Medical Career, First Mentor, R.A. Cowley M.D.

Medical Career, First Mentor, R.A. Cowley M.D.

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Medical Update  *
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Nothing much to report today. A little more pain and more regular medication for pain control. I'm using Ibuprofen 600 mg 3 or 4 times a day with a Tylenol #3 which probably helps a little with pain but suppresses cough as well. Stanford has given me a list of labs to be done before I come for my first chemotherapy treatment.
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By my second year of medical school, I was working regularly in D.C. on weekends. The company Android had been folded and Jimmie Osborn, the founder, and I were persuaded to accept Federal employment. My employee classification was called WAE, when actually employed, which meant that I was an hourly worker. By this time, Jimmie Osborn had finished the development work on the report generator for the Economic Development Administration (EDA) and he was spending most of his time trying to write programming algorithms for school class scheduling, something of personal interest for him.

There were several different reports cranked out on a weekly basis and a more detailed report done monthly. On light weeks, there might be ten boxes of printer paper output from these programs. On heavy weeks, more like fifteen.

After a summer of introduction to the COBOL language and the actual operation of the Honeywell 200 computer at the National Bureau of Standards, I became the individual who oversaw the system updating and the production of reports each week.

When the medical school year restarted in September 1966, I had no time for work during the business week and so I was assigned the task of actually producing the needed reports on weekends. This allowed Jimmie Osborn to deliver the the hundred pounds of report on Monday morning. There are weighty reports and then there are weighty reports. Mostly our report had a low information density (value of data per pound of paper).

From Monday to Friday I went to all of my medical school classes. Wife, Sally, was still in Nursing School. I would pick her up late Friday afternoon and drive our newly purchased VW from Baltimore to the Washington suburbs and drop her off at her mother's house. Then  I drove across D.C. to the computer center located on Connecticut Avenue and got to work about 7 P.M. Jimmie Osborn would have left information for updating the data. I made the changes using some of the programs in the system and then began the report cycle. Thereafter my job was to stay awake and feed the printer.

The evening Friday was pretty easy. I could read after getting the printer going. The most vivid memory I have is being unable to stop laughing after reading about Yossarian's bombing run in Catch-22. As the night wore on, the lack of sleep became more telling and it was as struggle to keep from dozing off and awakening in a cold sweat because the computer room was quiet, meaning the printer was out of paper.

The normal reports generally required 16-24 hours of straight work, and I would finish up somewhere between noon and 8 PM on Saturday evening, having missed a night of sleep. With the monthly reports, the time requirement was closer to 30 hours of work. Snafus could always increase the workload. On these heavy months, I might be at the computer center until Sunday A.M. having missed two nights of sleep. There was no cafeteria, only vending machines. Because of the security system, it was very difficult to leave the grounds and to return.

My Sundays were spent in trying to catch up on sleep, attempting any semblance of a social life by hooking up with our circle of college friends, and the trip back to Baltimore sometime in the late evening. It was a brutalizing several months. There was never a week-end off; I found myself falling asleep at traffic lights on occasion; I gained weight with infrequent exercise; and I was stressed with the thought of the coming baby and the need to put money aside.

I was also very frustrated with the randomness of the quality of instruction that I was receiving in medical school. Perhaps half of our lectures were well done, reflecting excitement by the teacher for the subject matter and proper attention to the manner in which the information was delivered. But there were so many bad lectures that I found myself wanting to stand up and scream and hurl my desk at those who didn't really seem to care or who were incompetent teachers. I wondered why in the United States with about 100 medical school we students were not being provided with the best possible instructors using film clips and other media. Why did each school decide to go it alone?

My school experiences and general level of exhaustion came crashing down on me in November 1966. My internal emptiness had driven the search for a female partner and marriage the prior year. I was still yoked to religious beliefs in spite of attempts to remove the harness. (I probably carry a gene for rapid and strong pair bonding--how else to explain my lifelong falling in love with practically any woman that I slept with, including Sally, my first lover and marriage partner.) With the marriage came a child and now I was trying to do something that was quite difficult--to manage medical school and a heavy work schedule as well. It seemed impossible to continue and I decided to leave medical school. I went to the dean and told him of my intention to withdraw.

For the next few weeks I searched for computing jobs within the field of medicine. There were many positions available in academic medical centers throughout the United States.  At least three recruiters told me that they thought I was making a mistake--that I should complete medical school in order to enhance my advancement and salary in this field. It wasn't necessary that I do medical practice, but the degree itself would be very valuable in my career.

It was also about this time that I received a phone call from a nurse who worked for R. Adams Cowley, M.D., the chief of Thoracic Surgery at the University of Maryland. He needed a computer programmer and one of my classmates had given him my name. And so I met my first mentor in medicine.

He was a bear of a man, on the short side but very powerfully built. His hairstyle was a brush cut that was no longer in fashion in the mid 1960's and he was almost always dressed in hospital scrubs. He had what I would call a "determined" gait and always appeared to be in slight hurry to get to an important meeting or event. He explained to me that hospitals were not safe for really sick people and that the level of care tended to fluctuate by nursing shift. He said that he had started a two-bed unit on the 4th floor of the hospital near his office because he was concerned about the level of  care for his very ill post-operative heart and lung patients.

