Taking a Stand Read online

  I knew, however, that my goal would only occur with great perseverance, some skill, and a little luck. I knew it wouldn’t be easy. I went to college knowing that I would have to get good grades and not let up for a moment. Looking back, it’s tempting to say my path was smooth and easy, but that would ignore the day-in and day-out work that it took to make it through college, medical school, and residency. The only way you get through it is to look only a few feet in front of you and not contemplate the whole.

  Halfway through my third year in college, when I was twenty-one, I took a semester off to help my father in his 1984 U.S. Senate campaign. He lost, but the highlight for me was getting to debate Phil Gramm and Rob Mosbacher at the Pink Elephant Ball in San Antonio in front of 300 people. I remember being very nervous appearing alongside a sitting congressman and a wealthy businessman. Not so nervous, however, to resist informing the crowd of primarily establishment Republicans that the Gramm-Latta budget had nearly three times more debt than Jimmy Carter’s most recent budget. I wasn’t sure if Gramm remembered the night, but twenty-six years later he commented, “I listened to him pretty closely,” he said, “and I remember the young man did quite well.”1

  I took the medical school entrance exam in the fall of my third year at Baylor, and Duke University School of Medicine accepted me early. I studied nonstop the entire previous summer in my carrel in the honors library at Baylor and achieved my best standardized test score ever—scoring higher than 90 percent of all premed students taking the test. Duke is my father’s alma mater, and it gave me great satisfaction to follow in his footsteps. I worried some about the expense of going to a private medical school rather than a state school in Texas, but my dad told me not to worry. He wanted the best for me, he said.

  On my first day in medical school, I rode my bike to class and sat down in the back left-hand corner of the Duke amphitheater. Little did I know that some of the young men and women around me would become lifelong friends. Three of them would be groomsmen in my wedding. Together, we would become physicians, overcoming the natural human inclination to avoid pain, blood, and suffering in the process. Together, we would go through the rite of passage that two thousand years ago Hippocrates understood to be knowledge that was not always easy to cope with and was not for general consumption.

  While studying at Duke, I lived in the basement of a brick ranch house belonging to a widow named Mrs. Deal, and I would mow her lawn and do other yard work in exchange for rent. When the mower wouldn’t start, I used the trick of dipping the spark plug in a little gas and trying again. I’d ride my bike to school in good weather, with an old station wagon that belonged to my parents as backup transportation. My friends gave me a hard time about the old station wagon. The lining of its roof hung down in the back, and since it appeared to be a dump my friends treated it as such and left their trash behind whenever they rode with me.

  Often the station wagon wouldn’t start, and I’d have to use a variation of the lawn mower trick. This maneuver, however, took two people to perform: one to sit in the driver’s seat and turn on the ignition, and one very brave person to toss a little gas onto the carburetor just as the key was being turned. Though a small explosion would occur, more times than not the old station wagon would rumble to life.

  Years later, when I returned to Duke for my ophthalmology residency, Kelley and I went back to visit Mrs. Deal. She made us dinner, and Kelley got to see my med student living quarters. Mrs. Deal also hosted families who had relatives at Duke University Medical Center for prolonged cancer treatment. Living under the roof of this kind woman had brought me some of the comforts of home.

  I needed them. My first year at Duke was a flood of information. I relied on the work ethic I’ve had all my life and kept my head above water. As a medical student, I worked in three different Veterans Administration hospitals in North Carolina, one in Fayetteville, one in Durham, and another in Asheville. The VAs operated under a single-payer system, like the Canadian health-care system. What that means of course is that the government pays the tab—as it should for veterans. But it also means that the health care is rationed. I’m not breaking any news here by telling you there are long waiting lines at VA hospitals. When I was working at them, medical students went home only after we did the workup of our last patient. I often wasn’t seeing my last patient until ten o’clock at night, so I had to get creative. I started asking the vets how long they’d been waiting. Some would say, “Since noon.” So I started going down to the waiting room to find my patient. Sometimes the vet would be outside smoking a cigarette, and I’d say, “Look, the system around here is not good. It can take you ten hours, but we can speed things up if we do the workup now.” I would do the workup before they were even checked in, drawing their blood and getting an EKG done. I knew somebody in X-ray, so I’d also get the X-ray done. In those days, med students had to learn about the disease and come up with a diagnosis and treatment for each case. I’d research the disease while the vets were waiting to check in. Once they were checked in, I’d stick the labels on the file and the vials, and both the patient and I would cut several hours off our day.

