The Clair Elgin Story

October 3rd, 1963 at Stanford Hospital – attired in white coat and trousers, stressed to the max from 36 sleepless hours, my “to do” list of work chores suddenly grows from 11 into 111, and it’s entirely from being paged on the ubiquitous overhead hospital loudspeaker. The chores are nonessential, nonsensical, and notoriously meaningless, announced by an operator with poor attitude toward those dressed in white, particularly interns like me. It seems that everybody wants everything, and from me!

I attempt to finally grab a calorie in the cafeteria but find myself at the end of a long line of silly people, none of whom are stressed or tired. As exhausted as I am, I hear loudly and clearly, “Dr. Laub, Dr. Donald Laub. . . stat, emergency room, stat, nurses’ station stat.”

I take off at a trot and grab each of the down escalator rails with one hand supporting my entire weight. I leap seven steps at a time, having had plenty of practice with this routine- seven, seven, then three, then smack in front of the nurses’ main counter, my eyes artifically wide-open as our sign language for “you called?”

“You are late, Doctor! Do the H&P (History and Physical) on the incarcerated hernia in room three.”

I have always known that when an experienced nurse pronounces “doctor” with the first syllable going up and the last syllable going down without saying your last name, the nurse is really saying “shithead.” Being thus completely intimidated—and I am not your average candidate for intimidation—I immediately reviewed the ER chart, which noted “Clair Elgin, age 60, room 3, acute abdomen, V.S. BP 140/88, P112, WBC 11,560, HTC 44S.”

I hopped into room 3, where I instantly observed a large person in pain. I introduced myself in a professional and compassionate manner, and asked “Are you Clair Elgin?”

“Yes.”

“Tell me about your pain.”

“It started yesterday after breakfast. Some cramps, and then things got worse. I felt sick awhile, then vomited.”

“Did you have a bowel movement?” I asked.

“No. None. I’d like to though. But I don’t have any feeling for that.”

“Have you passed any gas since yesterday after breakfast?”

“Hmm. Come to think of it, I haven’t.”

“Where is the pain?”

“Right down here on the lower right side, in the groin.”

“Have you had your appendix removed?”

“I don’t think so.”

“Let me examine you.”

She pushed down the sheet, pulled up her gown, and I felt the lower right quadrant for tenderness that would indicate possible inflammatory appendicitis, or rebound tenderness, which would indicate a rupture of the appendix and peritonitis. It didn’t feel too bad, and wasn’t very tender.

I asked, “where exactly is the pain?” and she pointed right down into the groin. I felt a lump there, about an inch in diameter, like a bratwurst, and it was very tender around the area. The abdomen was distended and I percussed a lot of gas in there. What I also observed was that every square inch of the skin that I had just been privileged to see was tattooed in a rather intricate and lovely pattern. I did a rectal exam and a guaiac test on the stool, which indicates presence of blood. There wasn’t any. I told her, “it looks like you’re going to have to have surgery to find out exactly what’s going on in this area here. It could be a loop of bowel that’s stuck down there in a hernia.”

“Oh,” she said.

I drew a few tubes of blood for electrolytes and CBC, requested a urinalysis, and called x-ray to take a regular flat plate of the abdomen. She wasn’t nauseated at the time, so we didn’t have to pass a nasogastric tube through the nose into the stomach to relieve gas pressure, which could have caused vomiting during induction of anesthesia for surgery and life-threatening aspiration pneumonia. We inserted the tube when she entered the O.R..

She thought a minute and then asked, “Doctor, where do you make the incision?” I showed her. She said, “be sure, if you can possibly do this, to get that tattoo aligned exactly right when you do the suturing.”

The actual surgeon, the excellent Dr. Hurley, was now by my right shoulder, a young cardiac surgeon in training. He said, “well, Dr. Laub wants to be a plastic surgeon, so that’ll be his job.” We all enjoyed a little exchange of words and went to work. We started an IV, gave her some fluids to replace what had been lost from this inflammatory episode, and I went out to write my observation on the H&P section of the chart.

