Mid manhood

Starting practice

 My first office was in the Doctor’s building at 3707 Gaston Avenue, across from Baylor Hospital.  The building was demolished and is now rehabilitation hospital.  Dr. Claude Winborn’s office had been on the ground floor, as he was one of the early tenants.  It was too small to accommodate the both of us.  We relocated to a larger space on the 6th floor.  It was adjacent to Dr. David Reisman’s office.  I could hear his patients scream through the wall in one of my exam rooms.  It was the room where he performed cystoscopies.

 David became a good friend and advisor.  We had many conversations over many years.  I remember a particular conversation when he explained that we all wanted to be the “rider of the white horse” when we first went into practice.  We soon learned that we were all not cut out to be heroes.  He understood the realities of life that took me several years to learn.  I envisioned myself as a “superior” doctor who would publish and become famous.  That was a foolish dream.

 When I was first in practice I worked at Baylor, Methodist, St. Paul, Presbyterian and Gaston Hospitals.  I got patients from all over town, and many patients from outlying communities that had no ENT physician.  I got a lot of patients from Greenville and areas adjacent in east Texas.  Most of my patients were adults, and many were geriatric.  The life blood of an ENT practice at that time was doing T&As and myringotomies on children.  There were not many children in the Baylor area.  There were too many good ENT doctors in the suburbs for mothers to be willing to drive to the Gaston office.

Second location

 I was impatient and felt I needed to open a second office in a suburban location, mostly to try to attract more children to my practice.  I opened an office on Forest Lane, near Inwood.  My practice grew steadily, and after a few years, my accountant convinced me to close my suburban office, as the expenses were more than the income.

Third location

 Dr. Winborn’s long time friend Dr. Cecil Stell purchased a building on Junius that had been an ophthalmology office.  Cecil was the last of the EENT doctors in Dallas.  We moved to 4020 Junius in the summer of 1971.  My practice grew slowly but steadily.

Fourth location

 My friend Trevor spoke to me about a new office building that was being considered in North Dallas and encouraged me to think about relocating my practice.  Trevor’s office was on Garland Road and he wanted to move to a north Dallas location.  The new location was to be across the street from Presbyterian Hospital, and would include an outpatient surgical facility.  This sounded good to me and I got on the band wagon. 

 Mr. Bob Wright, who was the administrator of the Southwest Clinic, was the main person involved.  He was looking for a new location for the clinic, as the Medical Arts building downtown was soon to be torn down.  I had met Bob earlier when I visited the clinic looking at their computer system.  I wanted very much to install a computer in my office, but at that time, the systems were way too expensive to consider for a small office.

 The financing for the proposed office across from Presbyterian did not finalize.  Mr. Wright then found a new “partner” in Trammel Crow, and they developed Medical City Dallas.  I moved to the new location when it opened.  Dr. Winborn did not want to consider relocating, so we dissolved our association.

 I shared a waiting room with Dr. Mabery, and we were on the ground floor in an office just off the lobby of the building.  It remains the only physician’s office in this location.  I worked there until I left practice in 1991, a story to come later.

 While I practiced in the Baylor area, I became friends with Dr. Marvin Sheppard.  He was an otologist who had a large and successful practice.  He also had significant health problems.  He had malignant hypertension, a ruptured peptic ulcer and lost some of his vision before his pheochromocytoma (a functional adrenal gland tumor) was diagnosed.  Shep was forced to leave his practice due to his health problems, and I fell heir to a large part of his practice.  Shep had been heir to the practice of Dr. Louis Adin, another otologist who had been killed in a Braniff plane crash in 1968.

 When I relocated my office to Medical City, I tried to limit my practice to otology.  It proved to me not successful, and after a year or so, I returned to a general ENT practice.

 I performed the first ENT surgical case at Medical City in the fall before I moved into the new office.  I enjoyed working at Medical City, as they were very responsive to the needs of the medical staff.  For one thing, the hospital furnished all the surgical instruments that were needed.  During my time working at Gaston Episcopal and Baylor Hospitals, I was required to furnish my own instruments.  I also had my own surgical scrub nurse for most of that time.  Having your own nurse was not necessary at Medical City.

Life changes

 Dramatic changes in my life all occurred within a very sort time span.  My first marriage ended in 1973.  I remarried on October 2, 1974.  I moved to a new office in November 1974.  We moved to a more permanent home in May 1976.  We moved again in May 1977 again November 1977.

 There are changes that are recognized as major life events.  Death of a parent, child or spouse, divorce, changes of jobs, change of home.  As I learned the hard way, a divorce was more difficult than a death, as the spouse was still there.  My divorce was and still is the most catastrophic event in my life so far. 

