Hugh Young — One resident's view

HISTORY

ONE RESIDENT’S

HUGH YOUNG JAMES Durham,

H. SEMANS,

VIEW

M.D.

North Carolina

The seven years I spent on the urology house staff at the Johns Hopkins Hospital were above all seven years of Hugh Hampton Young (Fig. 1). He was a man greatly admired by my father, and subconsciously this may have had a profound affect on my decision to specialize in urology. At first, I knew him only as a man highly esteemed by his patients and recognized as a leader in his field. He was a charismatic figure with boundless energy, always impeccably dressed, rimless pince-nez carefully balanced on his nose, who delivered lectures with a verve and enthusiasm that was infectious. After my interview with him in 1937, he left me stimulated and excited knowing that working with him could only be an enlightening and broadening experience.

Doctor Young wrote introductory letters for him to the leading urologists in seven countries in Europe. He did the same for me ten years later. His ego Hugh Young had an enormous ego. On some subjects, such as etiquette and ethics, he would

Born to Lead Hugh Young influenced all who came in contact with him in one way or another, but his influence on his house staff knew no bounds. He molded our professional personalities like putty; we became his alter ego. He demanded innovation, perfection, and accuracy; and if he did not get it, he would revert to calling us “Doctor Semans” or “Doctor Alyea,” instead of “Jimmie” or “Ed.” But together with this he was a natural teacher always constructive with well-directed criticism. He would fill us with confidence; anything he could do, he made us think we also could achieve. When we reached a high standard of competence, he rewarded us with responsibility and autonomy. He trusted us implicitly with the patients, never completely putting them out of his mind when he left the hospital, yet confident that they were well cared for. Doctor Young cared for us, too, following our careers carefully and opening doors for us at every proper opportunity, always contacting the top person in the field. My friend and colleague, Doctor Edwin P. Alyea, who also studied under Young as a resident in the 1920s remembers that

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FIGURE

1.

Hugh Hampton

Young.

not be challenged. Always on stage, he was an eminent showman who aspired to put on clinics for visiting surgeons. All that was missing in the operating room on these occasions was background music. Ed Alyea chuckles as he remembers one such occasion when he had draped the patient to be operated on for bladder surgery. Doctor Young made his entrance into the operating room and, mistaking the draped patient’s

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head for his feet, proceeded to make an otherwise accurate incision in the wrong direction. When Ed pointed this out, Doctor Young, without raising an eyebrow, turned around and calmly reversed the incision. Remarkably, he never lost his temper in the operating room in a generation of surgeons who were famous for doing so. He never raised his voice, but in his frustration would sometimes stroke his balding head and turn purple at the nape of his neck. On a particularly complicated case, and one of the rare occasions of death in the operating room, he gathered his audience together, drew a sketch of the operation and labeled it “A Tale of Errors. H. H.Y.” He was ashen gray; but he was not one to dwell on failure and returned to his dapper self the following day. His position as a leader in his field was not entirely by accident. He took care to attain the

FIGURE 2.

Reading from left to right: Robert McKay,

and Chester

Keefer.

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highest echelons in everything he did; his ego demanded it. He became one of the worlds foremost urologists by traveling all over to meetings and conventions (Fig. 2). He raised himself above others by learning enough of such esoteric languages as Greek and Italian to be able to deliver lectures in them. He had an eye for the newsworthy item, and his name would appear on the front pages of newspapers with famous patients such as Woodrow Wilson and Diamond Jim Brady. He had the best surgical illustrator in America working for him, William P. Didiisch, whose illustrations could only be a credit at lectures and conventions. Although well written and carefully documented, the fact that his book, Hugh Young: A Surgeon’s Autobiography, became a New York Times’ best seller was not entirely an accident

W. W. Scott, Hugh Hampton

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tion. These courtesies emphasized his dedication and never failed to produce more demand for his services. A notable contribution to urology and to medicine in general came from Hugh Young’s wholehearted support of research in the days when the medical profession was directed more to curing sickness and disease than to preventing it. I remember being taken to the DuPont Research Laboratory in Wilmington, Delaware, to observe experiments with the chemical betanaphthylamine, occurring in the manufacture of aniline dyes. The laboratory had discovered that beagles dosed with this chemical contracted cancer of the urinary bladder. Research such as this began the long, hard road toward prevention and cure of cancer that we still tread today.

either. The publisher, Mr. Harcourt, was a grateful patient, and the Times’s critic was entertained lavishly for a week end at Mr. Harcourt’s home on Gibson Island, Maryland, shortly before the book was released. Doctor Young was immensely proud of this book and took great care in the writing. The book itself caused an uproar at Hopkins because it was the first time medical illustrations of any kind had appeared in a lay book, let alone illustrations of socially unmentionable parts of the body. But Young believed that the public had a right to be educated. When the manuscript was completed, he sent it to his friend and ex-patient, the celebrated writer H. L. Mencken, asking for a candid opinion. Mencken wrote back saying that he would not change one thing in the book. Doctor Young carried this letter with him in his inside coat pocket and would produce it at every opportunity. He took it out so often that it finally fell apart.

