Leslie david hillis, md: a conversation with the editor*

LESLIE DAVID HILLIS, MD: A Conversation With the Editor* avid Hillis was born in Tyler, Texas, on November 25, 1945, and that is where he grew up. He D attended public high school, where he was an all-A student and a star athlete in both football and baseball. He graduated from Columbia College in 1967 with a major in history, took a year of post-graduate work at the University of Texas, and graduated from Columbia University College of Physicians and Surgeons in 1972. His internship and residency in internal medicine was at Parkland Memorial Hospital of the University of Texas Southwestern Medical School, and the last of those 3 years he served as chief resident. His 3-year fellowship in cardiology was at the Peter Bent Brigham Hospital of Harvard Medical School. With that completed in 1978, he returned to Dallas, Texas, and joined the faculty of the University of Texas Southwestern Medical School as director of the cardiac catheterization laboratory, where he has been ever since. By 1988, he was a full professor of internal medicine, and 4 years thereafter he had an endowed chair. Currently, he is the James M. Wooten Chair in Cardiology, Associate Director of the Cardiology Division, and Vice Chairman of the Department of Internal Medicine. Dr. Hillis has written 323 publications, most of which are in peer-reviewed medical journals. In addition to his highly productive clinical work, he has received numerous outstanding teacher awards in both the cardiovascular division and in the department of medicine. He is a major force at his medical center. He has been the husband of Nancy Addington Hillis for 34 years. Additionally, he is a great guy. William Clifford Roberts, MD† (hereafter, WCR): I am in my home with Dr. Hillis and it is August 31, 2002. Dr. Hillis, I appreciate your willingness to talk to me and therefore to the readers of The American Journal of Cardiology. Could we start by my asking you to describe what it was like growing up in Tyler, Texas, what your parents and siblings were like, and some of your early memories? Leslie David Hills, MD‡ (hereafter LDH): I was born and grew up in Tyler, a town with about 50,000 people at the time. (Now, it is about 75,000.) It is about 100 miles east of Dallas and about 50 miles from the Louisiana border. My parents, neither of whom had ever gone to college, were determined that their 3 children would be well educated, and they put a very high premium on being well educated. I am the youngest of 3 children; my sister is 5 years older and my brother is 3 years older than I am. Growing up in *This series of interviews are underwritten by an unrestricted grant from Bristol-Myers Squibb. † Baylor Heart & Vascular Institute, Baylor University Medical Center, Dallas, Texas 75246. ‡ University of Texas at Southwestern Medical Center, Dallas, Texas 75390.

302

©2003 by Excerpta Medica, Inc. All rights reserved. The American Journal of Cardiology Vol. 91 February 1, 2003

FIGURE 1. LDH during the interview.

Tyler in the 1950’s and early 1960’s was built around a lot of outdoor activities— hunting, fishing, and sports (football, basketball, and baseball)—plus the incredibly high premium my parents placed on excellence in the classroom. I was captain of both my high school football team and baseball team. I attended Robert E. Lee High School, which at that time had not yet been integrated. There was a separate high school in town for people of color. (The Tyler schools integrated about 5 years after I had graduated.) WCR: What were your parents like? What did your father do? Did your mother work outside the home? LDH: My mother taught kindergarten in a private school, a circumstance that did not require that she have a teaching certificate, meaning that it didn’t require that she have a college degree. My father for most of his adult life was a buyer for a local office supplies company. He did that work most of his adult life. Both my mother and father believed that the possibilities were limitless if one truly valued education and pursued it aggressively. No matter how modest one’s background might be or how modest one’s 0002-9149/03/$–see front matter doi:10.1016/S0002-9149(02)03226-5

means might be, one could, in essence, do almost anything that one wanted to do if he/she studied diligently. They instilled that in us, not in a malignant or in an unmercifully demanding way, but in an incredibly supportive way. They were interested and very active supporters of everything we did, not only athletic activities, but also academic activities, and they were determined that we would be well educated and that we would go to college. All 3 of us ended up getting doctoral degrees. My brother is a physician in Tyler, and my sister has a PhD in English literature. WCR: Where did your mother and father grow up? LDH: My mother was born and grew up in Tyler. My father was born and grew up in Wylie, a small town north of Dallas and not far from McKinney. My mother was from a large family. After my mother and father married, they lived briefly on the Texas coast during the war, but by 1942 they moved to Tyler and remained there the rest of their lives. WCR: Where did they meet? Do you know? LDH: They were married in 1939. I am not sure when exactly or where they met. WCR: When did your father live? LDH: He was born in 1908 and died in 1969, which was during final exam week of the first year I was in medical school. He had been a heavy smoker and died from oat cell carcinoma of the lung. WCR: When did your mother live? LDH: She was born in 1916 and died in 1968. She died suddenly at age 51 of an intracerebral hemorrhage secondary to a ruptured berry aneurysm about a year-and-a-half before my dad died. I was then a senior in college. WCR: What was your mother like? LDH: She was very loving, very supportive, and incredibly generous with all 3 of us. Whatever we were interested in, she was interested in. As wideranging and as sometimes foolish as those things might be, whatever they were, she took as much interest in them as we did. WCR: What was your father like? LDH: He was also that way, but differently, in that he didn’t show his emotions as much. He was more reserved, quieter, more deliberate, but generous with his time and incredibly interested in his children. For example, both my brother and I played football and baseball. My parents never missed one of our high school games. Sometimes that required driving 50 or 100 miles on a weekday when we would play in Lufkin or Nacogdoches or Texarkana. It was a family very much built around the 3 kids and built around the notion that our future was bright and unlimited. They were there in every way they could to support and encourage us and to help us to succeed. WCR: What was your home like? LDH: It was a modest home. My brother and I shared a bedroom. All 3 children shared a bathroom. My sister’s room was directly across the hall from ours. We were encouraged and expected to spend time in the evenings studying and reading. Homework was the norm during all evenings. We always ate all of our meals together. Dinner in the evening was when dad

got home from work, which was usually around 5:30 to 6 P.M. WCR: What were the conversations like around the dinner table? LDH: Almost all of them dealt with what was going on in our lives, what we were doing at school, not only with us, but also with our friends, both athletically and academically. WCR: Did your father or mother tend to dominate conversations? LDH: Probably my mother, simply because she was more verbal. She was more of a “talker” than dad. Both were involved, but probably my mother more than my dad. WCR: It sounds to me like both your mother and father were very intelligent people, although they didn’t have the opportunity to go to college themselves. Did they read a lot? Were there many books around the house? LDH: There were. My mother read a lot more than my dad did. Both were very intelligent. My dad was extremely gifted mathematically. He could do fairly complicated arithmetic in his head. My mother was more interested in books and in reading, and she tried to impart that to us. She imparted it probably more to my sister than to my brother or me. My sister was an avid reader and still is, and has been ever since she was a teenager. WCR: Was your home a religious one? LDH: It wasn’t highly religious. We went to a protestant church (“Disciples of Christ”) probably 2 of every 3 Sundays. The church was a not huge part of our lives. WCR: When you sat down at the dinner table at night, did you say a blessing? LDH: Yes. WCR: Are you a regular church member now? LDH: No. WCR: And your wife? LDH: She belongs to a Methodist church here that she attends occasionally. I’m not a member of a church. I have fairly strong personal religious beliefs that I basically have chosen not to exercise through some formal structure like the church. WCR: Do you have a dog? LDH: No. We have a couple of cats. When growing up we always had dogs. Dogs were a part of our lives in Tyler for friendship and companionship. WCR: You mentioned hunting and fishing. Did you do a lot of that with your dad? LDH: Not with our dad. My brother and I hunted more than we fished. Most of the hunting we did was with shotguns, hunting small birds, doves in the fall, quail in the winter, nothing bigger than ducks. We fished for bass in the local lakes. I did a fair amount of it. I didn’t do nearly as much of it as some of my friends did. With some of my friends, hunting was as much a part of their lives as going to school. WCR: Did your family go on vacations in the summertime? LDH: Occasionally. One thing we did almost as a ritual was to take a long weekend and go to the nearest INTERVIEW/LESLIE DAVID HILLIS

303

city to watch major league baseball. Until about 1960, that was St. Louis, the nearest town to Texas with major league baseball, the St. Louis Cardinals. I have vivid memories of listening to St. Louis Cardinal baseball on KMOX radio in St. Louis. We could barely pick it up on our radio in Tyler. Then in 1960, Houston got a major league team, initially called the Colt 45s, then the Astros, and then our yearly trips to St. Louis turned into long weekend trips to Houston. Rather than being a 12-hour drive to St. Louis, it became a 4- to 4.5-hour drive to Houston. The reason we didn’t travel otherwise was probably because there wasn’t a lot of money to do so, and both my brother and I were heavily involved in baseball, and we were not anxious to take time off for a family vacation and miss baseball. WCR: David, you mentioned that you were captain of both your football team and your baseball team in high school. What position did you play? LDH: I played quarterback in high school and defensive back (cornerback) in college. We did not have a terribly good high school football team. I was an average high school football player. I was not a star. What I could do, probably better than others on the team, was pass. Those were the days, however, when high school football was not built around passing. We passed only as a last resort. I might throw 5 passes a game. WCR: Did you have a T-system? LDH:Yes. WCR: So you got every snap. LDH: Yes, I got every snap, but I usually handed it off to somebody else as soon as possible. WCR: Did you play defense at all in football in high school? LDH: No. I played only offense in high school. In college, I played predominantly defense. WCR: What position did your brother play? LDH: Steve initially was a quarterback, but during his senior year he played fullback. He was a very good football player. He was a much better football player than I was. He had several colleges looking at him seriously. He played 1 year for Tyler Junior College, and then he went to the University of Texas. WCR: It sounds like you were a pretty good pitcher in baseball? LDH: I was a much better baseball player than I was a football player. I had a couple of scholarship offers to play baseball in college, one at Rice, one at Texas A&M. I played baseball in the summers with a bunch of guys from East Texas who played for Texas, or Baylor, or Rice, or A&M. I also played baseball in college (Columbia University) and we had a very good baseball team. There were some very good baseball players, not only on our team, but also in the Ivy League in general. I pursued baseball with more tenacity than football, probably because I was better at it and I enjoyed it more. I played baseball every summer until my senior year in college. WCR: How did you become a pitcher? LDH: My brother was a catcher, but that had noth304 THE AMERICAN JOURNAL OF CARDIOLOGY姞

VOL. 91

FIGURE 2. LDH on the pitcher’s mound as a member of the Columbia University baseball team.

ing to do with my becoming a pitcher. I am lefthanded. My father played baseball as a young man and he encouraged me to be a pitcher from the beginning. WCR: When you did not pitch, did you play? LDH: Sometimes I did. Occasionally, I would play the outfield or first base, but most of the time in high school I only pitched. WCR: Could you hit? LDH: Better than most pitchers, but not as good as most non-pitchers. WCR: Did you play basketball? LDH: Only recreationally. I never played on our high school team. I was never a particularly good basketball player. WCR: How big were you in high school? LDH: Six feet tall and 155 pounds. WCR: Were you fast? LDH: Yes. The one thing that helped me survive in playing college football was that I was very fast. I was fast relative to most of my teammates and our opponents. WCR: Did you ever run track? LDH: No. FEBRUARY 1, 2003

