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The Life of the Clinician

The Life of the Clinician: The Autobiography of Michael Lepore

Michael J. Lepore
Copyright Date: 2001
Edition: NED - New edition
Published by: Boydell and Brewer,
Pages: 488
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  • Book Info
    The Life of the Clinician
    Book Description:

    Michael Lepore (1910-2000) was a pioneer in the field of gastroenterology. He was a member of one of the first graduating classes of the University of Rochester Medical School, and went on to a distinguished career at Columbia University, New York University, and St. Vincent's Hospital and Medical Center of New York. This autobiography tells of his experiences as an Italian-American who overcame prejudices to become the personal physician to such notables as Greta Garbo and President Herbert Hoover. His story is witty and cleverly written, and details the way the medical profession changed from the Great Depression to the late 1990s. Michael Lepore was an alumnus of Duke University Medical School and the University of Rochester School of Medicine, and was the Director, Gastroenterology Section, Departments of Medicine and Surgery Emeritus, St. Vincent's Hospital and Medical Center of New York.

    eISBN: 978-1-58046-612-7
    Subjects: History

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. List of Illustrations
    (pp. ix-x)
  4. Preface
    (pp. xi-xiv)
  5. Chapter 1 Early Days
    (pp. 1-9)

    I was born in a flat in Harlem’s Little Italy on 115th Street in Manhattan where I was delivered by a midwife, as were all of my siblings. My arrival was greeted with jubilation and prayers of thanks to Our Lady of Mount Carmel whose church was nearby where my parents, immigrants from southern Italy, were communicants as were most of our neighbors. I was the third child born to Giuseppe and Filomena Lepore. The first born, also a son, died an infant, of something called “summer complaint,” a diarrheal disease. In the tradition of Italian families, the first son...

  6. Chapter 2 Washington Heights
    (pp. 10-21)

    Mother persisted in trying to move us away from Harlem to the northern area of Manhattan. In a community called Fort George, there was a group ofpaesaniwho welcomed more of the same, but mother did not approve. Getting a place to live for a large family, still growing and especially one of Italian origin, was not easy. We were called, usually behind our backs, Wops or Guineas. I remember that my mother had to lie about the number of children she had in order for us to be accepted as tenants. No landlord welcomed a large family, especially...

  7. Chapter 3 Speyer School for Gifted Children
    (pp. 22-26)

    I have already mentioned my early days in the elementary schools of New York City. When I enrolled in P.S. 46 in Manhattan because our apartment on 162nd Street was in that school’s district, I was faced with a brand new environment and new teachers. This was a challenge that did not faze me one bit, but I soon ran into a problem. The head boy in my first class was a chap named, Edward Minor, who had been the local teacher’s pet. Mrs. Hamill, who was in charge of that class, had a method of rewarding outstanding performance by...

  8. Chapter 4 New York University at University Heights
    (pp. 27-29)

    New York University at University Heights in the Bronx in January 1926 was not a very impressive sight. There had been a mixture of snow, sleet, and rain, turning the paths into mud puddles that were traversed only by walking atop wooden walkways built of slats of lumber. The buildings were modest. The students appeared businesslike as they hurried from one class to another. The faculty was kindly as well as scholarly. I soon found that the atmosphere was extremely competitive, especially among the premedical students who seemed greatly preoccupied by their grade standing. I was only fifteen years old...

  9. Chapter 5 To Each His Farthest Star–A Medical Student at Rochester: 1929–1934
    (pp. 30-78)

    Let me tell you what it was like to be a student in this new medical school at Rochester in the early days. In the spring of 1929 I was invited to appear in Rochester for my interview for admission to the medical school. At eighteen years of age, except for my childhood voyage to Italy, this was my first long trip away from my home in New York City and I was not too well informed about the procedure to follow. The train fare was quite high and I found that the bus fare was about half the price,...

  10. Chapter 6 Duke University Hospital and Its Medical School, 1934–1935
    (pp. 79-100)

    For a young man who had never been below the Mason-Dixon Line, my first intimation of what was to come was when I woke up in my Pullman upper berth 30 June 1934 and felt as if I were in a hot shower. But it was only Baltimore in late June with its usual sweltering and oppressive heat in an era before there was any air conditioning. By the time we reached Durham, North Carolina, I began to wonder whether I could take the climate or whether it would take me. I thought back to my Southern Italian ancestry and...

  11. Chapter 7 Yale Medical School, 1935–1936
    (pp. 101-114)

    I arrived in New Haven 30 June 1935, ready to start work the next day. I had already arranged for living quarters in Harkness Hall and they were really quite comfortable and attractive. My sisters went to work decorating the studio, adding drapes and other niceties, so that it looked warm and home-like.

