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Lazar John Greenfield, MD: An Interview With the Editor
Lazar John Greenfield, MD: An Interview With the Editor Lazar John Greenfield, MDa,*, and William Clifford Roberts, MDb,c,d
Lazar Greenfield was born in Houston, Texas, in 1934, and that is where he grew up. He attended public schools and then Rice University before graduating with honors from Baylor University College of Medicine in 1958. He trained in general and thoracic surgery at The Johns Hopkins Hospital from 1958 to 1966. During that period he also spent 2 years in the surgery branch of the National Heart Institute at the National Institute of Health. Following his training he went to Oklahoma City as Chief of the Surgical Services at the Veteran’s Administration Hospital at the University of Oklahoma Medical Center. He was named a Markle Scholar and rapidly ascended the academic letter to become a Professor of Surgery in 1971. In 1974, Dr. Greenfield moved to Richmond, Virginia, to be the Stuart McGuire Professor and Chairman of the Department of Surgery at the Medical College of Virginia, Virginia Commonwealth University. He remained in that position until 1987 when he became the F.A. Coller Distinguished Professor of Surgery and Chairman of the Department of Surgery at the University of Michigan School of Medicine in Ann Arbor. He developed an outstanding department of surgery which rose to the national ranking of No. 4 in research awards from the National Institute of Health. After 15 years as chair, he retired from that responsibility and was appointed Interim Vice President for Medical Affairs and Chief Executive Officer of the University of Michigan Health System from 2002 to 2003. He then took a sabbatical at the Center for Medical Devices at the Food and Drug Administration the next year. He retired from the university in 2004 but remained as a consultant to the Medical Products Surveillance Network. From 2004 to 2011, he was editor-in-chief of Surgery News, the monthly publication of the American College of Surgeons. Dr. Greenfield has been highly productive in his career having published 128 book chapters, and more than 404 scientific articles in peer reviewed journals, as well as 2 major textbooks of surgery. He has served on the editorial boards of 15 scientific journals and on an NIH study section. He is best known for his development of an intra-caval filter device to prevent pulmonary embolism and the device bears his name. He has received many awards, including the Rene Leriche Prize, the Roswell Park Medal, and the Jacobson Innovation Award of the America College of Surgeons. Annual research awards in his name have been established by the Humera Society of the Medical College of Virginia, and the Section of Vascular a Professor and Chair Emeritus, University of Michigan, Department of Surgery, Ann Arbor, Michigan; bExecutive Director, Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas; cDean, A. Webb Roberts Center for Continuing Medical Education, Baylor Health Care Systems, Dallas, Texas; and dEditor in chief, The American Journal of Cardiology and Baylor University Medical Center Proceedings. *Corresponding author: Tel: (520) 885-8692. E-mail address: [email protected] (L.J. Greenfield).
0002-9149/13/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.amjcard.2013.08.005
Surgery of the University of Michigan. He is recognized as an expert in vascular surgery and has lectured extensively in the USA and abroad. He has been elected to membership in 51 scientific and professional societies and received honorary membership in 9 additional organizations. He has served as member and then President of the Lifeline Foundation and chair of the board of the American Surgical Association Foundation. As a fellow of the American College of Surgeons he served on the Board of Governors, the Advisory Council for Vascular Surgery, and as Vice President and President-elect. He has been elected President of the American Surgical Association, the American Venus Forum, the Society of Surgical Chairs, American Association of Vascular Surgery, International Federation of Vascular Societies and the Halsted Society. He has been a director of the American Board of Surgery and has served as chairman of the National ACGME-Residency Review Committee for Surgery. In 1995, Dr. Greenfield was elected to the Institute of Medicine of the National Academies of Science. He has been designated a Johns Hopkins Society Scholar and has received Distinguished Alumnus Awards from Rice University and Baylor University College of Medicine. He has been happily married to his wife, Sharon, since 1956. They have 3 children and 8 grandchildren. His oldest son is Professor and Chair of the Department of Neurology at the University of Arkansas. Additionally, Lazar Greenfield is a great guy. William Clifford Roberts, MD (hereafter Roberts): Dr. Greenfield, it is a pleasure to have the opportunity to talk with you. Your lecture The Frank Kidd Jr., MD Annual Lectureship in Surgery was wonderful. Could we begin by your describing a bit of your growing up in Houston, your parents, siblings? What the atmosphere was like in your home growing up? Lazar John Greenfield, MD (hereafter Greenfield): I have no siblings. My mother was divorced when I was a baby and we lived in my maternal grandfather’s house. I grew up there. We raised chickens and pigeons in the backyard. When I was 6 years old, a squab fell out of the nest and was pounced upon by the chickens resulting in a lot of damage to its neck. I rushed over, picked him up and took him to my grandfather to see if he could help it. He looked at it and said, “We will eat him for dinner”. I said “Oh no, we have to save him”. He took a needle and thread, sewed up the neck of this little squab, and told me to take care of him. And I did. Eventually, I put him back in the nest and he grew up. I could always spot him because he never grew any feathers on the back of his neck. I was amazed that one could repair something back to health. That convinced me at an early age that I wanted to go into medicine and to become a surgeon. Roberts: What did your father do? Greenfield: I’m not sure. I never had any contact with him. He had been trying to start a filling station during the www.ajconline.org
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Depression, which was a tough time. They had gotten married in California and I think he went back to California. Roberts: What was your mother like? What was her name? Greenfield: Her maiden name was Betty Greenfield. She was very focused on education although she had been taken out of school in the sixth grade in order to work. She always wanted to get a higher education. Later in life she did go back for course work. She told me early on that if I wanted to be a physician I had to make good grades in school. She was a very talented pianist. Obviously, having me didn’t do much for her career. She became a legal secretary. Although she continued to teach piano she never performed again. She was a bright woman who I think could have done well in terms of her own education if she had had the opportunity. Roberts: She never went to college? Greenfield: Correct. She got a degree from the Houston Conservatory of Music and as a graduate of the conservatory qualified to take courses at the University of Houston This was when I was in high school. No one in my family had gone to college. I was the first one. Roberts: What did your maternal grandfather do? Greenfield: He was in real estate. He had immigrated from what is now Israel at the age of 19. He had a grocery store and when my mom was growing up she worked in the store. He branched out from that one store and got into real estate. He was a successful realtor. Roberts: What was your relationship with your maternal grandmother? You were the only youngster with 2 grandparents and your mother? Greenfield: My mom was one of 7 siblings, 6 sisters and 1 brother. There were other women in the home but I was the only child. It was a traditional middle eastern family. Roberts: How many lived in the house you lived in? Greenfield: At different times there were 2 or 3 of them in the home. The sisters got married and moved out as I grew up. Roberts: Did you have a room of your own growing up? Greenfield: From time to time. Roberts: What was school like? Grammar school, junior high, and high school? Greenfield: I enjoyed school. I got a little bored so they jumped me in grades. There wasn’t an enrichment program at that time so I was simply advanced. I was always 2 years younger than everyone else in class. That meant I had to learn to run fast because I usually got chased after school. Roberts: You were advanced? This happened in grammar school? Greenfield: Yes. Roberts: Were there any teachers who had considerable influence on you early on? Greenfield: When I got to junior high school, there were some teachers that took an interest in me, encouraged me to do projects, and helped me learn more about science. Roberts: Did you take to science? Did that come naturally? Greenfield: I loved it. I wanted to do research from an early ageeasking questions and finding out about things.
