The Demise of my Teaching and the Methodist Program

Indiana is one of the 16 states with only one medical school (Indiana University School of Medicine). It’s funding is from taxes appropriated by the state legislature. The medical school’s primary mission is to produce physicians to care for citizens of Indiana. This has always complicated how private hospitals and physicians interact (town vs. gown) with the medical school.
For years, the medical school looked on all physicians in the surrounding communities patronizingly, which caused an acrimonious relationship.
The medical school had a group of hospitals the IU Hospital Group that was part of it’s clinical base, but with so many students it had to use several private hospitals for junior and senior clinical rotations. These rotations gave the students a perspective on how physicians in private practice ( the real world ) delivered health care. And these experiences influenced some students to choose post graduate training at some of these hospitals (i.e. Methodist, St Vincent’s, etc).
As one of the faculty at Methodist, I was instrumental in a number of potential candidates choosing us because of their exposure to advanced laparoscopic surgery. This influenced their choice in the resident matching program by ranking us #1 to the chagrin of IUSM. This produced a degree of acrimony and because the process of program accreditation required an on site recertification visit every 4 years, Methodist was cited for not having a full time Gyn Oncologist by the site reviewer and when one was recruited the IU OB/GYN Department Chair(an Oncologist) would not offer a clinical professorship to the prospective candidates apparently knowing that The American Council of Graduated Medical Education ( ACGME ) required that specialty directors be clinical professors. But in the mid 1990’s a new sub specialty Urogynecology was recognized as one of the required specialties to join Ob/Gyn, Reproductive Medicine, Maternal Fetal Medicine and Oncology. Dr Benson, the program, director of the Methodist program, was one of the pioneers to form the specialty and Methodist became the 1st accredited fellowship in the country under his direction. This produced a bargaining point with IU since they did not have this required service and were unable to meet the new requirements set by ACGME. This forced an agreement between the two programs and talk of integrating the programs began.
IUSM took 7 candidates/ year and Methodist 4/year. An agreement was made that any applicant that chose either program as their 1st choice would spend 75% of their rotations on a chosen campus. And when the 1st group graduated in 4 years the programs would be completely merged. This was a complex administrative dance requiring formation of a combined resident education committee with alternating the chairmanship between the two program directors yearly.
Bare with me because the details of this arrangement produced vexation as to function and how funds were allocated and revenue from fees for service assigned.
Because institutions with approved residency programs receive government funding of approximately 30k /resident/year for the service that is provided for Medicare and Medicaid. It became a financial issue as to what funds supported salaries for staffing residents. The University using full time employees (FTE’s) and Methodist both FTE’s and volunteer staff who donated their fees for service to the program. As in most things, money became an issue. Also it should be noted that the Dean at a medical school controls the funds like a fiefdom and there is a Dean’s tax assessed each Department Chair to which all faculty contribute. A custom that those of us at Methodist were not about adopting and Methodist Hospital Inc. was not about to split funds with IUSM. I know this is probably a little more than you want to know but it is important to understand what transpired next, because it had a huge affect on the direction medicine took and how it is being taught and practiced in the USA today.
Let me digress for a bit. When physicians are self employed it behooves them to be efficient and productive, but there is no incentive for salaried physicians to be equally motivated. This became one of the obstacles to any integration of the philosophies of the two institutions. A second impediment was that historically medicine was taught by mentoring and a new paradigm was being develop called evidence based knowledge. And though I agreed in principal with some of it’s merits teaching was losing it’s luster for me
What happened next led to the dissolution of the Methodist Residency program, a merger with IUSM and led to the end of my teaching career.
The changes made I came to really dislike and in the end both Dr Benson and my positions as full time faculty at Methodist were dissolved.
To finish out my schedule to retirement consisted of the mundane position as a physician in the Methodist HealthNet clinics which was basically a 9 to 5 job that I came to detest. And the program merger eventually help pave the way to the formation of a bigger consolidation, the formation of Clarian Health Services. The story of this will be in a following chapter.

The Teaching Years (continued)

The Teaching Years (continued)

What I enjoyed most about the years I spent in the academic environment was not only the interaction with medical students and residents, but the opportunity that was accorded me by Dr Benson to expand my knowledge and to do basic research and develop technology. I had at my disposal a lab that I had crammed with all sorts of surgical and technical equipment as well as a trove of “junk” that I could use to satisfy my imagination about what needed to be developed or improved.
Historically, tools are objects that man has adapted to perform specific tasks, I took this a step further by studying whether there were surgical instruments or procedures I could improve on their function. One of the things I tried to stress to my students was that if you understood how an instrument functioned, this knowledge could improve your surgical technique. An example of this was: why did a particular clamp have a curve or teeth in a certain pattern or why is a surgeon’s knot more secure and ideal for large vessels or the ergonomics of how scissor cut? When I showed them that speed in surgery was something that could be attained by eliminating purposeless movements, they could later see themselves developing into better surgeons.
One of the things most stressful in teaching surgery can be likened to teaching ones child to drive; except you’re dealing with trying to teach how to operate on a human being. At times it would be so much easier and quicker to do the surgery yourself but the student has to learn and the good teacher has to have the patience and temperament to endure the learning curve or one misstep could be catastrophic; not only to the patient but to the budding surgeon’s confidence. One of my better residents loss a patient and switched to a non-clinical program being unable to cope with the reality that death is always a part of medical care.
I had the philosophy that the earlier in ones career you are allowed to operate with the proper instructions, the more competent you would be later in your training. I am sure that most of the residents I trained would agree with this. It must also be said that some physicians do not have that special something that it takes to be a surgeon and it’s better to find this out early in ones training.
During these years, there were so many things happening in the field of Gynecology like new concepts of disease and the research and development of treatments were exciting and of enormous interest to me. I was extremely fortunate to have been totally supported by my director and also have the resources of the hospital’s research lab at my disposal.
My interest spanned a whole litany of subjects that I felt needed to be investigated or developed and I would sometimes awake at night and an idea would pop in my mind which I would jot it down and go into my lab to work out the merits.
Some of the many projects I worked on were either in conjunction with other
investigators or of my own interest. The list includes endometriosis, adhesions, tubal obstructive disease, sterilization methods, colposcopy, hysteroscopy, chorionic villous sampling , in-vitro-fertilization, Human porphyrin derivative use, use of Laser in gynecology, Electro surgery, hydro dissection and the use of fibrin glue. The list also includes development of better laparoscopic scissors, surgical staples and suturing techniques that were adaptable to using a cannula.
Some of the very first procedures done in Indiana like GIFT (gamete intrafallopian tube transfer) and laser ablation of the endometrium through the hysteroscope were done at Methodist Hospital under my tuteledge.
One of the things I foresaw was the ability to operate remotely with a video camera and a robotic device, this is now a reality in the “Da Vinci Operating System” being used today to perform a myriad surgical procedures.
My interest was not to just expand knowledge in gynecology but to stimulate other investigators to see the possible integration of techniques and instruments their specialties.
Though recognition of my contributions are buried in the details, I know that there is a light I lit among some of my students to question the status quo and expand it by their curiosity.
The teaching years lost it’s luster when the residency program started in a new direction. In the next chapter how a merger with IUSM became a reality and ended what I feel was one of the best OB/GYN programs in the country.