His famous patients

His contributions to medicine His eminence, however, was definitely well deserved. He earned his fame, not only by his skill but by his inventiveness. His gift to urology was innovation, both in performing operations never before performed and in inventing instruments to aid in those operations. As Ed Alyea says, he was a brave surgeon who would elect surgery “where angels fear to tread.” Young would dare to do a more extensive cancer excision and the challenge thrilled him. His critics judged him harshly for what appeared to be dangerous or unnecessary surgery, but the lack of available information in those days justified his pioneering spirit. He did not have the information available to him that we have now. For us, his house stalf, it was both instructive, if a little perturbing, to stand by and watch our teacher perform operations never before performed. If we observed sceptically and without empathy on occasion, we often erred. He was an extremely thorough doctor who emphasized doctor/patient relations. In fact I think the ability to relate well to patients was a prime factor when he chose his house staff, He always insisted on well-written and comprehensive histories on all patients and, in particular, on articulate and complete discharge summaries. After every operation he would take the time to sketch for the patient’s family exactly what the operation had entailed. He would also, within the hour, telephone the referring physician or family doctor and give a complete report of the opera-

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Hugh Young’s reputation as a leader in his field brought him many famous patients, two of whom have already been mentioned. Diamond Jim Brady, a diabetic, grateful for a simple operation relieving his prostatic obstruction where another urologist would not dare to operate, donated the money for the Brady Urological Institute at the Johns Hopkins Hospital. A lasting friendship developed between these two high achievers, and Hugh Young found constant inspiration from the success-oriented tycoon of railroad supplies. Another famous patient was Woodrow Wilson who was incapacitated by a cerebral accident while in office. Doctor Young was called in when the President had gone for thirty hours without voiding urine. His abdomen was hugely distended, and he lay there in the White House in great discomfort. Every known kind of catheter had been applied without success, and the situation was becoming desperate. Doctor Young knew that the President could not stand an operation in his condition. He remembered his experiences with paralyzed bladders in the Army during the War and guessed that the bladder neck would eventually relax of its own accord and the President would be able to relieve himself. He therefore took his time returning to the White House on this occasion, driving around Washington in the White House limousine, admiring the sights. Indeed when he arrived at the White House, nature had asserted herself - the sheets were wet. In 1937 I remember that Doctor Young was able to persuade a man who swore he would never travel by airplane to fly back to Baltimore with

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him for surgery. This man was Don Rafael Martinez Nadal, President of the Senate of Puerto Rico and highest ranking native officer. Doctor Young flew to Puerto Rico when President Nadal’s own doctors had given up hope and pronounced him a dead man - an overdose of morphine had almost eliminated respiration. When the effects of the morphine had worn off, Doctor Young convinced Nadal that he could save him. In Baltimore he performed a conservative perineal operation to remove the cancerous prostatic obstruction. The operation was a success and gave President Nadal almost two more years of life. It was a tremendous triumph, and Nadal lived to lead his Senate back into session in 1939. Another celebrity Doctor Young treated was Senator Borah whose spartan existence as a senator gave him the reputation of being the “great commoner. ” In an error of judgment perhaps, Doctor Young charged Borah a high fee for the operation, for which he had had to cancel a European trip. This mistake brought him a deluge of complaints and many angry remarks from his internecine critics. His generosity Doctor Young did have a reputation for charging astronomic sums to those he considered able to afford them, and whenever possible he would persuade wealthy patients to give gifts or endowments (no mean task in the days when such generosity was not tax deductible). But he also operated on indigent people without charge, especially in unusual or challenging cases, out of pure surgical motivation. In 1943, my last year as a resident, he helped me with a poor black patient with pheochromocytoma producing paroxysmal hypertension and diabetes. He assisted in the operation and thus shared the responsibility. The operation was a success, and he would not even accept a by-line when it was written up. He was an extremely generous man. He always treated his house staff well, taking them to the theater and opera and paying the expenses. In Ed Alyea’s day residents did not get paid and Doctor Young presented his residents individually with $500 from his own pocket at the end of their residency. I remember when the late Doctor Wyland Leadbetter was resident, he had symptoms of arthritis in his hands - a surgeon’s nightmare. Doctor Young sent him off on vacation, paying all the expenses. All Wyland needed was a rest, and after that his arthritis did not bother him and he was active in surgery for more than thirty years.