Clair Elgin was under the overall guidance of “HAO,” Dr. Harry A. Oberhelman, who had just checked in on the case. He was the professor of surgery specializing in the gastrointestinal tract, a perfect match of patient and surgeon. Dr. Oberhelman was possibly the most empathetic person in existence. A big man in every way, he had sympathy for the patient and did daring operations that nobody else would try , repeatedly pulling his patients through. He is famous for his skill at performing surgical miracles. When the patient has pain, he relieves the pain. When a patient needs surgery, he doesn’t hesitate. He was my role model at that time. I was to scrub in on the case as second assistant, and I was quite excited to be able to learn about an incarcerated inguinal hernia. The two super-doctors cleared away from the gurney and I started the IV while attempting light conversation, which went nowhere. But then she revealed, “Doctor, there’s something you should know. Please keep it quiet. People in general are not aware that I originally had a penis.”

The cover was still far enough down that I said, “Well, I don’t see it here. What did you do with it?” She said, “I didn’t want it and I removed it myself because I couldn’t get any surgeon to believe that I was a transsexual.” I said, “What is that?”

She explained it to me. She told me further that she was born in Arabia, the son of a Scottish trader who ran a ship between Arabia and England, and was educated aboard ship by specialized tutors. She was genetically XY, a male born with a grade 3 hypospadias, a birth defect in which the urine comes out just above the scrotum. The mistake was made that Clair was a female because the genitalia resembled a clitoris and labia in appearance. The diagnosis was plausible, since no genetic karyotype was available in Arabia in 1900. When puberty came along she developed an ample penis, which was upsetting to her, having been raised for 15 years as a female. For many years, she sought medical advice but there was no one who would help her. Unable to live as the woman she felt she was, she removed the penis and the rest of the male apparatus with a sharp knife and presented herself at the University of California emergency room. She was taken care of there by urologist Dr. Goodwin, who was sympathetic to her plight and fixed her up as well as possible at the time.

I didn’t examine her further. We went to surgery, where the incarcerated inguinal hernia turned out to be a greater focus of conversation than the gender conundrum. During wound closure, I confidentially revealed to Dr. Hurley what she had told me, and he simply said, “Oh.”

I was grateful to him for his explanation of the pathophysiology of the incarcerated hernia: the testicles in our embryonic life as males originally enjoy a home around the kidneys. Shortly before birth they descend down from the kidney under the influence of various signals, mainly hormonal, and they migrate beneath the abdominal contents to the groin, and then through the groin area into the area of the external genitalia. In effect, these masses of germinal tissue called testicles end up in the labia, which become enlarged and assume the role of the scrotum.

Occasionally bowel follows the testicle down, and if the passageway has not spontaneously closed just before birth, a hernia is thus produced, with the bowel going up and down from the intra-abdominal area into the labia or the scrotum when a person strains. Now if the bowel gets stuck down and will not return to the abdomen, you must try to push it back up or stand on your head, thereby enlisting gravity to assist the push – you might even put a little ice on there to reduce the swelling, and see if this maneuver might reduce the hernia, putting the loop of bowel back into the abdomen. The hernia failed to reduce in the Elgin case. She was in danger of losing her life because the intestine’s blood supply can be easily blocked off by the swollen tissues. Trouble was imminent.

Dr. Hurley deftly made the incision and dissected expertly down to the loop of bowel that was the lump. With manual, gentle yet firm pressure, he coaxed the incarcerated segment of large intestine to go back into its rightful home in the abdominal cavity. And thus the hernia was “reduced” just in time, because the bowel segment had begun to turn cyanotic blue, the beginning of the pathophysiologic process of dying from lack of arterial blood flow. We found that the intestine was not completely without viability. It revived, pinking up with the liberation procedure, allowing circulation of blood to be restored, and putting the patient out of danger. Hurley repaired the defect, which was in our jargon labeled direct inguinal hernia, with 0-nylon (very strong sutures), permanently fixing Clair’s condition.

I sutured the skin extra carefully to fulfill my promise to the patient to preserve the integrity of her tattoo art as much as possible. She healed well and was a most pleasant patient. Her face was not tattooed at all. Her feet were not tattooed. But most everything else was. I noted that on the back of her elbow was an eye. When she straightened her arm, the eye closed. I asked her about her body art, and she said she had a tough childhood and had ended up in the circus as a tattooed lady and sword swallower. She was interesting and nice, so I made a place for her in my mental list of friends. I was glad that her recovery went so well.