The Teaching Years

While I was focused on developing Pelviscopy after becoming the Associate Director of the OB/GYN Residency program at Methodist Hospital my basic duty was to train residents in Gynecology according to specific guide lines set by the Council on Resident Education for Obstetrics and Gynecology (CREOG). After taking the position, I made a commitment to teach in a way I had wanted to be taught early in my career and strive to be recognized by the students and residents as one of the best teacher they had encountered. I have always believed that it is a duty to pass on knowledge and my love for teaching was a payment on the debt to the special teachers I was privileged to have.
I had a 3 ring binder that I kept all of my lectures filed and tried to make the difficult easy and fun to learn, spicing them with colorful anecdotes and in surgery dropping “pearls” about techniques to make them better surgeons.
One of the things I first noticed after I started was when cases were presented either for staffing or at grand rounds, the residents lacked skill in how to properly present them succinctly. So I introduced how to format cases into the curriculum and I tried to teach some basic things and develop lectures that covered subjects in a way that was not threatening. And over the years I was awarded both “ The Best Teacher and Distinguished Professor Awards” which I treasurer as a measure of my teaching ability and value to the program.
I have always believed that learning is a continuum of life’s experiences, so I incorporated what I had gleaned from nurses, surgical techs, professors and
other l ancillary personnel to create a lesson plan I could follow that would take advantage of my knowledge to train my residents and medical students to the best of their abilities. I always repeated to myself what would I like to know and how would I liked to have been taught. This was my mantra for teaching!
I put together a course that I directed towards medical students that covered basic surgical skills, things that I had never been formally taught but had picked up. Things like how instruments came into use and how they worked ergonomically, why you use certain suture and the reason that specific knots are used for different tissue (i.e. surgeons knot vs a granny knot). I showed student in their junior clerkship these techniques so they would not feel awkward when asked to perform in the operating room as I once had.
Every time I gave a lecture, I always put it in a way that challenged me to teach as I was learning the subject for the first time. And I believe that my awards were in recognition for that passion for knowledge I passed along.
It should be stated that the OB/GYN Residency program was in a state of transition when I joined. With only 3 programs in the state it was in competition with IU and St. Vincent’s Hospital for candidates in the national resident matching system. IU
had 7 residents/yr, Methodist 4/yr and St. V’s 3/yr. It seemed that the top candidates 1st choice was Methodist especially those who had attended IU School of Medicine.
One of the unique things about the Methodist program was the vast clinical exposure that resident were getting because they were assisting attending physicians on their private cases and that they had their “own clinic” called the OB/GYN Care Center that was run like a private office. A concept that was put together by Dr Benson the program director.
In 1989 to evaluate the program, a retreat was held, the entire staff along with the residents met at a near by lodge to brain storm what were the program’s weaknesses, strengths and direction.
Because I believed that gynecologist in general were poorly trained in surgery, I suggested to the resident education committee that methods be instituted to enhance our residents exposure to surgery by having them rotate on general surgery in their intern year, having surgical techniques taught both by lecture and animal labs and doing a rotation where they were assigned to my service.
What I suggested was that since one of the duties in my job description was to perform all the Gyn surgery for Healthnet, it would be a clinical bonanza for the residents to be assigned to me as part of their Gyn service. At the time the OB/GYN Department had a contract to perform all the Gyn surgery for the Healthnet a community based agency that provided care for the indigent at 5 centers around the city of Indianapolis and performing the Gyn surgery was part of my duties. With a patient base of approximately 14,000 patients seen a year this provided a ideal clinical exposure.
When graduating medical student are applying for residency one of the question most asked during interviews is how much surgery will I be allowed to do. And it is known through out the country that some programs offer a stronger clinical base then others. We at Methodist were in position to use this as a strong recruiting tool. This became a favorite rotation.
I think it is important to understand that one of the most sought after services in a residency that deals with surgical procedures is to be in situations where you can be 1st assistant or primary surgeon. It was what the Healthnet service provided. The resident tagged with me in their 2nd and 3rd year and saw the patients in the clinic, assisted in making the diagnosis and scrubbed on the surgery with me as the attending surgeon. No resident could be bumped from a special case unless the chief on Gyn had never performed the surgery, in those cases the resident that worked up the case was the 1st assistant. This particular benefit went a long way in making our program attractive in the matching choices.
From my point of view it was a real stimulation to teach one on one residents who wanted to learn and have them over 2 years and see their cognitive and clinical skills reach fruition. They could wait to be on my service and it was basically a 24/7 rotation except when they had OB night call. Our day would start with rounds on postop patients, see patients at one of the Healthnet sites, see my private patients in my office and scrub with me on all surgeries 2 days a week in what was called block time. Also they had the opportunity to observe any technology or research project I was currently investigating. This gave them so much experience by the time they assumed chief resident, that they were more than willing to give up operative cases to a lower year colleague. When case lists of procedures were turned in each quarter for the Resident Review Committee our residents were far more experienced than most programs in the country. This was one of the things I was most proud of having put together towards resident education.
The Methodist OB/GYN Residency Dr Benson took over went from a scale of 5/10 to 9/10 based on the total opportunity to learn and turn out superior graduates. I was just part of a total package that included the Center Maternal Fetal Medicine and Genetic Diagnosis and Counseling, The Center for Reproduction and Transplant Immunology and the Center for Urogynecology and Pelvic FloorSurgery. These were heady times and we were getting our residents accepted in post graduate fellowships at some of the most prestigious programs in the country.
I was basically a gynecologic surgeon with a fascination for technology that was coming on line in medicine that complimented advanced laparoscopy and minimally invasive surgery. Things like Colposcopy, Hysteroscopy, Micro-surgery and the use of Lasers in Gynecology. All these technologies I learned and began teaching to others on our attending staff and surgeons in our surrounding referral base and to our residents. I was then appointed to the position Director of Gynecological Surgical Education.
I like to think that I had a meaningful impact on Methodist Hospital’s place in teaching and research in the time I spent as a member of the faculty.
But as in life nothing is static and in an attempt to adapt to a growing changes in hospital and medical education the hospital and resident education began to go in a different direction. Most of it I believe they would now reverse if given the option. The changes that evolved will be related in the story that follows.

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Rejection, Recognition and Reward

The idea that I had formulated in 1986 to advance Pelviscopy had reached fruition with the embracing of minimally invasive surgery in the 1990’s, primarily Cholecystectomy. But it did not come easily or without rejection, impediments and jealousy. I distinctly remember one member of our staff saying “since you didn’t learn how to do laparoscopy in your training who are you to teach us something so advanced”. To which I replied “I’m basically a surgeon, I can technically operate anywhere in the abdomen but I choose not to, so what about you!” There is an axiom that is often quoted in medicine about doing procedures that goes “See one, do one, teach one.” I had a hell of a surgical foundation in my residency, much better that most gynecologists and was complimented often by general surgeons as to my abilities. Indeed there was no gynecologist on our staff who could come close to out operating me. With this confidence I was ready to face any and all adversity.
My base of support was really Benson, who knew if I was given a task it
was done when I was involved.
I knew that the OB/GYN section was reluctant to embrace anything new or different from when I joined the staff in 1963 and things had not changed They were still having heated debates in section meetings about the most mundane procedural things, sometimes a 7 PM meeting would drag on until midnight with inane arguing.
I had received IRC approval to do animal studies to deal with the technical aspects of performing surgery but there was no administrative support from medical education for financial seed money
So when, I went to the Director of OR Services Dr. Edwards, I had only Benson’s support. But when it turned out that lapcholes were going to be a winfall the equipment couldn’t obtained fast enough once the general surgeons were all wanting to do the procedure.
It was as if my idea wasn’t worth supporting until another discipline (surgery) validated it. Dr. Edwards was now imploring me to use my contacts in the industry to obtain sets of instruments and equipment from any source available.
Since I was the expert in developing and teaching the technology, I had personal contacts with which company or supplier had what was needed and was advising Connie where to purchase the equipment, which was now scarce nationwide.


Once the first lapchole. was performed by Dr. Rich Graffis and I in 1990, we collaborated to put on a symposium with a practicum animal lab for surgeons in our surrounding communities. We had so many applications, we could only accommodate 16 attendees. This was so well received that it mushroomed into what we later called mini-fellowships in which we trained surgeons in a special course we designed. I taught the didactics of laparoscopy and Grafffis allowed them to scrub in with us on 10-15 cases a week. The $1,500 fee that was charged for these courses was turned over to the general surgery education fund. A total of 70+ surgeons were trained at Methodist by us over the ensuing year. We both were than asked to teach courses that were being given periodically nationwide due to the demand for instructors.
In 1992 the NMA ( the black medical society) held it’s annual meeting in Indianapolis, and I offered to provide a training symposium for the Surgical Section. The course was specifically designed to teach Black surgeons how to perform Lapcholes for all that wanted learn at a reasonable cost at a convenient location. I don’t know how many of the attendees expanded their training, but I have never had any acknowledgement of my contribution to their surgical skill by the NMA or it’s Surgery section. I think one has to remember that white surgeons had embraced lapcholes as the acceptable way of removing the gallbladder and the open method was basically not indicated. Financially any Black surgeon who could not do lapcholes was losing patients.
One of the things I stressed in courses and teaching my residents was safety and knowing the equipment so a procedure would not have to result in a laparotomy (open abdomen) because of technical problems. This was one of the reasons I insisted on having a dedicated team of nurses who were able to trouble shoot problems.
I remember after giving a presentation to the surgery section at Methodist only one of it’s members, Dr. Cedric Johnson, came up to me and thanked me on their behalf for sharing my knowledge unselfishly with them. It at least showed me that some one recognized my contribution, appreciated it and expressed it.
During this period a tragedy occurred that brought an interesting series of events that connected 2 countries Japan and the US. In the late 1980’s Subaru Motors built a factory in Lafayette, IN. One of it’s executives was brought to a local hospital and died of a heart attack probably due inability to communicate. The Subaru Corp had close ties to Purdue Univ. and Dr Lloyd the president of Methodist and Dr Beering the president of Purdue Univ. were close associates and set up an exchange so that bilingual physicians from Japan could come to the US to act as interpreters for their employee’s medical conditions and as a bonus could avail themselves to American graduate medical education at Methodist. One of the physicians happened to be a young OB/GYN who Lloyd told what I was doing with Pelviscopy and asked me to tutor him.
His name was Toshio and he would come every Tuesday for me to teach and to observe my cases in surgery. We became very friendly and I attempted to learn some Japanese words and phrases. The doctor’s dining room had a great luncheon menu and I would treat him every time he came. One of the selections they always served was a huge standing round of beef roast, which he ordered every time. I told him he could have as much as he wanted and he would make 2-3 trips to the carving board. So I asked him what was his favorite American food. He said steak and that he and his wife would go to Kroger and buy a dozen porterhouses at a time a bargain compared to the 30-40 dollar/ pound price in Japan, all the while scarfing down roast beef. So to practice my Japanese, I asked him what was the word for roast beef. He said “roooast ah beef”. I said,” no what is the Japanese word” for example I said octopus is “toku su”. I repeated my question and he replied “roooast ah beef”. I was getting exasperated and said “ bull shit Toshio” What is it in the Japanese?
“Roooast ah beef Robi san, that’s it”…… then I realized there was no translation. We laughed and really bonded and I would tease him about not having a translation for his favorite food.
When he left he thanked me profusely and some months later the president of Subaru Motors made a special trip to the US and personally visited Dr Lloyd and brought him a gift of thanks and I was given a kimona as a token. The act of respect and thanks that was given to us still impresses me to this day especially since it was not as forthcoming from some of my colleagues.
Though rejection finally led to some degree of recognition during any reward came from being commended for my teaching. The residents awarded me the honor of best teacher of the year in 1989-90 and the senior class at Indiana University presented me with the Distinguished Professor of the Year Award that year. This was the only time anyone at Methodist had be so honored. I was also elected to the American College of Surgery unanimously by the local chapter in the same time frame.
My goal was always to advance laparoscopy (i e. pelviscopy) to new heights and I feel I achieved that and more by the expanded applications of the technology that are now common place.