Roberts: You went to public schools? Were the schools close to your house? Greenfield: Yes. I walked to school. Roberts: Where did you live in Houston? Greenfield: I lived on San Jacinto Drive, which was in the MacGregor School District. It’s not there anymore but it was a good area to grow up in. There were other kids in the neighborhood but I was alone a lot and became somewhat self-sufficient. Roberts: Being 2 years younger than all your classmates, was that scary? Greenfield: It was educational. Roberts: When you got into high school, did you play sports or what were your activities? Greenfield: I liked sports. I was small in size so it was hard to play football, but I was on the ROTC team. I had a great time in high school. The age difference wasn’t as big a deal by then. My mother wanted me to get involved in performance activities, so I was a child actor. I was in several drama plays and that gave me access in high school to do things involving the variety shows as Master of Ceremonies. Roberts: You were a local celebrity? Greenfield: Not really. But I was popular. Roberts: Did learning come easy for you? Greenfield: Yes. Roberts: Did you read fast? Greenfield: I enjoyed reading. I read everything I could get a hold of. I was able to get books. My mother bought me adventure books and we had a set of encyclopedias. Money was in short supply so I had to get a job. I had one when I was 14 and got a driver’s license early. Roberts: When you were 14, what grade were you in? Greenfield: I was in high school as a sophomore. Roberts: You graduated from high school at 16? Greenfield: Yes. I got into Rice University. At the time Rice was an institute with essentially all scholarships once you got accepted. It cost me $25 a year, an activity fee. I was very fortunate. I continued to work at a grocery store as a checker through college. Roberts: Was that just on the weekends? Greenfield: No, I worked during the week as well. Roberts: Did you consider other colleges or was Rice the only choice? Greenfield: It was my only choice. We couldn’t afford for me to go anywhere else. Roberts: Did you live at home during college? How far was Rice from your home? Greenfield: By that time, my mother had wisely taken advantage of her real estate upbringing and got us into a duplex, and then a home located fairly close to Rice University. I was able to go by either bicycle or walking every day. Roberts: It was still just you and your mother? She never remarried? Greenfield: She did but after I had gone off to medical school. Roberts: Did you and your mother get along well?
Interview/Lazar John Greenfield, MD
Greenfield: Yes. It was a good upbringing. I had some unruly episodes growing up, frustrated by having to work all the time. Early on I got sent to a ranch in West Texas for “attitude improvement”. That was a good experience. Roberts: How old where you then? Greenfield: I was about 13. Roberts: What do you mean by “unruly?” Greenfield: At the time I was rebellious and my mother was having difficulty with me. She was working and didn’t want me to be alone in the summertime, so she sent me out to this ranch in West Texas. Roberts: That was summertime? When you were living with all your aunts and grandparents and mother, what was dinner like? Did all of you eat together? Greenfield: No. It was strictly the middle-eastern approach e the men were fed at the table and then the women ate afterwards. I ate dinner with my grandfather and then my mother, her sisters and my grandmother would eat. Roberts: Were you religious? Did you go to synagogue? Greenfield: I went to Hebrew school but I was not particularly religious. I was indoctrinated, had my bar mitzvah at 13, and stayed connected. Roberts: Where there many Jews in your public schools? Greenfield: Yes, there was a comfortable number. I was in a Jewish high school fraternity and that was a source of a lot of good social interaction. Roberts: You mentioned that you did have some influential teachers in junior high and high school. Specifically who and how did they influence you? Greenfield: They encouraged me to not only look at science but to look at some of the better writers. I was given a book of Emerson’s essays by one teacher. She encouraged me to read and develop more mature approaches to life. They were well aware that I was socially in a disadvantaged position because of my age. It was more difficult in junior high because I was much shorter than everyone else. Roberts: What did you major in at Rice? Greenfield: They had a pre-med curriculum. I was premed from the very beginning. After 3 years I wanted to go to medical school. I went across the street and applied to Baylor University College of Medicine but didn’t hear from them. I heard a rumor that the dean at Rice was very unhappy with premeds planning to leave Rice before graduation. I applied to Tulane University and got accepted. I took my acceptance letter back to Baylor and requested an answer or I was going to Tulane. They admitted it was true that the dean had asked them not to notify me that I had been accepted. I was able to get into Baylor and the Rice dean eliminated the premed curriculum after that. Roberts: Basically Rice was or is an engineering school. Did you take a lot of engineering courses? Greenfield: No I did not. I got influenced more at Rice by my philosophy teacher, Radoslav Tsanoff, a wonderful man. I took as many of his courses as I could. Roberts: Did anyone else at Rice have an influence on you? Greenfield: I was there with friends that I had gone to high school with and that was very helpful to be in a group
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because I didn’t live in a dormitory. We were “townees” and a little different from the rest of the students who boarded on campus. Roberts: Did any of your classmates at Rice become prominent in their elected fields? Greenfield: My best friend and best man at my wedding is a prominent internist in Houston. Roberts: How big was Rice when you were there? Greenfield: Our class was about 400. The entire school included probably 1,400 students. Roberts: In your graduating class, how did you rank? Greenfield: I never graduated. I had been on the Dean’s list every year and with those good grades I was able to get into medical school after 3 years of college. Roberts: You skipped 2 grades in grammar school and 1 grade in college. Now, entering medical school, you are 3 years younger than most of your classmates? Greenfield: Yes, I was 19 when I entered medical school. Roberts: Were there any major surprises in medical school that you didn’t expect? Greenfield: Not really. It was as much fun as I thought it would be. I loved it from the very beginning. I loved the cadaver dissection, and everything related to it. Roberts: How many were in your class? Greenfield: 83 students. Roberts: What year did you enter medical school? Greenfield: 1954. Roberts: And you were born in 1934? Greenfield: Right. Roberts: How did you come out in medical school? Greenfield: I did well. I was able to get involved early in research. The first summer I went to the chief of pharmacology to try to get a job doing research. He gave me an assignment to test some drugs. Then he promptly took off for Europe. I was on my own doing this research project all summer. I got it done, wrote it up, and got published. Roberts: Did you work outside also at the grocery store while you were in medical school? Greenfield: No. I was able to get some paying positions as a lab assistant when I got into surgery. I tried to make that surgical connection as quickly as I could. It took another year before I got that connection. I was given the opportunity to do some surgical research and to be paid as a laboratory assistant. Roberts: Did you have scholarship money while in medical school? Greenfield: No, but by then my mother had been saving money all along for me to go to medical school. Medical school tuition was a little over $800 a year. Roberts: Who had major influence on you in medical school? Greenfield: I got connected with George Morris, and worked with him on a variety of projects, both clinical and experimental. I did some work for Dr. Michael DeBakey although I didn’t spend time with him personally. I was sewing grafts in animals as a junior medical student and really loved vascular surgery.
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Roberts: How much time were you spending on these research projects? Greenfield: Lots of time. I was doing the regular classes too. I was able to do some of the clinical projects while I was a junior. Roberts: By the time you finished medical school, you had how many publications? Greenfield: 12. Roberts: Did you feel the impact of Dr. DeBakey in everything you did even though you didn’t spend time with him directly? Greenfield: Oh yes, and Denton Cooley also because he was in the department at that time. I was able to watch their interaction and to watch them operate. I scrubbed in as a student. Roberts: Was it pleasurable to operate with DeBakey? Greenfield: Not really. But it was instructive. Everything about the school was clearly supportive of surgery but the surgery training program sort of turned me off because it was a very hostile environment. It was a situation where there was a lot of blaming. There was not enough learning from what had happened to patients. I knew that I didn’t want to train there. I was encouraged train elsewhere also by Denton Cooley. He encouraged me to go to Hopkins, which I subsequently did. Roberts: How did you like operating with him? Greenfield: I didn’t get to operate with him. I just watched him. Roberts: The Hopkins surgical internship in 1958 only took 12 interns? Greenfield: They took 12 and finished 2. It was a steep pyramidal program. Roberts: You did the internship and then where did you go? Greenfield: I went to the NIH right after the internship. Roberts: But you had an understanding with Dr. Blalock that he would accept you back? Greenfield: No. There was no understanding. I just knew that I was going to the NIH and I was grateful for that opportunity because it took care of the selective service requirement. I assumed that if I did a good job at the NIH I would get to come back. Roberts: How did Hopkins hit you? You had grown up in Houston, your college and medical school were in Houston, and all of a sudden you are in Baltimore. Greenfield: By then I was married and my wife was pregnant when we moved to Baltimore. My concern was for my budding family as well as for what I was doing. We lived across the street from the hospital. The call situation was very rigorous e on call 24 hours a day, 7 days a week. I got a few hours off if my patients were doing well, which I was usually able do on weekends. Roberts: Alfred Blalock was chairman while you were there. Did you have much contact with him? Greenfield: Not a lot. But I did get to scrub as an intern a few times with him and he did call me in at the end of the year and offer me the opportunity to go to the NIH. I did that and had a terrific time there.
