Thomas Starzl Interview (page: 6 / 8) Father of Modern Transplantation	Print Interview

From what you've said, it sounds like confidence in surgery grows with experience, and that confidence, in turn, allows you to take risks and gain more exeprience.

Thomas Starzl: That is absolutely true if you're in surgery, because you have to make decisions. Sometimes if you're not confident, you can reach a Y on the road, and there's an easy one that goes to the left that can be taken if you simply pronounce the objective to be unachievable. That's kind of a chicken way out, if in fact you're dealing with a problem that might be achievable, but only with great risk to yourself, risk of failure and professional disgrace. So if you're confronted with that kind of decision on a frequent basis, you can't take the tough road unless you're confident.

You've also learned from experiences that might have been judged as failures. After you moved to Denver, you experimented with treating diabetes by rerouting portal vein flow around the liver using portacaval shunts. That didn't work with diabetes, but it led you to eventual successes with transplantation. How do you deal with these apparent failures at the time?

Thomas Starzl: In that particular instance the first thing that you have to do right up front is to announce -- to yourself above all, but other people have to know right away -- that this was a dumb idea. And that's where writing, sitting down and actually writing a paper -- not in a deceptive way, in a very straightforward way -- becomes important. I don't know how many papers I've started pretty convinced of what a big boy I was and then, in the course of writing the paper, every word that is going in a false direction gives you heartburn, and it forces you back along lines of integrity. But that's just about a rather distant step down the line. You were asking about failures. That's a quite interesting question, at least from my point of view, because...

Get the Flash Player to see this video. I never experienced any failures in life until I was fairly old, I mean until I was about 21 or 22, because everything had been so easy up to that point. I went through the Navy experience with no particular trauma, and going to school was easy, as I wrote in that book, because in order to get into the Navy with my parents' permission I had to skip a year of high school. No problem! Just go up and hire a few teachers and take the year in six weeks or so. So it was all easy, easy, easy. And then right around the age of 22, I woke up to the fact that I was going to have failures. I couldn't win all the time. It's kind of an experience that even the best professional athlete or boxer is going to have, discover somebody was smarter, stronger, out there somewhere, at least as it affected wherever specific enterprise was involved. So that's a bitter lesson. I learned that probably in my early twenties. Once you accept the fact that you can't always win, but you can always try, was an important turning point. I'm sure that because things still were pretty easy, and I advanced through life at a rapid rate, I always had that uneasy feeling that I didn't really deserve all this, that in some ways I was just a pretender with the shiny veneer, but without substance beneath. If you were to talk seriously to just about anyone who has done anything important you'll find that this concern, at some time, in many had a dominant force, and just trying to learn what your own true worth is. I think you keep pushing at that envelope maybe until you're 60, or maybe until you're 85. I don't know.

[ Key to Success ] Perseverance

You took a reduction in your personal income from private practice in Chicago to come to the University of Colorado. What led you to this decision? Did you see greater potential for advancing liver transplantation at this facility?

Get the Flash Player to see this video. Thomas Starzl: I didn't see how you could do transplantation in Chicago in any facility with which I was affiliated at the time. The teaching hospitals were all bread-and-butter private hospitals, Passavant and Wesley. I don't know whether you know the Chicago system, but Northwestern had at the time only two full-time members in surgery, was not at that time committed to research of one kind or another. So I was kind of a loony, and the people in private practice regarded me as a competitive threat, so they did everything they could to keep me out of the hospitals. And if you don't have a strong presence in the hospital it's foolish to think that you can ever bring anything from the lab to the hospital. I had a protocol to do kidney transplantation at the Cook County Hospital, which was a carefully thought out one. I went away on a weekend, for some reason or another, came back to find that all the people that I had gathered together to do this thing had run off and done one and messed it up so badly that there would never be another one done for years. So it just didn't seem like a place where the overall game plan or long-term plan for development was consistent with what I wanted to do.

Get the Flash Player to see this video. I was exhausted by the life that I was leading, which -- I had left those mainstream hospitals, the society hospitals and had got practice privileges in a Northside hospital called Lutheran Deaconess Hospital, where the Sisters and the staff were willing to start cases at five in the morning, so I could do surgery and be out of there by nine o'clock and be in the lab and have a full day. But then, by having patients out there at the end of the day, I had to go back and make rounds, and I found myself getting two, three hours of sleep at night, if I were lucky at all. I was thinking at the time that I probably wouldn't make it to the age of 40, unless in some way I changed everything. So there's nothing noble about that, or mysterious. I couldn't conceive of getting done what I was supposed to do.

When you made your move from Chicago to Denver, there was a difference between the private practice of medicine and the work of full-time medical faculty in university hospitals. Has that changed over the years?

Get the Flash Player to see this video. Thomas Starzl: There was this wall between private practice as a way of life and academia, which is where the research ideas were played out, were drummed up and played out into reality and exported. The salary differential between the two sides of the wall was enormous. Like the last year I was in Chicago I was quite busy. I can't remember how much money I made, but it was a lot, probably in the range of four or five times as much as the salary that I settled for to go to Colorado. If I said it was $100,000 in The Puzzle People, which I may have done, that would be, I probably wouldn't have been so indiscreet as to have done that. But if I had, that would be a correct, an approximately correct figure, because I had debts that had been accrued during this long period of training. Those were all paid off, so I was debt free for the first time in my life by the time I went to Colorado. So it was an exercise that I could -- it was a gesture, in fact -- that I could afford to make. And I'm describing 1960, 1961. What has happened, in my opinion, is that that wall broke down, and the university became a competitor with the people that are in private practice, and in so doing contributed to what I think is a very unfortunate situation that exists throughout the country, in which health care became an industry and we -- I'm talking about the United States -- became the only country in the world in which health care became a venture capital industry. I believe that to be a disgrace and a tragedy. You need to censor my remarks, somebody might actually hear them!

Thomas Starzl Interview, Page: 1   2   3   4   5   6   7   8