 My divorce left me financially in pretty sad shape.  I had no assets other than my mortgaged home and my retirement plan.  As it was not possible to divide my retirement plan with my wife, what few liquid assets I had, including the home, went to her in the settlement.  To pay my debts to her, she agreed to a contractual alimony settlement.  As I remember, that lasted for ten years.  I elect to say no more about this part of my life.  I can say that my relationship with my first wife is better now than when we were married.  She required more attention that I was able to provide trying to get through medical school and work several jobs a the same time.  I was also busy trying to establish a medical practice.     

 My remarriage was to Jane Wright Wood, an audiologist who had worked in our practice.  After my divorce, we learned that each of us had been in an unhappy marriage.  After a considerable period of courting, we got married.  I was very hesitant about re-marriage, as the first had been so unsuccessful and left me with much pain.  The most pain was the separation from my children who I loved very much and wanted to be a part of their lives.

 My marriage to Jane was the best thing that ever happened in my life.  My only regret is that she was not the mother of our children.  We celebrated our fourtyseconed wedding anniversary October 2, 2016.

 My practice continued to develop slowly, but I was convinced it needed to be relocated.  In the Baylor area, the practice was mostly adult in nature.  I felt I needed children in my practice to help it grow. 

 The move to Medical City was a good one, even though it was almost like starting over.  I lost most of my referral base.  The doctors at Medical City were mostly younger than I and had their own referring patterns.

New opportunity 

 Just before my move to Medical City, I was approached by another friend, Dr. Michael Glasscock.  He wanted me to join him in practice.  Mike had taken a fellowship in otology at the Otologic Medical Group in Los Angeles, and returned to his home town Nashville to practice.  He needed someone to practice general ENT and to help him with his practice.  He had become very busy and well known, attracting patients from all over the country.

 I visited Mike and took along my long time friend and former college roommate, Wayne Gillies, to look at the situation and help me make a decision.  I wanted it to be a business decision.  I was very flattered by the offer, but decided to stay in Dallas.  By the time of this offer, I had fallen in love with Jane and did not feel comfortable about leaving my children behind in Dallas.  I wanted to be a part of their lives as they grew up.  This turned out to be a good decision.  With Jane’s help, our relationship with our three children is very good.  I think Jane has a better relationship with them than does their biologic mother.  We continue to have an active part of their lives.

 We have often wondered what would have happened had we moved to Nashville.  Mike Glasscock has remained a very good friend, and later became an internationally known otologist.  He is now active in various business affairs and lives in Austin, Texas.  We are in frequent communication.  Mike is having trouble with his memory and now lives with his daughter Tina in Asheville, North Carolina.

 One decision I made with the relocation was to give up major head and neck surgery.  My good friend Lewis Raney was interested in this type of practice, and became one of the specialists I referred to on a regular basis.  I also thought it would be a good time to limit my practice to otology, my first love.  I learned pretty quickly that there was not enough demand for my otologic skills to be able to make a living.  After about a year, I gave up and rebuilt my general ENT practice.

 The next few years of practice were productive.  Dr. Mabery added Dr. Dan Dansby to his practice.  Our practice continued to grow.  My relationship with Jane continued to get better.

Jane's parents

 Jane’s parents, Bill and Juanita Wright, lived in Artesia, NM.  She moved there when she was twelve from her home town Hobart, OK.  Several of their friends had summer places in Cloudcroft, NM, and they purchased a travel trailer permanently located on a spot in a beautiful setting just east of town at the Chalet Camper Village.

 We visited Jane’s folks often.  We visited them at Cloudcroft, and we liked the area very much, but four people sleeping in a small travel trailer was too much.  A mobile home became available, and we joint ventured the purchase with the Wright’s.  We spent many enjoyable days with them in this new location.

 Bill Wright was as fine a man as I have ever known.  He managed the co-op feed mill in Artesia for many years.  The mill treated him very poorly, and laid him off without any retirement benefits when he was 62.  Nita continued to work at her job with the New Mexico Oil Commission.

 As the years went by, it became obvious that health problems were occurring with both of her parents.  Bill had a stroke that left him with a leg and arm weakness.  Nita’s memory was failing fast.  The final blow was when Nita told Jane she did not know the old fat guy she was living with, but she wasn’t going to feed him any more!  Shortly afterward, they moved to a retirement home in Carlsbad, New Mexico.  The started out in the assisted living unit, but it quickly became apparent to everyone that Nita would not do well in this environment.  She was a wanderer, and she was found at night, walking on the highway headed out of town.  She frequently said she “wanted to go home.”  We learned this is a frequent situation with Alzheimer’s patients.

 Nita was moved into a part of the home that was able to contain her.  Bill stayed on in the assisted living unit where he could get his meals in the cafeteria.  He could visit Nita easily after a short walk.