The Keyhole Opens the Door

The next set of events I have concluded were the most satisfying achievements of my 50 year career in medicine, and one of the reasons I am writing this chronicle. But also that my children and grandchildren can appreciate what contributions I made with my knowledge and inventiveness to further medical science.
For obvious reasons, Gynecological applications were not driving manufacturers to enthusiastically develop the technical equipment to expand Pelviscopy. So when I was at a tactical brain storming gathering at US Surgical Corp in 1989. the many applications that I foresaw were not appreciated by most of the other participants, especially the company’s CEO. When it became the common mode of taking out 98% of all gall bladders, the whole industry was literally falling over each other trying to out develop and market equipment.
One interesting thing happened with a major orthopedic manufacturer, I asked them since they made video equipment, would they be interested in helping me start a division to capture the market that was out there and be a major player in this new approach to surgery. They responded that they were comfortable in their present position. Over 15 years have transpired and they are now Johnny come lately, but now they finally have a minimally invasive division.
I realized that the key for this revolutionary surgery to catch on was not going to be driven by it’s unique applications that reduced pain, shortened hospital stay and speeded recovery. It was that the inroads other modalities had for treating gall bladder disease had made a deep hit on the general surgeons pocket book but lapcholes could now provide them with a surgical procedure that cured the condition permanently. And for that reason, there was a frenetic amount of interest to learn the procedure and a tidal wave of surgeons wanting in line. So courses were being taught by gynecologist, who were proficient in laparoscopy teaching the rudiments to the surgeons.
I was approached by one of the leading general surgeons on the Methodist staff and asked if I would teach him how to perform what was being called a “laparoscopic Cholecystectomy”. He had gone to a work shop in Georgia to learn the rudiments. And the course was recommending that a laser was needed to do the procedure. I was skilled in all the applicable surgical lasers
and questioned that need. He had recruited an ideal young thin male patient to do the first procedure on. This case was done in 1990 and it took us roughly 6 hours to perform. The lengthy operating time was mostly due to he having no proficiency in using the instruments or operating with me.
I later concluded that if he had practice on my trainer and learned the basics of working in concert, we probably would have done the case in about 2 hours; but after working together on 4 or 5 cases, we had reduced the operating time to under an hour. By the end of his first year he had personally performed 700+ cases usually a busy surgeon might so 20 open cases in a year! ( also bought a vacation house in Florida ).
Because he had the foresight to see the impact this was going to have on surgery he asked me to collaborate with him in setting up a course to teach the technique to interested doctors at our hospital and around the Midwest.
We set up a series of courses approved by out Medical Education Dept. for CME accreditation and proceeded to teach over 100 attendees.
Spanning the years 1990-1992, he and I acted as instructors for courses that were taught across the Eastern US to surgeons who were signing up in droves. These courses provided didactics and pigs as models to operate on because their gallbladders were similar to humans. The interesting thing about the course was an operating room was set up in the most unlikely places…… convention centers, hotel auditoriums even a school gym.
The pig lab was developed by a veterinarian who had contracted with pig farms across the country who raised animals to his specs and he had a 18 wheeler that was decked out with a corral and a prep area to anesthetize the animals. Once at a course site he would pull into the loading area and transport the pigs asleep in special containers to the area where the operating tables were set up. There could be other functions going on in the venue and no one knew that an animal lab (no odors or squeals) was being held. He was good and all this was under government approval and supervision.
One of the last courses we taught was for the NMA in 1992 when they met in Indianapolis. There we provided the only dedicated course to their surgical section at a significant reduction in cost since all the instructors donated their expertise as a favor to me for teaching them.
With all the surgeons now trained at Methodist, there was not enough equipment to do the surgery. The Director of OR Services ended up buying 7 sets at 50K to provide for the rapidly expanded income source where as 2 years before I couldn’t get any support.
There is one thing I taught every student or course participant; have a plan so you do not have to convert the case to a laparotomy (open case). We emphasized know the equipment and learn how to suture and use the bipolar forceps for bleeding. Now anyone in the country that uses these techniques I know was trained by some one that I trained. That is one of the indelible marks I left on the general surgeons that had some degree of connection with me.
I tried to show that the keyhole opened the door to a myriad of surgical procedures that now include the brain, heart, lung, colon, bladder, prostate spine it goes on and on. I hope that I passed Herr Dr Semm’s torch diligently. The one thing that he inspired in me was to peak my curiosity to challenged his concepts and seeking out what I didn’t understand about light. And when I solved the problem, I opened a whole new
minimally invasive method of doing surgery.

The Road to success in Pelviscopy

The path I had to take to be able to successfully get Pelviscopy established at Methodist Hospital in Indianapolis was difficult and convoluted.
Once I reported my experiences in Germany to Benson, my boss, he asked what were my thoughts on incorporating it’s use in our institution. I told him frankly that I didn’t understand how to solve some of the limitation it presented to teaching American doctors; but I had a plan if I could somehow purchase the needed equipment and develop a teaching model it might be doable.
Because the initial investment for the basic equipment was around $40,000 dollars, I knew that going to the hospital for funding a major expenditure in their budget was slim to none. But fortunately Benson was Chairman of the Ob section and Director of the OB/Gyn residency program and had proposed that the OB/GYN clinic be incorporated calling it the OB care center (OBCC) and that the OBCC be run like a private practice removing the stigma to the patients of attending a “clinic”. In the past the clinic ran at a $200,000 loss to the hospital and he proposed that the hospital turn it over to the OBCC and allow it to keep all income and be self sustaining. The hospital readily agreed to relieving itself of it’s loss.The genius of the plan was that he had a corporation formed of the 26 attending OB/GYNs who agreed to allow the OBCC to bill for their physician service which were being lost due to some physicians keeping the insurance payments which they now allowed the OBCC to collect. This concept was unique and I don’t know of any other OB program in the country that used this paradigm. What it essentially did was to have a clinic that functioned like a private office with the residents participating in the business side of practice and the income after expenses were than available for equipment, resident education, stipends and conferences eliminating the usual red tape.
Because the hospital was not involved in appropriating the money any expenditures were voted on and approved by the OBCC board of directors. By this mechanism, I was able to secure funds for developing Pelviscopy.
Even though Benson was totally supportive, I still had to sell the concept to the board. And because there was a group in opposition the vote to support me and buy the equipment was 14 to 12 in my favor to buy the equipment. ……..at times facing adversity goes a long way in helping one achieve a goal.
Having the funds to purchase equipment was not even half the task of instituting Pelviscopy, I first had to convince a doubting staff of the perceived benefits of the technology.
I did a grand rounds on what Pelviscopy was as apposed to laparoscopy and what surgical benefits it provided and what I saw was it’s potential in the future.
One of the attendees to my lecture was the Director of the General Surgery residency program and he asked me later was there any surgery applications where this could be used. I told him that I had heard that some surgeons in France had successfully taken out a gall bladder through the scope. Because of his interest and support, I approached the IRB ( institutional research board ) to approve some animal studies to perfect the procedures. We still had no instruments and I had not done any surgery on a single patient. I got approval to set up an animal lab using pigs and my practice instruments and an old laparoscopy set borrowed from surgery.
Working with one of my gyn resident and one of the surgery residents started to practice doing some surgical procedures. Here we were able to refine our suturing and tissue manipulating skills.
To give you an idea of how Pelviscopy differed from laparoscopy, you have to understand what Semm contribution did to expand the
capabilities. To understand what he did was to transfer what is done in a laparotomy ( open abdomen ) to doing it all by laparoscopy. There is a saying by a famous surgeon who disparaged laparoscopy “ why look through a keyhole when you can open the door”. Sadly he did not envision what the future had in store.


To convert the mechanics of open surgery is to understand that you need light, you need to see (eyes), exposure (retraction), instruments to manipulate, grasp, cut and coagulate, suturing and lastly tissue removal. What is so unique about Semms’ genius was he developed a light source, auto insufflator ( to distend the abdomen), a scope to see, coagulation for hematstasis, special instruments to grasp, cut and tie etc, irrigation and a morcellator (bite pieces) to remove tissue virtually duplicating everything that was possible in an open operation. All this may sound difficult to learn and it was……. and now I was attempting to teach this to my colleagues
What I did next was to invite members of the Gyn faculty to the lab along with my residents and teach them the basics of handling instruments and the rudiments of suturing so when the equipment did arrived from Germany in about 6 months they would be ready for the next step…..operating on a patient. The other thing that I did was ask the Director of Surgery Services if I could form a team of 6 surgical nurses in the techical intricacies of Pelviscopy and the complex equipment and it would be familiar to them scrubbing on cases. They were later christened by me the “Pelviscopy Queens” and their number rose to 18 so that all three shifts in surgery were covered with a knowledgeable scrub staff.
But my biggest challenge lay ahead. I had already rejected the use of a direct view scope ( as done by Semm)and decided that a system in which a video camera and monitor was the only way surgeons in America would embrace this technology; but I first had to figure how to do it since Semm had shot me down about not understanding how light worked in relation to utilizing a camera.
I guess people paths cross in ways we don’t realize later in life and fortunately mine intersected with a nurse who I has grown up with in Evansville, who was now the head of operating room purchasing at Methodist Hospital. What happened will follow.