  I thought of my days at the VA recently when the scandal erupted over veterans dying while waiting for care and VA administrators using fake waiting lists to hide the problem.

  When liberals are aghast at waiting lists and lines for care at the VA, I remind them that the VA is the single-payer system they all covet.

  The care wasn’t bad in the VA hospitals of my time. Yes, there were young surgeons in training at the hospitals I worked in, but we were working under established doctors and surgeons. Nor do I believe the quality of care is bad today. What’s bad is the distribution of veterans’ health care. It’s not the quality of the doctors and nurses working in the VA system that is the problem, but the economics of distribution, or, in the case of the VA, the poor distribution due to the lack of a pricing mechanism. Today, the problems are likely worse, as we have hundreds of thousands of disabled veterans from the two-decade-long war in the Middle East. Frankly, there are only so many doctors and surgeons to go around in VA hospitals. Under this system, the only way to distribute veterans’ health care is to ration it. Everyone eventually gets care—that is, if they survive the wait time. It’s the same principle on which Obamacare is based. Just like the VA system, Obamacare inflates demand through subsidies and tax credits. Demand then overwhelms supply, which causes rationing through mandates and waiting.

  As I moved toward graduation from medical school, I began considering a specialty. I’d become fascinated by the idea of curing diabetes by transplanting insulin-making cells into “privileged” areas, locations where the body protects itself from immune responses. Two of those locations are the brain and the eye.

  I spent my third year of medical school researching the immune status of the eye. My thought was that since the cornea and, to a certain degree, the entire eye is in somewhat less contact with the immune system during development, perhaps the eye’s relative privilege might hold the answer for finding a place that wouldn’t reject transplants of insulin-making cells. At the time, researchers were using similar logic to inject insulin-making cells into the fluid around the brain. Was a cure for diabetes to be found in this world of relative “privilege”? I was young and, like many med students, I believed that we could one day find a cure for most diseases. I spent plenty of late nights transplanting corneas into rats that had graciously volunteered. Even before I earned my MD, I published a solo-authored paper in the prestigious American Journal of Ophthalmology—an achievement of which I am very proud. It was a great honor, as very few medical students are sole authors of a peer-reviewed paper. My research was one of the reasons I began to pursue a career in ophthalmology.

  The other reasons were my grandmother’s eyes and a jar of pennies.

  The story of the pennies begins in Pittsburgh, first in my father’s childhood home and later mine in Texas.

  My father had watched the pen
nies accumulate in a jar in his parents’ kitchen. At the time, the country was just coming out of the Depression, and his parents collected the pennies as savings, not as a hobby. Some of the coins were Indian Heads that dated back to the early 1900s. The pennies intrigued my father, and he offered to buy them from his father, who agreed, but only if his son paid above the market price—$25 for about 900 pennies. In those days $25 was a significant sum for a kid to have saved. My grandfather was both a practical man and a father who refused to favor any one of his five sons over the others. The surcharge would ensure that he wasn’t making an exception for my dad. My father, though, having sorted through the pennies, knew that one of them was a 1909 S, which was rare. He gladly paid the premium.

  My dad has always had a knack for successful investing, and he still looks at every penny he gets.

  In about second or third grade, I became interested in collecting coins. My maternal grandmother, Carol Creed Wells, or Gram, as we called her, had taken over and added to my father’s collection. I remember as a kid, when we’d go to visit, climbing four flights of stairs to her attic to see the coin collection. I knew the coins must be valuable to be hidden so deeply amid the rafters.