 This was a rough time for Jane and me.  Jane made many trips to New Mexico to look after her parents.  She sold their home in Artesia to some neighbors completely furnished and very quickly.  It was a nice place and maintained very well.  Jane took a lot of abuse from her dad, as he blamed her for them having to move to the retirement situation.  She took it well and understood this too was a common occurrence.  I think the complaints were less after Nita moved into the locked unit.  Bill was very protective of her, and did not want to admit she was having major memory problems.

Changes in medicine

 It was during this time I began to think more about a change of my life and practice.  I was becoming more skeptical that private practice would continue to be good.  There was more and more talk about a “single payer system.”  I was worried about getting sued.

 I had one malpractice suit during my practice, and except for my divorce, it was the second most traumatic event in my life.  It happened during the time I was single.  I got a call from a man about 11:00 PM one night.  I had never seen him or his wife before.  They were referred by an orthopedic surgeon friend, Dr. Ted Bywaters.  He explained that his wife had an ear ache.  I agreed to seem them the first thing the next morning.  As I look back on it now, I should have referred them to the emergency room.

 I saw the lady, and she did indeed have an ear infection.  She had fever, and was in great pain due to pressure in her ear.  I performed a myringotomy to relieve the pressure and obtain material for a culture.  She was allergic to penicillin, and I started her on oral erythromycin.  She was to call me if she had more trouble.  I got a call about 4:30 PM the same afternoon.  She was vomiting and was unable to keep her medication down.  I suggested she be admitted to the hospital and made arrangements for her to come to Baylor Hospital.  I went to the hospital and waited for them until about 6:30 PM but then did not show up.  I left orders on the ward and went home.  I did not learn that she finally showed up until I got a call from the hospital about 6:00 AM the next morning.  They said she was unresponsive.  I immediately went to see her.  It was clear that she had meningitis.  I placed a call to Dr. Alan Naarden and spoke to him on the phone and explained the situation.  Dr. Jack Edwards were her family doctor, and I talked to him as well.  I returned to see her at noon, and Dr. Naarden had started her on IV Chloromycetin.  This came as a great surprise to me, as it was a wonderful antibiotic, but others had been sued because it caused aplastic anemia in some people.  I did not know it was the antibiotic of choice for people who were allergic to penicillin.

 The patient never responded to treatment, and died after about two days.  I felt badly, but also thought I had done everything I could have done for her.  At that time, 50% of people with pneumoccal meningitis died, irrespective of treatment.

 Within a short time, I got a call from Mr. Bruce Crim, my Medical Protective agent that I was being sued for malpractice.

 I was devastated.  There were several meetings and one I remember when I attended when the prosecution had scheduled a meeting with a doctor of infectious disease.   He felt there had been a delay made by the hospital in getting the IV antibiotic started.  Dr. Naarden ordered it, but it was a few hours before it got started.

 After much worry, the case was settled by my insurance company for $10,000.  They had sued the hospital, Dr. Edwards and me.  I wondered why Dr. Naarden was not named in the suit, as he had the primary responsibility for the care she received.  I learned many years later that Dr. Naarden served as an expert witness for the prosecuting lawyer!

 That experience left an indelible mark on me for the remainder of my life.  When I was in private practice, I was very careful with every patient and wondered which one would sue me.  It was one of the reasons I thought about leaving the private practice of medicine.

 The other factor was the development of  “managed care.”   There was a new HMO in town, and I signed up as one of their doctors.  I also signed up for the PPO that Baylor organized.  I had experiences with both organizations that helped me decide to leave practice.  The HMO referred a child to me with chronic secretory otitis media.  I recommended she had an adenoidectomy and bilateral myringotomies and tube insertion.  I spoke to the young pediatrician asking her “permission.”  She said she was trained in her residency that there was no need for a child to have an adenoidectomy for this problem.  She only approved myringotomy and tubes.  I had a meeting with the child’s mother and she agreed to my recommendation.  I did the adenoidectomy and put tubes in her ears, but did not charge the insurance company for anything but the myringotomy and tubes.  The child did fine.  I decided that managed care was eventually going to get me into trouble when a pediatrician could make surgical decisions that were not correct for the patient.

 I had another event about the same time, this time with an adult patient.  I had a young woman about 25 years old who had two or three episodes of peritonsillitis with impending peritonsillar abscess.  I recommended that she have her tonsils removed.  I had to get “permission” from the Baylor PPO medical director, who I knew and was a gastroenterologist.  He said he knew of no reason an adult patient ever needed to have a tonsillectomy.  I suggested to him that I would hate for him to have to make such a statement in a court of law.  He took offence and asked me to resign from the PPO.  I did resign, but only after I took the lady’s tonsils out, again at no charge to the insurance company.

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