- Email: [email protected]
Recollections of Robert M. Zollinger, M.D.
The American Journal of Surgery 186 (2003) 226 –233
Special article
Recollections of Robert M. Zollinger, M.D. Larry C. Carey, M.D.a, Dan W. Elliott, M.D.b, E. Christopher Ellison, M.D.c,*, Timothy C. Fabian, M.D.d, Letitia Robertse a
University of South Florida, Tampa, FL, USA b Wright State University, Dayton, OH, USA c Department of Surgery, Ohio State University, 327 Means Hall, 1654 Upham Dr., Columbus, OH 43210-1250, USA d University of Tennessee, Memphis, TN, USA e Peoria, IL, USA Manuscript received April 30, 2003
Abstract Remembering Dr. Robert M. Zollinger are Dr. Larry C. Carey, professor of surgery at the University of South Florida, in Tampa, Florida; Dr. Dan W. Elliott, professor emeritus of surgery at Wright State University, in Dayton, Ohio; Dr. E. Christopher Ellison, the Robert M. Zollinger professor and chairman of surgery at Ohio State University, in Columbus, Ohio; Dr. Timothy C. Fabian, professor and chairman of surgery at the University of Tennessee, in Memphis, Tennessee; and Mrs. Letitia Roberts, the widow of Dr. Stuart S. Roberts, the first recipient of the Zollinger Chair of Surgery at Ohio State, of Peoria, Illinois. © 2003 Excerpta Medica, Inc. All rights reserved. Keywords: Zollinger
Larry C. Carey, M.D. January 1975 was a momentous time in my life. I accepted the challenge to succeed Dr. Robert M. Zollinger as chairman of the Department of Surgery at my alma mater, the Ohio State University. My first formal encounter with Dr. Zollinger was 17 years earlier, when, along with three classmates, I was assigned to his service for 3 months as a junior medical student. He knew all of our names, where we were from, and something about us. One of our group was a bit of a con man; it was Dr. Zollinger’s reference to him as a “strawberry salesman” on the first day of our rotation that got our collective attention. As students we were assigned a small group of the chief’s patients. We were expected to measure the urinary chloride, calf circumference, and vital capacity on every patient every day. When one of our patients went to the operating room, we were to draw the anatomy of the operation on a blackboard outside the theater. When Dr. Zollinger did a Whipple operation in a little * Corresponding author. Tel.: ⫹1-614-293-8701; fax: ⫹1-614-2934063 E-mail address: [email protected]
under 3 hours, no one seemed surprised. He never appeared to be moving rapidly. There was no cautery in the room, almost every bleeder was suture-ligated, and of course, all anastomoses were hand-sewn. As you watched him work and occasionally looked at the clock, you wondered if it might have stopped. It was common to be the last assistant left at the end of the case, because both residents would have been banished (if not fired) for some perceived flaw in either knowledge or character, or both. Doctor Zollinger continued to practice until January 1983, the year of his 80th birthday. He guarded against the temptation of the operating room by not renewing his malpractice insurance. Doctor Zollinger could not have been more gracious in his relationship to me. He never expressed criticism and was always available for counsel. He introduced me to his friends, both in and out of medicine, and was always supportive. Perhaps my most cherished moment came at a Zollinger Club meeting. This was an American College of Surgeons event heavily attended by leaders in surgery from all over the world. I was talking to some people when I felt a tug on my sleeve. Doctor Zollinger said, “Can I talk to you for a minute?” We went to a corner of the room, where he said, “Louise has a lump in her t . I think it’s a cancer and I want you to take it out next week.” As it turned out,
0002-9610/03/$ – see front matter © 2003 Excerpta Medica, Inc. All rights reserved. doi:10.1016/S0002-9610(03)00217-4
L.C. Carey et al / The American Journal of Surgery 186 (2003) 226 –233
it was a cancer, and she survived a second one in the other breast. Knowing the truly remarkable closeness of Louise and Robert (she always called him Robert), I was deeply touched to be entrusted with her care. I called on him at his home as he neared the end of his life. He had lost weight and was physically feeble but mentally very sharp. We talked for about an hour, and as I prepared to leave, I thanked him for his kindness to me. As I started out of his bedroom, he stopped me and said, “Boy, don’t get cancer.” The world of surgery has never since known the likes of Robert M. Zollinger.
Dan W. Elliott, M.D. It was the spring of 1950 when I first met Dr. Zollinger at an interview for a position in his residency program. He was 47 years old and had been chairman of the Department of Surgery at Ohio State for just 3 years. Its base of operations was the old, cramped Starling-Loving Hospital with 170 beds. In order to wheel one patient out to surgery all the beds in a room had to be moved. The new University Hospital was only a promise and a hole in the ground awaiting funds. At that time I was a first-year surgical resident at Columbia-Presbyterian Hospital in New York City and could have stayed. Our chief surgical resident, Dr. Tom Randell, had put together with his own hands the first flame photometer used to measure sodium and potassium in patients. This opened up a whole new era in the study of electrolyte balance. However, I needed to come home to Ohio because of my father’s illness. I interviewed first at Cincinnati General and then phoned Doris, Dr. Zollinger’s long-time secretary, for an appointment. At my interview it was soon obvious that this would be unlike any I had ever known. Doctor Zollinger started off by insisting I tell him what I really thought about Cincinnati General, and then why the surgeons at Columbia were so slow. I wondered how he knew I had been to the General. Finally I realized Doris had told him I called from Cincinnati and he guessed the rest of it. Already I had an insight that would prove useful in the years ahead. Doris was very loyal and important. She told Dr. Zollinger everything she heard and he pumped her regularly. Finally he asked me if I had any questions. He seemed so cocky that I wanted to test him. Politely I inquired if he had heard about our flame photometer. He roared with laughter: “Where do you think you are, son, out west among the Indians?” Then, “Doris, show him our flame photometer!” He insisted I go see it and there it was, busily operated by a surgical service employee in a closet under the stairs. I decided to come to Ohio State as a second-year resident. It has turned out to be the best professional decision I have ever made. Doctor Zollinger was first of all a master technical surgeon, very quick and very gentle, but intolerant of assistants, especially residents. “All I want is a high-school
227
performance,” he would say. “Sponge that once more and I’ll sponge your cornea.” He laughed at his own little jokes and could be vulgar: “With the assistance you’re giving me today I would have trouble incising flatus!” He wanted us to laugh, but he could be irascible. When first-year resident Bob Gilsdorf was tying sutures for him, Bob broke two in a row and then pulled another out of his needle-holder. Doctor Zollinger calmly laid down his instruments and told Bob to hold out each hand, thumbs up. He opened a long sponge and tied the four fingers of his left hand firmly together. Then he did the same to his right hand and insisted that Bob go right on assisting. “I’ve always wanted to train a lobster,” he laughed. When I had assisted him just a few times he sent me out of the room: “You’re weak. Go have lunch!” I did, but that was my mistake. By the time my cafeteria tray was filled there was an emergency page from the operating room nurse. “Where are you?” she demanded. “I’m at lunch.” “Oh, you don’t understand,” she told me, “you’re supposed to go to the next room and get his next case started.” Why was he so difficult, I thought. Why did he constantly deride us, brag about his prowess, and demand more details about our patients than anyone could possibly remember? We held little notes in the palms of our hands to help us present a case, but he would demand those notes and insist, “The only thing that matters is what’s in your head!” Art Simpson, a Zollinger resident of my era, had a memorable evening shortly after his assignment to the chief s service. He had to call Dr. Zollinger back to the hospital to see an emergency admission one evening because Art couldn’t get all the tests finished before time to go home. The chief was furious, his evening out spoiled, and Art was fired on the telephone for total incompetence: “Leave and don’t come back!” Art couldn’t leave— he was on call that night. He waited in the lobby, full of trepidation, as he described it. Before long Dr. Zollinger appeared, all friendly and full of smiles. He put his arm across Art’s shoulder as they walked to the elevator as if nothing had ever happened. Sooner or later we all learned Dr. Zollinger totally forgave and forgot anything critical he ever said. He never kept a grudge. As Art wrote, “His bark was far worse than his bite. Certainly his demand for meticulous attention to detail is never forgotten. The trauma of the residency has made practicing surgery seem easy.” His basic kindness was confirmed by Loren Humphrey, once a resident who knew Dr. Zollinger only by reputation. He wrote a fascinating surgical reminiscence for the Archives of Surgery [1]. Doctor Zollinger knew he was a role model and loved the attention, but he would never ask any of us to do more than he would do. We saw his silver Thunderbird parked at the hospital before most of us arrived in the mornings, and it was often still there when we left at night. He demanded a call at 9:00 PM every night from the resident covering his personal patients. He wanted the temperature, urine flow, and every pertinent detail for every patient. Even though Dr. Zollinger was out of town, the late Bill Stewart, then the ever-efficient resident, insisted that the hospital operator get