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His boundless interests Doctor Young’s energy appeared to know no bounds and never ceased to astound us. The fact that one man created at the Brady Urological Institute a medical unit complete with research facilities, a record library, fiscal accounting, a national journal (The Journal of Urology), an instrument shop, examining rooms and x-ray facilities, as well as a medical artist and a photographer, is hardly less than miraculous, Of course it was merely part of his style to produce a collection of distinguished guests from all over the world for the occasion of the opening of the Brady Urological Institute. In so many ways Doctor Young was the original renaissance man whose days only began in the hospital. His interests and skills overwhelmed me sometimes, and he encouraged us always to broaden our sights. He was chairman of the planning committee for Friendship Airport near Baltimore and was an air passenger at every opportunity. He had a passion for opera and became actively involved with the Metropolitan Opera in Baltimore. At one time he stayed up all night long, two nights in a row, to raise money to buy the Lyric Opera House so the Metropolitan Opera Company could still perform in Baltimore. His activity in politics led him to become chairman of the nominating committee to nominate the Governor of Maryland, Albert C. Ritchie, for President. Doctor Young went to Chicago himself to nominate the Governor and was extremely disappointed when Ritchie was defeated. Anything new or innovative fascinated Young, whether in surgery, government, or even in the home. Ed Alyea remembers the day that the Hindenburg airship (the first inflatable hydrogen dirigible) made its maiden flight across the Atlantic. As it flew over Baltimore Ed recalls that he and Doctor Young were in the basement of the Brady Clinic. Doctor Young, then in his fifties, in his hurry to get to the roof of the hospital to witness the event, raced up the six flights of stairs with Ed trailing along behind. He could not wait for the elevator. On another occasion Doctor Young took all of us to listen to the first recital of a new musical instrument, the theremin, which was the first instrument to experiment with electrical waves - a forerunner of the synthesizer used widely in jazz today. His fertile mind was fascinated by this innovation and its potential in the musical world. The innovation could be quite humble and not lose its fascination for Doctor Young. When he

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came to Durham for a visit to Duke he stayed with Ed Alyea who was then professor of urology at Duke Hospital. One morning at breakfast at the Alyea’s house in Hope Valley, Ed recalls that Doctor Young was absolutely thrilled by the then new pop-up toaster, a fairly new domestic innovation, and resolved to get one for his own kitchen. His humor

In his day urologists as a whole tended to have a rather bawdy sense of humor. It is the nature of their work; it takes away the strain and anxiety often associated with the sexual organs by their patients. Doctor Young was no exception; he loved a good lewd joke and would use his humor professionally to his patients for their comic relief. Some considered him outrageous and shocking, and we can hardly be surprised. When I was a resident, he attended a medical convention for eminent doctors held on board a ship. At a fancy dress party one night he appeared dressed in a woman’s low-backed evening dress, reversed so it revealed his navel. His wit was very quick and repartee remarkable. On the occasion of the unveiling of his bust in Charlottesville, a woman approached him and said, “I have driven two hundred miles just to see your bust,” to which he replied “Madam, I would drive a thousand miles just to see yours!” He met his match in a young opera prima donna, Ed Alyea tells me. At a party Doctor Young and his elderly colleague “Popsie” Welch were talking to the young diva and Doctor Welch, admiring her decolletage, asked the lady what kept the dress on, to which she replied, “only your age Doctor Welch.” Doctor Young was very fond of relating this story. Up until his death Doctor Young always had a sense of humor, and he championed the hedonistic approach to life. He thoroughly enjoyed a good party where he was usually the center of attention; and with his death died a unique kind of festivity. This hedonistic ideal may have been his exodus. In the summer of 1945 (his last) he went to a medical convention in Atlantic City, New Jersey, where he gave a couple of lectures and attended an inordinate number of cocktail parties, luncheons, and dinners, as well as a beach

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party. It was too much for him and one morning, in the small hours, he suffered a heart attack. But this did not deter his zest, and he spent five hours the following afternoon on a fishing boat, stripped to the waist in the hot August sun. The same evening he suffered another heart attack. When he arrived in Baltimore five days later he was so exhausted he decided to enter the Brady Urological Institute at once. As they brought him in in critical condition he said, “I just had too good a time!” After what appeared to be a remarkable recovery, he died suddenly in his hospital bed. He had had a series of heart attacks in the past but we never really knew how serious they were, nor how ill he was. We used to joke privately that he merely needed the time to editorialize, for when I was on his house staff he had been in bed for two months with a particularly painful herpes zoster and had used the time to dictate his autobiography. After he died, however, the autopsy showed that both kidneys were filled with stones, gall bladder also filled with stones and ready to rupture, as well as an early cancer of the prostate. His own radical operation was obviously contraindicated. This remarkable man has probably had the greatest lasting influence on my life of any one person. He was my professor and I his resident. The seven years on his house staff were some of the most memorable and remarkable, but not always the easiest years I have spent. Breaking away from this charismatic figure was not easy either. It took several years to be “de-Younged,” to decide what of his to adopt and what to put aside. It was a personal triumph to go into the Army and to make my own concepts and contributions to the medical profession away from him. Now, so many years later, I can look back only with gratitude and admiration toward one of the real pioneers of medicine I was lucky enough to know. Duke University Medical Center Division of Urologic Surgery Durham, North Carolina 27710

ACKNOWLEDGMENT. To William P. Didiisch and Edwin P. Alyea, M.D., for their helpful suggestions.

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