  Gram would buy unsorted “wheat” pennies for me to look through. Wheat referred to the reverse side of the penny, which had two strands of wheat. The penny was minted from 1909 till 1959, and so by the 1970s the wheat penny was somewhat of a rarity.

  There is a framed photo of Gram in the foyer of our house in Bowling Green that never fails to attract comments from guests. In it, she sits sighting a rifle in the crook of her shoulder. A row of carbines is seen in the background. The picture was taken in the 1930s at a shooting range at Ohio University, where Gram was a member of the rifle team. A stand for women’s rights and the Second Amendment all in one photograph—I love it!

  As a child, I spent hours with Gram. I’ve always felt very comfortable with older people, and my relationship with my maternal grandmother is one of the reasons why. Together, we’d pore through piles of change looking for mint marks while she told me stories. One of my favorites was of my maternal grandfather, who climbed in an open window of her dormitory one night at college when he was her beau.

  As the months and years went on, however, Gram’s sight began to dim. Soon we were spending our time together at the ophthalmologist’s office instead of sorting coins. First she had her cataracts removed, then her corneas replaced, and finally she received the sad news that macular degeneration had irreparably damaged her retinas.

  The study of corneal transplant research at Duke led me to my specialty, but it was the memory of Gram’s dimming sight that cemented my decision to become an ophthalmologist.

  Love Story

  It’s funny, but when you start looking back at life, the events that seemed so disconnected while you were experiencing them suddenly fall into perfect order. After I graduated from Duke Medical School in 1988, I took six months off to help my father campaign for the presidency. I traveled the country, mainly speaking to college crowds. Then, in January 1989, I began my general surgery internship at Georgia Baptist Hospital in Atlanta.

  One Saturday afternoon, in April of 1989, I went to an oyster roast at a friend’s house. When I walked out to the sunny backyard filled with twentysomethings eating, drinking, and socializing, I never imagined that I would meet my future wife that day. While I’m not always the most outgoing person, that spring afternoon something was in the air. Life is full of serendipity; you just need to recognize it when you come upon it. Sometimes the best discoveries are not only what you find, but what finds you.

  The day I met Kelley, she had come to the oyster roast to meet a guy she was seeing on and off. To my good fortune, the soon-to-be ex-boyfriend was called away from the party—a friend of his was involved in some type of fender bender, I think. I was standing by the keg pouring myself a beer when Kelley and I first spoke. It was a brief encounter. Kelley didn’t seem overly interested in me, much to my disappointment.

  She later told me she thought I looked so young she figured I was still in college and, at twenty-five, she had no desire to meet an undergrad.

  That evening, standing in the noisy, crowded kitchen, I found another chance to speak with her. Kelley told me she was working as a marketing communications manager for Sprint, the telecommunications company. A few years before, she had graduated from Rhodes College in Tennessee, where she’d majored in English. I’d taken many English classes in college and am a great fan of literature. I love the novels of Dostoyevsky and the short stories of Hemingway.

  I tried my best to woo her with literature and wit, anything I could possibly think of to keep that dramatic, smart, and beautiful girl in the blue striped sundress from walking away again. We talked for a couple of hours and then I surprised myself with my boldness. I leaned over and gave her a brief kiss. We still laugh about it sometimes, since it was so out of character for me. What else can I say? I was already in love.

  I asked for her phone number but didn’t have a pen to write it down. I promised that I would remember it. Kelley half rolled her eyes. What were the odds that I would remember, her expression read. But I wasn’t about to forget that number. I called her the very next day.

  The following May, I invited Kelley to take a trip with me to Roan Mountain, North Carolina. We packed a picnic lunch and found a beautiful spot surrounded by rhododendrons, with a view of mountains all around. At the time, I was finishing up my surgery internship in Atlanta and was about to begin my ophthalmology residency back at Duke. I would be moving back to Durham in a month. I knew Kelley wouldn’t move from Atlanta to Durham unless I showed her I was serious, especially since she quickly changed the subject whenever I tried to “casually” mention all the great companies in Research Triangle Park that she might want to look into.