228
L.C. Carey et al / The American Journal of Surgery 186 (2003) 226 –233
him on the phone at the regular time. “Ye gods, Bill!” he answered, “Do you know it’s 2:00 AM, the middle of the night in London! If I ever go to Hong Kong, please just don’t call!” But he discussed the patients as carefully as always. Doctor Zollinger was intensely competitive and enjoyed it thoroughly. Starting when he was a little boy, his father would challenge him regularly to a foot race, and that continued for years. Strange as it seems, he really wanted us to compete with him in medical knowledge and in good patient outcomes. Sunday mornings were not for sleeping in. We had 8:00 AM chart meetings that could go on for hours, in which each resident proved that all his charts were complete, with histories, operative notes, and discharge summaries all in place. But that wasn’t enough. We had to present the statistics for our services: hospital discharges with the percentage of complications and deaths. On top of that were the hand-written record books in which we recorded each patient’s name and number (computers were too expensive). There was a book listing patients with peptic ulcer, and others for biliary surgery, spleens, colon surgery, and more. These were the topics on which residents were supposed to write papers for publication, all summarizing the hospital’s actual experience. We were actually beginning “evidence-based practice,” now all the rage for the improvement of medicine. We didn’t know how far ahead of our time we actually were. We just knew that Dr. Zollinger was convinced that care was better where doctors honestly reviewed and published their own experiences with pride. Doctor Zollinger would invite us to his home in order to help us with our first papers. To his credit he would never put his name as author ahead of ours. He would decline our offer to list him as an author unless he had truly helped. I can still see him at his desk at home, squaring his shoulders as he tried to help me, declaring “Dan, you’ve got to come to grips with this.” Being competitive led naturally to repartee, sometimes funny, sometimes pointless, but we tried hard. Doctor Zollinger became a master at it and loved the humor, but he understood its use. “Why do you suppose Bert Dunphy and I could fill a ballroom with 2,000 surgeons at an American College of Surgeons meeting? Do you think they thought we were leading surgical scientists? No! They knew better. It’s our repartee! If they stay awake, maybe we can make a point or two.” The showplace for the patients in whom we could take pride was the weekly grand rounds, held then at 9:30 on Saturday mornings. Doctor Zollinger and his close and most trusted associate, Dr. Edwin Ellison, presided from the front row while the auditorium filled with descending rank to the medical students in the back. Doctor Zollinger was fond of calling on the student whose name he saw on the chart he held while the patient was presented. One morning no student responded. “Get that boy on the phone,” the professor demanded, “and give the phone to me.” Sure enough, the
student was at home. “This is Dr. Zollinger,” he told the student loudly, “I’m here in front of grand rounds looking for you. Are you enjoying your bed? What are you—a Simmons athlete?” One of our residents, Mitchell Karlan, was senior enough to disagree with Dr. Zollinger about some finding in the case presented, with a grin, of course. “Oh, you’re wrong, Karlan,” the chief exclaimed. “Put up your money. I’ll bet you $50!” Karlan was quick on his feet, “But chief, that’s half my year’s salary!” and the audience roared. Doctor Zollinger wouldn’t be put down: “I had no idea you were so overpaid!” The only time I ever saw Dr. Zollinger truly nonplused occurred one Saturday morning when his residents, students and a rotating intern had just finished seeing his patients and were heading to the elevators to go to grand rounds. The rotating intern turned back. “Aren’t you coming with us to grand rounds?” Dr. Zollinger demanded. “No, sir,” the intern replied, standing up tall and speaking firmly. “I am a Seventh-Day Adventist and Saturday is our Sabbath. I am not allowed entertainment on the Sabbath!” Doctor Zollinger constantly reminded us of every deadline for the submission of abstracts so that we might appear on all the prominent surgical programs. He spent hours trying to show us how to make our slides crisp and easy to read. Then there was the endless practicing and timing of our talks. We knew we were getting results by 1957, when our department gained sufficient respect nationally to host a Society of University Surgeons meeting in Columbus. We provided a local program on our campus and invited the late Dr. Bruce Wiseman, then chairman of the Department of Medicine, to speak. He gave a scholarly paper on splenectomy for the hematological disorders he treated, but he talked and talked far too long. Doctor Zollinger presided, but he knew when to stay cool. Then he had to introduce me for a talk about bile and pancreatitis. After a few glowing words he cautioned me, “Remember, Dr. Elliott, 10 minutes only. You are the chief resident in surgery, not the chairman of medicine!” I had a long wait for the laughter to subside. Other Zollingerisms were collected in 1973 for his retirement party at age 70, after 26 years as chairman of the Department of Surgery. They were published in a redcovered pamphlet with a big “Z” on the cover, 60 pages long! The late Colin Howe, an English surgeon who spent a year with us in research, sent a letter purported to be from British Customs, seizing his pamphlets for their “salacious” content. That was, like much we heard about The Big Z, grossly exaggerated. Perhaps the highlight of my career at Ohio State was admitting Dr. Zollinger’s famous patient who led to the discovery of the Zollinger-Ellison syndrome. That was a landmark development at a time when ulcers were common and we knew little about their causes. I was the senior resident assigned to the chief’s service. When I called to let him know she was back again with pain, he told me regretfully that he knew he must now completely remove all of
L.C. Carey et al / The American Journal of Surgery 186 (2003) 226 –233
her remaining stomach. She was only 26 but had undergone a vagotomy and pyloroplasty, then a Billroth I resection, more resection, and finally gastric irradiation, but nothing controlled her huge acid output. I was to schedule her surgery and notify Dr. Ellison, whose advice he had sought on this case. Doctor Ellison had seen a similar patient who died with uncontrollable gastric hemorrhage. At autopsy she had an islet tumor in her pancreas. At the operation Dr. Ellison decided to assist. I was displaced to the end of a retractor. Doctor Zollinger neatly removed all the rest of her stomach as planned. This exposed a very normal-appearing pancreas. Doctor Ellison pointed out two small lymph nodes on its surface and asked Dr. Zollinger to take them out, just in case they might contain metastases. Always the skeptic, Dr. Zollinger replied, “Oh, go wash your glasses, Eddy. There’s enough inflammation in here to engorge all her nodes,” but he promptly peeled them out. Postoperatively she did beautifully and all the pain was gone—a perfect case for Saturday’s grand rounds. I was to present her case. I knew the chart had to be perfect for me to survive the chief s inspection. Every note was dictated and signed. The medical student’s history was graded and signed. Multicolored drawings of the anatomy were ready on the blackboard. It was early Saturday morning, but where was the pathology report? Nowhere to be found. I called up surgical pathology and was switched to the chief, the late Dr. Hans Schlumberger. I told him the report was late, but if he would read me a brief summary, I would put a note on the chart in time for rounds. He nearly shouted, “You mean you want the most important pathology report in the world today just read to you over the phone!” I said yes. Then he told me, “If you want that report you had better bust your britches down here right now.” I found six pathologists sitting around the teaching microscope with big grins on their faces. They swore me to secrecy and then told me the secret they were going to spring on Drs. Zollinger and Ellison at grand rounds. The two nodes were islet cell tumors! They matched perfectly the tumors in Dr. Ellison’s previous patient with the hemorrhages. The syndrome was born, and there was dancing in the aisles at rounds that morning. Doctor Zollinger had a long and brilliant career in surgery, winning many awards, high offices in all the national organizations, and an endowed professorship at Ohio State in his name. His residents and associates benefited everywhere from his national reputation. He was generous with recommendations, and they were well-received. He promoted us professionally in many ways and as far as he thought he could get away with. His more senior residents all had faculty titles in recognition of their responsibilities to teach students. From chief resident I became a full professor in about 5 years (it would have taken 30 at Columbia) and was accepted into prestigious surgical societies because of his sponsorship. It took me a long time during my association with Dr. Zollinger to figure out what he was really after. Eventually he told us at grand rounds: it was sustained heroic achievement!