    After a hectic year’s internship at Duke on twenty-four-hour call, it was a great relief to know that I had no on-call responsibilities for the coming year. Getting through a night without being called out would be a really miraculous change. What I had not figured on...

  12. Chapter 8 Return to Duke, 1936-1937
    (pp. 115-121)

    On one of my return visits to Duke I made sure that a nice room would be assigned to me in a well-ventilated and quiet area of the residents’ quarters. This was quite an improvement over the internship year. I also found that while I was at Yale, the house staff at Duke had rebelled against the twenty-four-hour on-call schedule patterned on the Johns Hopkins model. Instead, the house staff was now on call every other night and every other weekend. This was a lark compared to the old schedule. My duties as a senior assistant resident placed me in...

  13. Chapter 9 You Can Go Home Again
    (pp. 122-132)

    My mind made up, I left Duke in 1937 to go home to start a private practice in general internal medicine. Home was a comfortable and well-built three-story brick house in the Wakefield section of the Bronx in what was then a white, middle class, largely Catholic neighborhood. There were three apartments, three rooms on the ground floor and the middle floor of six rooms with the top floor of seven rooms. Our family occupied the middle floor while the other two were rented to reliable tenants, providing income that helped to pay off a first and second mortgage. A...

  14. Chapter 10 My One and Only Wife
    (pp. 133-140)

    The most important decision the young doctor must make is to court, pick, and win the hand of a good woman. This decision should not be made too early in life for many reasons. Medicine is a jealous mistress and calls for all of one’s energy, passion, and dedication. Osler’s admonition to “keep the emotions on ice” during these early years, still makes sense but is seldom heeded. Early marriage is the trend as is the premature raising of a family when study, reading, working with patients at the bedside, in their homes and the clinics and pursuit of experience...

  15. Chapter 11 The Bronx Is the Graveyard for Specialists, 1937
    (pp. 141-148)

    My practice in the Bronx was keeping me very busy and I was learning lots of things they had never taught in medical school. The first unpleasant experience was to find that virtually all of the doctors I encountered were splitting fees and accepting kickbacks. A specialist would charge the patient a fee and then split it with the referring doctor. A surgeon would operate and split the fee with the family doctor. If you called a private ambulance for a patient, the ambulance company would kickback a portion of their fee. If you ordered a back brace or a...

  16. Chapter 12 The Columbia-Presbyterian Medical Center, 1937 — The First of Its Kind
    (pp. 149-163)

    As my practice flourished with my beloved wife helping to run the office and assisting me, my ties to the Medical Center became closer and closer. We finally decided to move our home from Bronx River Parkway to Washington Heights and combined the office and home in a first-floor apartment in a nice building, first on 173rd Street and then in a new building at 200 Haven Avenue. During this period Ardean’s mother, a very sweet and charming woman, moved in with us and became a full-time member of our family. We gradually phased out the Bronx office because there...

  17. Chapter 13 Pearl Harbor and World War II
    (pp. 164-170)

    The war in Europe seemed far away and many Americans, if not most, hoped that we would not become involved in it. The depression was lifting, unemployment was diminishing, and, once again, America seemed to be on the move. The Japanese attack on Pearl Harbor on 7 December 1941, “the day of infamy” described by President Franklin D. Roosevelt, shook us out of our complacency and self-insulation and isolation from the problems faced by our friends in Europe. Very soon the impact of entering the war was felt at Columbia-Presbyterian Medical Center. The first major move was the organization and...

  18. Chapter 14 Valley Forge General Hospital, 1942–1945
    (pp. 171-201)

    The return trip north automobile was a little hairy, especially in the mountains where we encountered a good deal of snow and ice. There were no snow tires in those days and chains could quickly wear out and were almost impossible to purchase. I breathed a sigh of relief when we finally reached Philadelphia and proceeded to drive to Phoenixville, Pennsylvania, where Valley Forge General Hospital was under construction. We searched Phoenixville for private housing and found to our dismay that almost nothing was available and that rents were simply out of sight. When I applied for extra gasoline to...

  19. Chapter 15 Tinian, 1945
    (pp. 202-228)

    My overseas orders Arrived during the 1945, couched in classical “Army Speak”:


    I was about to embark on one of the most interesting journeys of...

  20. Chapter 16 Saipan, 1945–1946
    (pp. 229-263)

    Now that the war was over everyone wanted to go home, right now. Clearly, this was impossible for many reasons, including lack of transportation. Some of the B-29 units used their airplanes to fly home, but this was stopped after several serious crashes occurred, probably due to inadequate maintenance. It upset us no end to learn that brave men who had eaten with us and enjoyed our company, had completed their wartime bombing missions only to die in an aircraft accident while heading for home. Our commanding general, W. W. Irvine, was equally disturbed and ruled that airplane travel was...