Roberts: What did you like about NIH? You were with Andrew G. Morrow in the clinic of surgery in 19591961? Greenfield: I had a wonderful experience. I was able to spend a lot of time in the lab. I did some clinical work but because of my interest and because I was productive in the lab, he arranged it so that I could spend more time in the lab and that gave me a chance to work with Jerry Austen and Paul Ebert. Paul subsequently became my co-resident and we finished the program together at Hopkins. Paul and I had been interns together. He stayed on at Hopkins when I went to the NIH and then he came the next year. Roberts: You got married in 1956 and your wife’s name is Sharon Bishkin. What were some features that attracted you to her and how did you happen to meet? Greenfield: She was dating a friend of mine and was younger than me. Still in high school when we began to date. Then she went to the University of Texas and won a beauty contest. I knew I had to make a move or otherwise I was never going to see her again. She went to secretarial school and worked for George Morris at Baylor. Roberts: She was able to complete how much college? Greenfield: Two years. Roberts: After you were married a couple of years, you had a baby? Greenfield: Yes. He is now Professor and Chair of Neurology at the University of Arkansas in Little Rock. Roberts: How did you let him get into neurology? Greenfield: It wasn’t easy. I was amazed he became a physician. He was a philosophy major at Yale and I thought I’d be supporting him his whole life. Roberts: The experience at NIH kept you in the research arena. Do you know any other colleagues that had 12 publications by the time they had finished medical school? Greenfield: No. Roberts: How did you and Dr. Blalock hit it off? Greenfield: Very well. He was declining in health and activity over the years I was there, so I had more contact with Frank Spencer and Hank Bahnson. I was at a senior level in the program when Dr. Blalock stepped down and subsequently died. I was a senior resident the year that Dr. George Zuidema came to Hopkins. Roberts: What was the change in atmosphere at Hopkins when Dr. Zuidema came? Greenfield: It was difficult. Dr. Blalock had such a strong presence and had been such a good operating surgeon. Dr. Zuidema was young and I think it was a difficult transition for him too because of the resident’s loyalty to Blalock. Also, the fact that it had been a cardiovascular program and now was changing to general surgery. It was a challenge for me just to find a job after I finished the program. Roberts: He couldn’t help you from a cardiovascular standpoint. He wasn’t interested? Greenfield: He didn’t know me that well. Roberts: What year did he come to Hopkins? Greenfield: 1965.
Interview/Lazar John Greenfield, MD
Roberts: How did it work out that you came to the University of Oklahoma? Greenfield: John Schilling was a visiting professor from the University of Oklahoma at Hopkins. He was the chair of surgery at Oklahoma. We met and got along very well. He seemed interested in me. There was another Hopkins product, Rainey Williams, already at the University of Oklahoma. It was an attractive opportunity. Roberts: You became immediately head of surgery at the VA Hospital. Greenfield: Yes. It was an interesting situation. I was a little anxious because this was an administrative job for which I had absolutely no training. Dr. Schilling told me not to worry that the secretary for the chief knew how everything worked in the VA and he was right. She taught me everything I needed to know about administration. Roberts: How many surgeons were on staff at the VA? Greenfied: I was the only fulltime surgeon. There were a lot of visiting surgeons who were practitioners in town who would attend but we had only 5 faculty members to staff 3 hospitals e a children’s hospital, a university hospital and the VA hospital. I had responsibilities in the University Hospital as well. I even had some responsibilities at the Children’s Hospital. It was an ideal environment. I got to do so many different things like trauma call. And I did the first kidney transplant in the state. Roberts: You were trained in general surgery and in cardiac surgery. You had no specific training in vascular surgery? Greenfield: Correct. There wasn’t any at that time. Roberts: I gather that you gradually gave up cardiac surgery? Greenfield: Yes. As I got more involved in responsibilities for teaching general surgery residents, I found that if I was going to spend any time with them I had to be doing cases that general surgery residents would scrub on and those were the vascular cases. Roberts: Vascular is very exciting though. You are everywhere. How did you get into the inferior vena cava filter, which your name is attached to? Greenfield: Like a lot of things, that interest came from a bad outcome in patients. I had a young man who died after a motorcycle accident from massive pulmonary embolism. I had resuscitated him and performed an open pulmonary embolectomy but he didn’t survive. It was a very frustrating experience. At the time I was working with a petroleum engineer, Garman Kimmel, on an entirely different problem. I was working on a technique to measure pulmonary surfactant. This was a hot topic because of the interest in the wet lung syndrome. We designed a device to measure surface tension which was the only way to do it at the time. This was before the biochemical approach had been developed. We got the device developed. (And sure enough the biochemistry technique came along to make that no longer necessary.) But this surfactometer was exquisitely sensitive to the presence of detergent in water and it became a very useful approach in public health for detecting it in water systems. The device was called the “Greenfield Surfactometer”. So, when my patient
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died it was terribly frustrating and I considered the possibility of a different approach to getting clots out of the lungs that would not require the use of a heart-lung machine. I asked Garman Kimmel if he could fashion a cup that I could screw on to the end of a catheter. At the NIH I had spent a lot of time getting catheters into the pulmonary artery. And I knew if I could get a cup on the end of a catheter I could use suction to grab a clot and potentially pull it out of the pulmonary circuit. He was able to develop and fashion a cup that I could screw onto the end of cardiac catheter. I did 10 cases in shock like that salvaging 7 of the 10 but 2 of them had recurrent emboli. At that point I was unhappy because I would have to take these sick patients and open them up to put a clip on the vena cava. That was the standard approach at the time. Roberts: Clip means totally occluding it or just narrowing it? Greenfield: No. This is a clip that compartmented the vena cava. It required a direct approach to put it on the vena cava. It was a big operation. Roberts: Compartmenting means what? Greenfield: It means pinching the vena cava down to a smaller diameter and having prongs that separate it into small channels. That was the “Miles-DeWeese Clip” that was the standard approach. I was talking to Mr. Kimmel about an alternative way to trap clots. He said that sounded a lot like the problem he had in the oil field with sludge because sludge in the pipelines gets into the valves and they have to dig them up. It is very labor intensive. They used a cone-shaped trap to capture the sludge and the pipeline stays open. He proceeded to show me geometrically what that meant. I thought that it was a great concept e what if we added some hooks, fashioned it out of wire, and figured out a way to put it into the inferior vena cava? He got his machinist to build one, made it out of stainless steel wire. We tested the concept in dogs for 2 years and there was evidence that it was working well. I persuaded the VA to allow me to begin to put them in patients. Then I presented the data on the use of the embolectomy catheter and the filters at a cardiology meeting in Dallas. That meeting was attended by John Abele from Meditech (subsequently became Boston Scientific). He was very interested in the catheter and wanted to come to Oklahoma City with me. At that time, the filter concept had been patented, not by me since I was a State employee, but by Mr. Kimmel. We worked out a deal where Meditech took the patent, and although I never got royalties, they agreed to pay for follow-up studies. I was primarily interested in following the patients and finding out what happened to the filters and to the trapped clots. The company agreed to do that. Roberts: That continued over many years? Greenfield: It continued about 23 years until the company changed hands and direction. Roberts: You developed that filter within 2 or 3 years after you came to the University of Oklahoma. How did the move to Richmond and the Medical College of Virginia (subsequently Virginia Commonwealth University) come about?