WCR: You don’t know what you did the 100-yard dash or the 40-yard dash in? LDH: I have no idea. WCR: It sounds to me like you made all A’s in junior high and high school and you were a star athlete. You must have been the talk of the town. LDH: I’m not sure that I was the talk of the town. Some of the terms that you use probably are stretching it a bit. I wouldn’t call myself a star athlete. I was a good athlete by local standards and I did make almost all A’s. I was in the top 10 in my high school class of about 220. In Tyler at that time, a number of people were better athletes than I was. Some of my teammates went to Southwest conference schools on football scholarships or on other scholarships. I was among them, but not among the very best. WCR: Were there any teachers in junior high school or in high school who had a particular impact on you? LDH: Yes. I had a magnificent American history teacher, Bob Wyche, in high school. He had the ability, as most really good teachers do, to make whatever subject he was teaching come alive. He had a particular interest in the Civil War, so we spent 80% of the semester talking about 4 years of history, 1861 to 1865, but we learned a lot. Elton Chaney, who taught geometry and trigonometry, also was a terrific teacher. He exuded enthusiasm, so it was hard not to become enthusiastic about his subject. WCR: Did your mother and/or father have an extended family in Tyler? LDH: My mother did. She had 1 brother and 3 sisters in Tyler, so there were a number of cousins. My mother was the youngest of 10 children. Because I was the youngest of her children, almost all of my cousins tended to be anywhere from 4 to 12 years older than me. The cousins were more my sister’s and my brother’s peer group than mine. WCR: Did your father have siblings? LDH: Yes. He had a brother who lived in Wylie, the town he had grown up in, and a half-sister who lived in Dallas. We saw them once or twice a year. WCR: I suspect that there are not many graduates of Robert E. Lee High School in Tyler who go to Columbia University. Columbia is a pretty expensive school. Did you get a scholarship to go there? LDH: Yes. At that time (1963), Columbia was going through a period when they were stressing geographic distribution. They made a concerted effort to recruit a student body, not only from the northeast or from the New York metropolitan area, but from all over the country. As a senior in high school at the time, I was all ready to go to Rice and play baseball. A guidance counselor at my high school called me one day and said there was a man from the Columbia admissions office who was driving through Texas, stopping at various high schools along the way. (The guidance counselor, in fact, had graduated from Columbia in the mid-1950’s, having grown up in Amarillo, Texas.) The counselor called me to meet with him. I met with him, and he interested me enough that I applied. I was enjoying life and already had my future, so I thought,

planned as far as what I was going to do the next year. Nevertheless, I filled out the application, and I discussed it with my parents. Had it been left up to me, I probably never would have pursued it. The reason I pursued it was that my parents thought it was an opportunity of a lifetime. Although neither parent had gone to college and neither had lived outside of Texas, when their youngest son was given the opportunity to go to New York to college— even though I had in hand a full baseball scholarship to Rice or to A&M, such that my college would have cost them nothing— they thought this was an opportunity of a lifetime, despite the fact that it would cost them money and I would be moving far away. They thought that this was just the most exciting thing they had heard of. They really pushed me to apply to Columbia and then try to get financial help. The only time they ever went to Columbia University was to see me graduate from college. They did not have the money to make trips to New York. WCR: They never saw you play baseball or football at Columbia? LDH: They never did. When I came home at Christmas I would bring a suitcase full of film that the coaches gave me and we’d sit around at home (I would borrow the projector from the local high school football coach) in the evenings and watch all 10 football games. Baseball games weren’t filmed, so they never saw a college baseball game. Within 18 months after I had graduated from college, both of them had died. They had a big vision of the world, even though their own world was not terribly large. They realized that there was a world out there that one should not be fearful of, and they encouraged all of us to be expansive in our ambitions. WCR: Your home sounds as if it was very pleasant and warm. There wasn’t a lot of fussing or arguing going on? LDH: That’s correct. WCR: Was there alcohol in your home? LDH: There was early on, but after my dad had some trouble with it, he abstained, beginning when I started in junior high on, and he never drank again. WCR: What kind of scholarship did you get from Columbia? LDH: At that time, several schools (Columbia among them) would give whatever amount of money one needed to make up the difference. My parents filled out a very detailed financial statement, and the university put that through some sort of a formula. They wanted to know what it would take to make up the difference. They usually would give you a combination of a grant, a scholarship, or a loan, plus they provided a part-time job working 10 to 15 hours a week for meal money. In my freshman year (this is in the days when dormitories were segregated by sex), the graduate women’s dormitory at Columbia had a formally served dinner in the evenings, and my job that first year was to serve dinner in the women’s dorm. In return, I got all of my meals in a little room off the kitchen. WCR: How did New York hit you? Here you were INTERVIEW/LESLIE DAVID HILLIS

305

from a town of 50,000 people, and the furthest you had been away from home was St. Louis, Missouri. LDH: I had never been to New York. I had only seen some photographs of the Columbia campus. WCR: How did you get up to Manhattan to begin your freshman year? LDH: By bus. I got on a Greyhound bus in Tyler and 48 hours later pulled into the Port Authority bus terminal in New York City. WCR: Was it understood when you went to Columbia that you would play both football and baseball? LDH: No, it was understood that I could do whatever I wanted. In my freshman year, I only played baseball. The institution, academically for me, being from a small town in Texas, was very intimidating. I thought that academically I would need all the time that I could possibly muster to survive, and so I didn’t want, in the fall of that year, to do anything that would pull time away from studying. That was why I chose not do any extracurricular activities during that first semester. WCR: How did Columbia hit you? You were suddenly with a very sophisticated group of people, most of whom, I presume, had gone to private high schools. LDH: Probably half of my class was from the New York metropolitan area. They were bright and extremely motivated. All the Ivy League schools at that time were all male, except Penn and Cornell. Columbia was still all male and the women’s college, Barnard, was across the street. I guess the answer to your question is that I was terrified. WCR: You were terrified of the potential difficulty of the academics or of the city? LDH: The city was very foreign, intimidating, but not terrifying. That’s probably the right adjective for Columbia as well. I was intimidated at Columbia by my perception that my classmates and my dorm mates, and basically all of the people with whom I interacted were about 10 times smarter than I was. WCR: When you went to Columbia were you premed? LDH: No. I started out not knowing what I wanted to do and ended up majoring in history. I took some science courses, but I was not a premed. Academically, I had gone to a reasonably good high school, but I had some catching up to. I did that catching up predominantly during that first year. My grades during that first year were adequate, but they weren’t nearly as good as they became during years 2, 3, and 4. Academically, I was behind, not hopelessly behind, but I had some work to do. WCR: You really applied yourself, particularly that first year? LDH: Yes, I did. I think for everyone going from high school to college that this is true. It’s not unique to Columbia, but what struck me hardest and was most intimidating and difficult was just the huge amount of reading, at least relative to what I did in high school. It took a semester or 2 to become accustomed to that and to get up to speed. WCR: By the time you entered Columbia, had the 306 THE AMERICAN JOURNAL OF CARDIOLOGY姞

VOL. 91

thrill of learning become a part of your existence or did you sort of pick that up in college? LDH: I more or less picked it up in college, but I have always and continue to be “intellectually curious.” I am sure that was something that was instilled in me by my parents. My favorite courses in college were those that I took simply because they seemed interesting and stimulating. In my sophomore year, the course I enjoyed the most was one titled “Tolstoy and Dostoyevski.” During that semester, we read about everything that both of them had written. It was 500 or 600 pages a week. But it was a magnificent course. At Robert E. Lee High School in Tyler I hadn’t read a lot of Tolstoy and Dostoyevski. I had fulfilled my language requirement because I had taken Spanish in high school, so I had placed out of all but one semester of Spanish. As a junior, I decided it would be fun, interesting, and enlightening to take a language with a different alphabet. I still remember standing in the registration line to sign up to take Chinese, and, at the very last minute, I decided to take ancient Greek, which I did. I took 2 years of Greek, and in that second year we read The Iliad and The Odyssey—all of the Greek tragedies—and The New Testament. That was a fun thing to do. It was those kinds of things that were the most fun and had absolutely nothing to with science, and usually nothing to do with what I majored in. It had to do with things that I thought would be interesting. If you don’t know much about something, the more you get into it, usually the more interesting it becomes. WCR: You took courses that both appealed to you and challenged you? LDH: Yes, and that broadened me. WCR: How big was Columbia University in 1963? LDH: At Columbia, the undergraduate part was, and still is, the smallest of the Ivy League schools. My college class was about 700 and now each college class is about 960 or 1,000. Harvard, Princeton, and Dartmouth are all about 1,200 to 1,300 per class. WCR: Do you have a handle on how you placed approximately among those 700 by the time you graduated? LDH: I made the Dean’s List for the last 6 of my 8 semesters, throughout my sophomore, junior, and senior years. One had to have a B⫹ average to be on the Dean’s List. WCR: Out of the 700, how many made the Dean’s List? LDH: I don’t have any idea. It was certainly not the days of grade inflation, that’s for sure. There were a lot of “C’s” flying around those days. WCR: You worked hard? LDH: Yes. I had the accelerator to the floor. I wouldn’t say all the time, but most of the time I worked hard. WCR: I presume that you didn’t have a lot of money to allow you to play around too much? LDH: I could do whatever New York offered that was either free or cheap. And there are a lot of things in New York that one can afford to do. You can go to a lot of museums without breaking the bank, and you FEBRUARY 1, 2003

could in those days buy standing room for most music performances of Broadway plays, opera, and the philharmonic. When I was in college, especially my freshman year, there was a group of us who loved going to Broadway shows (of course, I’d never seen one until I got there), but we couldn’t afford the tickets. There is almost always one intermission at each Broadway show, and during the intermissions the theatergoers spill out onto the sidewalk in front of the theatre (these days it is usually people who are smoking). We would go down to the theatre district, and during the show intermissions, we would mingle with the people who had spilled out of the theater. When the bell would ring to call the people back into the theatre, we would also go in and stand at the back. I have seen the second act of every show on Broadway! I had no idea what went on in the first act, but it was a way of seeing the second act free. WCR: You had never been to an art gallery before you went to New York? LDH: Correct. Never! WCR: How did the New York culture strike you? LDH: “Foreign” is the right word to describe it. I had been to a few live performances or other cultural events. Our senior play in high school was about the extent of it. It was a whole new world for me. It was a world, until then, that I didn’t know existed until I got there. WCR: It sounds like you flourished in it? LDH: I did. The first year was not pleasant, and I say that only because I felt inadequate intellectually and I felt “under the gun.” I felt pressure. I felt basically vulnerable to not making it. That feeling of discomfort, of feeling, like you’ve “got to hack it” is not one that feels comfortable. Once I got through the first year, then I became convinced that if I stuck to my work and did my job that I wasn’t going to flunk out, and I realized that I could make it. WCR: Did you have any thoughts during that first semester that maybe that baseball scholarship to Rice or A&M sounded pretty good after all? LDH: No. We had no telephones in our dorm rooms. To make an outside phone call, the pay phone in the lobby of the dorm had to be used. We could only afford for me to call home once a week, and I did so on Sunday evening. I remember vividly calling home those first few weeks and wishing (I had so much pride that I would never say to them “Can I come home?”) that one of my parents, in a moment of weakness, would say, “Would you like to come home?” Had they asked that question, I would have said “Yes” and would have been on the next Greyhound bus out of there. But they were smart enough and insightful enough not to ask the question. WCR: You mentioned, David, that your parents went to Columbia only once during your time there. Did you go home occasionally? LDH: We had enough money for me to go to Columbia in September and to come home in June on the bus, and to fly back and forth at Christmas. I stayed in New York for the rest of the time. My roommate, who I had been assigned by total random drawing, was

