Dr. Robert A. Chase is my professional father, a mentor most professional and sophisticated by virtue of his technique and his abilities. Judge him by his results.
He has guided me up the highest mountain. My career went so smoothly all the way to the summit; I was able to make each and every decision with an algorithm that I selected. RAC never said no, and yet he never said yes. It was as if tenure had been given to me from him; I had free reign to decide where to go, how much energy and resources to expend on each project of mine, which project to put into the “objectives” list and in which order of priorities without political, economic, religious or social pressure. I knew, I realized, that he provided all the political muscle for which one could ever ask. He was #1 in the department, The Chief, and I was in the next layer on the TO&E chart as chief of the Division of Plastic and Reconstructive Surgery. The magic of his management was that I thought I was pulling all the levers, changing all the gears; that I was in charge. In retrospect it was his instinct that guided him to provide for me everything needed for a successful career and without me ever knowing that he was the snowplow silently clearing the way. He had the political genius to make me unaware who really pulled the strings. Even the advice he gave appeared to me to be what I had thought up.
I know that his goal for me was to excel in the molecular sciences by applying them to clinical problems. In this way I was to produce solutions for all to benefit from in a wonderful and basic way. In fact he formally told me so after we arrived at the Stanford School of Medicine in 1963 on the 4th birthday of the hospital. “A great wisdom has created Stanford, and though unheard-of now, it will be, and is ordained to be great,” He said. I was happy to have the chance. At the debriefing dinner he declared, “this is the game: think of Stanford as NIH West. The very best brains have come here in their pre-Nobel laureate phase of life. The hospital has been created to have a ready source of human pathology for the clinical aspects of their basic biomolecular research. And Don, if you are addicted to solving clinical problems in your research, wisdom has set it up so that you will be rubbing shoulders, even eating lunch, with this huge reservoir of talented genius; your job is to hook up with them to the both of your advantage.”
Indeed, this was a wonderful life. There were four memorable examples of Stanford’s excellence, each one of them impressive. RAC led me to them all.
“Don, do you desire to remove tattoos from the skin ? OK, here is the ”inventor” of the laser. Also, I introduce you to the top expert in the development of Q-Switched Ruby laser, Arthur Vasiliadis. He has a grant from the US Air Force to develop a laser suitable to use as a weapon in the Saturn rocket. He is actually developing the laser for use in the eye.
“Might you desire to solve the insoluble problem of healing the severed spinal cord? They don’t ever heal you know. Here is a Nobel candidate in histopathology to help you.
“Do you desire to produce a test instrument to gauge the education of the residents in the various training programs in plastic surgery? Here is a Nobel laureate in educational psychology; his Ph.D. candidates and he himself will help you analyze every question and tell you the theories behind what you are doing.
“Or perhaps you desire to become expert in the very large flaps to heal the decubitus ulcers of the paraplegics who don’t have protective sensation? Here is a top professor of Physical Medicine and Rehabilitation (Physiatry). He also knows the facts and figures in all literature regarding your project for the jail patients to reduce recidivism by Lombroso’s theory of making the socially deviant more acceptable with the method of improving the appearance of those who “look like crooks”. Dan Feldman, Physical Medicine Professor, had brought his entire department from the University of Washington. We will make rounds with him every day and there will be our first hand patients, non-healing ulcer patients, and spinal cord injury patients for the newly minted plastic surgery division.”
RAC identified three paraplegics with the very worst decubitus ulcers, refractory to every treatment. He then showed me how to do his special operation: to remove most of the bones of the lower extremity-half the bones of the thigh, the tibia and the fibula in the lower leg, all the bones of the foot. This “Chase Filet” of the lower extremity yielded more than enough vascularized soft tissue to heal anything that came its way including all incurable ulcers. When I did the operation with my mentor, I simultaneously happened to produce a motion picture, and also presented the paper on the subject to a national audience– RAC made some subtle suggestions and drew the blue lines on the skin. I only “connected the dots”. That was all, but my self esteem was bursting at the seams! I thought that I was a fantastic surgeon as a fourth year resident.
Here was the genius of RAC: he was introducing a new technique to the fund of knowledge, doing an operation worthy of a paper and producing a scientific motion picture. He was making a breakthrough while here I thought this was my operation and my thing. At the same time, I was also learning his clever teaching philosophy. As I went on, I made it part of my repertoire. I did my best to emulate and copy his methods.
Thank you, father.
I had been recruited, rather offered, or rather RAC was nice enough to find some sort of a position for me in this heaven by name of Stanford. However, it turned out that in those days, heaven had all the research in the world but very few patients. Because he did not say no, I began to search for patients from the extramural area.
As goes the poem by Frost: “Two roads diverged in a yellow wood and sorry I could not travel both.” I wanted both the opportunity to work with the great ones and also to contribute in clinical plastic and reconstructive surgery. “Long I stood and looked down one as far as I could to where it bent in the undergrowth then took the other, as just as fair.” I took the one that best satisfied the dream with which I was programmed: to heroically help other people.
Then came Antonio Victoria, the first patient of what would become Interplast – a 14 year old Mexican boy with cleft lip and palate who came to us from our neighbor to the south, not having received any care for the condition which made him a social pariah. Here was the opportunity to study skeletal growth, and muscle development in the presence of this very significant deformity – basic research, having to do with the growth of bone, the enzymes that controlled this growth, and other basic processes that were active on the molecular level.