229
E. Christopher Ellison, M.D. I had the good fortune to work with Dr. Robert M. Zollinger when I was a resident in training, from 1976 to 1983. A unique quality of Dr. Z was his careful preparation for everything he did, a characteristic that some may consider incompatible with his bravado and presence, but which I think was the essence of both. I came to the Ohio State Department of Surgery in 1976, after my graduation from the Medical College of Wisconsin. I wished to train with Dr. Larry Carey and hoped that my professional experience would include some exposure to Dr. Z, whom I had known as my dad’s mentor. My dad had called him “Zolly” and clearly respected him. Doctor Z was his confidant and advisor, and to a certain extent, the converse was true. They were of different generations. Doctor Z’s circle was the leadership of American surgery. My dad was his link to the pulse of the younger generation, the “young turks.” These included notables such as Friesen, Mulholland, and Thompson. In 1974, my second year of medical school, I received a copy of a monograph that Dr. Z had prepared on the ulcerogenic syndrome. It was inscribed, “To Chris Ellison, whose father was a fabulous teacher, investigator and surgeon. . . .” [2] Upon graduation from medical school, I received my first copy of the Atlas of Surgical Operations. Needless to say, I was anxious to meet Dr. Z and hopeful that I could live up to some as-yet-unspecified expectation that he would have of me. On my first rotation on the Surgery 1 service, I ran into “The Old Man,” as my resident colleagues referred to him, and as I would later—not out of any disrespect, but on the contrary, with the utmost respect. I would round with him and the team. He was decreasing his practice, which now mostly consisted of VIPs, community notables, difficult cases and, of course, the patients with suspected or proven ZE syndrome. Doctor Z wanted us to be prepared for rounds. To him this meant knowing not only the laboratory and radiology results, as we insist that our residents do today, but also how the patients felt, how their pain was controlled, how they had slept the night before and, most importantly, if they had specific complaints that we could address and rectify. He had us do bedside spirometry and weigh the patients daily. Spirometry was an index to pain management. The larger the volume, the better the pain control. Weight measurement was a check on our fluid management, and reinforced our instruction in postoperative physiology, where we were taught to expect a diuresis on postoperative day 3. Doctor Z wanted his patients to be prepared for surgery. I recall an inadequate bowel prep on one of his patients. I was a third-year resident, and we were doing a low anterior resection. Doctor Z preferred the “Baker anastomosis” with two layers of silk. I thought I was prepared. I read the Atlas the night before. The senior resident had assigned me to scrub the case. After exploration, the problem became pal-
230
L.C. Carey et al / The American Journal of Surgery 186 (2003) 226 –233
pably obvious: the colon was not prepared to Dr. Z’s satisfaction. I was ready for the lesson, but instead, he directed the circulating nurse to find the “ ” [chief] and get him to the room ASAP. Doctor Z waited, and about 10 minutes later, the “ ” appeared. Doctor Z asked the resident to scrub and then examine the bowel. The room fell silent as the chief felt the colon. Doctor Z said, “What if this was your mother?” He asked the chief to stand next to him and observe the procedure. “The Old Man” masterfully resected the bowel and performed an anastomosis without contamination. He then asked the chief to scrub out and place a rectal tube, which Dr. Z then advanced above the anastomosis. He personally closed the abdomen and then said, “Ellison, don’t let this happen on your watch.” He wanted to be prepared and was. For those who can recall his command of a panel chair or a discussion at the “American Surgical,” you will appreciate the fact that no matter how off-the-cuff and quick that he appeared, it was because he was well prepared. He anticipated every question, comment, or joke well in advance. I was in the lab from July 1978 through June 1980. He invited me to help him prepare the 25th anniversary paper for the ZE syndrome, an abstract to be submitted to the American Surgical Association in early winter of 1979. As a result, I had the opportunity to be his sounding board for many of his panels and visiting professorships and also to participate in our preparation for “The Paper,” as we called it. If asked to run a panel, he would send a letter to the participants well in advance and solicit them to provide a list of the questions they would like to receive on the subject, and then he would provide them with a list of his own questions. He would start this process six to eight weeks in advance. Once assembled, he would outline the questions. He would have me role-play, for the lack of a better term. I would read the responses to his questions, and he would practice dissecting the response and providing some humor. He would take notes, and later his secretary Doris would type them. Only after several drafts of these notes did he consider the preparation complete. I recall that he visited Emory when Dr. Warren was chairman. He presented his entire talk to me more than once, having a Ho Ho or two from the refrigerator in his office between trial runs. He even practiced a reference to Sherman as the last Ohioan to visit Atlanta in an official capacity. He wanted my reaction to his slides and comments not as a surgeon—I was far from completing my training— but as a person. He was preparing! “The Paper” was an incredible experience. We assembled all the charts, histological slides, and labs from his well-kept files. This was accomplished with the aid of his able research assistant Joann Sparks. He saw these patients in person and examined them on a regular basis. He did not depend on the clinic notes of others— he was preparing. He knew the patients and their families, and he helped me to know them as only he could. He would refer to the patients as Ivory-Jane (the first ZE), the twins (MEN I), the fireman,
or the bartender. He (I hoped we) proposed hypotheses based on the current issues regarding ZE: survival prediction and the importance of tumor resection, which became the foundation of the paper. It was difficult for him to let go of total gastrectomy for all patients, but he knew that medical therapy was effective and newer drugs in the future would likely obviate the need for gastric surgery in most patients with ZE syndrome. So he switched his focus. He was not surprised that he had resected so many patients. He was surprised that he had not emphasized how important this was to the successful outcome and long-term prognosis. We prepared an abstract and rewrote it more times than I can recall. This was at a time that predated word processing, and we were both thankful for the nimble fingers and editorial wisdom of Helene Ayers. The paper was accepted. Then the real preparation began. We would meet twice a week. He would challenge himself and me, saying, “We have nothing to say,” or “There is nothing new.” Then came a spark of showmanship and preparation: “I will write to the experts in the area and ask what they think is important,” he said. He wrote Professor Richard Melbourne of London, England; Lord Rodney Smith of London, England; Professor Maurice Mercadier of Paris, France; James C. Thompson of Galveston, Texas; James D. Hardy of Jackson, Mississippi; and Stanley R. Friesen of Kansas City, Kansas— the experts in ZE syndrome in 1980. All responded, perhaps unaware that they were preparing the discussion for the 25th anniversary paper at the “American Surgical” in Atlanta in April 1980 [3]. To conclude the paper, Dr. Zollinger wrote, “It is time perhaps, to move away from total gastrectomy, except when cimetidine fails, and when the patient does not take the drug. . . . We have to convince our physician friends that it is time to recommend that every gastrinoma be considered a surgical problem. . . . It is the basic principle to take out the malignant tumor, rather than treat the end result.” What I remember most of “The Old Man” is that he was always prepared.
Timothy C. Fabian, M.D. “You always hurt, you hurt the one you love . . .” —First line of a song composed by Allan Roberts and Doris Fisher for the Mills Brothers in 1944 From time to time you hear that song played, and when I hear it, I always think of the Old Man. It may have been written for the Mills Brothers, but I have to think that Roberts and Fisher must have met Dr. Zollinger. While he was known around the world as “The Big Z,” he was generally affectionately referred to by his surgical trainees as “The Old Man.” It was widely acknowledged locally and nationally that he was indeed a tough boss. While not all of the trainees appreciated or necessarily responded to his approach, I believe most understood that it was his way of trying to get the most out of our often meager talents. But
L.C. Carey et al / The American Journal of Surgery 186 (2003) 226 –233
while we usually recognized he was doing it for our own good, most of us at some point would think, “Gee, Old Man, do you have to love me so much?!” It was aptly stated in his obituary in the Columbus Dispatch (June 13, 1992): “As a teacher, Zollinger had a reputation as a stern task master who bullied his students toward excellence.” I don’t think any of the boys would argue with that. Rounds with Dr. Zollinger were always interesting. However, it didn’t take the trainees long to recognize that when the team was making rounds, it was best to avoid being the one presenting the patients. As an intern, I remember being coached by one of the residents ahead of me, Phil Catalano, on how to make rounds with The Old Man on 7 East. He instructed me on what to know, what to avoid, when to talk, and when to shut up. However, there were a couple of things that he misinstructed me on, such as the preferred way to handle IV solutions and the preferred approach to dressing management. On rounds with The Old Man the following day, he rapidly lit into me when I made faux pas related to these “accidental” misinstructions from Dr. Catalano. Out of the corner of my eye, I could see Phil chuckle. That was always the way it was with The Old Man— humorous when he was working on someone else but extremely painful when he was working on you. I must admit, though, that I took up the game when instructing Chris Ellison on how to make rounds with The Old Man. I guess all of us became a little bit like him. Perhaps it is academic genetics. The team would make morning rounds at 5:30 or 6:00 AM to check on the patients and make sure everything was in order (The Old Man would not have done well with the 80-hour work week). He was a stickler for the most minute detail. We needed to make sure that the patients were comfortable, that their bowels were working, and that they had a good night of sleep. He would require that the patients had intravenous catheters removed prior to bedtime and reinserted the following morning so that they could sleep comfortably. This could drive the intern up the wall. We would always make sure that the patients had their Milk of Magnesia written so that their bowels would be working and their dressings were meticulously changed. Almost always during work rounds, the patients, when queried by the visiting house officers, would be fairly satisfied with care and seemingly generally doing well. But it was amazing how things changed so quickly between work rounds and rounds with The Old Man. It seemed that when he queried the patients, either they were unhappy because their bowels were not moving, they slept poorly, or they were having pain which the analgesics were not resolving! Following their complaints, Dr. Zollinger would wear out the team. It seemed as if the patients had to get into the act. To this day, I think the patients enjoyed seeing us squirm. Doctor Zollinger said that he wanted to be remembered as a “teacher, surgeon, soldier, farmer.” He was from what one might call a blue collar background, growing up in the small Central Ohio town of Millersport. That is where the
231