from Fairfield, Connecticut (he is now a lawyer in Greenfield, Massachusetts). He and I roomed together all 4 years. He was a swimmer. A couple of Thanksgivings I spent with him and his family. His parents were kind of my surrogate parents while in college. Although my parents could not attend my college football or baseball games, my roommates’ parents attended many of my baseball games! They would drive to Boston to see us play Harvard or to Hanover to see us play Dartmouth! Talk about a labor of love and devotion to some kid who wasn’t even theirs. WCR: What were their names? LDH: Mr. & Mrs. Craig Barry. Craig, Jr, was their son. WCR: What was your pitching record in high school? LDH: I don’t remember. It was good. In my senior year, the team that won the state championship came from Lufkin and it had a 35 and 1 win–loss record that year. Their one loss was to me. My pitching record in college was actually better than in high school. The only record I remember was 15 and 2, which represented my combined sophomore year in college in the spring and the summer season record when playing in a summer college league, and my earned run average was of 0.6/9 innings. WCR: Did you have a good fastball? LDH: Yes. I was going to say “incredibly good,” but that’s a bit boastful. I also had a very good curve ball. WCR: How fast could you throw the fastball? LDH: It was in the days before radar guns. I guess “fast enough,” but I’m not sure how fast. WCR: When you were in high school, did you have jobs a lot? LDH: I worked in the summers usually. East Texas has oil and gas fields, and several summers I worked on drilling rigs. To drill an oil well you need huge amounts of water, and often within a few hundred yards of the oil well several teams drill water wells. I worked on those crews drilling water wells to support the oil wells. WCR: David, who on the faculty had an impact on you as an undergraduate at Columbia? LDH: Three professors, none of whom had anything to do with medicine. There was Howard P. Davis, a magnificent art history teacher. I took 2 courses from him— one on Italian Renaissance painting and one on Northern European painting. He was a phenomenal teacher of art, and I have vivid memories of how exciting he made those 2 subjects. He was a world expert on Giotto (the name of the course should have been “Giotto” because we spent the whole semester looking at every one of his paintings). In the Northern European course we studied mainly Jan Van Eyck. The teacher who taught Tolstoy and Dostoyevski was Bob Belknap, and he also was magnificent. He would stand in front of the class and read from the work by Tolstoy and Dostoyevski. His copy was in Russian. He would translate it into English as he was reading it himself in Russia. He was a magnificent teacher. Jim Shenton, a history teacher, also was magnificent. WCR: You filled in some of the holes you had not INTERVIEW/LESLIE DAVID HILLIS

307

encountered in your first 18 years. There weren’t many people back in Tyler with whom you could discuss these subjects. LDH: There probably were, but I just didn’t know who they were. They were not my football and baseball-playing buddies. WCR: How did baseball work out at Columbia that first year? LDH: We had an undefeated team my freshman year. Back then, the freshman team didn’t play a lot of games. We were 12 and 0. My sophomore year, we had our best team. The Ivy League for all minor sports played in a league called the “Eastern Intercollegiate League,” which included the 8 Ivy League schools, plus Army and Navy. There were 2 or 3 members of our team who could have, had they wanted, played major league baseball, and all of them are now physicians. It was an unusual group of guys. There were a group of us who played baseball together and hung out together, and almost all of us went to medical school. When I was a sophomore, the shortstop on that team was Archie Roberts, who was all-Ivy League quarterback and is now a cardiothoracic surgeon in New Jersey. Had Archie decided to pursue baseball rather than football, unquestionably he would have played major league baseball. He was a magnificent shortstop and a left-handed hitter. But he wanted to play football, so he played with the Cleveland Browns for a couple of years when he was going to Case Western Medical School. We also had good teams the next couple of years, but not quite as good as during my sophomore year. WCR: You were in the starting rotation from the beginning? LDH: I was. There were 3 of us who were: 2 seniors and me. We didn’t win the league, but we should have. We came in second or third that year. WCR: How many games would you play? LDH: We would play about 25 games each spring season. In those days we did not make a trip to Florida, which almost all of the northern schools now do, so it really wouldn’t be very warm until the 1st of April. We played only in April and May. WCR: You’d start about 8 games? LDH: Yes, 8 or 9 games. WCR: You’d pitch the whole game? LDH: If I could. If I lasted. WCR: What was your record in the entire 4 years in college? LDH: I don’t know. I’ve never thought about that. WCR: What kind of time commitment was baseball for you in college? You practiced, I presumed, every day? LDH: We practiced everyday for probably 2.5 to 3 hours. Most games were on Fridays and Saturdays, with a middle-of-the-week game in the New York area. The games away would be on Friday or Saturday. We started practicing indoors in February and went outdoors as soon as the weather allowed. WCR: You’re talking about 28 hours a week. LDH: Yes, something like that, but it was something 308 THE AMERICAN JOURNAL OF CARDIOLOGY姞

VOL. 91

I enjoyed tremendously, and most of my teammates did as well. WCR: How did you decide to go out for football your sophomore year? LDH: I guess I missed it. A number of my friends played football, and I thought it would be fun to do, and by then I was academically confident that I could do it and that I would not suffer academically. WCR: I presume you went out for quarterback? LDH: I did, but that year Archie Roberts, a senior, was the quarterback and so I didn’t play a lot until my senior year. My senior year I was a starting defensive back; one of the 2 cornerbacks. I missed 1 game that year due to an injury. WCR: How was the switch from quarterback to defensive back? LDH: In my case, it was pleasant. I remembered as a high school quarterback feeling lots of pressure to perform. (Texas high school football is big business, and the whole town would try to convince you that the whole town was riding on your shoulders.) I enjoyed playing football my senior year in college. It was probably the only time in my entire football career that I actually enjoyed playing. The pressure in high school made it uncomfortable, and even today, when I look at kids playing high school sports, I have mixed feelings about it. Learning to be an effective member of a team is something, however, that transcends sports—learning to deal with adversity and failure. Those are life lessons that hold you in good stead forever. I wish that one could impart those lessons in a less pressured environment. I lived in a state where high school football was a passion with lots of people. It’s good to be passionate about something— but just not pathologically passionate. WCR: It sounds to me, David, that your 4 years of college were very successful. You made the honor role 6 of 8 semesters. You played on the first team in baseball from the very beginning, and you played 3 years of football. How did you decide that you wanted to become a physician? Did all of the other people with whom you were playing sports influence you in that regard? What happened? LDH: They did. There were a couple of things. My brother and I grew up in Tyler about 2 houses down from a physician, a urologist, named Earl Clawater. Dr. Clawater was very much a role model for both Steve and me. He was the person who first got us thinking about medicine. It was a great help that this bunch of football and baseball friends were guys intending to go to medical school, and all of them did. On baseball trips, for example, a lot of things like organic chemistry were being thrown around the bus. These were a bunch of smart, highly motivated, ambitious teammates and classmates. WCR: When did you decide in college that you were going to be premed? LDH: Probably about halfway through my junior year. I wasn’t sure until then that I wanted to go to medical school. In my junior year I took inorganic chemistry, and in my senior year I took zoology. FEBRUARY 1, 2003

had a whole year where all I had to do was pass organic chemistry. It was a great year. WCR: What were Nancy’s characteristics that attracted you? LDH: She was a good student, a business major. (She has been a buyer for JC Penney all her working life.) She had and still has a magnificent sense of humor, and is an incredibly warm and kind person. WCR: She grew up in Highland Park in Dallas? LDH: Yes. WCR: During that year you must have come to Dallas a few times. LDH: We did. My mother died suddenly in January of that school year, so I tried to go to Tyler as often as FIGURE 3. The Hillis family: left to right, Steve (LDH’s brother) and his wife, June; possible to see my dad. LDH and Nancy, Harriet (LDH’s sister) and her husband, Jerome. WCR: That was a real shocker, wasn’t it? LDH: It was, very much so. When I graduated from college, I went to graduate WCR: Did you apply to any medical school other school for a year (in history) and during that year, I than Columbia? LDH: Yes, I applied to Southwestern. That was the took organic chemistry, the science course I needed only other one. for medical school. WCR: Did you get into Southwestern? WCR: When you actually graduated from ColumLDH: I don’t know. When I got admitted to Columbia, you hadn’t finished your requirements for medical bia, I withdrew my application from Southwestern. school? LDH: Correct, I had 1 more course to go. I had taken The person who interviewed me at Southwestern was physics, zoology, and inorganic chemistry, but not Dan Foster, who is now the Chair of the Department (I am the Vice Chair). Dan now is one of my very organic chemistry. WCR: Did you play football or sports that post- closest friends and colleagues and, of course, that was at a time when I was a 22-year-old first-year graduate graduate year? LDH: I spent that graduate year in Austin at the student, and Dan was in his late 30’s. He’s 15 or 16 University of Texas. That’s where I met my wife years older than I am. He was a junior faculty member Nancy. She was a senior at Texas. We met in the on the admissions committee at the time. WCR: Why did you get married after such a quick spring and married August 31, after courting for only 4 months. We then went to New York, and I started courtship? LDH: It just seemed like the thing to do. When medical school. you’re young and foolish and as much in love as we WCR: How did the University of Texas fit you after were. . . . She had just graduated. We got married and 4 years at Columbia? then went to New York. I started medical school, and LDH: The graduate courses I took were very good. she started working for JC Penney. Their national They had a good history department, and the couple of buying office then was in New York, and 15 years the courses I took just for medical school purposes later it moved to Dallas. were adequate. A large state university, in general, is WCR: That worked out well. not as rigorous or as demanding as are smaller more LDH: It worked out very well. intellectually demanding Ivy League schools. At any WCR: My mother used to give me little booklets of large state university you can work incredibly hard or sayings by JC Penney. I loved them. How did medical you cannot work hard. I was in Austin knowing that I school strike you? Other than the physician down the was going to medical school, and so I didn’t find that street from you when you were growing up, did you I had to work terribly hard. have any contact with hospitals or nurses or other WCR: Did you apply to medical school while you physicians? were in Columbia? LDH: No. LDH: Yes. WCR: In actuality, when you entered medical WCR: They told you that you ought to complete this school, you didn’t know much about doctors or what course? doctors really did? LDH: In mid-September, after being in Austin for LDH: That’s correct. Medical school was in some only a week, I received a letter of acceptance to respects similar to college. I found medical school, medical school at Columbia for the next year. Thus, I especially the first year, to be intimidating and very INTERVIEW/LESLIE DAVID HILLIS

