A Wonderful Life

Was there a specific moment that piqued your interest in ophthalmology?
 

No. I simply went through doors that opened. When I went to college, I had no interest in going into medicine. The only reason that I went to medical school was because the interview I had at medical school was all about Goethe and Schiller; it was conducted in German and it seemed so wonderful. I thought, “Gosh, this would be great.” But that was not what medical school was about at all. As I was finishing medical school, I didn’t know what I wanted to do so I took a rotating internship. The University of Michigan was a tertiary referral center and so, on many of the rotations, it was just custodial care because the people were so sick. It was very discouraging. Towards the end of that internship, I took a rotation on ophthalmology, and it was just lovely – and clean. There were three faculty members – all wonderful, kind, caring people – who ran a small department. In ophthalmology, I was able to see people of all ages and I was actually able to help them. It was only after that experience that I decided to go into ophthalmology.

You famously set up a practice specializing in glaucoma at Wills Eye Hospital – how did that come about?
 

I didn’t want to go to the Korean War so I enlisted in the Public Health Service and was assigned to the National Institute of Health. When I got there, I was assigned to the field of glaucoma – so I never chose it; I suppose it chose me. When I went back to Philadelphia, I entered into practice with my father and my brother – both absolutely superb clinicians and wonderful doctors. After about three years with them – learning about how to be a doctor – I decided that if I wanted to use my glaucoma skills I should do it in a full time institution and I moved to Wills Eye Hospital. (I’ll add that my decision was influenced by the fact that both my brother and father smoked, and I didn’t like being in a smokey office!)

You say you are a product of those closest to you. How has your family shaped your career and life trajectory?
 

My father was a very bold man. He never went to college, he couldn’t care less for degrees, he was very courageous, he had been in the war. When he came back from WW1 he established a department of ophthalmology at Walter Reed, started a whole new way of doing plastic surgery, and was one of the founders of the American Board of Plastic Surgery. He was a real innovator, but he never took any credit for any of those things. He was improvisational, direct, enormously honest, blunt – and that honesty and courage very directly influenced me – and still influences me.

My brother, Philip, was a truly great surgeon, and very gentle with patients. He also influenced me because he was very thorough, very gentle, and meticulous with his surgery.

But probably the most important person was my wife, Anne, because she couldn’t care less for titles. She did not think of people as being worthy or unworthy because they were educated or uneducated, but rather that all people were worthy. She looked at each person as a unique, deserving individual and didn’t believe in comparing them. I remember her at one point chastising me. I had become a very busy surgeon and we had three clinical fellows on the glaucoma service at Will’s who had to see all the inpatients before they started on the outpatients, meaning they had to get to the hospital very early to make rounds. I remember one day Anne saying to me, “You don’t have any idea what education is about. Education is to lead forth, not to fill up.” And that’s just one example of how she was constantly modifying the way I thought about directing care towards a specific person in a specific setting at a specific time.

You place huge value in human interaction and connection. What could be gained in the field of ophthalmology, if doctors placed more value on hearing their patients?
 

I don’t think that it is so much an ophthalmic issue, it is how we are trained as scientists and as medical students to focus on standard distribution curves. If you’re in the middle – the mean – you are so-called “normal,” and that’s good. How do you get to that? Well, you measure the intraocular pressure, you measure all sorts of things. But what is a “mean” – in the sense of a mean average person? It is very hard to measure people. What science has done is look at symbols or representatives for the person. It measures your intraocular pressure and it says you have glaucoma. But there is no such thing as glaucoma. Glaucoma is simply a label – one that has changed its meaning drastically over time, depending upon what people want it to mean. The only real thing is the person.

I once gave a lecture at a well known university program and, at the end of it, the person who had invited me said, “Well, that was a great lecture, George, but we all know you can’t believe patients.” My whole lecture had been about how all care should be based on symptoms – on what patients say – and not on measurements of findings. Of course, we need those findings, but it is all directed on what patients say. But this view doesn’t fit in with the way we think about getting so-called objective information. We’re scientists.  We’re supposed to be in the business of facts. Well, there aren’t many facts. Everything is really gray. When it gets down to what’s really important to a person, they don’t care whether the value is 15 or 25, what they care about is whether their daughter has got pancreatic cancer or why they can’t walk quite as well as they would like.

If we focus on the individual patient, the patient responds and they make you feel wonderful – because they care for you as you care for them. This is hard to do in a busy practice where you're just trying to get through patients. How do you change this? By having trainees or people who work with you who see how you interact with patients and think, I think that’s pretty exciting, I’d like to work that way too.

You talk a lot about wonder, connectivity, and nature – why are these so fundamentally important to you as concepts?
 

They are not important to me as concepts, they are important to me as reality. Concepts are abstract symbols, but, when I hear a wood thrush sing, it’s not an abstract symbol – it’s something beyond belief in its beauty. I was fortunate enough to be raised in a situation where I was able to vicariously experience my parents’ wonder at beautiful things, marvelous things, good things. And so I experienced that too. But it’s not just people – we’re a pretty crummy bunch. It’s the wonder of existence – the wonder of life.

In an era of increasing specialization, you retain a reputation as something of a polymath – scientist, physician, and poet. How do you feel all of these things interconnect?
 

I’m not sure they do connect any more than everything connects with everything. I don’t think you need to be a poet to be a fine physician – and I think you could be a poet and be a crummy physician. I started writing poetry when I was six or seven years old. I memorize lots of poems – I can recite Shakespeare or Blake or Shelley or some modern poets by heart because the poems are still with me. I don’t think it’s really related to medicine in any way directly. It’s true that there’s an association between physicians and musicians – but I don’t know whether it’s anything more than just chance.

In your living memoir, you mention that Chuck Tressler said, “Your best work is yet to come.” Can you expand on this?
 

That was a very interesting comment by Chuck Tressler and it was similar to something my mother said to me. I was a very active boy, and she said, “I think you’re being saved for something special.” And I don’t think, to date, that I have properly made use of the great gifts I was given – not things that I did myself but the genes I was given, the educational opportunities I was given. I can’t take any credit for those. I’ve been very fortunate in my life and I’m still trying to find an answer to the question, “Is there something I can do that’s special?” But you never get there, you never reach that destination. It’s just a question of continually trying to do a little better than before – and hopefully making something of value.

If you could restart your career, would you do anything differently?
 

Our careers are only part of us. I remember when our middle child was about 23, he asked me a question: “Daddy, what kind of person are you?”

I said, “Well, I’m a physician, I’m a musician, I’m a poet, I’m a gardener.” I named a whole lot of roles like that. I thought it was sort of a stupid question. But then it sunk in. What kind of person am I? Isn’t that the most important question we all need to try to answer for ourselves? So that’s what I have been trying to answer and what I am still trying to answer. What kind of person am I and what kind of person can I become? Because, if i’m a good person, I’ll probably be a good physician because I will care.

So, I think the most important thing is not our career by any stretch – it’s what kind of people we are.