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Greenfield: While at OU I presented a lot of papers in various places, and I had also collaborated with a terrific basic scientist, Lerner Hinshaw. He was a world class investigator in the field of septic shock. We published a lot of papers together. At the time, I was getting visibility from our studies and for the cardiovascular articles. I got invited to look at some cardiac jobs which I really wasn’t interested in. I wanted to stay more broadly based. Then the politicians in Oklahoma decided that the surgeons at the University were abusing the system and stealing money. They made some wild accusations and the dean didn’t support his faculty. John Schilling resigned and left the institution and in that turmoil I got an offer to come look at the job at the Medical College of Virginia. I took that opportunity and accepted the chair of surgery. Roberts: That was what year? Greenfield: 1974. Roberts: At that time you were 39 years old? Greenfield: Yes. Roberts: How did you enjoy being chairman of a much larger department? Greenfield: It was a learning experience and interesting. I followed a very strong and charismatic leader, David Hume, who had flown his airplane into a mountain. It was a little difficult at the beginning but there were good people there and I was able to recruit and build that department. It was a very good experience. Roberts: When you came initially, how many full-time department members were there? Greenfield: I don’t remember the exact number. It was not a large department, maybe 20þ faculty members but it included all the specialties. Roberts: When you left, how many were there? Greenfield: It had more than doubled in size. Roberts: After you had been there say 5 years and you were comfortable with the chairmanship and the program you had set up, how much teaching were you able to do weekly? Greenfield: I ran generally one or 2 conferences a week, had an hour a week with the students, and made rounds with the students. I was very much involved in the teaching program. Roberts: How many operations were you doing yourself during this period? Greenfield: I was operating generally 2 days a week. Roberts: When you were operating, what was your most common type cases? Greenfield: I was doing both thoracic and vascular cases. I started out doing some cardiac cases but then I got away from that and just stayed with thoracic and vascular. Roberts: You’ve always kept thoracic under your domain? Greenfield: I did for a number of years and then gave that up when I went to Michigan. I primarily did vascular cases in Michigan. Roberts: So let’s say you were 45 years of age in Richmond. What was your typical day like? What time would you get up in the morning? What time did you leave
the hospital? What was your evening like? What time did you go to bed? Greenfield: I was always at the hospital by 7:00 A.M. and usually ran conferences starting at 7:00 A.M. Roberts: You would get up at 5:30 A.M.? Greenfield: 5:30 to 6:00 A.M. Roberts: And the days you were operating, what were those days like? Greenfield: They were long days. I would usually get home by 7:30 or 8:00 P.M. Roberts: What about the days you didn’t operate? Greenfield: I would still get home about the same time. Roberts: Did you enjoy teaching students? Greenfield: I did. That was the most rewarding part of itefinding talent and cultivating it. Roberts: Were you pleased with the support that your department received from the dean and others? Greenfield: It depended. The deanship changed a couple of times. Deans have different flavors and attitudes. Some were supportive and some were less supportive but I figured out how to make things work regardless of who was there. Roberts: Your research work continued to flourish during that Richmond period. Greenfield: Yes. I was able to continue activities in the lab. Roberts: How did you like Richmond? Greenfield: I liked Richmond. My kids had to make a significant adjustment then. It was a lot harder on them because I had taken them out of high school. Virginia is very much a Southern state. It is an inbred environment. Virginians are most interested in pedigrees. They want to know your lineage. It was hard on my kids. Like a lot of things it was a maturing experience. When they were told that if they wanted to succeed in any profession they had to stay in the state to go to college, they couldn’t wait to get out and all ended up going out of state to college. Roberts: Where did they go? Greenfield: My oldest son went to Yale, my daughter went to Pratt in New York, and my youngest son went to Vanderbilt and then Emory Law School. Roberts: How did the Michigan opportunity come about? Greenfield: Again, it was tied to pressure at both ends. There was a change in deanship in Richmond that was difficult and unfortunate. The dean didn’t like the department of surgery and wanted to extract as much out of it as possible. He made it very uncomfortable for me. When I got the call to come look at the job at Michigan, it was pretty easy to say “yes”. Even though we had enjoyed living in Virginia, and had built a home there, the opportunity in Michigan seemed to be essentially moving from the minors to the majors. I saw a very significant opportunity to do more and have more influence in surgery there. Roberts: That’s one of the great medical schools and universities in the USA? Greenfield: I think so. Roberts: You got to Ann Arbor Michigan in what year? Greenfield: 1987.
Interview/Lazar John Greenfield, MD
Roberts: I bet you were very glad you had had the experience in Richmond before you got to Ann Arbor? Greenfield: Yes. It was very helpful. I was fortunate to work with a very strong chair of medicine, Bill Kelly. Everyone said he was scary to work with but I found him to be very cooperative. We figured out that we had a lot more to gain from working together than working against each other. We were able to do some things at the institution that I don’t think either of us could have done individually. Roberts: He left in what year? Greenfield: It was just a few years after I got there that he went to Penn. Roberts: What were you most proud of during your 15 years at Richmond? Greenfield: At Richmond I was able to develop a training program that was very competitive. We were getting much better candidates into the program and a lot of them were headed for academic careers. Previously it had been essentially a community hospital type program. We were able to recruit strong faculty members and start a good trauma program for example. Roberts: What were the big differences between your department at the University of Michigan and that of the Medical College of Virginia? Greenfield: The resources were considerably better. The Michigan institution was very focused academically, and the community support was stronger. The reputation allowed us to recruit talent and good trainees to the program. I felt there were no limits. Over the years, we steadily strengthened the research program and became No. 4 in the country in research dollars from the NIH, which was light years from where it had been. Roberts: What did your budget just for the department of surgery reach? Greenfield: I would be guessing. It would be several million. We had a large faculty, over 110 full-time. Roberts: If you take 110 faculty, their assistants, lab technicians and other supporting people, how many employees were you talking about under your domain? Did you know all of the surgical faculty? Greenfield: It was several hundred. I did know all the surgical staff. I didn’t have direct contact with all of them but I was aware of their expertise, what they were doing, and what their problems were. I maintained an open office,
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essentially anyone could come in at any time. I tried to stay in touch. It was harder because the only people I could see on a regular basis were the section heads weekly. A lot of my management had to be through them. Roberts: What were your divisions? Greenfield: I had all the subspecialties too. Roberts: Everything under surgery, including ENT? Greenfield: No, ENT was separate. Roberts: Your department was similar to David Sabiston’s at Duke University? Greenfield: Yes. When Sabiston did not get Dr. Blalock’s job at Hopkins, he went to Duke. Roberts: Did you have time to operate very much at Michigan? This was a huge administrative ordeal. Greenfield: I still operated but generally only one day a week. Roberts: I suspect that was very good for the rest of the department? Greenfield: I hope so. It was important that I be there to defend turf and to keep track of what was happening. Roberts: You have been very active through the years in a number of surgical organizations e president of several. How much traveling were you doing in say 1995? Greenfield: I actually had more responsibilities away from the department in Richmond because I was on the board of surgery and on a study section for the NIH. I was spending a lot of time away while in Richmond and tried to control that a little bit more when I was at Michigan. I continued to travel while in Michigan but it was different. Roberts: It’s amazing to me how you were been able to follow through on your inferior vena cava filter through decades. There are very few people who continued working in an area for 40þ years. How have you been able to do that? Greenfield: I was able to set up a support system e a group of people who would help me track those patients and set up a feedback loop so that we could get the patients interested in coming back for examinations and follow-up. Meditech supported that for a long time and that helped a great deal. It involved staff people to a great extent. Roberts: Lazer, are there topics that we have not discussed that you would like to do so? Greenfield: No, I think you have covered the pertinent aspects of my career very well.
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Figure 1. Sharon and me from an event 10 years ago. We celebrated our 57th wedding anniversary in August 2013.
Figure 2. The editorial group from Greenfield’s Surgery Principles and Practice. Now in its 5th edition with Mulholland as Editor in Chief.
Figure 3. Pictured with Dr. Mike DeBakey when he was Visiting Professor at Michigan.
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Figure 4. Pictured with Dr. John Cameron (Hopkins) (L) and the late Dr. Alex Walt (Wayne State).
Figure 6. Introducing Dr. Diane Simeone who became the Greenfield Distinguished Professor of Surgery in 2007 at the University of Michigan.
Figure 5. Sharon and me enjoying another favorite recreation on the dance floor (1992).
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Figure 7. A fishing outing in New Orleans when I was a guest of their surgical society.