309

demanding. Remember that I had not been a science major, and a lot of my medical school classmates had been. It was similar to college, in that I had some catching up to do. I managed to do it, but it took a lot of work. WCR: Did you have a scholarship to medical school? LDH: Yes, and loans also. By the time I graduated from college and medical school, I was in debt to the tune of several thousand dollars, but not nearly to the extent that young men and women are now. We paid it off in a few years. WCR: What were some early surprises for you in medical school? Were you intimidated by the quantity of work or by your perception that you were behind your classmates scientifically? LDH: Probably both, but more of the latter. I felt that their knowledge of science was much deeper and much more extensive than mine. What I had was qualitatively good, but it wasn’t extensive. Up to that point, I had not thought about how necessary it was that I have an extensive knowledge of science. WCR: Why didn’t you stay in New York for your postgraduate year rather than go back to Austin? Your return changed your life; it determined whom you married! LDH: Austin was cheaper. After all, I was a Texas resident, and I could go to the University of Texas at that time for $100 per semester. Columbia would have cost several thousand dollars per semester. It was 20 or 30 times more. The cost was the determining factor. WCR: What did your parents think when they came to New York to see you graduate? LDH: They were pleased, satisfied, and proud. I was the last of their 3 children to graduate from college, and that was a point of great pride for them. The college was small enough, so by the time I was a senior, I knew the dean and the major faculty members, and I introduced my parents to all of them. The dean told them what a terrific young man I was, and they believed him. It was a time when they saw things come to fruition. WCR: Who had impact on you in medical school? LDH: More than anyone was Don Tapley, an endocrinologist, and my attending physician when I was a third-year clerk on internal medicine. That third year of medical school on medicine was a life-determining experience. WCR: It was during that period that you decided on internal medicine? LDH: Yes and no. I still flirted with doing surgery. Even when I came to Dallas as an intern in medicine, it wasn’t terribly unusual then to do a medicine internship and then a surgery residency. One of the places where a lot of trainees did that was Southwestern. When I came to Dallas as an intern, I wasn’t sure what I wanted to do. I considered that I might go into surgery after a year of medicine. I wasn’t convinced that I was going to be an internist, and certainly not convinced that I was going to be a cardiologist. WCR: What kind of impact did Dr. Tapley have on you? 310 THE AMERICAN JOURNAL OF CARDIOLOGY姞

VOL. 91

LDH: He, more than anyone else, was a role model and a clear thinker. He thought pathophysiologically. He possessed all of the things that all good physicians have— kindness, compassion, and a consideration of patients. He was an effective teacher, he was excited about medicine, and he wanted our experience in medicine to be good. WCR: He was on the full-time faculty at Columbia? LDH: Yes. Four or 5 years after I left, he became the dean of the medical school. WCR: How many were in your class at Columbia medical school? LDH: One hundred and fifteen. WCR: Did you and Nancy live close to the medical school? LDH: Nancy and I lived right across the Washington Bridge in Fort Lee, New Jersey, in the upstairs of a 2-story house. We had a yard and a Texas-like neighborhood. It was a 10-minute bus ride across the bridge and then a 10-minute walk down Fort Washington Avenue from the bus station to the medical school. WCR: When did you get a car? LDH: We had a car in New York, but we didn’t use it much. We’d use it to go to the grocery store and for an occasional weekend trip. WCR: You must have had a car when you went to Austin? LDH: No, I didn’t. I lived with a Columbia classmate who was at the Texas law school, and I borrowed his car occasionally. WCR: You didn’t get your first car until you were 22? LDH: Correct. WCR: Did you enjoy medical school? LDH: I enjoyed the last 2 years. The first 2 years were a lot like college and not particularly pleasant. The third and fourth years were a lot of fun. It gradually changed the way college had. WCR: I gather that you concluded that you had made the right decision to become a physician? LDH: Even in the darkest days of medical school, I always felt like I’d made the right decision. At least by the third year, I felt that way. And I still feel that way; I’d do it again. WCR: Your older brother was where at this time? LDH: He graduated from Southwestern the same time that I finished my first year of medical school, and during my second year of medical school he was an intern at Parkland Hospital. In my last 2 years of medical school he was a general medical officer on an Air Force Base on the island of Crete in the Mediterranean. He spent 2 years there with his wife and his young son and daughter. WCR: How did you decide to do your internship in Dallas at Parkland Memorial Hospital? Did you apply to several places? LDH: I applied to only 2 places, Parkland and Columbia Presbyterian. My brother had raved about what a terrific medicine department Southwestern had. I came to Dallas as a fourth-year student and did a 2-month student internship (July and August) of my FEBRUARY 1, 2003

FIGURE 5. LDH and Donald W. Seldin, who was Chief of Medicine at the University of Texas at Southwestern Medical Center for 37 years, under whom LDH trained.

FIGURE 4. LDH and his brother Steve, a urologist.

fourth year. I got to know some of the faculty and decided that indeed it was a terrific place. At that point, both Nancy and I were anxious to get back to Texas. I was told that if I applied to Parkland, that I would be one of their choices. At that time, Dr. Jay Sanford, the vice chair, ran their residency program, and Dr. Donald Seldin was the chair of the department. WCR: How did Nancy enjoy New York City? LDH: We both loved New York. The longer we lived there, the more we enjoyed it, and we still tremendously enjoy New York City. To enjoy New York, it helps to have money, and so our experience in New York now is different than it was when I was in medical school. She liked it then, but she likes it much more now because she is familiar and comfortable with it, and I am the same way. WCR: How did your medical internship at Parkland, beginning July 1972, work out? LDH: It was magnificent. College and medical school were good experiences. Being a medicine intern and a medicine resident in Dallas at that time was a life-changing experience for me. The department of medicine in Dallas at that time was an incredibly exciting and vibrant place. Dr. Seldin had been chair for 20 years, and he had built, what some people thought, was the best medicine department in the country; it was certainly one of the best, if not the best. Every section head was a young, vibrant, dynamic, enthusiastic physician-teacher. John Fordtran ran the gastrointestinal division; John Dietschy was with him. Jim Willerson had just arrived in the cardiology division. Joe Goldstein and Mike Brown had just arrived and Joe ran the genetics division, and he and Mike were getting their lab set up. Jean Wilson was there,

FIGURE 6. LDH and Dr. Daniel W. Foster, his close friend and the present Chairman of Medicine at the University of Texas Southwestern.

and he also was the editor of the Journal of Clinical Investigation (1972 to 1977). Dan Foster was there in endocrinology along with Jean Wilson. Those 3 years as in intern and resident were magical. It was magical because of all of these people who were incredibly good teachers. They had a presence. As an intern and resident, I saw them on the wards making rounds, teaching house staff, and students. They were good doctors. They were doing “cutting edge” research in their laboratories. It was an amazingly exciting place. Although college and medical school had been exciting, they did not compare to those 3 years as an intern and a resident. WCR: What made Donald Seldin a great chairman of the department of medicine? LDH: He was, and is, uncompromising in his insistence on excellence. He demands of himself, and of everyone around him, that they be the best, and there’s not a lot of fluff. There’s not a lot of praise or “pats on INTERVIEW/LESLIE DAVID HILLIS

311

the back” unless they are really deserved. The value of his currency is incredibly high. That is, if Dr. Seldin tells you that you have done something well, take it to the bank. That means you’ve done it well. What makes him so special? I’ll use a term that he would use. He has “good taste,” and what he means by that is the ability to choose people well. You have to be able to look at them and not so much see them in what they’re doing now, but see them in the potential of what they will be doing 5, or 10, or 20 years from now. I don’t think that there is anyone that I’ve ever known who has the kind of taste that he has. He built this department with good taste. Over the course of 30 years he identified young people who he saw something in, and he was not bashful enough to plan their whole career, if they needed it planned and to bring them back into positions of leadership. He did that with Jean Wilson, John Fordtran, Dan Foster, Joe Goldstein, and me, and with numerous others. He planned my career, in that he told me where to go for my cardiology fellowship, and what I would be doing when I returned. He was not hesitant in doing that, and he did that with numerous other people. WCR: It must have been both a surprise and an honor to be selected by him as his chief resident after only an internship and 1 year of residency? LDH: In those days, that’s the way Southwestern did it. The chief residents now spend an extra year. They are fourth-year house officers. In those days, the way the department operated was that there were 2 chief residents, the 2 Seldin believed were his 2 best senior residents. Doing it that way taught me a lot about leadership. My co-chief resident was John Harper, now a cardiologist here in Dallas. John and I were all of a sudden thrown into a situation where a third of the house staff we directed were our peers. They were house officers who we had been interns and first-year residents with. It teaches one a lot about leadership and about interpersonal skills to be their friend, and yet not be their friend if they need to be kicked in the rear or need to be disciplined in some way. WCR: How did you work that out? LDH: I worked it out probably similar to the way I work out things today. How do you get people to do things they don’t want to do, or how do you get them to change their behavior? You cajole them, you prod them, you throw things at them, you scream at them. It’s whatever works for them individually. Different people need different stimuli. For some it is just putting your arm around them and telling them that if they ever do that again, you will be profoundly disappointed, and that’s enough. For others, it’s looking them in the eye and telling them if they ever do that again that they better have a lot of life insurance. WCR: It is my understanding that many in those days were relatively fearful of Dr. Seldin? It sounds to me like you hit it off with Dr. Seldin right away. Is that proper? LDH: That is proper, but I, too, was incredibly fearful of him. We all were. And fear is not all bad. Fear served me well as a freshman in college and as a 312 THE AMERICAN JOURNAL OF CARDIOLOGY姞

VOL. 91

freshman in medical school. The fear of not making it. It was fear of incurring his wrath. But it was no different than the fear I had with my parents; my biggest fear was that I would disappoint them, and my biggest fear with him was that I would say something or do something that was stupid, and he would look me in the eye and tell me it was stupid, and I know that would be disappointing to him. Did he throw charts at me and scream at me? I can’t remember that he ever did that. There were all sorts of stories about what went on back in the 1950s and 1960s. He was demanding and he had very high expectations. What I didn’t want to do was not meet those expectations! WCR: How many senior residents were with you your first year of residency? LDH: About 25. WCR: So you and John Harper were the 2 picked from 25. LDH: Correct. WCR: How did you get interested in cardiology? LDH: I think largely through Jim Willerson. Jim had arrived in Dallas about 6 months before I did. He had come from the Massachusetts General Hospital, where he had been a medical resident and cardiology fellow, and then a junior staff person for a few months. My first 2 months as an intern were spent in the coronary care unit with him as the attending. Jim, as he is today, was demanding and intense, but all in a good sense. He was a magnificent role model, and he turned me on to cardiology. It was the center of the universe from that point on for me. A lot of it had to do with Jim’s enthusiasm, and his being such an incredibly good role model. WCR: What were your working hours like as an intern at Parkland Hospital in 1972? LDH: We were on every third night for the whole year, and we worked every day. We worked an average of 110 or 120 hours a week. WCR: You’d get to the hospital at what time? LDH: I’ve always been an early morning person. I would usually get there at 6:15 or 6:30 A.M. and start rounding by myself, seeing my patients. I would leave for home anywhere from 4 to 7 P.M. WCR: And the third night you were on, you were really on? LDH: Yes, you were cross-covering all of the other interns’ patients, plus you were admitting new patients. So you were busy. Usually, I was able to get a couple of hours sleep, but sometimes it was none. WCR: David, I gather that during the course of that year and probably very early in the course of that year, you decided that internal medicine was the thing for you, not surgery. LDH: Yes, that’s correct. That was largely through the excitement of Dr. Seldin and his department. WCR: How did it come about that you went to the Brigham and Women’s Hospital (I guess it was Peter Bent Brigham at that time) for your cardiology fellowship? LDH: It wasn’t complicated. About halfway through my first year of residency or 18 months after I came to Dallas, Dr. Seldin (I had already told him I wanted to FEBRUARY 1, 2003