  I had hidden an engagement ring in the picnic basket, which I’d purchased just the week before with the money I earned working as a locum tenems (the Latin term means placeholder) doctor in various small hospitals on weekends. I was praying hard she’d say yes, and it was one of the very best moments of my life when she did.

  We were married in Trinity Episcopal Church the following October in Kelley’s hometown. Tiny Russellville, Kentucky, which was named in honor of Revolutionary War general William Russell in 1798, has a colorful history. Jesse James once robbed a bank in the town, an event that is re-created every year on horseback during the annual Tobacco Festival. Homes in Russellville date back to the early 1800s, and four Kentucky governors have lived there.

  We were married in the evening and when our wedding party and guests stepped out from the storybook brick church, glowing paper lanterns illuminated the entire downtown street leading to the beautiful, historic Bibb House, where our reception was held. Once owned by Major Richard Bibb, a Revolutionary War officer and early abolitionist, the home was built in 1817 and is steeped in the Southern tradition. The white reception tent and lanterns, beneath a canopy of crimson maple trees, lit up the lawn in front of the grand home.

  Kelley’s bridesmaids included her college friends Brigid, Blair, and Meg, my sisters Joy and Lori, and Lally, Kelley’s childhood friend. My brothers Ronnie and Robert and Kelley’s brothers David and Jeff were groomsmen, along with my medical school friends George Ibrahim, Keith Ozaki, and Mark Goldberg. My dad was my best man.

  We lived in Durham for three years while I finished my ophthalmology residency. Kelley took a job with Nortel Networks in Research Triangle Park, North Carolina. We had a blast those three years. Most of our friends from the residency program were newly married as well, and we all had a lot in common. We’d go out to dinner in Chapel Hill, go on deep-sea fishing trips, and spend weekends in the mountains in Asheville. We were especially close to Phil Ferrone, a fellow ophthalmology resident, and his wife, Jeanine. The Duke men’s basketball team won back-to-back national championships during this time, and Phil, Jeanine, George and Stacey Ibrahim, Kelley and I, and others of ou
r ophthalmology gang watched just about every game on television together, and often went to campus afterward to celebrate the big wins.

  We were in our house in Durham with friends watching Duke vs. Kentucky in the 1992 NCAA men’s finals. With 1.4 seconds to go, Kentucky sank a two pointer to go ahead by one. At the time we were Duke fans (after twenty years in Kentucky and with two boys at UK, our allegiances have shifted), so we were all pretty dejected. We were sitting there silently on the couch during the timeout and suddenly the phone began to ring. This was before everyone had a cell phone, and Kelley walked into the kitchen to answer it, thinking there was nothing more to see in the game.

  Precisely at that moment Christian Laettner made his inconceivable basket, sealing Duke’s come-from-behind victory. Because of the phone call, my wife missed one of the most famous shots in college basketball history—maybe the most famous. To make matters worse, whoever was on the phone hung up without saying a word. A year later Kelley’s brother Jeff admitted he was the caller. A Wildcat fan, he had called a bit prematurely to razz us about Kentucky’s victory.

  During my residency, Kelley and I played on an ophthalmologist softball team called the Sy-Clops, named for fellow ophthalmology resident and team organizer Sy Maroi. Our uniform shirts featured a baseball mitt with a single large eyeball in the middle—gotta love that ophthalmologist humor! We had a great time and at the season’s-end cookout Kelley was awarded a kitschy baseball figurine for being the most improved player. She says it’s her only athletic trophy.

  Our newlywed years in North Carolina were very happy, and we made many friends who have stayed in our lives through the decades. Kelley comes from a military family, and she likened our experience to hers growing up—people linked together in a common cause.