On discharge of a patient from the hospital, my duty as an intern was to make what is known as a discharge summary, putting all the facts of the case on one typed page. In her chart I noted that in the urinalysis I had ordered, there was microscopic evidence of red blood cells (RBCs) present. I called and asked her to repeat the lab. She of course wanted to know why, and I told her. Lo and behold, the repeat micro was positive for RBCs again. On the telephone once again we asked for an intravenous pyelogram (IVP) to see the kidney through an x-ray taken with dye infused into the organ by way of a vein in the arm. This would show the cause of bleeding into the urine. She had to have an enema and an empty bowel at the time. The reasoning was explained to her and she was compliant, although naturally questioning what could possibly be the cause of concern. I was as helpful as could be without mentioning the C-word (cancer). The IVP turned up a hypernephroma, a type of cancer – adenocarcinoma of the kidney cells. It was a medium-size mass. I reported this finding to Dr. Oberhelman and we called Clair back to clinic for more studies. I explained that she had cancer and needed to have the left kidney surgically removed.

This was promptly arranged, and Dr. Oberhelman performed a brilliant operation. Again, Clair did well after surgery. She was happy and we were happy. She had undergone a second successful surgery.

As we made daily rounds on her, we noticed that there was a frequent visitor to Clair’s room, a man with glasses and a stiff leg indicating a knee fusion. He wore so much jewelry that he provided us with a new definition of human ornamentation. The appearance of this fellow was definitely on the ostentatious side. He had a large piece of gold fashioned into a cross that hung on a golden necklace. He had a huge ring with peculiar designs on it etched in amber with a ménage à trois scene under a tree. Diamond rings were on the other hand. His clothes were definitely noticeable, e.g. an orange jump suit. He wasn’t on exhibition, but he was memorable. After a few days, we asked Clair who he was. She said he was “my private nurse, Gene Gaynor.”

Gene had been a nurse, and a very good one. He previously had run the U.S. Army operating room in a hospital in Fiji and then in Korea. He fractured his leg when he was escorting and nursing twelve patients on a DC-3 plane evacuating the wounded combatants to Japan. Gene had been sitting near the huge cargo exit door when the plane crashed in the frigid mountains. The door blew wide open, throwing him out into the snow. He was the only person who didn’t perish. After his rescue, he was brought stateside to the VA Hospital, where he was scheduled for above-the-knee amputation of his left leg. Of course Gene said no; he refused. He was still in the hospital, attempting to heal his knee and not doing too well, when Clair met him. She was a Pink Lady at the VA, entertaining patients by coming around and playing tunes on her harmonica. As the story slowly worked out, Clair felt sorry for his plight and hired Gene as her private nurse.

Well, Clair had some idiosyncrasies, as you might have suspected by now. Having been raised Muslim, she had good habits; she abstained from drinking coffee or alcohol. Despite being female, Clair had retained some of her male spirit, owning a motorcycle, a gull-wing Mercedes, and a 300 Savage telescopic rifle. She had a fondness for Japanese architecture. Her profession was photography, which she had been taught on the ship during her schooling years, and during the birth of Silicon Valley she was able to make microphotography negatives of the plans for a computer chip; the manufacturing process utilized silver salts in the negatives of her microphotos to etch silicon into chips.

Clair was rewarded for her efforts and gained a large number if shares in one of the more prominent laser and computer companies in the Silicon Valley. With her money she built a Japanese home, a five-sided pagoda on the top of one of the highest hills in a most exclusive suburb, Los Altos Hills. She included koi fish tanks where the fish were able to swim from outside the home into the inside for Clair’s pleasure. The five alcoves of the pagoda each had a wind-generated musical organ, insulated so that there was no sound of blowing air during the playing of the pipes.

It was to Clair’s dismay that she contracted a finger infection and subsequent tendon scarring in her right index finger. I saw her for the third time in the hand clinic with a tenosynovitis, severe. She was hospitalized under the care of internationally famous Dr. Robert Chase, who treated her with skilled surgery, appropriate antibiotics, and drainage. But alas and alack, even with such expert medical care, Clair ended up with a stiff finger, reducing her organ playing ability to near zero.

So now Clair utilized another aspect of Gene’s talents. He had been trained as a concert pianist and could play all sorts of music, especially background music for Army cocktail parties during his active duty days. He had actually played on occasion at Radio City Music Hall as a civilian, and did a great job playing the organs at Clair’s home. To satisfy your curiosity, Gene lived in a guest house on the side of the hill where Clair lived. So the relationship was purely professional, and I remained calm about that after I inquired.