Connie, Me and Pelviscopy

Because I believed that operating through the laparoscope could be vastly improved on if a camera could be used instead of the eye and the operative field projected on a TV monitor. I still had to figure on a system and out of the blue I remembered that the orthopedic surgeons used a similar system to operate in joints (arthroscopy). So with this idea, I went to my friend Connie and asked to borrow the video equipment orthopedics used. She said “done, no problem”. then while doing a simple case decided to try it out. I inserted the scope hooked up the camera and expected to shout “Eureka” but lo and behold the video screen had no image. To be sure everything was hooked up properly I removed the camera and looked through the scope with my eye and could see a vivid image. I couldn’t figure what was wrong, so it was back to the drawing board as to why it wasn’t working. I knew that light was the key and that I now understood that the delivery system was highly inefficient but I didn’t know where I was losing luminance in my system. Then I realized that I had been using an operative laparoscope which had three channels 1.light fibers 2. a lens 3. an operative channel. The operative channel was reducing the amount of light for delivery in the system and that’s why I couldn’t see. I also figured out that the abdomen was a light sink that absorbed virtually all the light where as in orthopedics joints they were lined with white tissue that reflected light…..so I needed to deliver more light. I remembered that we had a direct view 0 degree scope with just lens and light fibers and damn if I didn’t have an image because it delivered the needed light. I had essentially solved the problem but refining it would take some time at least I was going in the right direction. I had been working to develop this technology for over a year and in a way that was good because it made me cautious about operating on a patient. Another thing was that the instruments had still not been delivered. One reason being they were made in Germany and it was a cottage industry process in which craftsmen constructed the components in their own good time. And I found out later that they took off the whole month of August to vacation.
So I spent my time practicing the manual operative skills, instructing the residents and getting my Pelviscopy team of nurses ready for when we finally could operate. I am an impatient person with performing tasks but am the opposite when it comes to safety and I knew that if I messed up and had a bad outcome there were so many doubters it would set back the project. Communication with some of my course colleagues who had gone to Germany alluded that they were proceeding well in developing this at their institutions, but none had envisioned using the video system which I reasoned was the key to general acceptance of Pelviscopy in the United States.
While I was impatiently waiting for the equipment to arrive, I was honing my technique in the animal lab with a Gyn and General Surgery resident. Here we took out structures, sutured bowel tears and tied off blood vessels becoming so facile that we could do it literally blindfolded.
I don’t want to leave the impression that I was the only person to see the value of doing this surgery with a camera and a monitor. There were some surgeons in France and in the USA who were experimenting with its use.
No one had actually published any papers on it yet. Everything was word of mouth and anecdotal. So I decided to bring in someone to help support my contention of it’s value. An innovative Gynecologist, named Harry Reich, who was doing some similar things on the East Coast and he accepted my invitation to do a Grand Rounds. He was more advanced than I, and had actually done a partial hysterectomy through the scope. I wanted my colleagues to see that what I was trying to introduce wasn’t “smoke and mirrors”. He was a dynamic speaker and when he showed his video and they could actually see that he was able to secure a bleeder that was pumping blood and showed how he systematically clamped and coagulate it, the audience was spell bound and actually applauded the scene on the TV monitor. I felt that was a step toward winning some of them over and I soon was getting call from some asking could I give them a tutorial in the technique so they could be ready when the equipment arrived.
Because the term Pelviscopy sort of indicated a limited use to the pelvis, I started calling it minimally invasive surgery. As I mentioned the Director of the Surgery Residency was interested and the fact that a Cholecystectomy (take out the gall bladder) could be done was a compelling reason to adopt the method.
At last I got a call from Connie that the equipment had arrived and was being sent to biomed to be checked out for safety.
I was like a child awaiting Santa, my toys are in the house but I have to wait to play with them.
Once we had them up in Surgery and inventoried, Connie, the Pelviscopy nurses and I set up a room and I laid out how the instrument table and the cabinet should be arranged and we had a dry run of an operation.
The very first case was an ovarian cyst that was benign on ultrasound making spillage of any fluid an unlikely hazard. Prudence had paid off an everything went well but I found that Semm’s instrument ( the endocoagulator) was awkward and didn’t control bleeding easily.

So from the very beginning I proposed using the Kleppinger Bipolar forceps and they became our very practical and efficient way of hemastasis.
Now that I were operating on a regular basis most of the Gyn doctors wanted to learn the technique. So on top of my teaching duties with the residents, I was named Director of Gyn Surgery Education and set up weekly mini labs so they could learn the basics and then scrub in with me and later I would scrub on their cases.
In the background, some general surgeons were hearing about the possibility of doing cholecystectomies and asked if I could help them do one. Since they didn’t have any equipment and only knew what I had taught their resident they were forced to rely on my expertise.
Since Cholecystectomy is one of the most common operation surgeons do and the post op recovery is long and painful, the idea that this could be a procedure that was basically outpatient and back to work in days rather than weeks……I was in great demand. Not only did they need me to teach them a technique that was foreign to them, there was only one set of equipment in the hospital and it belonged to the OB care center. Even if the Director of Operating Room Services approved purchase of more sets at 50K/set it would take over a year for delivery! I was as it were in the “cat bird seat”.
I was now being courted by several surgical instrument companies who had started marketing trocars, cannulaes ,graspers, scissors and staplers to use their products and later be a consultant for their development of new products. My plate was full and I loved it but the true reward was yet to come.

Trip to Keil Germany

Going to Germany was an experience in itself, I was to fly from Indianapolis via TWA into Kennedy in NYC and connect with Lufthansa for 7:00PM departure to Frankfort. My TWA flight was late leaving Indy and on reaching Kennedy I had to get a limousine for $50 to go to the International terminal which was literally 100 yards across the road. As I rushed to the check in, the clerk said the boarding for my flight was closed. I panicked. Here I was on the hospital’s dime and had missed my flight and I had to be in Kiel the next day. I asked her what options did I have and she nicely said “I can put you on a flight that leaves in an hour to Hamburg from there you can get a train to Kiel”. That was a relief plus it gave me time to exchange some currency which I hadn’t had a chance to do. So I finally boarded and wondered what was ahead. I almost suffocated on the flight because the German passengers bought cigarettes duty free and tried to smoke them all on the flight.
Arriving the next morning, I cabbed to the train station which was huge and my not being able to read or speak any German manage to find the ticket window and purchased a ticket to Kiel. Instinctively, I listened for the train to be called and since I had no idea about what car to board I decided to get in the one closest to the engine, which was a smart move on my part; because the train as it went north dropped off cars from the rear that were switched to other destinations. Luckily I didn’t take the car towards the end of the train or I would have ended up I don’t know where.
The train trip was through some beautiful scenic country side and I knew I was safe to arrive at my destination since Kiel was the end of the line.
As soon as I checked into the hotel which was about 3PM, I crashed with the time zone change and slept until about 10PM. Since dining is done late in Europe I ate and decided to scout my surroundings for tomorrows adventure at the University Hospital. Arriving back at the hotel I found the hotel bar and immediately connected with the bartender and a keyboardist that played in the bar until the wee hours. Now that I knew I was situated, I felt relieved.
The course started the next morning and as I trudged up an inclined path to the Hospital, wondering what was in store for me. I hadn’t met anyone that was an attendee until I entered the auditorium.
We were greeted by Dr Jordan Phillips an internationally known laparoscopist who had established a society called the American Association of Gynecologic Laparoscopist and had coordinated this course and introduced with Dr Semm.
Herr Proffesor Semm began by describing how he envisioned being able to do operaterations via laparoscopy and what innovations he had developed to achieve that goal.Having a degree in engineering helped bring his technology to fruition.
The goal that he had was to be able to do most of the common gynecological operations through the laparoscope using multiple puncture sites in the abdomen to access the organs and develop a technique for cutting, clamping, suturig and removing pathology. He than proceeded to describe what he had invented or designed to achieve this.
First, was an automatic insufflator that pumped gas on demand to distend the abdomen for visualization. Second, were special trocars (spikes) to insert into the abdomen where tubes could be inserted to allow instruments for manipulating tissue as you would in an open case. The insufflator kept up with any gas that leaked around the gaskets in the cannulas (tubes), Third, he
developed a series of instruments (grasper,clamps,needles, scissors and needle holders). Fourth, he invented a unit that could coagulated tissue without burning any adjacent structures. Fifth, he created an irrigation suction system to keep the operative field clear of blood and debri. Six, he designed a morcellator that chewed up tissue for removal. And lastly,
he perfected a technique of suturing that gave the surgeon the reassurance of securing bleeding from large blood vessels. All of these inventions and techniques were compiled in a syllabus that was handed out for future reference. This was definitely needed since most of the lecturers spoke English but some things were lost in translation.
Listening to the introduction to the course and having practiced on their trainer model to become facile in manipulating tissue and tying knots, I felt more comfortable than I had been in Miami a year ago.
There were 24 attendees and we were divided into twelve groups of two and assigned to a trainer with one of his fellows. My fellow was from India and we struck it off right away. He had us go through a series of exercises to see what our dexterity was and satisfied with that put us through a series of steps that replicated surgical procedures (ie. taking out a cyst, removing a tumor, tying a blood vessel with both kinds of knots). The knot tying (intracorporeal and extracorporeal) was emphasized since Semm believed this was the key to completing the surgery without having to convert the case to a laparotomy (opening the abdomen).
After practicing our trainer exercises all morning, I asked my instuctor if I could show him a maneuver that I had come up with for tying that was simpler than what Semm did and proceeded to demonstrate it to him. He was impressed! So I ask him if he could show it to Dr Semm. His reply “NO, I could never show Herr Professor anything”. I asked if I could show it to Semm’s Associate Professor Tennenbaum and he again said “NO WAY”. That’s when I got the feeling that Semm was not likely to take suggestions or take fools lightly (me). So I kept my mouth shut on this point. But found later that my technique was easier and having shown some of the attendees they returned home with Robinson’s knot tying method.
With the basics over we were told that Semm had 6 cases scheduled the next day to demonstrate Pelviscopy on actual patients.
That night we had a reception to welcome us to Germany and to sample the food and customs where we were bussed to a medieval castle. This was really an interesting event and we were plied with food and toasted with drink far into the night, making the early wake up call a little hard to accept.
The next day was the part of the technology I had come to see. Looking at video tapes and working on trainers was great but I wanted to see what Semm could do in real time on real pathology in real patients.
We were split in to 6 groups of 4 so one group could come into the operating room while the others were able to observe on close circuit in an adjoining room.
This was where something happened that produced a seminal moment in my thoughts about Pelviscopy.
When our group was in the operating room we saw that Semm sat on a special stool and had arm rest (like an ether scree) to brace his elbows over the patient and the laparoscope was held by his assistant who looked into a side port to observe what Semm was doing. And periodically they would attach a crude camera to the scope and feed a signal to a TV monitor back to the conference room where the we could see what he was doing. All this was fascinating and quite impressive as Semm provided a running commentary of what he was doing. As I recall they took out a cyst, removed a fibroid tumor and separated some adhesions along with removing the appendix.
When the surgery was complete we had a “snack” that was really a feast at about 11 O’clock between the next 3 cases in which they served sparkling drinks, cold meats, cheeses, black breads, pastries, fruit and the like which they told us was an everyday operating room ritual in Germany. (I was ready to definitely adopt this and bring back to the US).
When done we adjourned to the conference room for a question and answer
session. Dr Semm took the podium and was peppered with detailed questions about this and that from the audience.