do cardiology) said to me: “I want you to go and train with Gene Braunwald, because he is the best cardiologist in the world. After you’ve finished your fellowship with him, you will come back and join the faculty.” He and Dr. Braunwald, both then and now, were extremely close friends. I never filled out an application for fellowship. I never had a letter of support. It was one phone call from Dr. Seldin to Dr. Braunwald, and literally in 2 minutes it was settled. I would do my fellowship at the Brigham and then return to Dallas and join the faculty. About a month later, Dr. Braunwald came to Dallas as a visiting professor and I met him for the first time. He said: “Welcome, glad to have you, and I’ll see you in a year-and-a-half.” It was agreed that I would go there for 3 years and then come back. Dr. Seldin asked at the very end of my chief residency year when I got ready to go to Boston, “Now in 3 years, you are going to come back and join the faculty. What position would you like?” We were sitting in his office, and I remember thinking to myself, “I’ve never seen a cardiac cath but my impression was that what went on in there was kind of neat.” Naively, I said I would like to be the director of the cath lab. And he said: “OK.” He said, “Then it’s settled.” When you get back in 3 years, you’ll be the director of the cath lab. That’s what happened. WCR: What characteristics do you think that Dr. Seldin noted in you that allowed him to say that you were one of the people of his “taste?” LDH: I’ve thought about that. The short answer is that I don’t know. I should probably ask him. In my more egotistical moments, I would try to convince you that he saw some things in me that he saw in Jean Wilson, Joe Goldstein, Dan Foster, and John Fordtran, but that’s a pretty select group. I’m not sure I’m in their league. What he may have seen was an excitement about medicine, a lot of intellectual curiosity, a tremendous amount of energy and commitment, and a willingness to work hard. At that stage, those were the things that I brought to the table. I was excited about what I was doing, what I wanted to do, and I was willing to work my butt off to try to make it happen. That’s probably what he saw. WCR: It sounds like he liked you and that he just liked being around you? LDH: It was interesting. During the year as chief resident, we spent a lot of time together. Our present chief residents ask me sometimes what was most valuable or what was most fun, or what was most unique about the year as chief resident, and I think it was 2 things: one was learning leadership skills, and the other was the friendship that I developed with Dr. Seldin. I went from being a lieutenant in his department to beginning to develop a very strong friendship that has grown. He and I these days are extremely close friends. Nancy and I take trips with him and Ellen a couple of times a year, and have done so for several years. He has become much more than just a colleague; he’s a genuine close friend. That began during that year as chief resident. WCR: How did Boston work out? LDH: It worked out great. I spent the first year

FIGURE 7. LDH and his wife Nancy.

working in an animal laboratory with Peter Maroko, who had come from San Diego in 1972 with Dr. Braunwald. Peter and Dr. Braunwald were working on myocardial infarct size in the very early days. Also, there was Peter Libby. When I got there in 1975, Dr. Braunwald had been at the Brigham for 3 years, and he had 2 very active animal labs. One was run by Peter Maroko and the other was run by Steve Vatner. Steve was doing chronically instrumented dogs and looking at sophisticated basic cardiovascular physiology. I spent the first 12 months with no clinical responsibilities working in Peter Maroko’s lab, and then I began the clinical fellowship. WCR: How did you like the lab work? LDH: I liked it, I enjoyed it, but I missed patient contact. I was very busy and tried as best I could to be as productive as I could. I learned for the first time about the scientific method. The next 20 months were as a clinical fellow; I went back into the dog lab for my last 4 months of fellowship. Two-thirds of my clinical experience was in the cath lab. WCR: Did you have much contact with Braunwald? LDH: I did, especially during that year in the animal lab. We had weekly meetings with him, where we presented all our data to him. He was a very effective mentor. He kept very close touch with what was going on in the animal lab and made suggestions and critiqued data. He and I, at that point, also wrote some sizable papers together. Just writing papers with him was a real educational experience. Dr. Braunwald taught me to write scientifically. He’s an incredibly good writer. INTERVIEW/LESLIE DAVID HILLIS

313

WCR: Did you go to his house to work on papers? LDH: No, but I would sit down with him at his

office. A lot of manuscripts got kicked back and forth with huge amounts of scribbling on them, and then each time less scribbling as it came back. We would go through 5 to 10 drafts of each manuscript. WCR: You had the experience of working with 2 of the very finest departmental chairmen of medicine in the last half of the 20th century: Seldin and Braunwald. How would you compare the 2? LDH: In many respects, they have different personalities. Dr. Seldin is much less reserved, and possesses more spontaneity. He’s more talkative or “bubbly” than Dr. Braunwald. WCR: Would “charming” be a word? LDH: I think so, yes, although Dr. Braunwald is charming also. Their similarities are strong. They both demand excellence, and they do not compromise on that. They know when they see it. That is an important point. You could demand it, but if you didn’t recognize it, then you might have a problem. They know what they want. They know what they don’t want, and they have a pretty good feel for what it takes to get it; they expect it of themselves, and they expect it of those they work with. They are remarkably similar in that way. They are both very fair; they are both free of fluff. For both of them, the value of their currency is extremely high. If they compliment you and tell you that something is good, it really is good, because they are not just saying it. If it’s not good, they won’t say it, and I have a tremendous high regard for that. They’re demanding of excellence, but in a very good way—in a nondestructive way. There’s a lot of rigor, and I think rigor is good. I think people work best and do their best if things are rigorous. WCR: How would you sum up your experience of those 3 years in Boston? You had an opportunity to meet a lot of major figures in medicine, not just in cardiology, but in other areas as well. Was Tom Smith there? LDH: Tom was the chief of the division. Bill Grossman directed the cath lab, Joe Alpert, the coronary care unit, and Peter Cohn, the clinical service. The faculty was a terrific group of young people who were on their way up. My fellowship colleagues also were outstanding. They included Blase Carabello, Elliot Antman, Josh Wynne, and Shelly Goldberg. My time at the Brigham was professionally very satisfying and productive, and it armed me with what I was sent there to be armed with. They armed me with the skills to go back to Dallas and make the department better. WCR: Once you got back to Dallas, what happened? LDH: I was chief of the cath lab from the first day I walked in in July 1978, and I have been in Dallas at Southwestern ever since. I very much wanted to make the cath lab good in a number of ways. I wanted to make it a good place for people to learn and have the teaching in it be good. I wanted it to be my research laboratory. I saw the cath lab as an opportunity. It was an era when cath labs didn’t have the demands placed on them that are there today, i.e., to crank out huge 314 THE AMERICAN JOURNAL OF CARDIOLOGY姞

VOL. 91

numbers of cases. When I was a fellow at the Brigham, we usually did 2 or 3 cases a day in each cath room, and each case lasted a couple of hours. Part of that was doing some research protocol. That’s very much the way I wanted Dallas to be, and so what I tried to create was what I will term “an academic cath lab,” a cath lab where one could take an extra 10 to 45 minutes to address a question worth answering. That’s what I attempted to do from the time I arrived in 1978. I wanted it to be an exciting place for fellows to learn the technique and to learn physiology and to make it a place where we could do human investigation. WCR: Is it very difficult to do that anymore with so many coronary patients? LDH: Yes it is. The cath labs are overwhelmed, and the economics of hospitals these days usually don’t allow a procedure that should last for only 30 minutes to last for 120 to 180 minutes. If you occupy the room for that period of time, somebody’s got to pay for it. Twenty-five years ago, the hospital wasn’t pounding its fist on the desk demanding that one pay for it. In 1978 and for the first 10 or so years after returning to Dallas, one could do just about anything that one wanted in the cath lab from a time perspective. As long as the patient had consented to it, as long as the internal review board had agreed to it, the hospital really didn’t care whether the procedure lasted an hour or 2 hours, but now they do. WCR: Dr. Hillis, you’ve been at Southwestern for 24 years and during that time you’ve been highly productive. You have brought new knowledge about various cardiovascular conditions into the public domain. You have won numerous teaching awards from medical students, internal medicine house staff, and cardiology fellows as a superior, devoted, and caring teacher. You’ve been offered, at various institutions around the country, chiefships of cardiology and chairmanships of departments of internal medicine. You are a force at your medical center, not only in the department of medicine, but also in the entire hierarchy of the medical center. You have an endowed chair. You have served as chair of a number of committees to choose the chair of other departments and subdivisions. How has Southwestern been able to keep you through the years with these other opportunities frequently flying in your face? LDH: The short answer is because Southwestern and Parkland are very special places. The atmosphere of the medical center includes collegiality, camaraderie, and respect all the way from the most clinical of the clinical people to the most basic of the basic scientists. It is a remarkably friendly, supportive, and fun place to work. Surely, in other parts of the country or the world there must be other places like this. I credit a lot of that atmosphere to what Dr. Seldin created during his years as chair of the department of medicine. He was instrumental in building an institution where everybody involved was excited about being there, liked and respected their colleagues, and got along with them regardless of what they did. I FEBRUARY 1, 2003

have very deep friendships with Dr. Seldin, Dan Foster, Bob Alpern (the dean), and with numerous members of the medicine department and the cardiology division. In the past when I have been offered other positions, I have felt it impossible to leave because of those friendships and because of the atmosphere of the medical school. It is different than most other places. When Al Gilman won the Nobel Prize in 1994, after that announcement was made that morning, there was a spontaneous “pep rally” in the big auditorium, where people from all over the campus showed up to celebrate with Al Gilman and his lab, the fact that he and Rodbell had just been awarded the Nobel Prize. Hundreds of people from all over the campus were there to celebrate the success of one of their colleagues rather than to mumble to themselves, “He’s accomplished this, and I haven’t, and what can I do to pull him down so I’ll look better” or something like that. It’s an atmosphere of support that is largely due, or a substantial amount of it is due, to the atmosphere that Dr. Seldin began to create in the 1950s. So much of Southwestern revolves around Dr. Seldin. He had become chair of the department of medicine when he was 31 years old in 1951; in 1962, when he was in his early 40s, he was offered 1 of the 3 department of medicine chairs at Harvard. He had already been chairman at Southwestern for 10 years, and the school was getting better, but Southwestern wasn’t yet a world-class institution. Obviously Harvard was. Finally, he decided not to go to Boston, but first he sat down with the regents of the University of Texas and he basically told them: “Southwestern will never be a world-class medical school unless the basic sciences are world-class. What I am asking from you is that in return for my staying at Southwestern, I want major resources to be earmarked for the basic sciences. Don’t worry about the medicine department, the medicine department will do fine—we’re doing OK and we will continue to do well. What I want you to do is pour all of the resources that you can garner into the basic sciences, because until that happens, no matter how good the medicine department is, this medical school will never be a great medical school.” In other words, his request was totally selfless on his part. It would have been easy for him to demand a $25,000,000 endowment to stay in Dallas for the department of medicine. He didn’t demand a dime for the department of medicine. What he demanded was that the other departments be made as good as the department of medicine. That kind of selflessness—an institution-wide priority rather than a department-wide priority—still exists today. WCR: What department was he offered at Harvard? LDH: He was offered the Blumgart Professorship and the Chair of the Department of Medicine at the Beth Israel Hospital in Boston. WCR: Do you think that Dr. Seldin basically is a bit of a rebel? Harvard was going to do well, whether he took that chair or not, whereas Dallas needed him. He was the visionary here and no matter how good he