farmer in his psyche originated and was responsible for an important part of his personality. That influence was sustained through his adult life in his passion for growing championship roses and gourds. The small town background likely also influenced his tenacious loyalty. Although he trained and spent part of his early academic career in Boston, he was an Ohio boy through and through. He loved the state, the University, Woody Hayes, and the football team. I am quite sure he was teasing his fellow deceased surgical colleagues on January 3rd of this year about the miracle season. One of the things I most respect about this Midwestern surgical giant was his even-handed approach to all. He treated everyone essentially the same—from departmental chairs and professors down to the novice house officer. The Old Man became famous for his panel moderations at national surgical forums. When he smelled weakness in data or opinions, he was certainly not shy about accusing the most prominent of academicians of overinflation of their positions. This would generally either bring down the house or at least titillate the audience while embarrassing to varying degrees the recipient of his scorn. It was rarely an effective tactic to vigorously defend oneself, as the hole just seemed to get deeper. Most of the boys from the training program learned that lesson early on (at least the ones who finished). I remember at one American College of Surgeons Clinical Congress later in his career when The Old Man was moderating a panel which was composed of primarily young surgeons. After one of the surgeons presented some data, Dr. Zollinger, in his inimitable way challenged the conclusions regarding treatment of portal hypertension. The young surgeon began arguing with The Old Man and it simply did not work. The audience quickly realized the futility of the young surgeon’s positions. Eyes rolled. Had he talked to one of the boys prior to the panel, he could have saved himself some pain. The Old Man was a unique soul. He is definitely one of the proverbial varieties who, once God created, he threw away the mould. Most of his former residents recall individuals who were so influenced by The Old Man that they tried to ape his approach to teaching and training in the academic environment. It never worked. While he clearly made huge impressions on all of us, there was only one Robert M. Zollinger. I miss him a lot. The soldier in his soul was also strong. His experiences in France during World War II with the Fifth Army Hospital obviously had a tremendous impact on him which persisted throughout his career. He was always very proud of his French connection and had the greatest admiration and respect for his Gallic colleagues. I will always remember attending a Zollinger tribute in Columbus a few years before his death. It was attended by the French surgeons Drs. Mercadier and Dubost, two of the giants on the stage of world surgery during the mid-20th century, whom Dr. Zollinger worked with during the war. The three of them jousted throughout the evening and revisited old times. It was a true joy to hear Dr. Mercadier describe “Zolly”
232
L.C. Carey et al / The American Journal of Surgery 186 (2003) 226 –233
dancing on a table at a French bistro during an evening of enjoying the fruits of the French vineyards. Watching the three of them commiserating over those days in France during World War II is something that I will never forget. Teacher, surgeon—Doctor Zollinger was recognized as being one of the great technical surgeons in the United States. His prowess in the operating room was legendary and that reputation was partially responsible for taking Ohio State from a modest program in the Midwest to one of the fine surgical training programs in the United States. While his expertise in the operating room was impressed upon all of his young pupils, most of us were attracted to the residency because of his renown as a stern but exemplary teacher. All of the young, impressionable trainees knew it would be a tough row to hoe to get through the program under The Old Man. Most relished the challenge, recognizing that you would be melded into as good a surgeon as your abilities would allow. There was no slacking off on The Old Man’s watch. He made similar demands on himself. Teacher, surgeon, soldier, farmer—yes, he excelled in all of these areas. The Old Man definitely had his own way of stimulating curiosity in his residents. I distinctly remember one morning’s rounds, during which I brought up what I believed to be a novel approach toward improving patient comfort that involved utilizing local anesthetics in the wound. I mentioned this to Dr. Zollinger in hopes of impressing him with my curiosity and interest in potential clinical research. He looked me straight in the eye and said, “Remember, you little bastard, if you thought of this today, I thought of it 30 years ago!” Well, I went back through his curriculum vitae and indeed found an article: Zollinger RM. Observations on the use of prolonged anesthetic agents in upper abdominal incisions. Surgery 10(1):27-36, July 1941. It was pretty hard to get one up on The Old Man. Working in the operating room with the great technician was a wonderful learning opportunity, but learning usually came at a price associated with some pain. The Old Man did nearly all of his cases himself. Many house officers seem to have the belief that unless you are doing the case, there is not great benefit to be in the operating room. I can assure those who feel that way that you can learn an awful lot by watching. That is especially true when one observes a technician of Dr. Zollinger’s ability. You learned a tremendous amount by observing his tissue dissection and techniques of exposure and instrument handling. He made difficult operations appear easy. However, once again, it was not always painless, especially if you were the one of his boys who was first assistant. God help you if you broke a tie or cut a knot! It was actually somewhat humorous if you were watching a first assistant bearing the brunt of their mistakes, but it was never fun if you were the first assistant. Nonetheless, we all learned a lot. Another of his teaching techniques which always made a profound impact on the intern was The Old Man’s utilization of the “Harvard System” in the operating room. That
system requires the intern to gather the instruments before the case and organize them on the back table and the Mayo stand. The intern would act as scrub nurse and pass the instruments as long as he could survive the onslaught. This technique certainly made one aware of the names of instruments and their appropriate use. An important side benefit of this technique was that it provided excellent entertainment for the scrub nurse who was watching the circus. Another somewhat idiosyncratic approach of Dr. Zollinger was routinely taking the specimen from the operating room to show the family if they were so interested. After removing the diseased tissue, he would arrange it and take it on a tray to illustrate to the family what the problem was. Always the teacher, this seemed to have a great impression on the family. Upon entering my residency, I only knew that I wanted to be a general surgeon and probably go back to my hometown of Marion, Ohio, just north of Columbus, to practice. Based on the example of one of my childhood heroes, a local surgeon named Frank Murphy, I had always thought that if you wanted to be a doctor, being a general surgeon was the ultimate way to practice the medical profession. You have the opportunity to diagnose, be a physiologist, operate, and frequently cure. I still believe this. The influence of The Old Man cemented those early impressions. During the interview process for the residency, I remember going up to the Department of Surgery on the 7th floor of the University Hospital, and seeing a map of the United States on the wall. On that map were pins in various locations which, upon inquiry, I found were cities where prior trainees had gone to enter the arena of academic surgery. I thought that was quite interesting and reflected on it throughout my early years after matching at Ohio State. Doctor Zollinger was proud of training all of as surgical house officers and it gave him particular satisfaction in seeing some join academic departments. He would always tell us that if you were going to be an academic surgeon, you had to “be like a squid and drop a lot of ink.” I think this intimidated those of us who ultimately considered academic surgery, because we remembered how hard it was to write papers in college. Nonetheless, The Old Man was right as usual. Getting into the habit of dropping some ink is important and with time becomes not quite so daunting as when we first start. Anyone interested in an academic career should follow his recommendation. After completing residency, I moved to Emory University for a trauma fellowship, and following that was invited to join Dean Warren’s faculty as an instructor. Drs. Zollinger and Warren were close friends. I believe Dr. Warren looked upon Dr. Zollinger as a mentor, and he clearly had great admiration and respect for him. My first year as a faculty member, Dr. Warren asked him to come down as a visiting professor. He allowed me to pick The Old Man up at the airport since he was my mentor. I was greatly excited about the opportunity to escort him on a minitour around town and then took him to his hotel. I can remember
L.C. Carey et al / The American Journal of Surgery 186 (2003) 226 –233
his deep interest in the architecture and the beautiful flora of Atlanta. Curiosity was an important part of his character. He had an interest in many things and that is probably partially responsible for his great success in the world of surgery. It was also during that visit that I saw The Old Man taken aback for the only time. He was giving a lecture to area surgeons at the Capitol City Club. He was always an entertaining speaker with a great sense of humor and peppered his talks with that humor. However, his humor seemed to come up short on this one occasion. He started by explaining that “he was from the same town as Willie T. Sherman, you know, the guy who started urban renewal in the South.” While he anticipated a good chuckle from the crowd, you could have heard a pin drop. Never before or since did I see The Old Man stopped in his tracks so suddenly. But, of course, he went ahead and gave a great lecture and received a solid round of applause at the end. He was one of the greatest role models any surgeon could wish for. He had the ultimate degree of dedication and loyalty—to his family, his work, and his hobbies. He did not believe in doing anything halfway. He was dedicated to his patients, to his trainees, to the University, and to the profession. As a teacher, he was tenacious in his approach. While he might have bullied his boys toward excellence, it was always evident to me that he cared for us very much. That approach has been referred to as “tough love” in recent years. The Old Man must have invented the approach and, if not, he certainly did perfect it. He also pushed himself toward becoming the surgeon’s surgeon. That, he certainly achieved. An attribute which had a great impact on his pupils was his sincere love of the profession. He was proud to be a physician and surgeon and exhibited and believed in the highest ideals of the profession. He often reminded the students and residents of the importance of ethics and putting the patient before all else. That dedication was not lip service. He believed that financial concerns had a tendency to corrode and corrupt the system and the surgeon. He reminded all of us of these issues during addresses at the American College of Surgeons as well as in several publications, including “Surgical Tithing” (Bulletin of the American College of Surgeons, January-February 1962), “The Senior Surgeon’s Responsibility” (Annals of Surgery, 1965), and “Let’s Improve Our Image” (Bulletin of the American College of Surgeons, April 1992). While Dr. Zollinger was a highly successful practitioner, he was completely uninterested in the materialism that could be produced by a busy practice. He lived simply and his character remained rooted in his humble upbringing in Millersport. I guess that is why he thought everyone should be treated the same. To me, that was his greatest attribute. Prior to his death, I remember one last visit with The Old Man. It was his final meeting at the Zollinger Society in Columbus in 1992. He knew his remaining life was short. The event was held at the University Club. As I walked in, Dr. Zollinger was sitting on the dais greeting the attendees. He asked me to come up and sit with him to talk. I was
233
elated. For 15 minutes we talked and it was one of the best chats of my life. I had never seen him so calm, reflective, upbeat, and loving. He told me he was very proud of me and he believed that my accomplishment reflected well on Ohio State. He encouraged me to continue in the endeavors of teaching and research in academic medicine. He reflected on his career and was very appreciative of all the opportunities he had been given. He was a spectacular human being, and for me, the greatest role model I could hope for. He was tough and he was exacting but he was very effective. The last line of the song: “. . . it’s because I love you most of all.”
Letitia Roberts We and our children, aged 10, 8, 7, and 6, arrived at our new home at Ohio State University, where Stu [Stuart S. Roberts, M.D.] was to be the first recipient of the endowed Robert M. Zollinger Chair of Surgery. At lunch time, the telephone rang and Mrs. Zollinger informed me there would be a reception for a visiting professor at the Columbus Club, and we should be there at 6:30 sharp. “Don’t be late!” she said. The moving van was in the driveway, and my dresser with all my clothes was on the bottom in the back of the van. Oh my—nothing to wear! With the help of a neighbor and the moving men, we finally found all the clothes I needed and arrived at 6:30 sharp. We walked in, and Dr. Zollinger began needling me about the house we had bought. I assured him that I was a fast adjuster— even to people. He brought me a drink . . . he brought me nuts . . . he introduced me to the visiting professor . . . and he was very attentive to me all evening. Later, we attended a cocktail party for a visiting professor at Dr. Zollinger’s home. I remember I wore a white A-line dress. I had a porcelain rose that matched my lipstick, which I wore in the center of the neckline. I thought I looked wonderful. When we arrived, Dr. Zollinger said—in a very loud voice—“What is that?” I said, “That is a rose.” He said, “That is a rose?” He then led me out into the back yard, where he cut a rose from his garden to replace my porcelain rose. I was not aware at that time that he was president of the American Rose Society. But he was unaware that I was allergic to roses and had to suffer through the whole cocktail party with a drippy nose.
References [1] Humphrey L. The professor touch. Arch Surg 2000;135:358 –9. [2] Zollinger RM, Coleman DW. The influences of pancreatic tumors on the stomach. Springfield, IL: Charles C. Thomas, 1974. [3] Zollinger RM, Ellison EC, Fabri PJ, et al. Primary peptic ulcerations of the jejunum associated with islet cell tumors: twenty-five-year appraisal. Ann Surg 1980;192:422–30.