  21. Chapter 17 Return to Columbia-Presbyterian, 1946
    (pp. 264-275)

    Words fail me adequately describe what it was like to return to my beloved wife after a separation of more than a year. To see her beautiful face, to hear her lovely voice, and to hold her close was an incredible reward for the many days and months of separation and living apart. Our first days were spent trying to make up for all that had been lost. Soon we had to come down to earth to face the realities of the day. We disposed of our Philadelphia apartment by turning it over to Ardean’s close friend and associate Helen...

  22. Chapter 18 The Changing of the Guard at the Medical Center
    (pp. 276-292)

    On 1 July 1947, one year after most of the veterans had returned from military service, Dr. Walter W. Palmer accepted mandatory retirement at age 65. He was succeeded as the Bard professor and chairman of the department of medicine by the brilliant and dynamic Dr. Robert F. Loeb, who had been standing in the wings for some years and had turned down many offers to go elsewhere. Dr. Loeb was probably the member of our staff most committed to the policy of full time in the clinical chairs. In fact, it was said of him that he believed that...

  23. Chapter 19 An Internist-Diagnostician Rebuilds His Practice
    (pp. 293-302)

    I was pleasantly surprised by how quickly I was able to rebuild my practice on my return to New York. Many of my former patients sought me out, providing a solid base for reconstruction. I was on call and available seven days a week around the clock. This was the way I was trained at Duke in my internship where we were on the Johns Hopkins’ system for twenty-four-hour call. I did not consider this a hardship, I thought it was how a real doctor should function. My patients, old and new, were greatly relieved that they had a doctor...

  24. Chapter 20 The Upjohn Grand Rounds
    (pp. 303-319)

    Early in 1955, while working in the Vanderbilt Clinic, I received a telephone call from a Mr. Stephen Schwartz, a total stranger, who introduced himself as a friend of Dr. Marianne Wolff, a former medical student of mine who was an outstanding young attending on the surgical pathology staff of P& S. Dr. Wolff had suggested that he get in touch with me regarding an important innovation in medical education. He quickly came to the point, asking, “How would you like to teach 20,000 doctors in one evening on closed-circuit television?” I was a little staggered by this proposal but...

  25. Chapter 21 The Iceman Cometh to Park Avenue
    (pp. 320-325)

    In 1948, only two years after returning from military service, I took Dr. Walter Palmer’s advice and leased a small office in a nice building at 944 Park Avenue at a rent I could afford. In those days, to avoid garage fees, it was still possible to turn the car keys over to the doorman who would see that the car was not ticketed by the cop on patrol. I asked my sister, Lucille Lepore Russo, R.N. to manage the office and perform R.N. duties as well. Lucille, a Bellevue Nursing School graduate, was the head nurse and ward instructor...

  26. Chapter 22 Songs My Patients Taught Me
    (pp. 326-339)

    The education of the physician begins in his childhood and his home, continues in college and medical school, and persists for the rest of his life. For the physician as well as his patient, survival and success depends upon constant renewal and assimilation of new facts and concepts. It is an old saw that fifty percent of what is taught in medical school will be obsolete in five years, the faculty uncertain which half it will be. A phase of the education of the doctor that is seldom addressed in medical school is the role of the patient in his...

  27. Chapter 23 Mr. J. Peter Grace, Chairman of W. R. Grace and Company
    (pp. 340-348)

    For the final case presentation of patients who have taught me so much and given me great pleasure in the personal practice of internal medicine, I present the saga of the illness of Mr. J. Peter Grace, the grandson of the founder of W. R. Grace and Company who became its chairman in 1945 and built the firm from a $ 5 million concern to a $ 5 billion corporation during his unprecedented forty-seven years of tenure as its chairman. “Sir Peter,” as I dubbed him in deference to his position as head of the Knights of Malta, admired the...

  28. Chapter 24 Birth of the Upjohn Gastrointestinal Service
    (pp. 349-354)

    One afternoon in October 1961, I received a very pleasant surprise. Out of the blue, without any previous discussion, one of my patients, Mrs. Janet Upjohn Stearns, made an appointment to come to my office at 550 Park Avenue to discuss an important matter. She was a member of the Upjohn family, her grandfather, Dr. W. O. Upjohn, had founded the pharmaceutical house in Kalamazoo, Michigan. Her husband was Dr. William Stearns, a highly regarded chest specialist on our staff. Mrs. Stearns was referred to me in 1958 because of a mysterious ailment that had begun in her childhood and...