I had this thought and when he recognized me I asked “ Herr Professor, why don’t you watch the TV monitor to operate so everyone can see what is going on rather than look through the scope”. He replied, to my embarrassment, “Dumbkoff don’t you anything about light, every time you connect a link to the light source (source to cable to scope to lens vs camera) you lose 50% of the light” and went on to answer other questions. I slid down in my seat and said to myself, I need shut up and learn something about light!
The next days in Germany consisted of more cases and some side trips to see some sites and then my return home.
On the flight back I reviewed the material I had received about the procedures, the equipment and the copious notes I had taken all leaving me with the burning question……would doctors in the US accept this tedious method of doing surgery no matter how elegant. And as I fell asleep high above the Atlantic, I surmised NOT!

My Story of Pelviscopy

In my life time and more specifically in the 50 years that I have been a physician some monumental events have affected the course of medicine worldwide; antibiotics, blood replacement, the cure for malaria, the Salk polio vaccine, cure for tuberculosis and more recently the DNA key to disease. The story I’m about to relate is my part in a technology that I believe shaped a new surgical approach in medicine to the magnitude of these events. The technical details of this story are necessary for me to relate so the reader can appreciate the magnitude of what followed.
This story starts in 1986 with a trip to Miami where Dr. Tom Benson the director of the OB/GYN residency at Methodist and I the associate director attended the first course held in the United States offered by Dr Kurt Semm from Kiel Germany. It involved teaching a technology he developed that was foreign to American gynecologists. We in the US had embraced laparoscopy for diagnostic purposes since the mid 1950’s. But because of certain limitations in equipment and with the only meaningful surgical procedure being tubal sterilizations, it was not seen as a truly operative procedure. And serious complications began to occur with alarming frequency that made a large number of gynecologists abandon it world wide ……electrocautery bowel injuries. These were produced because the electrocautery used monopolar current which cause burns if a structure was touched between the source and the object (i.e. tubes) due to a short circuit in electrical energy. These burns led to bowel perforation and in some cases death: making the procedure fall into disrepute and abandoned in the USA. In the 1970’s Dr. Richard Kleppinger invented a bipolar forcep that eliminated the danger of bowel injury due to their design. To understand the physics of this development is to understand how electrical current (energy) behaves. Monopolar current travels from the electrode (devise tip) through the body and exits to ground. Whereas, bipolar current is transmitted from one tip of a grasper to the other tip without any chance of shorting the circuit and causing an electrical burn.
The procedure Semm developed he coined the term Pelviscopy to differentiate it from the stigma that Laparoscopy had attached to it.
What Semm proposed was to be able to operate intraabdominally using a scope for visualization and insert multiple operating cannulas in the abdomen whereby instruments could be inserted to perform the tasks of grasping, coagulating, cutting and sewing that mimicked what was done in an open abdominal case (laparotomy). With that capability, he felt that he would not only eliminated the need for a large incision, recovery would be reduced as would post op pain.
His first task, which was his real contribution, was to design the equipment and instruments to achieve his operative goal.
The first thing he invented was an Automatic insufflator that would pump gas on demand to keep the abdomen inflated so multiple puncture sites for instruments could be used. The second thing was what he called an endocoagulator, an instrument that used heat to coagulate instead of electrical current. Thus, sealing off bleeding for hemastasis. Thirdly he constructed a series of instruments that could be inserted through the abdominal wall called cannulas (tubes) to grasp, cut and sew tissue. And lastly, and most importantly he developed a technique of ligating blood vessels ( intracorporeal and extracorporeal knotting) so diseased tissue could be removed. All these steps went to produce an elegant surgical innovation.
You don’t have to be a doctor to see that if this approach to surgery was feasible the impact it would have would be mind boggling. You could literally operate through a key hole and with some refined instruments remove diseased tissue the same way.
The course I attended in Miami was my introduction to this fascinating new approach to what was to be the surgery of the future.
I have always been fascinated by technology and when Benson, my boss, asked me if I saw any value in this in our hospital and residency, I said let me work on how hard it is for me to learn this and teach the basics and go from there as to it’s adaptation. But first I needed to have one of his practice units called a “pelvic trainer” and a few of the basic instruments so I could gain skill in doing the surgical maneuvers on an inanimate model.
He approved my request to purchase the needed equipment and I went to work honing my skill. I also had a group of lower level residents who were required to learn the skill in my lab to the point that we had a good feel for our ability to perform an operation but not on any patient yet.
About 6 months had gone by and I still wanted to feel more secure in doing this on a patient when I was invited to Germany to take a hands on course where I and 24 other doctors from around the world would get to see Semm actually perform Pelviscopy. Since Benson knew I was cautious and wanted to be as knowledgeable as possible he requested the hospital send me to the course.
Going to Germany was a learning experience that led me to developing Pelviscopy at Methodist Hospital and expanding it to the general surgeons, who reluctantly finally embraced it. Today that surgery is called minimally invasive surgery and spans practically every surgical specialty (ie. Hysterectomy, Cholecystectomy, colectomy, nephrectomy, pulmonary, heart, ortho, etc, etc). The story of the learning curve follows.

Reds

Two friends of mine a while back bought a liquor licenses and a place called Reed’s that had been a neighborhood bar for years. They decided to name it Red’s the reason for the name change is lost since they are both dead now.
It became the “it” place to go. It was on one of the most traveled streets in the black part of town and right at an interstate exit. If anyone came to town and was looking for someone they would go to Red’s or someone there would know where they were.
I was a good friend of the owners and the manager Jack and knew all the barmaids: Loretta, Wanda, Anna, Lilly, Paulette, Jeannie, Dee, Millie, Nancy, Rene’ and Brenda.
Jack was a real character, a guy with a heart of gold, who would run a tab for the winos and pour a free drink for the bar for any reason what so ever just so he could knock back a “shooter”. He was a great cook and would fix huge pots of chili, white beans, chitlins, chicken wings, beef stew or neck bones on Saturdays and everyone would be eating drinking and getting down. Marvin Gaye’s “ What’s goin on “ or Al Greene’s “Lets stay together” would be blastin and before there was an “electric slide” or “stepping” we would be forming a line dance of our own and dancing the night away. I closed the place a thousand times. It was my nostrum
Red’s had a character of it’s own and anyone from out of town I took there always said they wished there was a Red’s in there town. I’ve been around and in many bars and joints but Red’s was something else.
The characters that came thru Red’s would have been a perfect cast for Damon Runyon story. Like “Capt Bob” who was a stone wino who could recite any dirty poem or story for a bottle of “hooker” ( Wild Irish Rose) or “Junior” who passed out and fell in the middle of the street out front. And it was summer and the doors were all open and the crowd said Doc “ give Junior mouth to mouth” and I replied “NOT ME, I’ll direct traffic around him until the paramedic come”. Jimmy the owner abhorred cursing and every other word was usually MF this and MF that and when he wasn’t around we would play card or shoot dice in the back room.
One thing Jimmy did not tolerate was disrespect to women and that’s what let to his untimely violent death. Jack had a way with people, even drunks and could get them out the door before anything happened. One night before Jack came to work a guy insulted a woman and Jimmy grabbed him to put him out and the guy pulled his gun and shot Jimmy point blank. He died before the medic arrived. After the funeral his cortège drove by Red’s and the customers stood on the front porch and held their glasses high in a last salute to him. Red’s was never the same after that.