would have been in Boston, Harvard would have continued to do well without him. LDH: I think that’s true. Why in the world in 1951 did he leave Yale and come to Dallas, when the medical school was a bunch of old army barracks? I think Dr. Seldin thought Dallas was an opportunity to build something that would be him, and that he could point at and say that this is something I had a significant part in doing, and that might not have happened at a place like Hopkins or Columbia or Yale or Harvard. WCR: Do you feel that your Texas heritage keeps you here? You were born in Tyler, you have been a major part of this medical center for 24 years, you have that competitive spirit to make this medical center great, which in turn makes Dallas better, and in turn makes Texas better. If you went off to the University of Iowa as chair of medicine, that’s great, but was that what you were put on planet earth to do? LDH: Yes, I do. That’s not unique to me by the way. People who did not grow up in Texas oftentimes have difficulty understanding the Texas mentality, but in my generation there was a feeling that Texas was a special place. It was the “can do” attitude among the people who lived here. I have it, and I know Jim Willerson has it. Jim has had numerous opportunities to go all over the country, but he has deep Texas roots, just like I do, and I think that is part of the reason he has stayed in Texas. Having been born and raised here, I feel the same way. That’s not to say that I don’t enjoy other parts of the country. I have numerous friends from elsewhere, but this is kind of where my heart is, and certainly professionally, Southwestern is where my heart is, and that was formed during those magical years of internship and residency. WCR: David, I’m fascinated by how you have survived so beautifully at Southwestern, and you are purely a clinical researcher. You’re not in a dog lab. You’re surrounded by molecular biologists and geneticists and yet you have brought new things out of a cardiac catheterization laboratory in the last 20 years, and most people haven’t been able to be productive in that environment. At the same time, you’re losing some very good clinical people. They’ve gotten a bit frustrated because they’re not appreciated enough in a center that focuses on genetics and molecular biology. How are you going to work that out? LDH: I’m not sure I have an answer. This is not a problem unique to Southwestern. All top echelon medical schools are wrestling with this problem. Harvard, Hopkins, Duke, Washington University, University of California at San Francisco, etc., are places where oftentimes clinicians do not feel as appreciated or as rewarded as faculty in the basic science arena. I have never felt that way in my career at Southwestern. Why haven’t I? I guess my answer would be leadership. Here’s what I mean by that. I never felt as if I were a second-class citizen because I was doing clinical investigation rather than cloning genes, because the people for whom I worked—Jim Willerson as my divisional chief and then Sandy Williams, and Donald Seldin and then Dan Foster as my departmental INTERVIEW/LESLIE DAVID HILLIS

315

chiefs—sent me the clear message that they highly valued what I was doing. The message they gave me was that they thought I was doing terrific work and that I should continue to do it. If there are clinicians who are doing clinical investigation and feel that they are second-class citizens, then we as the leaders of the institutions need to be better at convincing them that what they are doing is valued. It may be a leadership deficiency. WCR: What do you do as vice chair of the department of medicine at Southwestern? LDH: I run the house staff program. I am the program director of the internal medicine residency. WCR: And how many residents and interns do you have? LDH: A total of 142. WCR: Do you know all of them? LDH: I know all of them extremely well. Better than they wish I knew them, probably. I am in charge of choosing them. I am in charge of interviewing them. I don’t interview all 350. We take 50 interns each year, and I am in charge of the interview process, I am in charge of choosing them, and I am in charge of running the residency program. Obviously, I have a lot of help from numerous people, but I am the program director for the residents. I chair, not all, but at least a good percentage of the search committees for divisional chiefs. Right now I am the chair of the search committee to choose a new chief of the hematology/ oncology division. Our chief has just left. I also work on faculty development and faculty issues concerning interpersonal problems, things like that, and other things that Dan Foster asks me to do. WCR: What is your day like? What time do you get to the hospital now? Do you still run to work? LDH: I still run to work every day and I run home at night. WCR: How far is that? LDH: It is 3.5 miles each way, or 7 miles a day. WCR: Do you keep your clothes in a backpack? LDH: No, I keep clothes at work. The only thing that travels with me in a little fanny pack is my wallet and my keys. I awake at 5 A.M. and I walk out the door at about 5:15 with my T-shirt, shorts, and shoes on, and I walk through the door at Parkland Hospital at about 5:45. I shower, shave, get dressed, and then I start to work at 6:30. Since the day I joined the faculty 24 years ago, we have, every morning with the cath lab attendings (4 of us) and the fellows rotating in the cath lab, a session where we go over the previous day’s catheterization cases, and we do that from 6:45 until 8 A.M. WCR: Do you go through every case done the previous day? LDH: Yes. We spend more time on some than others. We do about 5 cases a day on average. We talk at that conference about whatever it makes sense to talk about. We might spend 15 minutes talking about aortic stenosis if we catheterized a patient the previous day, and then talk about various issues related to that. Then we look at angiograms. The conference is aimed 316 THE AMERICAN JOURNAL OF CARDIOLOGY姞

VOL. 91

at the cath fellows, their time to sit down one-on-one with faculty. WCR: How many cardiology fellows do you have? LDH: We have 6 new ones each year. WCR: That means you have at least 18, plus you’ve got some fourth-year fellows? LDH: Yes. WCR: How many total cardiology fellows? LDH: Around 20. WCR: The cardiology division has how many faculty? LDH: About 35. WCR: And in the entire department of internal medicine? LDH: About 260. WCR: Your “bird list,” so to speak, is 21 plus 142 plus 35 plus 260. That’s the minimum? LDH: Yes. WCR: And you know people in other departments, too? LDH: I know a lot of people in other departments. WCR: And you’ve got secretaries and lab technicians, so your total “bird list” at Southwestern must approach 1,000. LDH: I’m sure it does. I’m not nearly as good as Dan Foster, who knows the janitors and the nurses’ aides on each of the wards at Parkland Hospital. He knows everybody. It’s that kind of a place. It’s the kind of place where people speak to each other and know each other, and interact with each other very collegially. WCR: After the cardiology cath conference, what do you do? LDH: We start cath cases at 8. Some days I’m in the cath lab and some days I’m not. I’m there now for no more than 1 case a day. The other time I do administrative things for the department. I go to teaching conferences for the house staff a couple of days a week. Other activities include such things as reviewing manuscripts for journals, writing articles and book chapters, etc. WCR: Your major commitment to the division of cardiovascular medicine is the cardiac catheterization laboratory? LDH: Yes, but it is a little more than that because I round in the coronary care unit. There is 1 attending cardiologist for the 12-bed coronary care unit plus the same cardiologist for the 12- to 18-bed step-down unit, which totals about 25 to 30 patients on the service at any one time. WCR: You do that how much a year? LDH: I do that 6 weeks a year. I do it in 3, two-week blocks. It is an intense experience because you are the attending for 15 straight days. You have 1 fellow, 3 residents, 3 interns, and 1 to 3 fourth-year medical students. WCR: The rounding for that lasts how long? LDH: We start at 8 A.M. and it usually lasts most of the morning. During that 15-day period, there is hardly time for anything else. I enjoy that time, because if I’m going to be an effective program director for the residency program, I need to spend a lot of time FEBRUARY 1, 2003

interacting with house staff. I need to see them and watch them work. The coronary care unit is where I can do that best. WCR: Do you make ward rounds in general medicine? LDH: I do that 1 month a year. WCR: That’s a pretty intensive activity also? LDH: Yes. WCR: You are responsible for most of the evaluations of the house officers? LDH: Yes, I am. I have a committee of faculty called the “Committee to Evaluate Clinical Competence,” and that committee, which is made up of about 10 faculty, has regular monthly meetings to evaluate all of the house staff. If there are problems, they come to me, and I take care of them. WCR: What time do you usually leave the hospital? LDH: Anywhere from 5:30 to 7:00 P.M. I probably average about 6:15 or 6:30 P.M. I am home about 7 usually. WCR: What do you do at night these days as a rule? LDH: I usually watch the news on television and maybe some sporting activity. I usually go to bed at 9 o’clock. I need 8 hours of sleep. I’m only home for a couple of hours. I might go to bed at 9:30. I’m rarely awake at 10 P.M. WCR: What about Saturday and Sunday? LDH: We have a house staff conference on Saturday morning that I attend. Then, I’ll usually work for an hour or 2 after that, and I get home around noon. I usually work about half a day on Sunday. Sunday is my favorite day, because I’m the only one in the office. The phone doesn’t ring, no one interrupts me, my beeper doesn’t go off, and I really get a lot of work done. WCR: Where’s Nancy? LDH: Nancy, on Saturdays, usually does errands. On Sundays, until her mom died a few months ago, she spent time with her. Now, she usually visits relatives or takes care of other business, and I’m home by noon or 1 P.M. on Sundays. WCR: What hobbies have you continued? LDH: Besides running, I love to bicycle. I am an avid cyclist. I cycle on both Saturday and Sunday afternoons; I enjoy that tremendously. WCR: How many miles? LDH: Usually each day about 50. I usually cycle for about 3 or 3.5 hours on both Saturday and Sunday. WCR: Does Nancy cycle? LDH: No, she doesn’t. I cycle with a group of friends. They are all medical school people. This afternoon I will cycle with Rick Lange, my close associate and good friend. Cycling is my passion in life now. WCR: Do you continue to read history? LDH: To some extent. The non-medical reading I do is in history, but I’m embarrassed to say, it is only 2 to 4 books a year, and that is usually on long trips. WCR: Are you interested in professional football? LDH: Not really. I enjoy college football, however. If professional football disappeared tomorrow, I would hardly care.

