school football team when I separated my shoulder during a game. He treated me for the injury and then asked me if I wanted to become the athletic trainer for the team, rather than sit out the remainder of the season. At that point in time, there were no formal programs in athletic training. He developed an educational program for me and supervised my training. I took a first aid course and then worked in the local hospital learning how to tape and stabilize injuries. My work as a student athletic trainer enabled me to earn a scholarship to the Franciscan University of Steubenville, where I became the athletic trainer for the Barons basketball team. At the same time, Dr. John, as my friend and supporter, became the team’s physician.
I always knew I wanted to be a physician, and Dr. John provided me with encouragement, focus, and mentorship. My goal was to graduate from medical school, complete an internship and residency, and then come back and work with him. Both of us shared that dream.
After graduating from Rush Medical College in Chicago, I became interested in internal medicine and considered applying for a residency in the specialty. Dr. John encouraged me and told me one of his great regrets after finishing medical school was not pursuing additional training. He always thought he would go back for postgraduate training, but it became impossible with the demands and rigors of general practice. He encouraged me to complete the residency, even though he knew it would be several years before I could come back and work with him.
During my residency at Cleveland Clinic, I developed an interest in hypertension and nephrology. I again had to make a tough decision about what I wanted to do in medicine. Did I want to start a medical practice as a community-based internist or did I want to pursue additional training and, perhaps, a career in research? Again, I went back to him. Dr. John told me that if I had the desire and the ability, this was the time to pursue the opportunity. Every time he gave me his advice, he knew that it was less and less likely that we would be partners in a medical practice. Over the years, I have found that many of my medical colleagues have difficulty defining mentorship. Dr. John defined the term by his actions: He was clearly interested in giving a young student and colleague the best possible advice, even at his own expense.
Years later, Dr. John had a heart attack. After too brief of a rehabilitation period, he went back to work. A couple of years later, he developed progressive shortness of breath and called me. At the time, I was at Mayo Clinic. I suggested he come to Rochester and that I would make arrangements for his clinic visit. As it turned out, he asked me to do his examination and supervise his work up. I referred him to a cardiologist, who confirmed my diagnosis of severe left ventricular dysfunction with heart failure. I became his physician and supervised his treatment for the last 10 years of his life. We completed the circle. I started out as his patient, and at the end of his life, he was my patient.
When I was in medical school and residency, I noticed that few medical students had someone with whom they could sit down and discuss their aspirations or who would give them advice or just listen. I’ve tried as often as possible to provide the same opportunity that Dr. John gave to me to medical students and residents.
This year, a medical student from the University of Minnesota who was doing a dermatology clerkship in Rochester stayed with my family for three weeks. I made it a point to speak to him nightly and give him an opportunity to discuss what he learned and what his aspirations were. At the same time, I gave him an idea of what my journey in medicine has been like. The student and I have kept in contact. Our conversations remind me of the ones I had with Dr. John—my physician, my patient, my friend, my confidant, my role model.
Daniel Wilson is senior medical director and senior research scientist for Pfizer Global Pharmaceuticals. He resides in Rochester.
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James P. Lillehei, M.D.
By Thomas F. Mulrooney, M.D.
James Lillehei, the younger brother of famed heart surgeon C. Walton Lillehei, was the first director of the pulmonary medicine section at the University of Minnesota. In 1965-66, I was his first trainee (a “fellow” in current parlance). My traineeship was essentially a one-year tutorial in pulmonary medicine and research; but even more, it was an opportunity to watch an exemplary medical scientist approach the problems of diagnosis and treatment. He taught by example, and his example approached perfection.
The fellowship was a work in progress. It was funded by the U.S. Public Health Service, which was hoping to train a cadre of physicians who had some understanding of pulmonary disease and physiology. But I don’t know that anyone had really hammered out a firm curriculum for it. Jim and I shared a little office in the old Mayo building, with a desk along the wall and two chairs. Much of our work involved seeing patients hospitalized with breathing problems whose attending physicians had requested a consultation with Dr. Lillehei. My job was to see them first, learn something about them, arrive at some diagnostic possibilities, present their cases to him, and suggest how to proceed. He’d agree or not.
The next step would be to review the medical literature relevant to the problem. At that time, this was not easy to do. I had to walk a couple of blocks to the Diehl Medical Library, pull out volumes of the Index Medicus—a huge dictionary-like reference—to look up the papers, then fill out little cards so the librarian could pull the articles. Today, you could do the research with a few keystrokes at your desk.
Jim believed practicing physicians needed to collect their own data. I remember him saying, “Show me the data.” One couldn’t get away with saying, “I saw a case like that.” He’d say, “How many? Do you keep a file? How do you know what you’ve seen?” He taught that if you rely on experience and memory you tend to remember the unusual cases. He advised keeping records. He did, and I did for that year. The habit of keeping cards on file about patients didn’t survive the time constraints of practice in later years, but I did continue to keep track of my notes about patients and the articles I read.
I recall how this approach worked in the case of a patient in her 40s who had severe emphysema. Because she was young to have the condition, Jim was curious. He recalled reading a report from Sweden that showed that people who were deficient in the protein alpha-1 antitrypsin had a predilection for emphysema. He sent me to the library to dig out that paper to see if it might be applicable. Today, you can measure that protein specifically, but in those days there was only rudimentary testing. We did have electrophoresis and discovered that, indeed, the protein was absent in that patient. It was the first such case recognized at the university and probably the first in this area.
In essence, Jim was a scientist, and he brought the rigor of his scientific approach to the practice of medicine. He was curious, reviewed the evidence and medical literature, and then made diagnostic hypotheses and investigated them. Other teachers had preached about that sort of approach, but I hadn’t seen anyone who invariably worked that way.
I’ve made a career-long attempt to emulate his model, which was scholarly (to use his term). To the degree that I have had any success, I would attribute it to his teaching. I do not mean his transmission of factual data; I mean his modeling of how to interview and examine a patient, gather data, and then turn to the library and notes of previous encounters to structure and then test diagnostic hypotheses. He taught me, long before it became an in-vogue term, to apply “evidence-based medicine.” MM
Thomas Mulrooney is a semi-retired pulmonologist who still sees patients at the Minnesota Lung Center.