The Rough Years 3

Now that I was in the recently completed house, things were a mixture of sadness and confusion. It was difficult living with a new wife and baby, my aunt and a teen ager, and trying to work with the fear that someone may be stalking me. I spent many a sleepless night hearing noises and seeing shadows in the woods around my house. Plus my aunt talked constantly about how my mother and she had planned something in the house and I was doing it all wrong. I had hired a nanny to care for Becky and my aunt had miffed her by assuming she was a housekeeper so I ended up paying her to keep Becky and her house. This did free Rena up but it did nothing to give me any space. I tried taking up golf as a distraction, but golf is a game that does not do well by being distracted and many a peaceful day was interrupted by a call about a perceived problem at home.
All this led to more frustration on my part and tension with Rena and my aunt. I finally persuaded my aunt to get an apartment right around the corner from where we lived to salvage our sanity and relationship. Right after that Rena decided she wanted to move back to Atlanta to pursue a “career”.
Now, only 4 years into the marriage and trying to deal with numerous financial and personal problems, I was essentially left to deal with all this alone. It was really a separation that allowed Rena to have space an no problems and me problems and no space. My spiral was tightening as I felt lower and lower emotionally.
The clinic was only doing fair now that there was more abortion protests and I was burnt out by medicine in general. I had nothing that stimulated me, surgery was to say the least easy for me and basically something I could do by rote. So all I did was go to the clinic, go to the office, go to surgery and to Red’s. and drink day after day after day. On this endless merry-go- round, I could not catch up……..debt increased and back taxes accrued with all the penalties and interest the government could apply. I saw no way out of this hole that I could not stop digging.
Then to my surprise Rena wanted Becky to come back to Indy and stay with me. To this day I have not be able to understand what she was searching for or why she wanted her to go back with me but I said yes and she brought Becky home and she and I set out to care for ourselves, something we have continued to do until this very day.
I was in deep tax debt and I chose to pay my alimony, child support and college obligation rather than the IRS….so as was expected the IRS forced me to sell the house for a portion of the back taxes.

My taxes were never going to get current because I was never able to pay my quarterly tax estimates. This not only incurred a penalty but an interest that accrued monthly each being 18% a year. I was drowning in a whirlpool of debt with no life preserver.
During all of these problems, I was badgered by my ex-wife about timely support payments. I was mentally exhausted and to top it all off the IRS forced me to sell the house.
Now, I had to find a place for Becky and I to live when Rena decided to return to Indy. We found a condo that only held about 1/3 of our things and put the rest in storage and started to regroup our lives. This I hoped would be a restart personally though I had no clue to how I would get right financially.
As the saying goes “ when it rains it pours” the landlord for my clinic lease which also housed my office cancelled renewing it which essentially put me in a situation where I had to lease another place under unfavorable terms ( a five year lease ). I was screwed but I fought thru that and after a year when I thought things could not get worse my landlord informed me that he was selling the condo he was leasing me and I had 1 month to leave. What else could happen? I still don’t know how I managed to survive all these reversals in my life……but I did survive. I found another place that looking back was what I really felt was ideal. It was a condo in a converted old factory building and it had exposed brick walls with floor to ceiling windows and hewn wood overhead beams. What I really liked was it had an underground garage and my unit was on the fifth floor with a view of downtown Indianapolis. All this was only 6 minutes from the hospital and 15 minutes from my office.
During my stay here I started exploring the possibility of relocating my practice to Atlanta, but since I was in so much debt it made no sense to move to another city in which I had no professional contacts.
Rena and I were going through some serious changes since I had made so many concessions and felt I was doing all that I could to provide a decent life.
She decided to move back to Atlanta, which was really an impulsive thing and I was glad to have some peace by being alone. She decided that Becky should go with her and I agreed. This impulsive move lasted less than a year and she was back again unhappy as ever. None of these moves helped any of the problems we were dealing with and only caused us more tension in our marriage.
I knew that the only way out of my situation was to try to get a job where I was salaried and my taxes were withheld at least this would allow me pay my current taxes in a timely manner and not pay estimates on income that I didn’t have.
I ran my dilemma by my friend Benson who was the Director of the OB/GYN residency at Methodist Hospital. And he said he might be able to hire me part time to staff the GYN clinic. He was able to do this and for about 4 months I worked not as a full time employee but at least I had my foot in the door.
The interaction with the medical students, interns and residents revived my love for teaching and I asked Benson how was the chances for full time employment and he said the OB/GYN education committee would have to approve the need and Dr Frank Lloyd the CEO of the hospital would have to approve the position. I told him I was really desperate and needed a job.
Then something occurred that changed my whole life. A seminar was being held in Miami where a new surgical technology was being taught by a leading pioneer from Germany. He, Benson, arranged for the two of us to attend this first course in what was called Pelviscopy. On the flight back to Indy, he asked me did I see this revolutionary approach having any validity and being integrated into our institution and patients. I said I saw some potential but would like to work with the teaching model trainers we used in the course to get a feel for how difficult the technique was to learn and teach. He gave me the go ahead and found some funds to buy the teaching model to practice on.
The path ahead is really one of the major achievements and contributions I have made in my medical career. The story of Pelviscopy and what was spun off from it follows. HospitalHo

The Rough Years 2

The murder of my parent not only put me into a spiral of depression, the investigation was unsuccessful in ever solving the crime
When I was released from the hospital I felt really guilt ridden for not being able to attend the funeral and on top of that I had to find strength to return to work since my responsibilities had not stopped. ( alimony, child support and taking care of my aunt and family).
The police sent detectives to interview my aunt and later me about the murder. I was even asked to take a lie detector test which they said was routine to clear me of any suspicion. And for weeks a team of detectives poured over details with my aunt and I trying to find a motive or what had occurred………to no avail.
Because I had no clue as to why they were murdered, I felt fearful for my family and myself since I may have been the target because of my involvement in the abortion clinic and they were the victim of some crazys by mistake. This fear had me looking over my shoulder and losing sleep for several years. It definitely had an affect on my health in general and though I had stopped smoking the alcohol use continued. ( I was not into any sedatives or antidepressants).
I set about the project of completing the house they had started with all the headaches and financial burden that it entailed. Once that got started it at least gave my Aunt Mad and Rena something to distract them by the job of getting that job done.
One of the problems of a new building project was what I had experienced with my previous ones…….a poor general contractor. I ended up firing him and getting someone to finish the job but at an increased cost. ( my continuing luck).
Once the house was completed we moved Aunt Mad in with us because it had been my parents plan for her to live with them. This proved to be a disruptive situation in that I had a 1yr old, a 14 yr old and a 70 yr old and a recent marriage. I wouldn’t wish this on anyone especially recovering from the trauma that we had all experienced. So it was probably to be expected I had another arrhythmia attack 6 months later. Now my physician had me on a potpourri of medicines that made me constantly fatigued. I was mentally and physically exhausted and on a spinning wheel that wouldn’t stop.
Then I received a call that my favorite cousin Bill had been murdered in Chicago……..would all this never end!


We had hired a nanny to care for Becky and a very good friend invited us to visit him in my favorite city San Francisco. This was a needed relief and I was able to relax and recharge my body and spirit. We shopped, ate crab by the bay and generally had a good time. When I returned home unfortunately
It was back to the usual.
I was trying to find some sort of outlet to release my tension, I had always loved to read but it was not getting it done. So I took up golf and really loved the game but I never could concentrate because Rena was always interrupting me on the course with some trivial problem, So I ended up just hanging out in my spare time a bar run by a friend called Red’s. And because bars are for drinking, I drank and drank. Luckily I was able to function and avoid anything like a DUI, but I knew it was not the healthiest behavior in the world. But it was an escape to go into a dark cool bar and BS with friends about nothing, sipping on a favorite libation mixed by a favorite barmaid. This was my hangout and my friend Jimmy, the owner, was himself murdered by an irate customer one night over nothing some years later. Bad things seemed to be circling me like a vulture circles a carcass.
What more could happen? Plenty, just read on.