WCR: You’re not a golf or tennis player? LDH: I’m not. I used to play tennis, but I haven’t

played in 30 years, and I don’t play golf. WCR: Do you continue to keep up with baseball? LDH: Not much. I watch it, but I don’t have strong feelings about it. As I have gotten more into endurance-like sports, cycling and running, baseball has become less attractive to me, because I don’t think baseball takes much endurance. It does take physical dexterity, but not the kind of endurance that basketball does. WCR: You’ve been running to work for 24 years? LDH: Yes. WCR: How fast do you run now? LDH: I probably run about an 8-minute mile now. I used to run 6-minute miles. In 1983, I came in 24th among about 4,000 runners in the White Rock Marathon. WCR: What was your time? LDH: It was 2:51 hours, which is about 6:30 minutes a mile. WCR: Do you run 10K’s or marathons anymore? LDH: No. WCR: David, you and Nancy have a lot of friends in this town. Do you entertain a good bit? LDH: We eat out a lot, but we don’t entertain at home a lot. We get together with friends at a restaurant or at their house, or occasionally at our house. WCR: How do you work out your travels? I’m sure you get a lot of invitations to give talks at various places. I expect you decline most of them. LDH: I do, yes. WCR: It sounds like you like staying home. You’ve got a lot of activities. LDH: Yes, I do. WCR: You mentioned that you and the Seldins take a couple of trips a year together. How do you work these travels out? LDH: We do enjoy traveling, but I always have mixed feelings about it, because I feel like I should be here doing my job. Nevertheless, we make time for them. We have enjoyed tremendously our trips with the Seldins, and we have done everything we can to go whenever these trips become available. Trips with the Seldins are usually for 7 to 10 days and always to Europe. That’s where he likes to go and we end up in his favorite country, Italy. WCR: When you travel with the Seldins you’ve got a ready-made tour guide? LDH: We do. It’s fantastic. It couldn’t be better. He’s a very learned and knowledgeable person about lots of things outside of medicine. He loves art, music, and history, and, if you believe in reincarnation, which I don’t, I know he must have lived during the Italian Renaissance in Venice or in Florence or in Rome. WCR: Are you an opera buff? LDH: I’m not. I’ve gone to the opera numerous times, but I’m not an enthusiast about it like some of my friends are. WCR: Do you have music on in your house when you’re home? LDH: No, usually not. We like it quiet. INTERVIEW/LESLIE DAVID HILLIS

317

WCR: I hear that you’re easy game for Dr. Seldin when it comes to ping pong? LDH: That’s true. The year that John Harper and I were chief residents, we got into a discussion one day with Dr. Seldin when John and I were about to go over to the student union building at Southwestern at lunchtime to play ping pong. He started telling us about what a good ping pong player he was. John and I at the time were 27 years old and at or near the height of our athletic powers. Dr. Seldin was in his mid-50s and we started saying, “Yeah, yeah, yeah, tell us how great you were back in the old days” and he said, “Well, let’s go play.” We played and it wasn’t even close; he destroyed us. I’m not exaggerating, and believe me we were not trying to lose; he hit shots with upspin and downspin and sidespin, and the scores ended up being something like 21 to 7 or 21 to 5. The tour-de-force at the very end was John Harper’s splitting the rear-mid crease of his slacks wide open while lunging for a shot. He went back to Dr. Seldin’s office with his tail between his legs, because he had to walk in such a way where you could see his underwear. WCR: You have about 200 medical students per class at Southwestern? LDH: That’s correct. WCR: Two hundred per class and 163 house officers per year and 21 cardiology fellows per year. Your potential impact on a number of very bright people in this community is astounding. LDH: I really haven’t ever thought about it, but that’s pretty frightening. WCR: The number of physicians you know in this community and in the entire state must be very large. You can’t go to many places where you don’t know a number of doctors. LDH: That’s very true. WCR: That must bring you a great sense of satisfaction. LDH: It does, absolutely. WCR: How knowledgeable now are you in the non-cardiologic subspecialties of medicine? LDH: Moderately knowledgeable. I attend several non-cardiologic teaching conferences each week for the medicine house staff and the students. Almost all of my continuing medical education in non-cardiology comes from those conferences. If you go to those conferences week in and week out, month in and month out, it is remarkable how well abreast you can stay on the important facts in each subspecialty. I go to 3 or 4 hours a week of house staff conferences that allow me to do that. WCR: You go to those conferences not for what you can get from them, but from what you can give to them? LDH: I would say both. We have a magnificent conference on Tuesdays at noon. It’s called our potpourri conference, where the ward residents present in the course of an hour, 6 to 9 cases. The house officers call on whomever they want to in the audience— students, interns, faculty. Only 1 or 2 of the cases have to do with cardiology. That’s where I do my learning about non-cardiology. 318 THE AMERICAN JOURNAL OF CARDIOLOGY姞

VOL. 91

WCR: Would they call on you for a hepatology case? Do they try to embarrass you? LDH: No, it’s done in a very constructive way. They oftentimes call on people outside their specialty, and that’s a good message to send to students and to house staff: that is, it’s OK not to have the definitive answer. What you want to show them is that there is some logical thought process about how you approach a clinical problem. WCR: Do you think one of Dr. Seldin’s characteristics that made him a great chairman, not only his “good taste” in picking people, but the fact that he was incredibly broad in his knowledge of medicine, not just in nephrology and metabolism, but the whole shebang? LDH: Yes, I think so. Absolutely. Even to this day, he’s that knowledgeable. He has not only very broad non-medical interests, but also very broad medical interests. Dan Foster as chair of the department has continued that tradition. Dan is incredibly knowledgeable and skilled in all of medicine. It is important for the department chair to be that way. WCR: When will you retire? LDH: I don’t know, but probably in the next 3 years. WCR: What are your goals from here on? You are 56 now? LDH: My goal is to continue to do what I’m doing and to enjoy it. I tremendously enjoy the job that I have and the things that it allows me to do. I enjoy playing a leadership role in the school and in the department, and I hope to continue to do that. WCR: If you were offered the chairmanship of medicine tomorrow, would you want it? LDH: I would take it. It would be intimidating to try to follow Dr. Seldin and Dan Foster because I think they have been, in their different ways, as good as one could possibly be. WCR: What makes Dan Foster a good chairman? He’s quite different from you. LDH: He is different. He is demanding of excellence, uncompromising. He has magnificent interpersonal skills; he engenders loyalty and affection, and the respect of those with whom he works. The bond that he has with everyone in the department is quite remarkable, from the vice chair down to the secretaries. He knows them all and knows what their children do, and he knows what their problems have been. He is a quality human being who genuinely cares about the people who work in his department, and he is willing to do anything he can to help them to be successful. WCR: How much time do you take off a year? LDH: Probably 4 weeks total. WCR: Are most of those involved in some kind of medical activity? LDH: Probably half. Soon Nancy and I are going to Scotland for a week. We started doing that about 10 years ago. We go to Scotland at the end of the summer to get away from the Texas heat, and we go there just to enjoy being there. WCR: Where do you go? FEBRUARY 1, 2003

LDH: We go to a place about 2 hours north of Glasgow called Inverlochy Castle, which is a country house hotel. We enjoy going back there every year. WCR: You fly to Glasgow? LDH: We fly to Chicago and then to Glasgow, and then drive for 2 hours north of Glasgow. WCR: David, is there anything that we haven’t discussed that you would like to talk about? LDH: The only other thing I would say is that whatever success I have had in Dallas is a testament to the people who we have talked about. It’s also a testament to people like Rick Lange, who has been my colleague and close friend for 14 years. Rick is a magnificent person and physician and a magnificent colleague. If you ask Joe Goldstein and Mike Brown how their scientific marriage has prospered, I think each would tell you that they bring different things to the table. Rick and I bring different things, but they compliment one another. Rick has been an incredibly supportive good friend and colleague. I couldn’t have asked for a better person to work with for 15 years. WCR: David, thank you for being so open. I’m sure the readers of this journal will enjoy getting to know you. LDH: Thank you, Bill. You’re very kind to say that. LDHs Best Publications as Selected by LDH 4. Hillis LD, Braunwald E. Myocardial ischemia. N Engl J Med 1977;296:971A–

978;1034 –1041;1093–1096. 10. Hillis LD, Braunwald E. Coronary artery spasm. N Engl J Med 1978;299:

695–702. 26. Hirsh PD, Hillis LD, Campbell WB, Firth BG, Willerson JT. Release of

prostaglandins and thromboxane into the coronary circulation in patients with ischemic heart disease. N Engl J Med 1981;304:685– 691. 28. Johnson SM, Mauritson DR, Willerson JT, Hillis LD. A controlled trial of verapamil for Prinzmetal’s variant angina. N Engl J Med 1981;304:862-866. 70. Winniford MD, Filipchuk N, Hillis LD. Alpha-adrenergic blockade for variant angina: a long-term, double-blind, randomized trial. Circulation 1983;67: 1185–1188. 88. Nicod P, Rehr R, Winniford MD, Campbell WB, Firth BG, Hillis LD. Acute systemic and coronary hemodynamic and serologic responses to cigarette smoking in long-term smokers with atherosclerotic coronary artery disease. J Am Coll Cardiol 1984;4:96 –-971. 93. Winniford MD, Jackson J, Malloy CR, Rehr RB, Campbell WB, Hillis LD. Does indomethacin attenuate the coronary vasodilatory effect of nitroglycerin? J Am Coll Cardiol 19844:1114 –1117. 98. TIMI Study Group. The Thrombolysis In Myocardial Infarction (TIMI) trial. Phase I findings. N Engl J Med 1985;312:932–936. 105. Hillis LD, Winniford MD, Jackson JA, Firth BG. Measurement of left-toright intracardiac shunting in adults: oximetric versus indicator dilution techniques. Catheter Cardiovas Diag 1985;11:467– 472. 107. Hillis LD, Firth BG, Winniford MD. Analysis of factors affecting the variability of Fick versus indicator dilution measurements of cardiac output. Am J Cardiol 1985;56:764 –768. 108. Winniford MD, Kennedy PL, Wells PJ, Hillis LD. Potentiation of nitroglycerin-induced coronary dilatation by N-acetylcysteine. Circulation 1986;73: 138 –142. 111. Winniford MD, Wheelan KR, Kremers MS, Ugolini V, van den Berg E Jr, Niggemann EH, Jansen DE, Hillis LD. Smoking-induced coronary vasoconstriction in patients with atherosclerotic coronary artery disease: evidence for adrenergically mediated alteration in coronary artery tone. Circulation 1986;73:622– 627. 113. Hillis LD, Firth BG, Winniford MD. Comparison of thermodilution and indocyanine green dye in low cardiac output or left-sided regurgitation. Am J Cardiol 1986;57:1201–1202. 117. Hillis LD, Firth BG, Winniford MD. Variability of right-sided cardiac oxygen saturations in adults with and without left-to-right intracardiac shunting. Am J Cardiol 1986’58:129 –132. 120. Winniford MD, Jansen DE, Reynolds GA, Apprill P, Black WH, Hillis LD. Cigarette smoking-induced coronary vasoconstriction in atherosclerotic coronary artery disease and prevention by calcium antagonists and nitroglycerin. Am J Cardiol 1987;59:203–207. 124. Niggemann EH, Ma PTS, Sunnergren KP, Winniford MD, Hillis LD. Detection of intracardiac left-to-right shunting in adults: a prospective analysis of