RAC took me with the other chief residents to dinner at the finest steak restaurant in Redwood city in 1964: Harry’s Hofbrau. I still sit at the very same table now, 45 years later in 2011. He outlined his plan for us, which ideally was to be one year in stewardship with these Nobel laureate class scientists who had been recently recruited to Stanford for the purpose of fusing molecular science with clinical science. The promise was that magnificent results would follow. All of us enjoyed the dinner, and we took the mentoring seriously.
But other magic also was being dished up. Antonio Victoria became the magnificent result of RAC the craftsman surgeon. His capable hands performed the operations with textbook precision. It amazed me that instant, permanent and dramatic results like Antonio’s could be taught to me and learned by a person like me in a period of two years. A happy life was produced from a non-productive stigmatized existence with three surgeries! Antonio, and thus RAC, steered my career 180 degrees from biomolecular researcher to physician educator.
What was it that completely turned me on to this helping way of life? Was it the basic doctor instinct of service or could it be psychic income, or the peak experience, and immediate gratification? These factors found fertile ground and RAC and I were soon off to Mexicali on the Latin American Rehabilitation Program in search of more Antonios.
Why was the first patient in line at our ad hoc clinic coming in with a bag on his head, being lead by grandma? His trouble was a burn scar deformity around the right eyelid that caused some ectropion (turning out of the lower lid), and nearly the end of his social and psychological life. Amazing what effects a physical deformity can have when the culture places such emphasis on it. Furthermore, deformity is fixable, if plastic and reconstructive surgery could just be exported the short distance of only 1 mile past the fence separating us from our southerly neighbor, and only 614 miles from us in northern California. So, the goal was “fixed;” I wanted to do this the rest of my life. What a great use of the skills RAC was making available to me. Goals are easily set; they require only a pen and paper and friends to fire you up, and give you a little push.
However, achieving objectives is more difficult than setting the sights. Having 25% of plastic surgeons participating in such programs, having international work become sort of an official field or sub-specialty in the plastic and reconstructive surgery discipline, requires commitment, some degree of control and the ability to change to accommodate external forces. These are the Three “C’s” – the Keys to happiness for the type A personality, as explained to me by Dr. Roy B. Cohn.
RAC helped maximally, especially with the control, the change and the commitment aspects, and with the fiscal aspects as well. It is said by the Swanson Family Foundation that any charitable or “free” program requires money, i.e. M.O.N.E.Y. And so the obstacle of real money, albeit spent most frugally, was to be solved.
My wife Judy arranged the Walks for Mankind, which allowed the community to raise money. My good friend Clair Elgin contributed as a grateful patient. The CIA was requested to help. All of the foundations likely to be interested were contracted, and every ad in the magazines with a picture of a forlorn child with big eyes received a personal letter or call. We devised a program to build an OR and recovery room in a naval ship, a yard freighter manned with pre-juvenile delinquents who would learn medical corpsman skills, culinary arts, electronics and seamanship, thus achieving positive reinforcement, self image increase, and the value of working as a team. We obtained a grant from the Rockefeller Foundation thanks to Dr. John Wilson, acting Dean at the Stanford School of Medicine, and a ship via Capt. Baran of the Pentagon. The ship was in the San Diego Reserve mothball fleet and a spanking new vessel despite being built in 1943. Hordes of volunteers came forth in every profession, only to have the “Good Ship Lollipop Sink in the Palo Alto Council Chambers” (headlines in the Palo Alto Times). Guidance from the legal profession and financial backing from the transsexual community inadvertently came up with “the great catalyst:” the money for the program.
Again, RAC was instrumental. He was the recipient of a telephone call from the president of the university, who in turn had been informed by the development office that an Orange County donor who had planned to donate $1 million was upset that Stanford was doing the most awful thing: the sex change operation. The donor backed out because of this heinous going-on for which I was partially responsible. Suddenly the whole international reconstructive surgery program that we had dreamed up was at risk because of the work I was doing.
RAC spoke to me; “What are you doing? Is it scientifically based? Is it worthwhile? Perhaps you might consider stopping this thing.” Father RAC, why did you allow all these coincidences?
RAC promptly arranged teaching grand rounds for medical students and residents with professors and the “ruling class” in the audience. The pressure was on as I presented several cases of bona fide surgical, psychiatric and behavioral human pathologies worthy of academic study. RAC made a deal with me: if the audience appeared to be in favor of my gender dysphoria study, we would go on. If they seemed to be uncomfortable, I would discontinue it. To my relief, everybody approved of it with little reservation except for a few female students, who wondered what happens when you give estrogen to males. The overwhelming majority responded positively. Thus, our funding for the international surgery program was secured. RAC’s indulgence, leadership, and overarching wisdom were therefore responsible for all the years of implementing the rather immediate solution to the worst condition imaginable: congenital deformity.
RAC was the head of the first academic department that conceived, developed, and implemented multidisciplinary trips to developing countries focused on a single diagnosis. He co-founded the residency program combining general surgery and plastic surgery training into one. He was and is an excellent leader and a superb surgeon, but primarily, he is a great teacher. He is my father, I am his son, and I could not have had even a fraction of the career I did without his guidance. Would that I could fully emulate this historic character.