The Rough Years

We moved into our new house and office in 1970 and about that same time
things started to go bad professionally and personally.
One of the problems that physicians encounter is delayed payment from third party payers ( insurance companies). This greatly affects cash flow and with salaries, expenses and taxes being on going it becomes impossible to stay current with debt. I soon was behind in payments on loans and than taxes which provoked an IRS audit. From there things went downhill since even after getting a payment agreement with them, I defaulted the terms.
With this going on it began to affect my marriage and led to a separation and later divorce.
Now I was burdened with maintaining living space for myself, the new house and the new office. My architect partners in the office were having a down turn in business which eventually led to foreclosure on the building. So in the midst of all this, I had to move to a new office.
An opportunity arose that fortuitously got me thru some of the financial hardships. The Supreme Court legalized abortions in January 1973 and I established the first abortion clinic in Indiana in July 1973. This was something that I had felt was necessary since during my residency I saw my share of horribly botched abortions some leading to death and I had no philosophical or religious reluctance to do them.
The clinic was a way for me to give up OB and concentrate on my Gyn office and surgical practice.
I also remarried and we had a new baby girl, Becky who brought a new dimension to my life. Things were looking up! We moved into a town house and were soon joined by my stepson Lenny.
To go back in time a little ways, my father and mother and brother had lived in Evansville for all these years and Evansville was going through a recession that had really crimped my Dad’s practice. He took a job with the VA hospital and they moved to Indianapolis 1965. My favorite Aunt Madeline had retired and moved from DC to join my parents. They had decided to build a new house about the time I moved out of mine. So both of our lives appeared to be on the upswing. As I have learned, life is a series of peaks and valleys and I was about to go through the deepest valley imaginable.
On the morning of August 7, 1975, I was at the hospital and my secretary said my Aunt wanted me to call her right a way. When I called she said she had called my wife Rena to see if she had talked to my mother that morning because my mother was not answering the phone and they talked daily at around 10AM, so she went out to the garage of the apartment building where they lived to see if my Dad’s car was gone, thinking they had gone on a errand. She said the car was in its parking space. I told her to get someone in management to open the apartment and I would be right over. Driving over I had this premonition that something bad had happened. My thoughts were that both of them wouldn’t have had some dire medical problem at the same time so what could have happened.
When I pulled up in front of the apartment building my apprehensions were worsened because there were several police cars at the curb with flashing lights. They lived on the first floor in a garden apartment and as I ran down the hall I saw my aunt slumped against the wall crying and as I approached she said “ Burley, Gwen and Earle are dead. ” At that moment I was paralyzed. A police officer stopped me and said I couldn’t go in the apartment until the crime lab comes. So my aunt and I went to sit in the neighbor’s apartment next door waiting for the investigators to finish. She was trying to tell me what she found when she went in with the maintenance man. As I recall I arrived at about 11AM and it wasn’t until around 2PM that they asked me to come make an identification. I had called my wife and brother who was in school in Bloomington. And now I sat trying to comfort my aunt about something I didn’t even know what.
A detective came and got me and said they had been brutally murdered and was I able to go in and identify them. I indicated that I could and as I climbed the stairs to the 2nd floor hallway I saw a hand sticking through the banister railing and steady myself to go on up. When I looked down the hall the carpet was soaked and the wall splattered with blood and there they lay in their night clothes stabbed innumerable times. The details are imprinted in my brain and I don’t want to describe the horrible picture I will carry to the day I die. I told the detective that they were my parents and staggered back to join my aunt and await my brothers arrival from Bloomington.
I had to get home to my wife and baby and I told my aunt she had to come with me so pack some things and we would go as soon as the police allowed us to. Because I had friends on the police force the murder was made a priority and by the time I arrived home many of my friends were calling or at the house.
I remember having this overwhelming sadness and wanting to cry but couldn’t and I was standing on my patio with one of my best friends and he said let it out and I wept in his grasp like I had never done before. My mother and father had reached a place in their lives where they were getting ready to enjoy the fruits of their labor……two sons raised and seven grandchildren between us; me with six children and Bruce with one and now their lives extinqished by a later to be an unsolved murder.
The stress of all this was not immediately evident and as I tried to take charge of their burial, cooperate with the police investigation and care for my aunt, I noticed that I was having anxiety attacks. At this time in my life I was a heavy smoker so between the cigarettes and the alcohol I was drinking to cool out, I noticed I would have these occasions of rapid heartbeat. This had happened before when I drank too much and I ignored it……too much to do and arrange and I was the only one that could physically and financially handle it all. My aunt was a basket case and my wife was recovering from recent surgery. The funeral was planned for August 11th which was a Monday and because of their disfigurement it was to be a closed casket service.
The morning of the funeral as I was getting dressed, I started feeling weak and dizzy and decided to lay down for a minute in the guest bedroom not wanting to disturb my wife. I asked a doctor friend to take my pulse and it was over 240/min. On the morning of my parents funeral they rushed me to the hospital with a cardiac arrhythmia, me thinking, is this how all this ends.
Until I wrote these words I haven’t recounted any of this to anyone or even gone over it in my mind. I am not a religious person so I cursed no god but I have never felt after their brutal deaths that life had much further meaning to me. I had escaped early death with tuberculosis and now my parents suffer death by murder so what ever becomes of me now is welcomed.
Whatever happens to me I look at as being on borrowed time from that day in August 1975. Much of me died along with them.
I did promise my aunt that as a kind of memorial to them I would finish the dream house they were so eager to build. That is the story that follows.

Building two houses and an office

If you have always wanted to build your own house as I did, I can guarantee from my experience of building 2 houses and an office I have run into every snafu that one could possibly encounter in the process.
Every project that I am about to describe had it’s own unique situation.
All the projects start out with a budget that no matter how prudent one wants to be rapidly multiplies like adding yeast to dough.
The house I decided to build was really unique and since it was designed by a friend who was an architect, he also agreed to supervise the construction since we had engaged a contractor who was doing the job on a material cost plus basis. That entailed me paying all the cost of material at his wholesale discount and he added a percentage for his services as general contractor. In that way, I would save substantially by being able to buy material at his discount. What sounded very good, turned out to be a bad deal I later was to learn.
I had secured a building loan from the bank that was paid out in disbursements, one half to frame out the project, one fourth to do finish work and the balance on their final inspection. The bank officer who handled my loan dispersed the funds as each of these marks was reached.
Once the footings were dug and poured every Thursday the contractor would come by to get a draw for labor, the architect would check the work and give me an ok to pay him. On a couple of occasion his laborers told me they weren’t being paid. Things were going well and it was time to order framing lumber which I paid the lumber yard directly. Much later I found out from one of his workers that the contractor was ripping me off on some of the lumber and using it to build another project on my dime. As the job progressed more shady stuff evolved. I found that the reason he was able to price the job so reasonable was he was using scab labor and stealing my stuff.
One time I was watching them put in the ceiling which was tongue and groove planks that had to be secured with special rod nails that were driven in with 8 pound hammers that cost 80 dollars each. As I watched, a worker carelessly dropped one in the mud never to be found again.






Next came the dealing with inexperienced subcontractors on a job this big and detailed. I had to have 600 amp electrical service because I had zone heating and cooling plus a swimming pool heater. all had to be run in conduits below ground. The contractor had never wired a house with more that 200 amp service, it so happened his son was working as a helper and told me.
Than the pool deck was to be smooth stones floated in concrete and it took 3 tear outs and pours ( that’s 3 concrete trucks loads @ $700/load ) to get it right because the concrete contractor had never poured and floated stone. I found out later that Portland Cement Co. had a special consulting service to advise how to do custom effect jobs like I had.
It goes on! The contractor told me that the area where I was building had a sanitary sewer system and hooked into the line it turned out it was a storm sewer, and after 2 days in the house sewage backed up into all the toilets and we found out we had to have a septic system dug in the front yard; all this costing me more money. Two final things happened that almost made me kill him. One was the foyer which was to be 3 sq foot marble slabs laid on mud ( a concrete base). It was so heavy I had to have the floor reinforced to support the load. Lastly the roof was to be redwood shake shingles, but the pitch was so steep that no one locally would do the job. Luckily some hillbillies were passing thru town and needed work and damn if they didn’t do a perfect job. They were all over the roof like band of monkeys. When the house was finally finished the cost had doubled the projected estimate. Even so it turned out to be a really a great house and I know that my kids loved it. Eventually I lost it to divorce and taxes but it was some house with it’s conversation pit for adults and areas for kids and guests. I don’t for a minute regret building it. I had two more building projects that brought me their share of grief and disappointment………. READ ON!
The next project was an office building that was (a co-adventure) with my friend the architect. He and his partner had gotten a huge job to design twin high rise low income housing units that necessitated their firm expanding and I was looking to move to another office location. So we decided to invest in building shared offices. I would occupy the 1st floor and they would have the basement and 2nd floor. The building was very contemporary having 16 panes of golden glass/ side surrounding a mansard type 2nd floor.





My space on the 1st floor would have no windows for patient privacy (OB/GYN’s). The basement having the architect’s firms draftsmen and utilities, the floors connected by an elevator. It was in a prime location and the bank was eager to lend us money in 1970.
This time we put out bids on the job and hired a general contractor to supervise the construction. He was good, but unfortunately he got hit in the ear by a nail on the job and contracted meningitis and died leaving us to run over on cost and delayed completion; this forced us later to lose business and ultimately lose the building to foreclosure. The plus was that the building was so avant gard that people drove by just to see it; but occasionally vandals shot out the window panels that cost $600 to replace. Another bitter lesson learned!
The last project was completing a house that my parents had started before their untimely death. Because the project was 3/4th complete and to sell at that stage would have been a big financial loss. I decided to complete the house which was agreeable with my wife since the design was something both of us could accept. The architect was my same friend but the contractor was the owner of the housing addition and builder. It turned out that he was inept and his sub-contractors equally so, the back patio had to be re-poured because the water drained into the house not away from it. And the drive way had to have a retaining wall built so we could access to the garage….more cost over-run There were so many faults in construction I had to legally dismiss him from the job and hire someone to correct the botched work. More time and more money. And to this day I can still see evidence of the workmanship that was so poorly done I get sick whenever I pass the house that I long since sold. As a house it was a great place for my daughter Becky to grow up in but the fact that it had a pall of sadness over it was always depressing to me, knowing that this was a dream house of my tragically deceased parents.
I know that I will never build another house, but the experience I have had in doing so are priceless and the journey of learning made the trip worth it.
What is money for unless we can use it to accomplish some dreams?