the variability of the standard indocyanine green technique in patients without shunting. Am J Cardiol 1987;60:355–357. 125. May DC, Popma JJ, Black WH, Schaefer S, Lee HR, Levine BD, Hillis LD. In vivo induction and reversal of nitroglycerin tolerance in human coronary arteries. N Engl J Med 1987;317:805– 809. 135. TIMI Research Group. Immediate vs delayed catheterization and angioplasty following thrombolytic therapy for acute myocardial infarction. TIMI IIA results. JAMA 1988;260:2849 –2858. 137. TIMI Study Group. Comparison of invasive and conservative strategies after treatment with intravenous tissue plasminogen activator in acute myocardial infarction: results of the Thrombolysis in Myocardial Infarction (TIMI) trial. N Engl J Med 1989;320:618 – 627. 138. Lange RA, Moore DM Jr, Cigarroa RG, Hillis LD. Use of pulmonary capillary wedge pressure to assess severity of mitral stenosis: is true left atrial pressure needed in this condition? J Am Coll Cardiol 1989;13:825– 829. 140. Cigarroa RG, Lange RA, Williams RH, Bedotto JB, Hillis LD. Underestimation of cardiac output by thermodilution in patients with tricuspid regurgitation. Am J Med 1989;86:417– 420. 143. Cigarroa RG, Lange RA, Williams RH, Hillis LD. Dosing of contrast material to prevent contrast nephropathy in patients with renal disease. Am J Med 1989;86:649 – 652. 145. Cigarroa RG, Lange RA, Hillis LD. Prognosis after acute myocardial infarction in patients with and without residual anterograde coronary blood flow. Am J Cardiol 1989;64:155–160. 146. Cigarroa RG, Lange RA, Hillis LD. Oximetric quantitation of intracardiac left-to-right shunting: limitations of the Qp/Qs ratio. Am J Cardiol 1989;64:246 – 247. 152. Lange RA, Cigarroa RG, Yancy CW Jr, Willard JE, Popma JJ, Sills MN, McBride W, Kim AS, Hillis LD. Cocaine-induced coronary artery vasoconstriction. N Engl J Med 1989;321:1557–1562. 156. Lange RA, Cigarroa RG, Hillis LD. Influence of residual antegrade coronary blood flow on survival after myocardial infarction in patients with multivessel coronary artery disease. Coronary Art Dis 1990;65:59 – 63. 157. Lange RA, Cigarroa RG, Wells PJ, Kremers MS, Hillis LD. Influence of anterograde flow in the infarct artery on the incidence of late potentials after acute myocardial infarction. Am J Cardiol 1990;65:554 –558. 159. Lange RA, Cigarroa RG, Flores ED, McBride W, Kim AS, Wells PJ, Bedotto JB, Danziger RS, Hillis LD. Potentiation of cocaine-induced coronary vasoconstriction by beta-adrenergic blockade. Ann Int Med 1990;112:897–903. 161. Flores ED, Lange RA, Bedotto JB, Danziger RS, Hillis LD. Assesment of the sensitivity of hydrogen inhalation in the detection of left-to-right shunting. Cathet Cardiovas Diag 1990;20:94 –98. 162. Flores ED, Lange RA, Cigarroa RG, Hillis LD. Effect of cocaine on coronary artery dimensions in atherosclerotic coronary artery disease: enhanced vasoconstriction at sites of significant stenoses. J Am Coll Cardiol 1990;16:74 – 79. 164. Hillis LD, Forman S, Braunwald E, and TIMI Phase II coinvestigators. Risk stratification before thrombolytic therapy in patients with acute myocardial infarction. J Am Coll Cardiol 1990;16:313–315. 174. Glamann DB, Lange RA, Hillis LD. Beneficial effect of long-term beta blockade after myocardial infarction in patients without anterograde flow in the infarct artery. Am J Cardiol 1991;68:150 –154. 176. Brogan WC III, Lange RA, Kim AS, Mokiterno DJ, Hillis LD. Alleviation of cocaine-induced coronary vasoconstriction by nitroglycerin. J Am Coll Cardiol 1991;18:581–586. 183. Boehrer JD, Lange RA, Willard JE, Hillis LD. Influence of collateral filling of the occluded infarct-related coronary artery on prognosis after acute myocardial infarction. Am J Cardiol 1992;69:10-12. 187. Brogan WC III, Lange RA, Glamann DB, Hillis LD. Recurrent coronary vasoconstriction caused by intranasal cocaine: possible role for metabolites. Ann Int Med 1992;116:556 –561. 191. Mokiterno DJ, Lange RA, Willard JE, Boehrer JD, Hillis LD. Does restoration of antegrade flow in the infarct-related coronary artery days to weeks after myocardial infarction improve long-term survival? Coronary Artery Dis 1992;3: 345–346. 196. Boehrer JD, Moliterno DJ, Willard JE, Snyder RW II, Horton RP, Glamann DB, Lange RA, Hillis LD. Hemodynamic effects of intranasal cocaine in humans. J Am Coll Cardiol 1992;20:90 –93. 197. Willard JE, Lange RA, Hillis LD. The use of aspirin in ischemic heart disease. N Engl J Med 1992;327:175–181. 198. Boehrer JD, Lange RA, Willard JE, Grayburn PA, Hillis LD. Advantages and limitations of methods to detect, localize, and quantitate intracardiac left-toright shunting. Am Heart J 1992;124:448 – 455. 201. Boehrer JD, Glamann DB, Lange RA, Willard JE, Brogan WC III, Eichhorn EJ, Grayburn PA, Anwar A, Hillis LD. Effect of coronary angioplasty of late potentials one to two weeks after acute myocardial infarction. Am J Cardiol 1992;70:1515–1519. 203. Boehrer JD, Lange RA, Willard JE, Grayburn PA, Hillis LD. Advantages and limitations of methods to detect, localize, and quantitate intracardiac rightto-left and bidirectional shunting. Am Heart J 1993;10:33–36. 207. Brogan WC III, Grayburn PA, Lange RA, Hillis LD. Prognosis after valve replacement in patients with severe aortic stenosis and a low transvalvular pressure gradient. J Am Coll Cardiol 1993;21:1657–1660. 208. Boehrer JD, Moliterno DJ, Willard JE, Hillis LD, Lange RA. Influence of

INTERVIEW/LESLIE DAVID HILLIS

319

labetalol on cocaine-induced coronary vasoconstriction in man. Am J Med 1993; 94:608 – 610. 209. Moliterno DJ, Lange RA, Meidell RS, Willard JE, Leffert CC, Gerard RD, Boerwinkle E, Hobbs HH, Hillis LD. Relation of plasma lipoprotein(a) to infarct artery patency in survivors of myocardial infarction. Circulation 1993;88:935– 940. 210. Glamann DB, Lange RA, Willard JE, Landau C, Hillis LD. Hydrogen inhalation for detecting intracardiac left-to-right shunting in adults. Am J Cardiol 1993;72:711–714. 215. Moliterno DJ, Lange RA, Willard JE, Boehrer JD, Hillis LD. Surgical restoration of antegrade flow in the occluded infarct artery improves long-term survival in patients with multivessel coronary artery disease. Coronary Artery Dis 1993;4:995–999. 221. Moliterno DJ, Willard JE, Lange RA, Negus BH, Boehrer JD, Glamann DB, Landau C, Rossen JD, Winniford MD, Hillis LD. Coronary artery vasoconstriction induced by cocaine, cigarette smoking, or both. N Engl J Med 1994;73:454 – 459. 222. Negus BH, Willard JE, Hillis LD, Glamann DB, Landau C, Snyder RW, Lange RA. Alleviation of cocaine-induced coronary vasoconstriction with intravenous verapamil. Am J Cardiol 1994;73:510 –513. 223. Snyder RW II, Glamann DB, Lange RA, Willard JE, Landau C, Negus BH, Hillis LD. Predictive value of prominent pulmonary arterial wedge V waves in assessing the presence and severity of mitral regurgitation. Am J Cardiol 1994; 73:568 –570. 226. Moliterno DJ, Lange RA, Gerard RD, Willard JE, Lackner C, Hillis LD. Influence of intranasal cocaine on plasma constituents associated with endogenous thrombosis and thrombolysis. Am J Med 1994;96:492– 496. 231. Pirwitz MJ, Lange RA, Willard JE, Landau C, Glamann DB, Hillis LD. Use of the left ventricular peak systolic pressure/end-systolic volume ration to predict symptomatic improvement with valve replacement in patients with aortic regurgitation and enlarged end-systolic volume. J Am Coll Cardiol 1994;24:1672– 1677. 233. Daniel WC, Lange RA, Willard JE, Landau C, Hillis LD. Oximetric versus indicator dilution techniques for quantitating intracardiac left-to-right shunting in adults. Am J Cardiol 1995;75:199 –200. 239. Pirwitz MJ, Willard JE, Landau C, Lange RA, Glamann DB, Kessler DJ, Foerster EH, Todd E, Hillis LD. Influence of cocaine, ethanol, or their combi-

320 THE AMERICAN JOURNAL OF CARDIOLOGY姞

VOL. 91

nation on epicardial coronary arterial dimensions in humans. Arch Int Med 1995;155:1186 –1191. 243. Daniel WC, Pirwitz MJ, Horton RP, Landau C, Glamann DB, Snyder RW II, Willard JE, Wells PJ, Hillis LD, Lange RA, Page RL. Electrophysiologic effects of intranasal cocaine. Am J Cardiol 1995;76:398 – 400. 257. Vongpatanasin W, Hillis LD, Lange RA. Prosthetic heart valves. N Engl J Med 1996;335:407– 416. 259. Daniel WC, Lange RA, Landau C, Willard JE, Hillis LD. Effects of the intracoronary infusion of cocaine on coronary arterial dimensions and blood flow in humans. Am J Cardiol 1996;78:288 –291. 275. Pitts WR, Lange RA, Cigarroa JE, Hillis LD. Preoperative left ventricular peak systolic pressure/end-systolic volume ratio and functional status following valve surgery in patients with mitral regurgitation and enlarged end-systolic volumes. Am J Cardiol 1997;79:1493–1497. 276. Pitts WR, Lange RA, Cigarroa JE, Hillis LD. Cocaine-induced myocardial ischemia and infarction: pathophysiology, recognition, and management. Prog Cardiovas Dis 1997;40:65–76. 281. Pitts WR, Vongpatanasin W, Cigarroa JE, Hillis LD, Lange RA. Effects of the intracoronary infusion of cocaine on left ventricular systolic and diastolic function in humans. Circulation 1998;97:1270 –1273. 284. Vongpatanasin W, Brickner ME, Hillis LD, Lange RA. The Eisenmenger syndrome in adults. Ann Int Med 1998;128:745–755. 301. Brickner ME, Hillis LD, Lange RA. Congenital heart disease in adults. N Engl J Med 2000;342:256 –263;334 –342. 312. Lange RA, Hillis LD. Cardiovascular complications of cocaine use. N Engl J Med 2001;345:351–358. 313. Rapp AH, Lange RA, Cigarroa JE, Keeley ED, Hillis LD. Relation of pulmonary arterial diastolic and mean pulmonary arterial wedge pressures in patients with and without pulmonary hypertension. Am J Cardiol 2001;88:823– 824. 314. Rapp AH, Cigarroa JE, Lange RA, Keeley EC, Hillis LD. Hemodynamic characteristics and procedural outcome of patients with mitral stenosis and a depressed cardiac output. Am J Cardiol 2001;88:1212–1213. 320. Saland KE, Hillis LD, Lange RA, Cigarroa JE. Influence of morphine sulfate on cocaine-induced coronary vasoconstriction in humans. Am J Cardiol 2002; 90:810 – 811.

FEBRUARY 1, 2003