Figure 8. Another favorite pastime e fishing for barracuda in Florida (Dec’ 2010).
Lazar Greenfield was born in Houston, Texas, in 1934, and that is where he grew up. He attended public schools and then Rice University before graduating with honors from Baylor University College of Medicine in 1958. He trained in general and thoracic surgery at The Johns Hopkins Hospital from 1958 to 1966. During that period he also spent 2 years in the surgery branch of the National Heart Institute at the National Institute of Health. Following his training he went to Oklahoma City as Chief of the Surgical Services at the Veteran’s Administration Hospital at the University of Oklahoma Medical Center. He was named a Markle Scholar and rapidly ascended the academic letter to become a Professor of Surgery in 1971. In 1974, Dr. Greenfield moved to Richmond, Virginia, to be the Stuart McGuire Professor and Chairman of the Department of Surgery at the Medical College of Virginia, Virginia Commonwealth University. He remained in that position until 1987 when he became the F.A. Coller Distinguished Professor of Surgery and Chairman of the Department of Surgery at the University of Michigan School of Medicine in Ann Arbor. He developed an outstanding department of surgery which rose to the national ranking of No. 4 in research awards from the National Institute of Health. After 15 years as chair, he retired from that responsibility and was appointed Interim Vice President for Medical Affairs and Chief Executive Officer of the University of Michigan Health System from 2002 to 2003. He then took a sabbatical at the Center for Medical Devices at the Food and Drug Administration the next year. He retired from the university in 2004 but remained as a consultant to the Medical Products Surveillance Network. From 2004 to 2011, he was editor-in-chief of Surgery News, the monthly publication of the American College of Surgeons. Dr. Greenfield has been highly productive in his career having published 128 book chapters, and more than 404 scientific articles in peer reviewed journals, as well as 2 major textbooks of surgery. He has served on the editorial boards of 15 scientific journals and on an NIH study section. He is best known for his development of an intra-caval filter device to prevent pulmonary embolism and the device bears his name. He has received many awards, including the Rene Leriche Prize, the Roswell Park Medal, and the Jacobson Innovation Award of the America College of Surgeons. Annual research awards in his name have been established by the Humera Society of the Medical College of Virginia, and the Section of Vascular a Professor and Chair Emeritus, University of Michigan, Department of Surgery, Ann Arbor, Michigan; bExecutive Director, Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas; cDean, A. Webb Roberts Center for Continuing Medical Education, Baylor Health Care Systems, Dallas, Texas; and dEditor in chief, The American Journal of Cardiology and Baylor University Medical Center Proceedings. *Corresponding author: Tel: (520) 885-8692. E-mail address: [email protected] (L.J. Greenfield).
0002-9149/13/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.amjcard.2013.08.005
Surgery of the University of Michigan. He is recognized as an expert in vascular surgery and has lectured extensively in the USA and abroad. He has been elected to membership in 51 scientific and professional societies and received honorary membership in 9 additional organizations. He has served as member and then President of the Lifeline Foundation and chair of the board of the American Surgical Association Foundation. As a fellow of the American College of Surgeons he served on the Board of Governors, the Advisory Council for Vascular Surgery, and as Vice President and President-elect. He has been elected President of the American Surgical Association, the American Venus Forum, the Society of Surgical Chairs, American Association of Vascular Surgery, International Federation of Vascular Societies and the Halsted Society. He has been a director of the American Board of Surgery and has served as chairman of the National ACGME-Residency Review Committee for Surgery. In 1995, Dr. Greenfield was elected to the Institute of Medicine of the National Academies of Science. He has been designated a Johns Hopkins Society Scholar and has received Distinguished Alumnus Awards from Rice University and Baylor University College of Medicine. He has been happily married to his wife, Sharon, since 1956. They have 3 children and 8 grandchildren. His oldest son is Professor and Chair of the Department of Neurology at the University of Arkansas. Additionally, Lazar Greenfield is a great guy. William Clifford Roberts, MD (hereafter Roberts): Dr. Greenfield, it is a pleasure to have the opportunity to talk with you. Your lecture The Frank Kidd Jr., MD Annual Lectureship in Surgery was wonderful. Could we begin by your describing a bit of your growing up in Houston, your parents, siblings? What the atmosphere was like in your home growing up? Lazar John Greenfield, MD (hereafter Greenfield): I have no siblings. My mother was divorced when I was a baby and we lived in my maternal grandfather’s house. I grew up there. We raised chickens and pigeons in the backyard. When I was 6 years old, a squab fell out of the nest and was pounced upon by the chickens resulting in a lot of damage to its neck. I rushed over, picked him up and took him to my grandfather to see if he could help it. He looked at it and said, “We will eat him for dinner”. I said “Oh no, we have to save him”. He took a needle and thread, sewed up the neck of this little squab, and told me to take care of him. And I did. Eventually, I put him back in the nest and he grew up. I could always spot him because he never grew any feathers on the back of his neck. I was amazed that one could repair something back to health. That convinced me at an early age that I wanted to go into medicine and to become a surgeon. Roberts: What did your father do? Greenfield: I’m not sure. I never had any contact with him. He had been trying to start a filling station during the www.ajconline.org
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Depression, which was a tough time. They had gotten married in California and I think he went back to California. Roberts: What was your mother like? What was her name? Greenfield: Her maiden name was Betty Greenfield. She was very focused on education although she had been taken out of school in the sixth grade in order to work. She always wanted to get a higher education. Later in life she did go back for course work. She told me early on that if I wanted to be a physician I had to make good grades in school. She was a very talented pianist. Obviously, having me didn’t do much for her career. She became a legal secretary. Although she continued to teach piano she never performed again. She was a bright woman who I think could have done well in terms of her own education if she had had the opportunity. Roberts: She never went to college? Greenfield: Correct. She got a degree from the Houston Conservatory of Music and as a graduate of the conservatory qualified to take courses at the University of Houston This was when I was in high school. No one in my family had gone to college. I was the first one. Roberts: What did your maternal grandfather do? Greenfield: He was in real estate. He had immigrated from what is now Israel at the age of 19. He had a grocery store and when my mom was growing up she worked in the store. He branched out from that one store and got into real estate. He was a successful realtor. Roberts: What was your relationship with your maternal grandmother? You were the only youngster with 2 grandparents and your mother? Greenfield: My mom was one of 7 siblings, 6 sisters and 1 brother. There were other women in the home but I was the only child. It was a traditional middle eastern family. Roberts: How many lived in the house you lived in? Greenfield: At different times there were 2 or 3 of them in the home. The sisters got married and moved out as I grew up. Roberts: Did you have a room of your own growing up? Greenfield: From time to time. Roberts: What was school like? Grammar school, junior high, and high school? Greenfield: I enjoyed school. I got a little bored so they jumped me in grades. There wasn’t an enrichment program at that time so I was simply advanced. I was always 2 years younger than everyone else in class. That meant I had to learn to run fast because I usually got chased after school. Roberts: You were advanced? This happened in grammar school? Greenfield: Yes. Roberts: Were there any teachers who had considerable influence on you early on? Greenfield: When I got to junior high school, there were some teachers that took an interest in me, encouraged me to do projects, and helped me learn more about science. Roberts: Did you take to science? Did that come naturally? Greenfield: I loved it. I wanted to do research from an early ageeasking questions and finding out about things.