Kids and Dogs

It seems that I had my share of kids and with them came a steady assortment of dogs and events which intertwined into a litany of tales.
Robbie my oldest proceeded to lose his glasses at 4 y/o on a trip to the St. Louis Zoo he had had them only a week, I was only making $70mo and the glasses cost $50. When we lived in our first house he was playing in the basement and was told not to run; he immediately bounced off the steel support post splitting his head open and required a trip to the ER for sutures. Kenny and Robbie were playing with Titan our German Shepard, with their friend. Titan grabbed him by the arm and tore a plug out trying to keep them from running from him. When we were building the new house it was muddy and we chained Titan on the pool deck, one of the workers teased Titan and underestimated the length of the chain, this ended in he being bitten. I had to get rid of my favorite dog because of this.
The house I had designed had a special area for kids, the boys had a room Kenny and Timmy in trundle beds and Robbie had a loft space. One night they had a sleep over and I went upstairs to see why I kept hearing a thump noise that shook the house, to find them taking turns jumping from the loft trying to touch a huge globe light suspended from their ceiling and bouncing off the beds. Ask them what happened to them?
Another time I came home late from a delivery and they were all sleep, I went to the refrigerator to drink one of my DO NOT TOUCH dad’s Nehi lemon soda. to find it all gone. I yelled for everyone to come downstairs NOW! Diane, Michelle and Timmy were small and Michelle they called “Niagara Falls” because she cried at a raised voice. Robbie and Kenny said Michelle drank it Dad. I said Michelle reach in the refrigerator and she couldn’t touch the shelf so I sent the little ones back to bed, and said you boys asses are mine and proceeded to dispense a whipping they still remember.
But we had a West Highland White Terrier named “Popcorn” who the kids loved. While chasing them onto the school bus at the end of our driveway, the bus ran over him as it pulled away, to the horror of all the kids on the bus. I remember to this day driving down the drive way trying to signal the driver to pull off with all these little faces staring out at smooshed “Popcorn” on the pavement. I had to go back and scrape him up with a snow shovel before going to work. Then we had “Popcorn II” who came to live with me in my apartment and bit the maintenance man so I had to get rid of him. Next we had “Tinkerbell” who I bought for my new wife and she ended up giving her to her 2nd son since he didn’t want to live with us.
Then we moved to a house and got a Norwegian Elkhound “ Weegie” who would run away in a minute. I paid so many rewards for his return that I finally took his collar off and said if he was so dumb he can’t find his way home good riddance. This was right after he jumped up and pulled off some short ribs of beef I had just grilled. After that I got “Honey” who was a favorite of my wife and who loved to roam at night, but he tangled with a raccoon and loss big time. Then we got a little Shih Tzu we called “Sushi”, she was 8 weeks and went for her shots, my vet being the one that Titan had run out of the house years ago. This was Becky’s dog and that night the dog was kind of feverish from the shots and Becky asked “ Daddy is my dog going to die” I replied “ No way baby, dogs feel bad after getting shots” but she decided to sleep on the floor in her sleeping bag with him in our room. During the night, I had my hand kind of slung over the bed and heard this whimpering and the puppy was licking my hand, In the morning, I got up to get ready for work and didn’t see her. So I searched around the apartment we were living in. Becky was sound asleep in her sleeping bag. So I looked everywhere during the search I thought I saw her under Becky’s bed but decided it was a teddy bear and got a broom to kind of prod it out, until I saw it was “Sushi” cold, stiff and dead.
When my Becky and my wife saw her they went berserk, crying and saying the doctor had killed their puppy by over dosing the shots. I was about to dispose of her down the trash chute when they called the vet’s emergency phone number. Now it was chaos and he said bring him to the office on my way to work. So I put him in a big zip lock bag and dropped him off to get an autopsy. They have never forgotten this nor forgiven me for taking him to this vet. We got a replacement for “Sushi” and as fate would have it, she slipped out on a frigid winter night and she got loss in a snow drift and froze to death. Between my kids mischiefs and dogs death’s, I have had my run of bad luck.
My present dog is Alvin who was named after the one of the chipmunks and is now 10 years old and holding……..good for him and me and us!

Housing in Indianapolis

After the relief of my passing my boards and draft cancellation, I was in pretty good spirits and looking forward to a fairly normal life of work and family. My wife and I started to look around for a larger house now having 5 children. There were several new sub-divisions being built that were attractive to us. I had always wanted to build a house like my parents had and harbored a secret longing to be an architect, so for years I had clipped and sketched plans for a house of my dreams. At this stage I felt that I needed to put that dream on hold and just buy a larger house.
There were some houses located in a very nice addition and we went to check them out after we decided that one would fit our needs we made an offer to buy and the builder informed us that he didn’t have any more for sale. I was suspicious and asked my friend Tom, who was white, to inquire and indeed he was told there were houses available. This was in 1967 and I decided to file a suit against the developer for housing discrimination, so I called the director of the local Federal Equal Housing Office who I knew. Her response was you have a case but when it’s over you will have wasted a lot of time and money and end up with no house. So as much as I hated to, I didn’t pursue it.
As fate would have it, I got a settlement from an auto accident in St. Louis occurring some years before which provided me with money to buy a lot and that gave me the opportunity to plan to build a house. Luckily, I had a close friendship with a young architect who had recently formed a firm and over the next 3 years we worked on my dream house. You can buy a house that has already been built and you can pick through a builders plans and build what you see or you can hire an architect and pour over your ideas and his designs and build what is basically yours. In a house that you pick out, you are given few choices on what goes into the construction, but in the house you build everything from brick to door knobs flooring to windows is chosen by you and based on your desires and pocketbook. The land I had purchased was an acre on a very busy boulevard and I had him design this special house with no windows fronting the street, instead everything was open to the back with an enclosed swimming pool and the house was so unique that many thought it resembled a church.
It had an area for adults and one for the children and another for guests. If I do say so, it was really a house I loved and I had some good times there, but some dark days lay ahead.
Unfortunately I had undertaken a lot on my plate, I needed to move my office since I was not interested in buying the building the practice was in.
So my friend the architect and I agreed to partner on a building, housing both our offices. During the construction of the building the general contractor developed meningitis and died delaying occupancy which led to my not having an office for 6 months. This necessitated my working out of rented space at the hospital and caused me to lose significant income. When I finally was able to occupy the space I had to borrow money to catch up on my mounting debts. All this happened during the passage of Medicare and their insurance carrier Blue Cross-Blue Shield was always 3-4 months delinquent in reimbursing services. I was being squeezed by debt and slow collections which eventually led to the building partnership dissolving because the architects were also overextended. We loss the building in a foreclosure and I was forced to sell my house because of tax issues. Also on a personal note, I was separating from my wife and a divorce was in the offing so I had to develop a plan to regroup.
One of the hardest things to happen was leaving the kids, but the solitude and peace I was able to get by moving out to a studio apartment was enough to energize me and I reveled in it. I felt some how that I could regain some control of my life even though I was dealing with a contentious divorce.
I had engaged a tax lawyer and his recommendation, which now I would have never followed, was concede to the IRS. That strategy kept me hostage to them for the next 25 years.
With all my financial problems, I decided to give up Obstetrics in my practice because I was having difficulty enjoying that part of my work and the patients were starting to piss me off. The recent trend toward catering to the patients request for care had me getting angry at the patient, so I felt they deserved a doctor that favored delivery care plans, which I did not. So I decided to do strictly office Gynecology and GYN surgery.
If I could practice Obstetrics in a way I thought was practical, I probably would not have given it up. It was my belief that the normal OB should be taken care of by Nurses ( midwives or nurse practioners) and complicated cases by the Obstetrician. In recent years, this paradigm has come to pass.
So like so many practical things in my life, I was ahead of the curve.
Here is a sample of a day in my practicing without the office that was being built. The nurse was hooked into the answering service which received the calls from patients as before; emergencies, deliveries and surgeries were done in the hospital. Office visits were done in rented space in the hospital clinic which I paid a nominal fee to use. I stayed in touch by pager from wherever I was. This arrangement lasted about 6 months and I managed to preserve my practice. I moved into the house and office in 1970 and ended up loosing both in 1973.
During this time, I met a young woman who I later married that was a great help in my gaining my equilibrium. She had recently divorced and it seemed that our lives just kind of came together at the right time. I was trying to take a path that would bring some meaning and happiness to my life.
I was in a loosely structured men’s club that really only did social things, like go to big sporting events and on a trip to a Chicago Bear game, I invited her to the city. Over that weekend, I found I could relate to her and she to me what we wanted in a relationship and from there we began what became a journey that has not always been happy but has been to say the least an interesting love affair. It did produce my 6th child Rebecca, who I named after the heroine in the novel “Tom Sawyer” a favorite of mine. When all is said and done Rebecca has turned out to be the most perceptive and supportive of my children maybe because she has always lived with me. I have no doubt that all my other children love me she and I have a special bond.