Special article
Recollections of Robert M. Zollinger, M.D. Larry C. Carey, M.D.a, Dan W. Elliott, M.D.b, E. Christopher Ellison, M.D.c,*, Timothy C. Fabian, M.D.d, Letitia Robertse a
University of South Florida, Tampa, FL, USA b Wright State University, Dayton, OH, USA c Department of Surgery, Ohio State University, 327 Means Hall, 1654 Upham Dr., Columbus, OH 43210-1250, USA d University of Tennessee, Memphis, TN, USA e Peoria, IL, USA Manuscript received April 30, 2003
Abstract Remembering Dr. Robert M. Zollinger are Dr. Larry C. Carey, professor of surgery at the University of South Florida, in Tampa, Florida; Dr. Dan W. Elliott, professor emeritus of surgery at Wright State University, in Dayton, Ohio; Dr. E. Christopher Ellison, the Robert M. Zollinger professor and chairman of surgery at Ohio State University, in Columbus, Ohio; Dr. Timothy C. Fabian, professor and chairman of surgery at the University of Tennessee, in Memphis, Tennessee; and Mrs. Letitia Roberts, the widow of Dr. Stuart S. Roberts, the first recipient of the Zollinger Chair of Surgery at Ohio State, of Peoria, Illinois. © 2003 Excerpta Medica, Inc. All rights reserved. Keywords: Zollinger
Larry C. Carey, M.D. January 1975 was a momentous time in my life. I accepted the challenge to succeed Dr. Robert M. Zollinger as chairman of the Department of Surgery at my alma mater, the Ohio State University. My first formal encounter with Dr. Zollinger was 17 years earlier, when, along with three classmates, I was assigned to his service for 3 months as a junior medical student. He knew all of our names, where we were from, and something about us. One of our group was a bit of a con man; it was Dr. Zollinger’s reference to him as a “strawberry salesman” on the first day of our rotation that got our collective attention. As students we were assigned a small group of the chief’s patients. We were expected to measure the urinary chloride, calf circumference, and vital capacity on every patient every day. When one of our patients went to the operating room, we were to draw the anatomy of the operation on a blackboard outside the theater. When Dr. Zollinger did a Whipple operation in a little * Corresponding author. Tel.: ⫹1-614-293-8701; fax: ⫹1-614-2934063 E-mail address: [email protected]
under 3 hours, no one seemed surprised. He never appeared to be moving rapidly. There was no cautery in the room, almost every bleeder was suture-ligated, and of course, all anastomoses were hand-sewn. As you watched him work and occasionally looked at the clock, you wondered if it might have stopped. It was common to be the last assistant left at the end of the case, because both residents would have been banished (if not fired) for some perceived flaw in either knowledge or character, or both. Doctor Zollinger continued to practice until January 1983, the year of his 80th birthday. He guarded against the temptation of the operating room by not renewing his malpractice insurance. Doctor Zollinger could not have been more gracious in his relationship to me. He never expressed criticism and was always available for counsel. He introduced me to his friends, both in and out of medicine, and was always supportive. Perhaps my most cherished moment came at a Zollinger Club meeting. This was an American College of Surgeons event heavily attended by leaders in surgery from all over the world. I was talking to some people when I felt a tug on my sleeve. Doctor Zollinger said, “Can I talk to you for a minute?” We went to a corner of the room, where he said, “Louise has a lump in her t . I think it’s a cancer and I want you to take it out next week.” As it turned out,
0002-9610/03/$ – see front matter © 2003 Excerpta Medica, Inc. All rights reserved. doi:10.1016/S0002-9610(03)00217-4
L.C. Carey et al / The American Journal of Surgery 186 (2003) 226 –233
it was a cancer, and she survived a second one in the other breast. Knowing the truly remarkable closeness of Louise and Robert (she always called him Robert), I was deeply touched to be entrusted with her care. I called on him at his home as he neared the end of his life. He had lost weight and was physically feeble but mentally very sharp. We talked for about an hour, and as I prepared to leave, I thanked him for his kindness to me. As I started out of his bedroom, he stopped me and said, “Boy, don’t get cancer.” The world of surgery has never since known the likes of Robert M. Zollinger.
Dan W. Elliott, M.D. It was the spring of 1950 when I first met Dr. Zollinger at an interview for a position in his residency program. He was 47 years old and had been chairman of the Department of Surgery at Ohio State for just 3 years. Its base of operations was the old, cramped Starling-Loving Hospital with 170 beds. In order to wheel one patient out to surgery all the beds in a room had to be moved. The new University Hospital was only a promise and a hole in the ground awaiting funds. At that time I was a first-year surgical resident at Columbia-Presbyterian Hospital in New York City and could have stayed. Our chief surgical resident, Dr. Tom Randell, had put together with his own hands the first flame photometer used to measure sodium and potassium in patients. This opened up a whole new era in the study of electrolyte balance. However, I needed to come home to Ohio because of my father’s illness. I interviewed first at Cincinnati General and then phoned Doris, Dr. Zollinger’s long-time secretary, for an appointment. At my interview it was soon obvious that this would be unlike any I had ever known. Doctor Zollinger started off by insisting I tell him what I really thought about Cincinnati General, and then why the surgeons at Columbia were so slow. I wondered how he knew I had been to the General. Finally I realized Doris had told him I called from Cincinnati and he guessed the rest of it. Already I had an insight that would prove useful in the years ahead. Doris was very loyal and important. She told Dr. Zollinger everything she heard and he pumped her regularly. Finally he asked me if I had any questions. He seemed so cocky that I wanted to test him. Politely I inquired if he had heard about our flame photometer. He roared with laughter: “Where do you think you are, son, out west among the Indians?” Then, “Doris, show him our flame photometer!” He insisted I go see it and there it was, busily operated by a surgical service employee in a closet under the stairs. I decided to come to Ohio State as a second-year resident. It has turned out to be the best professional decision I have ever made. Doctor Zollinger was first of all a master technical surgeon, very quick and very gentle, but intolerant of assistants, especially residents. “All I want is a high-school
227
performance,” he would say. “Sponge that once more and I’ll sponge your cornea.” He laughed at his own little jokes and could be vulgar: “With the assistance you’re giving me today I would have trouble incising flatus!” He wanted us to laugh, but he could be irascible. When first-year resident Bob Gilsdorf was tying sutures for him, Bob broke two in a row and then pulled another out of his needle-holder. Doctor Zollinger calmly laid down his instruments and told Bob to hold out each hand, thumbs up. He opened a long sponge and tied the four fingers of his left hand firmly together. Then he did the same to his right hand and insisted that Bob go right on assisting. “I’ve always wanted to train a lobster,” he laughed. When I had assisted him just a few times he sent me out of the room: “You’re weak. Go have lunch!” I did, but that was my mistake. By the time my cafeteria tray was filled there was an emergency page from the operating room nurse. “Where are you?” she demanded. “I’m at lunch.” “Oh, you don’t understand,” she told me, “you’re supposed to go to the next room and get his next case started.” Why was he so difficult, I thought. Why did he constantly deride us, brag about his prowess, and demand more details about our patients than anyone could possibly remember? We held little notes in the palms of our hands to help us present a case, but he would demand those notes and insist, “The only thing that matters is what’s in your head!” Art Simpson, a Zollinger resident of my era, had a memorable evening shortly after his assignment to the chief s service. He had to call Dr. Zollinger back to the hospital to see an emergency admission one evening because Art couldn’t get all the tests finished before time to go home. The chief was furious, his evening out spoiled, and Art was fired on the telephone for total incompetence: “Leave and don’t come back!” Art couldn’t leave— he was on call that night. He waited in the lobby, full of trepidation, as he described it. Before long Dr. Zollinger appeared, all friendly and full of smiles. He put his arm across Art’s shoulder as they walked to the elevator as if nothing had ever happened. Sooner or later we all learned Dr. Zollinger totally forgave and forgot anything critical he ever said. He never kept a grudge. As Art wrote, “His bark was far worse than his bite. Certainly his demand for meticulous attention to detail is never forgotten. The trauma of the residency has made practicing surgery seem easy.” His basic kindness was confirmed by Loren Humphrey, once a resident who knew Dr. Zollinger only by reputation. He wrote a fascinating surgical reminiscence for the Archives of Surgery [1]. Doctor Zollinger knew he was a role model and loved the attention, but he would never ask any of us to do more than he would do. We saw his silver Thunderbird parked at the hospital before most of us arrived in the mornings, and it was often still there when we left at night. He demanded a call at 9:00 PM every night from the resident covering his personal patients. He wanted the temperature, urine flow, and every pertinent detail for every patient. Even though Dr. Zollinger was out of town, the late Bill Stewart, then the ever-efficient resident, insisted that the hospital operator get