Roberts: You went to public schools? Were the schools close to your house? Greenfield: Yes. I walked to school. Roberts: Where did you live in Houston? Greenfield: I lived on San Jacinto Drive, which was in the MacGregor School District. It’s not there anymore but it was a good area to grow up in. There were other kids in the neighborhood but I was alone a lot and became somewhat self-sufficient. Roberts: Being 2 years younger than all your classmates, was that scary? Greenfield: It was educational. Roberts: When you got into high school, did you play sports or what were your activities? Greenfield: I liked sports. I was small in size so it was hard to play football, but I was on the ROTC team. I had a great time in high school. The age difference wasn’t as big a deal by then. My mother wanted me to get involved in performance activities, so I was a child actor. I was in several drama plays and that gave me access in high school to do things involving the variety shows as Master of Ceremonies. Roberts: You were a local celebrity? Greenfield: Not really. But I was popular. Roberts: Did learning come easy for you? Greenfield: Yes. Roberts: Did you read fast? Greenfield: I enjoyed reading. I read everything I could get a hold of. I was able to get books. My mother bought me adventure books and we had a set of encyclopedias. Money was in short supply so I had to get a job. I had one when I was 14 and got a driver’s license early. Roberts: When you were 14, what grade were you in? Greenfield: I was in high school as a sophomore. Roberts: You graduated from high school at 16? Greenfield: Yes. I got into Rice University. At the time Rice was an institute with essentially all scholarships once you got accepted. It cost me $25 a year, an activity fee. I was very fortunate. I continued to work at a grocery store as a checker through college. Roberts: Was that just on the weekends? Greenfield: No, I worked during the week as well. Roberts: Did you consider other colleges or was Rice the only choice? Greenfield: It was my only choice. We couldn’t afford for me to go anywhere else. Roberts: Did you live at home during college? How far was Rice from your home? Greenfield: By that time, my mother had wisely taken advantage of her real estate upbringing and got us into a duplex, and then a home located fairly close to Rice University. I was able to go by either bicycle or walking every day. Roberts: It was still just you and your mother? She never remarried? Greenfield: She did but after I had gone off to medical school. Roberts: Did you and your mother get along well?
Interview/Lazar John Greenfield, MD
Greenfield: Yes. It was a good upbringing. I had some unruly episodes growing up, frustrated by having to work all the time. Early on I got sent to a ranch in West Texas for “attitude improvement”. That was a good experience. Roberts: How old where you then? Greenfield: I was about 13. Roberts: What do you mean by “unruly?” Greenfield: At the time I was rebellious and my mother was having difficulty with me. She was working and didn’t want me to be alone in the summertime, so she sent me out to this ranch in West Texas. Roberts: That was summertime? When you were living with all your aunts and grandparents and mother, what was dinner like? Did all of you eat together? Greenfield: No. It was strictly the middle-eastern approach e the men were fed at the table and then the women ate afterwards. I ate dinner with my grandfather and then my mother, her sisters and my grandmother would eat. Roberts: Were you religious? Did you go to synagogue? Greenfield: I went to Hebrew school but I was not particularly religious. I was indoctrinated, had my bar mitzvah at 13, and stayed connected. Roberts: Where there many Jews in your public schools? Greenfield: Yes, there was a comfortable number. I was in a Jewish high school fraternity and that was a source of a lot of good social interaction. Roberts: You mentioned that you did have some influential teachers in junior high and high school. Specifically who and how did they influence you? Greenfield: They encouraged me to not only look at science but to look at some of the better writers. I was given a book of Emerson’s essays by one teacher. She encouraged me to read and develop more mature approaches to life. They were well aware that I was socially in a disadvantaged position because of my age. It was more difficult in junior high because I was much shorter than everyone else. Roberts: What did you major in at Rice? Greenfield: They had a pre-med curriculum. I was premed from the very beginning. After 3 years I wanted to go to medical school. I went across the street and applied to Baylor University College of Medicine but didn’t hear from them. I heard a rumor that the dean at Rice was very unhappy with premeds planning to leave Rice before graduation. I applied to Tulane University and got accepted. I took my acceptance letter back to Baylor and requested an answer or I was going to Tulane. They admitted it was true that the dean had asked them not to notify me that I had been accepted. I was able to get into Baylor and the Rice dean eliminated the premed curriculum after that. Roberts: Basically Rice was or is an engineering school. Did you take a lot of engineering courses? Greenfield: No I did not. I got influenced more at Rice by my philosophy teacher, Radoslav Tsanoff, a wonderful man. I took as many of his courses as I could. Roberts: Did anyone else at Rice have an influence on you? Greenfield: I was there with friends that I had gone to high school with and that was very helpful to be in a group
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because I didn’t live in a dormitory. We were “townees” and a little different from the rest of the students who boarded on campus. Roberts: Did any of your classmates at Rice become prominent in their elected fields? Greenfield: My best friend and best man at my wedding is a prominent internist in Houston. Roberts: How big was Rice when you were there? Greenfield: Our class was about 400. The entire school included probably 1,400 students. Roberts: In your graduating class, how did you rank? Greenfield: I never graduated. I had been on the Dean’s list every year and with those good grades I was able to get into medical school after 3 years of college. Roberts: You skipped 2 grades in grammar school and 1 grade in college. Now, entering medical school, you are 3 years younger than most of your classmates? Greenfield: Yes, I was 19 when I entered medical school. Roberts: Were there any major surprises in medical school that you didn’t expect? Greenfield: Not really. It was as much fun as I thought it would be. I loved it from the very beginning. I loved the cadaver dissection, and everything related to it. Roberts: How many were in your class? Greenfield: 83 students. Roberts: What year did you enter medical school? Greenfield: 1954. Roberts: And you were born in 1934? Greenfield: Right. Roberts: How did you come out in medical school? Greenfield: I did well. I was able to get involved early in research. The first summer I went to the chief of pharmacology to try to get a job doing research. He gave me an assignment to test some drugs. Then he promptly took off for Europe. I was on my own doing this research project all summer. I got it done, wrote it up, and got published. Roberts: Did you work outside also at the grocery store while you were in medical school? Greenfield: No. I was able to get some paying positions as a lab assistant when I got into surgery. I tried to make that surgical connection as quickly as I could. It took another year before I got that connection. I was given the opportunity to do some surgical research and to be paid as a laboratory assistant. Roberts: Did you have scholarship money while in medical school? Greenfield: No, but by then my mother had been saving money all along for me to go to medical school. Medical school tuition was a little over $800 a year. Roberts: Who had major influence on you in medical school? Greenfield: I got connected with George Morris, and worked with him on a variety of projects, both clinical and experimental. I did some work for Dr. Michael DeBakey although I didn’t spend time with him personally. I was sewing grafts in animals as a junior medical student and really loved vascular surgery.
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Roberts: How much time were you spending on these research projects? Greenfield: Lots of time. I was doing the regular classes too. I was able to do some of the clinical projects while I was a junior. Roberts: By the time you finished medical school, you had how many publications? Greenfield: 12. Roberts: Did you feel the impact of Dr. DeBakey in everything you did even though you didn’t spend time with him directly? Greenfield: Oh yes, and Denton Cooley also because he was in the department at that time. I was able to watch their interaction and to watch them operate. I scrubbed in as a student. Roberts: Was it pleasurable to operate with DeBakey? Greenfield: Not really. But it was instructive. Everything about the school was clearly supportive of surgery but the surgery training program sort of turned me off because it was a very hostile environment. It was a situation where there was a lot of blaming. There was not enough learning from what had happened to patients. I knew that I didn’t want to train there. I was encouraged train elsewhere also by Denton Cooley. He encouraged me to go to Hopkins, which I subsequently did. Roberts: How did you like operating with him? Greenfield: I didn’t get to operate with him. I just watched him. Roberts: The Hopkins surgical internship in 1958 only took 12 interns? Greenfield: They took 12 and finished 2. It was a steep pyramidal program. Roberts: You did the internship and then where did you go? Greenfield: I went to the NIH right after the internship. Roberts: But you had an understanding with Dr. Blalock that he would accept you back? Greenfield: No. There was no understanding. I just knew that I was going to the NIH and I was grateful for that opportunity because it took care of the selective service requirement. I assumed that if I did a good job at the NIH I would get to come back. Roberts: How did Hopkins hit you? You had grown up in Houston, your college and medical school were in Houston, and all of a sudden you are in Baltimore. Greenfield: By then I was married and my wife was pregnant when we moved to Baltimore. My concern was for my budding family as well as for what I was doing. We lived across the street from the hospital. The call situation was very rigorous e on call 24 hours a day, 7 days a week. I got a few hours off if my patients were doing well, which I was usually able do on weekends. Roberts: Alfred Blalock was chairman while you were there. Did you have much contact with him? Greenfield: Not a lot. But I did get to scrub as an intern a few times with him and he did call me in at the end of the year and offer me the opportunity to go to the NIH. I did that and had a terrific time there.