  29. Chapter 25 Roosevelt Hospital, 1962–1965
    (pp. 355-362)

    Roosevelt Hospital in 1962 was largely dominated by its excellent surgical service. There were three chiefs of surgery, Drs. Frederick Amendola, Howard Patterson, and James Thompson, all of them good abdominal surgeons. They served without salary and seemed always to be at the hospital. Their assistants were also first-rate. The medical service had two chiefs, Dr. Julian M. Freston and Dr. Arthur J. Antenucci, also non-salaried. All of these men had substantial and remunerative private practices. The trustees, led by an outstanding chairperson, Mrs. Donald Bush, were prominent in the business and social world of New York. Some were wealthy....

  30. Chapter 26 Consultant and Physician to President Herbert C. Hoover
    (pp. 363-382)

    On 7 January 1964, I was asked by Dr. Ralph Boots to see, in consultation, former President Herbert C. Hoover, who was suffering with gastrointestinal complaints. President Hoover had requested the consultation in writing. The request is in my possession. It is written in pencil on plain white stationery in Mr. Hoover’s own hand. It reads as follows:

    Dear Dr. Boots & Bowman [sic: Bauman]: It seems to me we have reached a point where our treatment for digestive gasses must be reviewed. I have asked Allan to take up the subject as to what can be done.

    I go...

  31. Chapter 27 Problems at Roosevelt Hospital: The Bête Noir of Full Time
    (pp. 383-388)

    The Upjohn Gastrointestinal Service had come to Roosevelt Hospital in early 1962 like a breath of fresh air in a torpid climate. One of the reasons for selecting Roosevelt Hospital for launching this innovative service was the new eleven-story Winston Building for private and semiprivate patients then well underway. It would serve as an excellent base for delivering health care in an up-to-date, state-of-the-art facility, replacing or supplementing the older Roosevelt facilities. The location of the hospital was in a relatively safe area of Manhattan easily reached by bus or subway. The story of the genesis of the Winston Building...

  32. Chapter 28 Internal Medicine as a Vocation (1897)
    (pp. 389-399)

    In 1897, over one hundred years ago, Sir William Osler, the greatest physician of modern times, was invited to lecture before the section on internal medicine of the New York Academy of Medicine. The title was “Internal Medicine as a Vocation.” There was, even in that early day, concern that general internal medicine was being neglected while the subspecialties were fragmenting it. Osler argued with eloquence that general internal medicine was the backbone of medical practice and every effort should be made to strengthen it and to maintain its position as the basic foundation for the education and training of...

  33. Chapter 29 The Upjohn Service Moves to St. Vincent’s Hospital
    (pp. 400-416)

    The decision to leave Roosevelt Hospital was approved by Mrs. Stearns, and she continued to be very supportive despite the disappointment over the unpleasant experience we had been through. The search for a new location for the Upjohn Service considered a variety of options ranging from setting up of an independent Institute of Gastroenterology to less ambitious plans. We were committed to placing the unit in an academic setting with excellent teaching facilities. We looked at several hospitals and several medical schools that were interested in our proposal. While going through these negotiations, I received a call from Dr. William...

  34. Chapter 30 Helicobacter Pylori and Peptic Ulcer: A Revolution in Gastroenterology
    (pp. 417-421)

    In the current era of big-money research with multimillion-dollar grants, impressive buildings, laboratories, institutes, elaborate and highly sophisticated equipment, and teams of collaborating scientists, we tend to forget that an individual, in a remote area using simple facilities, may sometimes make an extraordinary discovery that has eluded those in leadership levels of research. Such a discovery, was announced in 1983 in Brussels at a meeting of infectiousdisease authorities. The author was Barry Marshall, an unknown, brash young resident in medicine from Perth, Australia, who announced that he and his pathologist-collaborator, Dr. J. Robin Warren, had evidence that peptic ulcers were...

  35. Chapter 31 Plasmapheresis for Hepatic Coma at St. Vincent’s Hospital
    (pp. 422-453)

    The story of the important viral hepatitis research conducted at St. Vincent’s Hospital and Medical Center in New York City warrants a chapter of its own. My interest in viral hepatitis was whetted in 1942, when I volunteered for military duty in WW II and was awaiting my appointment as a captain in the Medical Corps of the Army of the United States and the call to active duty. At the time I was on the teaching staff of the Columbia University College of Physicians and Surgeons and in the private practice of general internal medicine and also director of...

  36. Epilogue
    (pp. 454-460)
    Frederick E. Lepore

    Michael J. Lepore, MD died on 2 September 2000. The year of his birth, 1910, was marked by the publication of the now famous Bulletin Number Four of the Carnegie Foundation for the Advancement of Teaching,Medical Education in the United States and Canada,by Abraham Flexner. The Flexner report would lead to the closure of substandard proprietary medical schools, to the creation of University of Rochester School of Medicine which my father would enter in 1929, and to emphasis “on medicine as a science, while the practice of the art would be relegated to a secondary role.”¹ The year...

  37. Back Matter
    (pp. 461-462)