228
L.C. Carey et al / The American Journal of Surgery 186 (2003) 226 –233
him on the phone at the regular time. “Ye gods, Bill!” he answered, “Do you know it’s 2:00 AM, the middle of the night in London! If I ever go to Hong Kong, please just don’t call!” But he discussed the patients as carefully as always. Doctor Zollinger was intensely competitive and enjoyed it thoroughly. Starting when he was a little boy, his father would challenge him regularly to a foot race, and that continued for years. Strange as it seems, he really wanted us to compete with him in medical knowledge and in good patient outcomes. Sunday mornings were not for sleeping in. We had 8:00 AM chart meetings that could go on for hours, in which each resident proved that all his charts were complete, with histories, operative notes, and discharge summaries all in place. But that wasn’t enough. We had to present the statistics for our services: hospital discharges with the percentage of complications and deaths. On top of that were the hand-written record books in which we recorded each patient’s name and number (computers were too expensive). There was a book listing patients with peptic ulcer, and others for biliary surgery, spleens, colon surgery, and more. These were the topics on which residents were supposed to write papers for publication, all summarizing the hospital’s actual experience. We were actually beginning “evidence-based practice,” now all the rage for the improvement of medicine. We didn’t know how far ahead of our time we actually were. We just knew that Dr. Zollinger was convinced that care was better where doctors honestly reviewed and published their own experiences with pride. Doctor Zollinger would invite us to his home in order to help us with our first papers. To his credit he would never put his name as author ahead of ours. He would decline our offer to list him as an author unless he had truly helped. I can still see him at his desk at home, squaring his shoulders as he tried to help me, declaring “Dan, you’ve got to come to grips with this.” Being competitive led naturally to repartee, sometimes funny, sometimes pointless, but we tried hard. Doctor Zollinger became a master at it and loved the humor, but he understood its use. “Why do you suppose Bert Dunphy and I could fill a ballroom with 2,000 surgeons at an American College of Surgeons meeting? Do you think they thought we were leading surgical scientists? No! They knew better. It’s our repartee! If they stay awake, maybe we can make a point or two.” The showplace for the patients in whom we could take pride was the weekly grand rounds, held then at 9:30 on Saturday mornings. Doctor Zollinger and his close and most trusted associate, Dr. Edwin Ellison, presided from the front row while the auditorium filled with descending rank to the medical students in the back. Doctor Zollinger was fond of calling on the student whose name he saw on the chart he held while the patient was presented. One morning no student responded. “Get that boy on the phone,” the professor demanded, “and give the phone to me.” Sure enough, the
student was at home. “This is Dr. Zollinger,” he told the student loudly, “I’m here in front of grand rounds looking for you. Are you enjoying your bed? What are you—a Simmons athlete?” One of our residents, Mitchell Karlan, was senior enough to disagree with Dr. Zollinger about some finding in the case presented, with a grin, of course. “Oh, you’re wrong, Karlan,” the chief exclaimed. “Put up your money. I’ll bet you $50!” Karlan was quick on his feet, “But chief, that’s half my year’s salary!” and the audience roared. Doctor Zollinger wouldn’t be put down: “I had no idea you were so overpaid!” The only time I ever saw Dr. Zollinger truly nonplused occurred one Saturday morning when his residents, students and a rotating intern had just finished seeing his patients and were heading to the elevators to go to grand rounds. The rotating intern turned back. “Aren’t you coming with us to grand rounds?” Dr. Zollinger demanded. “No, sir,” the intern replied, standing up tall and speaking firmly. “I am a Seventh-Day Adventist and Saturday is our Sabbath. I am not allowed entertainment on the Sabbath!” Doctor Zollinger constantly reminded us of every deadline for the submission of abstracts so that we might appear on all the prominent surgical programs. He spent hours trying to show us how to make our slides crisp and easy to read. Then there was the endless practicing and timing of our talks. We knew we were getting results by 1957, when our department gained sufficient respect nationally to host a Society of University Surgeons meeting in Columbus. We provided a local program on our campus and invited the late Dr. Bruce Wiseman, then chairman of the Department of Medicine, to speak. He gave a scholarly paper on splenectomy for the hematological disorders he treated, but he talked and talked far too long. Doctor Zollinger presided, but he knew when to stay cool. Then he had to introduce me for a talk about bile and pancreatitis. After a few glowing words he cautioned me, “Remember, Dr. Elliott, 10 minutes only. You are the chief resident in surgery, not the chairman of medicine!” I had a long wait for the laughter to subside. Other Zollingerisms were collected in 1973 for his retirement party at age 70, after 26 years as chairman of the Department of Surgery. They were published in a redcovered pamphlet with a big “Z” on the cover, 60 pages long! The late Colin Howe, an English surgeon who spent a year with us in research, sent a letter purported to be from British Customs, seizing his pamphlets for their “salacious” content. That was, like much we heard about The Big Z, grossly exaggerated. Perhaps the highlight of my career at Ohio State was admitting Dr. Zollinger’s famous patient who led to the discovery of the Zollinger-Ellison syndrome. That was a landmark development at a time when ulcers were common and we knew little about their causes. I was the senior resident assigned to the chief’s service. When I called to let him know she was back again with pain, he told me regretfully that he knew he must now completely remove all of
L.C. Carey et al / The American Journal of Surgery 186 (2003) 226 –233
her remaining stomach. She was only 26 but had undergone a vagotomy and pyloroplasty, then a Billroth I resection, more resection, and finally gastric irradiation, but nothing controlled her huge acid output. I was to schedule her surgery and notify Dr. Ellison, whose advice he had sought on this case. Doctor Ellison had seen a similar patient who died with uncontrollable gastric hemorrhage. At autopsy she had an islet tumor in her pancreas. At the operation Dr. Ellison decided to assist. I was displaced to the end of a retractor. Doctor Zollinger neatly removed all the rest of her stomach as planned. This exposed a very normal-appearing pancreas. Doctor Ellison pointed out two small lymph nodes on its surface and asked Dr. Zollinger to take them out, just in case they might contain metastases. Always the skeptic, Dr. Zollinger replied, “Oh, go wash your glasses, Eddy. There’s enough inflammation in here to engorge all her nodes,” but he promptly peeled them out. Postoperatively she did beautifully and all the pain was gone—a perfect case for Saturday’s grand rounds. I was to present her case. I knew the chart had to be perfect for me to survive the chief s inspection. Every note was dictated and signed. The medical student’s history was graded and signed. Multicolored drawings of the anatomy were ready on the blackboard. It was early Saturday morning, but where was the pathology report? Nowhere to be found. I called up surgical pathology and was switched to the chief, the late Dr. Hans Schlumberger. I told him the report was late, but if he would read me a brief summary, I would put a note on the chart in time for rounds. He nearly shouted, “You mean you want the most important pathology report in the world today just read to you over the phone!” I said yes. Then he told me, “If you want that report you had better bust your britches down here right now.” I found six pathologists sitting around the teaching microscope with big grins on their faces. They swore me to secrecy and then told me the secret they were going to spring on Drs. Zollinger and Ellison at grand rounds. The two nodes were islet cell tumors! They matched perfectly the tumors in Dr. Ellison’s previous patient with the hemorrhages. The syndrome was born, and there was dancing in the aisles at rounds that morning. Doctor Zollinger had a long and brilliant career in surgery, winning many awards, high offices in all the national organizations, and an endowed professorship at Ohio State in his name. His residents and associates benefited everywhere from his national reputation. He was generous with recommendations, and they were well-received. He promoted us professionally in many ways and as far as he thought he could get away with. His more senior residents all had faculty titles in recognition of their responsibilities to teach students. From chief resident I became a full professor in about 5 years (it would have taken 30 at Columbia) and was accepted into prestigious surgical societies because of his sponsorship. It took me a long time during my association with Dr. Zollinger to figure out what he was really after. Eventually he told us at grand rounds: it was sustained heroic achievement!