Roberts: What did you like about NIH? You were with Andrew G. Morrow in the clinic of surgery in 19591961? Greenfield: I had a wonderful experience. I was able to spend a lot of time in the lab. I did some clinical work but because of my interest and because I was productive in the lab, he arranged it so that I could spend more time in the lab and that gave me a chance to work with Jerry Austen and Paul Ebert. Paul subsequently became my co-resident and we finished the program together at Hopkins. Paul and I had been interns together. He stayed on at Hopkins when I went to the NIH and then he came the next year. Roberts: You got married in 1956 and your wife’s name is Sharon Bishkin. What were some features that attracted you to her and how did you happen to meet? Greenfield: She was dating a friend of mine and was younger than me. Still in high school when we began to date. Then she went to the University of Texas and won a beauty contest. I knew I had to make a move or otherwise I was never going to see her again. She went to secretarial school and worked for George Morris at Baylor. Roberts: She was able to complete how much college? Greenfield: Two years. Roberts: After you were married a couple of years, you had a baby? Greenfield: Yes. He is now Professor and Chair of Neurology at the University of Arkansas in Little Rock. Roberts: How did you let him get into neurology? Greenfield: It wasn’t easy. I was amazed he became a physician. He was a philosophy major at Yale and I thought I’d be supporting him his whole life. Roberts: The experience at NIH kept you in the research arena. Do you know any other colleagues that had 12 publications by the time they had finished medical school? Greenfield: No. Roberts: How did you and Dr. Blalock hit it off? Greenfield: Very well. He was declining in health and activity over the years I was there, so I had more contact with Frank Spencer and Hank Bahnson. I was at a senior level in the program when Dr. Blalock stepped down and subsequently died. I was a senior resident the year that Dr. George Zuidema came to Hopkins. Roberts: What was the change in atmosphere at Hopkins when Dr. Zuidema came? Greenfield: It was difficult. Dr. Blalock had such a strong presence and had been such a good operating surgeon. Dr. Zuidema was young and I think it was a difficult transition for him too because of the resident’s loyalty to Blalock. Also, the fact that it had been a cardiovascular program and now was changing to general surgery. It was a challenge for me just to find a job after I finished the program. Roberts: He couldn’t help you from a cardiovascular standpoint. He wasn’t interested? Greenfield: He didn’t know me that well. Roberts: What year did he come to Hopkins? Greenfield: 1965.
Interview/Lazar John Greenfield, MD
Roberts: How did it work out that you came to the University of Oklahoma? Greenfield: John Schilling was a visiting professor from the University of Oklahoma at Hopkins. He was the chair of surgery at Oklahoma. We met and got along very well. He seemed interested in me. There was another Hopkins product, Rainey Williams, already at the University of Oklahoma. It was an attractive opportunity. Roberts: You became immediately head of surgery at the VA Hospital. Greenfield: Yes. It was an interesting situation. I was a little anxious because this was an administrative job for which I had absolutely no training. Dr. Schilling told me not to worry that the secretary for the chief knew how everything worked in the VA and he was right. She taught me everything I needed to know about administration. Roberts: How many surgeons were on staff at the VA? Greenfied: I was the only fulltime surgeon. There were a lot of visiting surgeons who were practitioners in town who would attend but we had only 5 faculty members to staff 3 hospitals e a children’s hospital, a university hospital and the VA hospital. I had responsibilities in the University Hospital as well. I even had some responsibilities at the Children’s Hospital. It was an ideal environment. I got to do so many different things like trauma call. And I did the first kidney transplant in the state. Roberts: You were trained in general surgery and in cardiac surgery. You had no specific training in vascular surgery? Greenfield: Correct. There wasn’t any at that time. Roberts: I gather that you gradually gave up cardiac surgery? Greenfield: Yes. As I got more involved in responsibilities for teaching general surgery residents, I found that if I was going to spend any time with them I had to be doing cases that general surgery residents would scrub on and those were the vascular cases. Roberts: Vascular is very exciting though. You are everywhere. How did you get into the inferior vena cava filter, which your name is attached to? Greenfield: Like a lot of things, that interest came from a bad outcome in patients. I had a young man who died after a motorcycle accident from massive pulmonary embolism. I had resuscitated him and performed an open pulmonary embolectomy but he didn’t survive. It was a very frustrating experience. At the time I was working with a petroleum engineer, Garman Kimmel, on an entirely different problem. I was working on a technique to measure pulmonary surfactant. This was a hot topic because of the interest in the wet lung syndrome. We designed a device to measure surface tension which was the only way to do it at the time. This was before the biochemical approach had been developed. We got the device developed. (And sure enough the biochemistry technique came along to make that no longer necessary.) But this surfactometer was exquisitely sensitive to the presence of detergent in water and it became a very useful approach in public health for detecting it in water systems. The device was called the “Greenfield Surfactometer”. So, when my patient
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died it was terribly frustrating and I considered the possibility of a different approach to getting clots out of the lungs that would not require the use of a heart-lung machine. I asked Garman Kimmel if he could fashion a cup that I could screw on to the end of a catheter. At the NIH I had spent a lot of time getting catheters into the pulmonary artery. And I knew if I could get a cup on the end of a catheter I could use suction to grab a clot and potentially pull it out of the pulmonary circuit. He was able to develop and fashion a cup that I could screw onto the end of cardiac catheter. I did 10 cases in shock like that salvaging 7 of the 10 but 2 of them had recurrent emboli. At that point I was unhappy because I would have to take these sick patients and open them up to put a clip on the vena cava. That was the standard approach at the time. Roberts: Clip means totally occluding it or just narrowing it? Greenfield: No. This is a clip that compartmented the vena cava. It required a direct approach to put it on the vena cava. It was a big operation. Roberts: Compartmenting means what? Greenfield: It means pinching the vena cava down to a smaller diameter and having prongs that separate it into small channels. That was the “Miles-DeWeese Clip” that was the standard approach. I was talking to Mr. Kimmel about an alternative way to trap clots. He said that sounded a lot like the problem he had in the oil field with sludge because sludge in the pipelines gets into the valves and they have to dig them up. It is very labor intensive. They used a cone-shaped trap to capture the sludge and the pipeline stays open. He proceeded to show me geometrically what that meant. I thought that it was a great concept e what if we added some hooks, fashioned it out of wire, and figured out a way to put it into the inferior vena cava? He got his machinist to build one, made it out of stainless steel wire. We tested the concept in dogs for 2 years and there was evidence that it was working well. I persuaded the VA to allow me to begin to put them in patients. Then I presented the data on the use of the embolectomy catheter and the filters at a cardiology meeting in Dallas. That meeting was attended by John Abele from Meditech (subsequently became Boston Scientific). He was very interested in the catheter and wanted to come to Oklahoma City with me. At that time, the filter concept had been patented, not by me since I was a State employee, but by Mr. Kimmel. We worked out a deal where Meditech took the patent, and although I never got royalties, they agreed to pay for follow-up studies. I was primarily interested in following the patients and finding out what happened to the filters and to the trapped clots. The company agreed to do that. Roberts: That continued over many years? Greenfield: It continued about 23 years until the company changed hands and direction. Roberts: You developed that filter within 2 or 3 years after you came to the University of Oklahoma. How did the move to Richmond and the Medical College of Virginia (subsequently Virginia Commonwealth University) come about?