He said that in trying to improve the care of his own post-operative patients, he began thinking more about trauma in general and had become interested enough to want to study the changes that occur, for example, when a healthy person has a severe auto accident. His two bed unit had begun to function as a laboratory for other branches of clinical medicine. The hematologists were following the clotting changes that can occur in trauma, microbiologists were examining cultures to determine if and when antibiotics could be helpful, the pathology department was doing special tissue studies on autopsies from the little unit, and various "fellows" from anesthesia, thoracic surgery, and neurosurgery were spending time "helping out" in the unit.

He had created this little laboratory that provided the best medical and nursing care available in the hospital in a climate where the patient's condition could be followed in a scientific fashion. He was able to draw quality people to him who were interested in working on a significant problem in medicine. There were statisticians, mathematicians, experimental designers, administrators, grant specialists. He had formed his own little "operations research" environment where cross fertilization had occurred.

Cowley was definitely the motor. The rumor was that he was a Mormon who was separated from his wife. There was a nurse coordinator who worked with him, Elizabeth Scanlon, a very beautiful woman who seemed to work as many hours as Dr. Cowley. She nurtured him and put up with his occasional abusiveness. A part of me would have expected them to have an intimate relationship, but I think this was medical intimacy, a mutual embracing of vocation. His hard-working secretary was Sandy, who not only did the primary office work, but was also required to manage Dr. Cowley's business investment, The Cowley Trucking Company, a fleet of local dump trucks. Poor Sandy had eczema and it would flair when the good doctor was on a rampage and at a point where everything displeased him.

In our first meaning he said, "Eric, one day we won't die. If you think about it, the whole purpose of medicine is to keep people alive and in reasonable health for longer and longer periods of time. To my mind, it means that we are working toward immortality."

I thought he had a screw loose, but he offered me a job. He had thousands of observations on twenty or thirty different kinds of punched cards. He wanted me to take those cards and to begin to extract data. The only computing machine available to him on the Baltimore campus was an IBM 704, one of the first mass produced computers introduced in 1954. The available higher level language for the computer was Fortran, a symbolic language primarily intended for use by engineers, mathematicians, and other scientists.

Dr. Cowley's problem was a data handling problem and would be much more difficult to solve in Fortran than in COBOL, a language used in business where data movement rather than data calculation was the primary task at hand. I told Dr. Cowley that I was very interested in his problem, but that I needed to scout out the College Park campus of the University to see if a "friendlier" kind of computing machine was available. I was fortunate enough to stumble into the business center in College Park, where the manager was an unusual kind of bureaucrat--he was pleased think that his computer facility could be used after normal business hours to help in medical research. He offered us free use of his computer at off hours.

This was a wonderful opportunity for me. Dr. Cowley was offering me a job that I could work on whenever I pleased. At that time I lived in Laurel, Maryland -- about midway between College Park and the Medical School in Baltimore. I would have no need to work a solid block of time each weekend, but could break my work life into smaller pieces and perform many of them at home as I wrote programming code.

There was a catch. Dr. Cowley said that I had to get back into school. I had missed about six weeks of the 2nd year at that time. Mid-term examinations were coming within a month.  I went back to the dean and begged to be re-instated. They sent me to a psychiatrists where I cried the requisite number of tears in describing the demoralization that I had been experiencing. They let me back in.  I spent the Christmas vacation studying 16 hours a day trying to catch up. However, they did strip my scholarship. Since it only covered tuition and that had been paid for the entire second year, this loss would not affect me until the following September.

And so I became the programmer for the University of Maryland Shock Trauma Unit, founded by R. Adams Cowley--certainly a medical visionary. He bootstrapped his program into a full hospital for the study of shock and trauma. He worked tirelessly on his goal and eventually convinced the state of Maryland that an integrated Emergency Medical System was an essential part of modern medical care. Cowley was able to persuade the State Police to use helicopters for dual purpose, police work and emergency air ambulance work. The members of the State Troopers who did helicopter duty were trained as paramedics and certified in Advanced Cardiac Life Support and Advanced Trauma Support.

He was generally kind to me. I remember being reprimanded when I missed meeting of his advisors (I didn't go because I didn't think that I was needed or would have anything to contribute.) I remember one Sunday morning he took me out to breakfast. He picked me up on St. Paul Street in his Buick Toronado. He wasn't wearing surgical scrubs, but a nice pair of slacks and a tweed jacket. I remember him recounting his difficulty in medical school with a young wife and child. He recalled raking leaves for survival. He then went into surgery and the Army during World War II and had lots of hands-on thoracic work in Europe before returning to the states.

I last spoke with Dr. Cowley about a year after graduation. I was working as a consultant for the Public Health Service and some public information had come to my attention that I thought he should know about. He offered me a job but when I turned him down. I no longer wished to live in Baltimore at that time.  He wished me well and encouraged me to obtain a doctorate in computer science.

I left Maryland in 1974 before the statewide system had been implemented. When I returned to the state in 1983 I was in a little clinic on Smith Island desperately working on a women who had come to my office on Sunday morning from Church and almost immediately sustained a cardiac arrest. We called for help from the State Police Helicopter which arrived within about 20 minutes and landed a couple of blocks away. I looked up to see a trooper walking through the clinic door. He was carrying two medical bags. There was a strange holster that positioned his side-arm over his left chest.

He was incredibly competent and the tools that he brought were a little more modern than what we had been working with in the clinic. We brought the heart beat back several times and managed to get the patient to the waiting helicopter but we were never able to stabilize her to the extent necessary for transport. It was the first death that I encountered on the Island.

My first tough case back in Maryland from Montana. Dr. Cowley had reached out over 14 years and 150 miles to give me a hand.

http://en.wikipedia.org/wiki/R_Adams_Cowley