229
E. Christopher Ellison, M.D. I had the good fortune to work with Dr. Robert M. Zollinger when I was a resident in training, from 1976 to 1983. A unique quality of Dr. Z was his careful preparation for everything he did, a characteristic that some may consider incompatible with his bravado and presence, but which I think was the essence of both. I came to the Ohio State Department of Surgery in 1976, after my graduation from the Medical College of Wisconsin. I wished to train with Dr. Larry Carey and hoped that my professional experience would include some exposure to Dr. Z, whom I had known as my dad’s mentor. My dad had called him “Zolly” and clearly respected him. Doctor Z was his confidant and advisor, and to a certain extent, the converse was true. They were of different generations. Doctor Z’s circle was the leadership of American surgery. My dad was his link to the pulse of the younger generation, the “young turks.” These included notables such as Friesen, Mulholland, and Thompson. In 1974, my second year of medical school, I received a copy of a monograph that Dr. Z had prepared on the ulcerogenic syndrome. It was inscribed, “To Chris Ellison, whose father was a fabulous teacher, investigator and surgeon. . . .” [2] Upon graduation from medical school, I received my first copy of the Atlas of Surgical Operations. Needless to say, I was anxious to meet Dr. Z and hopeful that I could live up to some as-yet-unspecified expectation that he would have of me. On my first rotation on the Surgery 1 service, I ran into “The Old Man,” as my resident colleagues referred to him, and as I would later—not out of any disrespect, but on the contrary, with the utmost respect. I would round with him and the team. He was decreasing his practice, which now mostly consisted of VIPs, community notables, difficult cases and, of course, the patients with suspected or proven ZE syndrome. Doctor Z wanted us to be prepared for rounds. To him this meant knowing not only the laboratory and radiology results, as we insist that our residents do today, but also how the patients felt, how their pain was controlled, how they had slept the night before and, most importantly, if they had specific complaints that we could address and rectify. He had us do bedside spirometry and weigh the patients daily. Spirometry was an index to pain management. The larger the volume, the better the pain control. Weight measurement was a check on our fluid management, and reinforced our instruction in postoperative physiology, where we were taught to expect a diuresis on postoperative day 3. Doctor Z wanted his patients to be prepared for surgery. I recall an inadequate bowel prep on one of his patients. I was a third-year resident, and we were doing a low anterior resection. Doctor Z preferred the “Baker anastomosis” with two layers of silk. I thought I was prepared. I read the Atlas the night before. The senior resident had assigned me to scrub the case. After exploration, the problem became pal-
230
L.C. Carey et al / The American Journal of Surgery 186 (2003) 226 –233
pably obvious: the colon was not prepared to Dr. Z’s satisfaction. I was ready for the lesson, but instead, he directed the circulating nurse to find the “ ” [chief] and get him to the room ASAP. Doctor Z waited, and about 10 minutes later, the “ ” appeared. Doctor Z asked the resident to scrub and then examine the bowel. The room fell silent as the chief felt the colon. Doctor Z said, “What if this was your mother?” He asked the chief to stand next to him and observe the procedure. “The Old Man” masterfully resected the bowel and performed an anastomosis without contamination. He then asked the chief to scrub out and place a rectal tube, which Dr. Z then advanced above the anastomosis. He personally closed the abdomen and then said, “Ellison, don’t let this happen on your watch.” He wanted to be prepared and was. For those who can recall his command of a panel chair or a discussion at the “American Surgical,” you will appreciate the fact that no matter how off-the-cuff and quick that he appeared, it was because he was well prepared. He anticipated every question, comment, or joke well in advance. I was in the lab from July 1978 through June 1980. He invited me to help him prepare the 25th anniversary paper for the ZE syndrome, an abstract to be submitted to the American Surgical Association in early winter of 1979. As a result, I had the opportunity to be his sounding board for many of his panels and visiting professorships and also to participate in our preparation for “The Paper,” as we called it. If asked to run a panel, he would send a letter to the participants well in advance and solicit them to provide a list of the questions they would like to receive on the subject, and then he would provide them with a list of his own questions. He would start this process six to eight weeks in advance. Once assembled, he would outline the questions. He would have me role-play, for the lack of a better term. I would read the responses to his questions, and he would practice dissecting the response and providing some humor. He would take notes, and later his secretary Doris would type them. Only after several drafts of these notes did he consider the preparation complete. I recall that he visited Emory when Dr. Warren was chairman. He presented his entire talk to me more than once, having a Ho Ho or two from the refrigerator in his office between trial runs. He even practiced a reference to Sherman as the last Ohioan to visit Atlanta in an official capacity. He wanted my reaction to his slides and comments not as a surgeon—I was far from completing my training— but as a person. He was preparing! “The Paper” was an incredible experience. We assembled all the charts, histological slides, and labs from his well-kept files. This was accomplished with the aid of his able research assistant Joann Sparks. He saw these patients in person and examined them on a regular basis. He did not depend on the clinic notes of others— he was preparing. He knew the patients and their families, and he helped me to know them as only he could. He would refer to the patients as Ivory-Jane (the first ZE), the twins (MEN I), the fireman,
or the bartender. He (I hoped we) proposed hypotheses based on the current issues regarding ZE: survival prediction and the importance of tumor resection, which became the foundation of the paper. It was difficult for him to let go of total gastrectomy for all patients, but he knew that medical therapy was effective and newer drugs in the future would likely obviate the need for gastric surgery in most patients with ZE syndrome. So he switched his focus. He was not surprised that he had resected so many patients. He was surprised that he had not emphasized how important this was to the successful outcome and long-term prognosis. We prepared an abstract and rewrote it more times than I can recall. This was at a time that predated word processing, and we were both thankful for the nimble fingers and editorial wisdom of Helene Ayers. The paper was accepted. Then the real preparation began. We would meet twice a week. He would challenge himself and me, saying, “We have nothing to say,” or “There is nothing new.” Then came a spark of showmanship and preparation: “I will write to the experts in the area and ask what they think is important,” he said. He wrote Professor Richard Melbourne of London, England; Lord Rodney Smith of London, England; Professor Maurice Mercadier of Paris, France; James C. Thompson of Galveston, Texas; James D. Hardy of Jackson, Mississippi; and Stanley R. Friesen of Kansas City, Kansas— the experts in ZE syndrome in 1980. All responded, perhaps unaware that they were preparing the discussion for the 25th anniversary paper at the “American Surgical” in Atlanta in April 1980 [3]. To conclude the paper, Dr. Zollinger wrote, “It is time perhaps, to move away from total gastrectomy, except when cimetidine fails, and when the patient does not take the drug. . . . We have to convince our physician friends that it is time to recommend that every gastrinoma be considered a surgical problem. . . . It is the basic principle to take out the malignant tumor, rather than treat the end result.” What I remember most of “The Old Man” is that he was always prepared.
Timothy C. Fabian, M.D. “You always hurt, you hurt the one you love . . .” —First line of a song composed by Allan Roberts and Doris Fisher for the Mills Brothers in 1944 From time to time you hear that song played, and when I hear it, I always think of the Old Man. It may have been written for the Mills Brothers, but I have to think that Roberts and Fisher must have met Dr. Zollinger. While he was known around the world as “The Big Z,” he was generally affectionately referred to by his surgical trainees as “The Old Man.” It was widely acknowledged locally and nationally that he was indeed a tough boss. While not all of the trainees appreciated or necessarily responded to his approach, I believe most understood that it was his way of trying to get the most out of our often meager talents. But
L.C. Carey et al / The American Journal of Surgery 186 (2003) 226 –233
while we usually recognized he was doing it for our own good, most of us at some point would think, “Gee, Old Man, do you have to love me so much?!” It was aptly stated in his obituary in the Columbus Dispatch (June 13, 1992): “As a teacher, Zollinger had a reputation as a stern task master who bullied his students toward excellence.” I don’t think any of the boys would argue with that. Rounds with Dr. Zollinger were always interesting. However, it didn’t take the trainees long to recognize that when the team was making rounds, it was best to avoid being the one presenting the patients. As an intern, I remember being coached by one of the residents ahead of me, Phil Catalano, on how to make rounds with The Old Man on 7 East. He instructed me on what to know, what to avoid, when to talk, and when to shut up. However, there were a couple of things that he misinstructed me on, such as the preferred way to handle IV solutions and the preferred approach to dressing management. On rounds with The Old Man the following day, he rapidly lit into me when I made faux pas related to these “accidental” misinstructions from Dr. Catalano. Out of the corner of my eye, I could see Phil chuckle. That was always the way it was with The Old Man— humorous when he was working on someone else but extremely painful when he was working on you. I must admit, though, that I took up the game when instructing Chris Ellison on how to make rounds with The Old Man. I guess all of us became a little bit like him. Perhaps it is academic genetics. The team would make morning rounds at 5:30 or 6:00 AM to check on the patients and make sure everything was in order (The Old Man would not have done well with the 80-hour work week). He was a stickler for the most minute detail. We needed to make sure that the patients were comfortable, that their bowels were working, and that they had a good night of sleep. He would require that the patients had intravenous catheters removed prior to bedtime and reinserted the following morning so that they could sleep comfortably. This could drive the intern up the wall. We would always make sure that the patients had their Milk of Magnesia written so that their bowels would be working and their dressings were meticulously changed. Almost always during work rounds, the patients, when queried by the visiting house officers, would be fairly satisfied with care and seemingly generally doing well. But it was amazing how things changed so quickly between work rounds and rounds with The Old Man. It seemed that when he queried the patients, either they were unhappy because their bowels were not moving, they slept poorly, or they were having pain which the analgesics were not resolving! Following their complaints, Dr. Zollinger would wear out the team. It seemed as if the patients had to get into the act. To this day, I think the patients enjoyed seeing us squirm. Doctor Zollinger said that he wanted to be remembered as a “teacher, surgeon, soldier, farmer.” He was from what one might call a blue collar background, growing up in the small Central Ohio town of Millersport. That is where the
231