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Greenfield: While at OU I presented a lot of papers in various places, and I had also collaborated with a terrific basic scientist, Lerner Hinshaw. He was a world class investigator in the field of septic shock. We published a lot of papers together. At the time, I was getting visibility from our studies and for the cardiovascular articles. I got invited to look at some cardiac jobs which I really wasn’t interested in. I wanted to stay more broadly based. Then the politicians in Oklahoma decided that the surgeons at the University were abusing the system and stealing money. They made some wild accusations and the dean didn’t support his faculty. John Schilling resigned and left the institution and in that turmoil I got an offer to come look at the job at the Medical College of Virginia. I took that opportunity and accepted the chair of surgery. Roberts: That was what year? Greenfield: 1974. Roberts: At that time you were 39 years old? Greenfield: Yes. Roberts: How did you enjoy being chairman of a much larger department? Greenfield: It was a learning experience and interesting. I followed a very strong and charismatic leader, David Hume, who had flown his airplane into a mountain. It was a little difficult at the beginning but there were good people there and I was able to recruit and build that department. It was a very good experience. Roberts: When you came initially, how many full-time department members were there? Greenfield: I don’t remember the exact number. It was not a large department, maybe 20þ faculty members but it included all the specialties. Roberts: When you left, how many were there? Greenfield: It had more than doubled in size. Roberts: After you had been there say 5 years and you were comfortable with the chairmanship and the program you had set up, how much teaching were you able to do weekly? Greenfield: I ran generally one or 2 conferences a week, had an hour a week with the students, and made rounds with the students. I was very much involved in the teaching program. Roberts: How many operations were you doing yourself during this period? Greenfield: I was operating generally 2 days a week. Roberts: When you were operating, what was your most common type cases? Greenfield: I was doing both thoracic and vascular cases. I started out doing some cardiac cases but then I got away from that and just stayed with thoracic and vascular. Roberts: You’ve always kept thoracic under your domain? Greenfield: I did for a number of years and then gave that up when I went to Michigan. I primarily did vascular cases in Michigan. Roberts: So let’s say you were 45 years of age in Richmond. What was your typical day like? What time would you get up in the morning? What time did you leave
the hospital? What was your evening like? What time did you go to bed? Greenfield: I was always at the hospital by 7:00 A.M. and usually ran conferences starting at 7:00 A.M. Roberts: You would get up at 5:30 A.M.? Greenfield: 5:30 to 6:00 A.M. Roberts: And the days you were operating, what were those days like? Greenfield: They were long days. I would usually get home by 7:30 or 8:00 P.M. Roberts: What about the days you didn’t operate? Greenfield: I would still get home about the same time. Roberts: Did you enjoy teaching students? Greenfield: I did. That was the most rewarding part of itefinding talent and cultivating it. Roberts: Were you pleased with the support that your department received from the dean and others? Greenfield: It depended. The deanship changed a couple of times. Deans have different flavors and attitudes. Some were supportive and some were less supportive but I figured out how to make things work regardless of who was there. Roberts: Your research work continued to flourish during that Richmond period. Greenfield: Yes. I was able to continue activities in the lab. Roberts: How did you like Richmond? Greenfield: I liked Richmond. My kids had to make a significant adjustment then. It was a lot harder on them because I had taken them out of high school. Virginia is very much a Southern state. It is an inbred environment. Virginians are most interested in pedigrees. They want to know your lineage. It was hard on my kids. Like a lot of things it was a maturing experience. When they were told that if they wanted to succeed in any profession they had to stay in the state to go to college, they couldn’t wait to get out and all ended up going out of state to college. Roberts: Where did they go? Greenfield: My oldest son went to Yale, my daughter went to Pratt in New York, and my youngest son went to Vanderbilt and then Emory Law School. Roberts: How did the Michigan opportunity come about? Greenfield: Again, it was tied to pressure at both ends. There was a change in deanship in Richmond that was difficult and unfortunate. The dean didn’t like the department of surgery and wanted to extract as much out of it as possible. He made it very uncomfortable for me. When I got the call to come look at the job at Michigan, it was pretty easy to say “yes”. Even though we had enjoyed living in Virginia, and had built a home there, the opportunity in Michigan seemed to be essentially moving from the minors to the majors. I saw a very significant opportunity to do more and have more influence in surgery there. Roberts: That’s one of the great medical schools and universities in the USA? Greenfield: I think so. Roberts: You got to Ann Arbor Michigan in what year? Greenfield: 1987.
Interview/Lazar John Greenfield, MD
Roberts: I bet you were very glad you had had the experience in Richmond before you got to Ann Arbor? Greenfield: Yes. It was very helpful. I was fortunate to work with a very strong chair of medicine, Bill Kelly. Everyone said he was scary to work with but I found him to be very cooperative. We figured out that we had a lot more to gain from working together than working against each other. We were able to do some things at the institution that I don’t think either of us could have done individually. Roberts: He left in what year? Greenfield: It was just a few years after I got there that he went to Penn. Roberts: What were you most proud of during your 15 years at Richmond? Greenfield: At Richmond I was able to develop a training program that was very competitive. We were getting much better candidates into the program and a lot of them were headed for academic careers. Previously it had been essentially a community hospital type program. We were able to recruit strong faculty members and start a good trauma program for example. Roberts: What were the big differences between your department at the University of Michigan and that of the Medical College of Virginia? Greenfield: The resources were considerably better. The Michigan institution was very focused academically, and the community support was stronger. The reputation allowed us to recruit talent and good trainees to the program. I felt there were no limits. Over the years, we steadily strengthened the research program and became No. 4 in the country in research dollars from the NIH, which was light years from where it had been. Roberts: What did your budget just for the department of surgery reach? Greenfield: I would be guessing. It would be several million. We had a large faculty, over 110 full-time. Roberts: If you take 110 faculty, their assistants, lab technicians and other supporting people, how many employees were you talking about under your domain? Did you know all of the surgical faculty? Greenfield: It was several hundred. I did know all the surgical staff. I didn’t have direct contact with all of them but I was aware of their expertise, what they were doing, and what their problems were. I maintained an open office,
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essentially anyone could come in at any time. I tried to stay in touch. It was harder because the only people I could see on a regular basis were the section heads weekly. A lot of my management had to be through them. Roberts: What were your divisions? Greenfield: I had all the subspecialties too. Roberts: Everything under surgery, including ENT? Greenfield: No, ENT was separate. Roberts: Your department was similar to David Sabiston’s at Duke University? Greenfield: Yes. When Sabiston did not get Dr. Blalock’s job at Hopkins, he went to Duke. Roberts: Did you have time to operate very much at Michigan? This was a huge administrative ordeal. Greenfield: I still operated but generally only one day a week. Roberts: I suspect that was very good for the rest of the department? Greenfield: I hope so. It was important that I be there to defend turf and to keep track of what was happening. Roberts: You have been very active through the years in a number of surgical organizations e president of several. How much traveling were you doing in say 1995? Greenfield: I actually had more responsibilities away from the department in Richmond because I was on the board of surgery and on a study section for the NIH. I was spending a lot of time away while in Richmond and tried to control that a little bit more when I was at Michigan. I continued to travel while in Michigan but it was different. Roberts: It’s amazing to me how you were been able to follow through on your inferior vena cava filter through decades. There are very few people who continued working in an area for 40þ years. How have you been able to do that? Greenfield: I was able to set up a support system e a group of people who would help me track those patients and set up a feedback loop so that we could get the patients interested in coming back for examinations and follow-up. Meditech supported that for a long time and that helped a great deal. It involved staff people to a great extent. Roberts: Lazer, are there topics that we have not discussed that you would like to do so? Greenfield: No, I think you have covered the pertinent aspects of my career very well.
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Figure 1. Sharon and me from an event 10 years ago. We celebrated our 57th wedding anniversary in August 2013.
Figure 2. The editorial group from Greenfield’s Surgery Principles and Practice. Now in its 5th edition with Mulholland as Editor in Chief.
Figure 3. Pictured with Dr. Mike DeBakey when he was Visiting Professor at Michigan.
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Figure 4. Pictured with Dr. John Cameron (Hopkins) (L) and the late Dr. Alex Walt (Wayne State).
Figure 6. Introducing Dr. Diane Simeone who became the Greenfield Distinguished Professor of Surgery in 2007 at the University of Michigan.
Figure 5. Sharon and me enjoying another favorite recreation on the dance floor (1992).
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Figure 7. A fishing outing in New Orleans when I was a guest of their surgical society.
Figure 8. Another favorite pastime e fishing for barracuda in Florida (Dec’ 2010).