farmer in his psyche originated and was responsible for an important part of his personality. That influence was sustained through his adult life in his passion for growing championship roses and gourds. The small town background likely also influenced his tenacious loyalty. Although he trained and spent part of his early academic career in Boston, he was an Ohio boy through and through. He loved the state, the University, Woody Hayes, and the football team. I am quite sure he was teasing his fellow deceased surgical colleagues on January 3rd of this year about the miracle season. One of the things I most respect about this Midwestern surgical giant was his even-handed approach to all. He treated everyone essentially the same—from departmental chairs and professors down to the novice house officer. The Old Man became famous for his panel moderations at national surgical forums. When he smelled weakness in data or opinions, he was certainly not shy about accusing the most prominent of academicians of overinflation of their positions. This would generally either bring down the house or at least titillate the audience while embarrassing to varying degrees the recipient of his scorn. It was rarely an effective tactic to vigorously defend oneself, as the hole just seemed to get deeper. Most of the boys from the training program learned that lesson early on (at least the ones who finished). I remember at one American College of Surgeons Clinical Congress later in his career when The Old Man was moderating a panel which was composed of primarily young surgeons. After one of the surgeons presented some data, Dr. Zollinger, in his inimitable way challenged the conclusions regarding treatment of portal hypertension. The young surgeon began arguing with The Old Man and it simply did not work. The audience quickly realized the futility of the young surgeon’s positions. Eyes rolled. Had he talked to one of the boys prior to the panel, he could have saved himself some pain. The Old Man was a unique soul. He is definitely one of the proverbial varieties who, once God created, he threw away the mould. Most of his former residents recall individuals who were so influenced by The Old Man that they tried to ape his approach to teaching and training in the academic environment. It never worked. While he clearly made huge impressions on all of us, there was only one Robert M. Zollinger. I miss him a lot. The soldier in his soul was also strong. His experiences in France during World War II with the Fifth Army Hospital obviously had a tremendous impact on him which persisted throughout his career. He was always very proud of his French connection and had the greatest admiration and respect for his Gallic colleagues. I will always remember attending a Zollinger tribute in Columbus a few years before his death. It was attended by the French surgeons Drs. Mercadier and Dubost, two of the giants on the stage of world surgery during the mid-20th century, whom Dr. Zollinger worked with during the war. The three of them jousted throughout the evening and revisited old times. It was a true joy to hear Dr. Mercadier describe “Zolly”
232
L.C. Carey et al / The American Journal of Surgery 186 (2003) 226 –233
dancing on a table at a French bistro during an evening of enjoying the fruits of the French vineyards. Watching the three of them commiserating over those days in France during World War II is something that I will never forget. Teacher, surgeon—Doctor Zollinger was recognized as being one of the great technical surgeons in the United States. His prowess in the operating room was legendary and that reputation was partially responsible for taking Ohio State from a modest program in the Midwest to one of the fine surgical training programs in the United States. While his expertise in the operating room was impressed upon all of his young pupils, most of us were attracted to the residency because of his renown as a stern but exemplary teacher. All of the young, impressionable trainees knew it would be a tough row to hoe to get through the program under The Old Man. Most relished the challenge, recognizing that you would be melded into as good a surgeon as your abilities would allow. There was no slacking off on The Old Man’s watch. He made similar demands on himself. Teacher, surgeon, soldier, farmer—yes, he excelled in all of these areas. The Old Man definitely had his own way of stimulating curiosity in his residents. I distinctly remember one morning’s rounds, during which I brought up what I believed to be a novel approach toward improving patient comfort that involved utilizing local anesthetics in the wound. I mentioned this to Dr. Zollinger in hopes of impressing him with my curiosity and interest in potential clinical research. He looked me straight in the eye and said, “Remember, you little bastard, if you thought of this today, I thought of it 30 years ago!” Well, I went back through his curriculum vitae and indeed found an article: Zollinger RM. Observations on the use of prolonged anesthetic agents in upper abdominal incisions. Surgery 10(1):27-36, July 1941. It was pretty hard to get one up on The Old Man. Working in the operating room with the great technician was a wonderful learning opportunity, but learning usually came at a price associated with some pain. The Old Man did nearly all of his cases himself. Many house officers seem to have the belief that unless you are doing the case, there is not great benefit to be in the operating room. I can assure those who feel that way that you can learn an awful lot by watching. That is especially true when one observes a technician of Dr. Zollinger’s ability. You learned a tremendous amount by observing his tissue dissection and techniques of exposure and instrument handling. He made difficult operations appear easy. However, once again, it was not always painless, especially if you were the one of his boys who was first assistant. God help you if you broke a tie or cut a knot! It was actually somewhat humorous if you were watching a first assistant bearing the brunt of their mistakes, but it was never fun if you were the first assistant. Nonetheless, we all learned a lot. Another of his teaching techniques which always made a profound impact on the intern was The Old Man’s utilization of the “Harvard System” in the operating room. That
system requires the intern to gather the instruments before the case and organize them on the back table and the Mayo stand. The intern would act as scrub nurse and pass the instruments as long as he could survive the onslaught. This technique certainly made one aware of the names of instruments and their appropriate use. An important side benefit of this technique was that it provided excellent entertainment for the scrub nurse who was watching the circus. Another somewhat idiosyncratic approach of Dr. Zollinger was routinely taking the specimen from the operating room to show the family if they were so interested. After removing the diseased tissue, he would arrange it and take it on a tray to illustrate to the family what the problem was. Always the teacher, this seemed to have a great impression on the family. Upon entering my residency, I only knew that I wanted to be a general surgeon and probably go back to my hometown of Marion, Ohio, just north of Columbus, to practice. Based on the example of one of my childhood heroes, a local surgeon named Frank Murphy, I had always thought that if you wanted to be a doctor, being a general surgeon was the ultimate way to practice the medical profession. You have the opportunity to diagnose, be a physiologist, operate, and frequently cure. I still believe this. The influence of The Old Man cemented those early impressions. During the interview process for the residency, I remember going up to the Department of Surgery on the 7th floor of the University Hospital, and seeing a map of the United States on the wall. On that map were pins in various locations which, upon inquiry, I found were cities where prior trainees had gone to enter the arena of academic surgery. I thought that was quite interesting and reflected on it throughout my early years after matching at Ohio State. Doctor Zollinger was proud of training all of as surgical house officers and it gave him particular satisfaction in seeing some join academic departments. He would always tell us that if you were going to be an academic surgeon, you had to “be like a squid and drop a lot of ink.” I think this intimidated those of us who ultimately considered academic surgery, because we remembered how hard it was to write papers in college. Nonetheless, The Old Man was right as usual. Getting into the habit of dropping some ink is important and with time becomes not quite so daunting as when we first start. Anyone interested in an academic career should follow his recommendation. After completing residency, I moved to Emory University for a trauma fellowship, and following that was invited to join Dean Warren’s faculty as an instructor. Drs. Zollinger and Warren were close friends. I believe Dr. Warren looked upon Dr. Zollinger as a mentor, and he clearly had great admiration and respect for him. My first year as a faculty member, Dr. Warren asked him to come down as a visiting professor. He allowed me to pick The Old Man up at the airport since he was my mentor. I was greatly excited about the opportunity to escort him on a minitour around town and then took him to his hotel. I can remember
L.C. Carey et al / The American Journal of Surgery 186 (2003) 226 –233
his deep interest in the architecture and the beautiful flora of Atlanta. Curiosity was an important part of his character. He had an interest in many things and that is probably partially responsible for his great success in the world of surgery. It was also during that visit that I saw The Old Man taken aback for the only time. He was giving a lecture to area surgeons at the Capitol City Club. He was always an entertaining speaker with a great sense of humor and peppered his talks with that humor. However, his humor seemed to come up short on this one occasion. He started by explaining that “he was from the same town as Willie T. Sherman, you know, the guy who started urban renewal in the South.” While he anticipated a good chuckle from the crowd, you could have heard a pin drop. Never before or since did I see The Old Man stopped in his tracks so suddenly. But, of course, he went ahead and gave a great lecture and received a solid round of applause at the end. He was one of the greatest role models any surgeon could wish for. He had the ultimate degree of dedication and loyalty—to his family, his work, and his hobbies. He did not believe in doing anything halfway. He was dedicated to his patients, to his trainees, to the University, and to the profession. As a teacher, he was tenacious in his approach. While he might have bullied his boys toward excellence, it was always evident to me that he cared for us very much. That approach has been referred to as “tough love” in recent years. The Old Man must have invented the approach and, if not, he certainly did perfect it. He also pushed himself toward becoming the surgeon’s surgeon. That, he certainly achieved. An attribute which had a great impact on his pupils was his sincere love of the profession. He was proud to be a physician and surgeon and exhibited and believed in the highest ideals of the profession. He often reminded the students and residents of the importance of ethics and putting the patient before all else. That dedication was not lip service. He believed that financial concerns had a tendency to corrode and corrupt the system and the surgeon. He reminded all of us of these issues during addresses at the American College of Surgeons as well as in several publications, including “Surgical Tithing” (Bulletin of the American College of Surgeons, January-February 1962), “The Senior Surgeon’s Responsibility” (Annals of Surgery, 1965), and “Let’s Improve Our Image” (Bulletin of the American College of Surgeons, April 1992). While Dr. Zollinger was a highly successful practitioner, he was completely uninterested in the materialism that could be produced by a busy practice. He lived simply and his character remained rooted in his humble upbringing in Millersport. I guess that is why he thought everyone should be treated the same. To me, that was his greatest attribute. Prior to his death, I remember one last visit with The Old Man. It was his final meeting at the Zollinger Society in Columbus in 1992. He knew his remaining life was short. The event was held at the University Club. As I walked in, Dr. Zollinger was sitting on the dais greeting the attendees. He asked me to come up and sit with him to talk. I was
233
elated. For 15 minutes we talked and it was one of the best chats of my life. I had never seen him so calm, reflective, upbeat, and loving. He told me he was very proud of me and he believed that my accomplishment reflected well on Ohio State. He encouraged me to continue in the endeavors of teaching and research in academic medicine. He reflected on his career and was very appreciative of all the opportunities he had been given. He was a spectacular human being, and for me, the greatest role model I could hope for. He was tough and he was exacting but he was very effective. The last line of the song: “. . . it’s because I love you most of all.”
Letitia Roberts We and our children, aged 10, 8, 7, and 6, arrived at our new home at Ohio State University, where Stu [Stuart S. Roberts, M.D.] was to be the first recipient of the endowed Robert M. Zollinger Chair of Surgery. At lunch time, the telephone rang and Mrs. Zollinger informed me there would be a reception for a visiting professor at the Columbus Club, and we should be there at 6:30 sharp. “Don’t be late!” she said. The moving van was in the driveway, and my dresser with all my clothes was on the bottom in the back of the van. Oh my—nothing to wear! With the help of a neighbor and the moving men, we finally found all the clothes I needed and arrived at 6:30 sharp. We walked in, and Dr. Zollinger began needling me about the house we had bought. I assured him that I was a fast adjuster— even to people. He brought me a drink . . . he brought me nuts . . . he introduced me to the visiting professor . . . and he was very attentive to me all evening. Later, we attended a cocktail party for a visiting professor at Dr. Zollinger’s home. I remember I wore a white A-line dress. I had a porcelain rose that matched my lipstick, which I wore in the center of the neckline. I thought I looked wonderful. When we arrived, Dr. Zollinger said—in a very loud voice—“What is that?” I said, “That is a rose.” He said, “That is a rose?” He then led me out into the back yard, where he cut a rose from his garden to replace my porcelain rose. I was not aware at that time that he was president of the American Rose Society. But he was unaware that I was allergic to roses and had to suffer through the whole cocktail party with a drippy nose.
References [1] Humphrey L. The professor touch. Arch Surg 2000;135:358 –9. [2] Zollinger RM, Coleman DW. The influences of pancreatic tumors on the stomach. Springfield, IL: Charles C. Thomas, 1974. [3] Zollinger RM, Ellison EC, Fabri PJ, et al. Primary peptic ulcerations of the jejunum associated with islet cell tumors: twenty-five-year appraisal. Ann Surg 1980;192:422–30.