Clair began to become a little more depressed and lonely, in part intensified by her Muslim guidelines. She was not drinking, but always smoked heavily and drank coffee all night. Gene reported her as being rather down and doing nothing but using her new-fangled video recorder to tape her favorite shows (such as “Columbo”) and then watching them during the daytime.

Gene asked to have a private conference with me, and he related this problem that he hoped I could solve. I took two nights thinking about it and came up with the job of “Interplast Photographer” for Clair. She would make trips with us for humanitarian medical service in developing countries, taking photographs to chronicle the surgeries for cleft lip, cleft palate, and burn scar deformities. She took to this well and rightened up considerably. She had great pride and her self-esteem was rescued, especially because of the appreciation of one and all for her expert work and for her compassion toward the patients. Clair took wonderful pictures and we were delighted with the arrangement.

At that time we flew our own DC-3 airplane, which was not pressurized, and Clair, with her pulmonary condition, would become poorly oxygenated whenever we flew above 3000 feet. She would fall asleep and turn blue. It was a joke that we didn’t need an altimeter; we could just look at Clair to determine our height above sea level.

Clearly, Clair was quite talented, except in one area: financial matters. She parlayed her money on the advice of her clever lawyers into the company that bought her company, and then again into the company that bought that company, each time on as much margin as could be loaned by the bank. Clair was quite well-to-do at that point, being worth several million in the 1970s. She was a wealthy person, and Dr. Oberhelman and I knew it. We felt that we might ask her for some money for his research projects on cancer, and for my program in Mexico for kids with cleft lip and palate. So I became her general practitioner, treating sore throats, colds, constipation and other minor things. And Dr. Oberhelman was always informed about what was going on.

As time passed she began to complain to me about a dry cough and intermittent pneumonia. I was quick to pick up that with her history of smoking cigarettes we ought to look into lung cancer. Indeed, the bronchoscopy and chest x-ray were positive for cancer of the lung, of a type, position, and size that was not easily resectable with surgery. Furthermore, her breathing capacity was not as good as desired for a thoracic surgical patient. But she was treated with x-ray therapy with good success.

Shortly after we thought we had successfully irradiated and eradicated the tumor, Clair again desired a surgery, this time to improve her appearance and to look younger. The many lines in her face made her look more male than the ordinary female. Everyone who knew her realized that she was pretty much male. In Latin America they called her “Señor Clair.” But nobody had a chip on their shoulder or felt any umbrage toward her—they all seemed to take her at her value, as a good photographer and an intelligent and kind person.

Anyway, we did a face-lift on her which went very well. Postoperatively she told me that she would like to see the dean. I wondered, “why would you want to see the dean, dear Clair?”

She answered, “Well, I’ve donated some money, and I’d like to talk to him about it.” So I called him up, but he was not available. I called again and persisted until I finally reached him. He said it would be difficult to see her because he’s out of town a lot. He generally didn’t feel much like doing the appointed visit, but since he had been called to the University of Colorado the next day, he said he would stop in before he got on the plane. He failed to honor his word. Clair did not like that, nor did I appreciate that kind of service to my patient. Our illfeelings quickly passed.

We began to think of going to Mexico to see the patients that Dr. Chase and I had lined up in our first Interplast clinic, and we needed money. I had before and after pictures of patients with cleft lips, cleft palates, burn scars, and other wonderful things, and I repeatedly showed them to Clair in a prepared scrapbook (these were in the very same binder as shown in blog post number 2: The Glory Years). She was very much touched with that. When the time seemed right psychologically, I approached patient Clair in the clinic of Stanford University Hospital, second floor (the clinic we worked in for many years, with tiny rooms). I showed her the pictures again and said, “Clair, this is the first time I’ve ever asked anybody for money in my life. I was hoping you could help us with three thousand dollars to help with our trip back to Culiacán, Mexico, because I think you’re quite interested in this program.”

She looked at me, surprised and amused, and said, “Well, you’re the most goddamned ungrateful person I’ve ever known. I just gave you three million. And now you’re asking me for three thousand more?” She took out her checkbook. I was stunned. She dashed out a check and threw it at me.

Of course I caught it and was quick to say, “Clair, I didn’t know anything about it. Who did you give it to?”

She said, “Oh, I was here and finally talked to the dean and we got it all arranged. It’s for Dr. Oberhelman’s cancer research and for your Mexico project.”

To which I replied, “Oh.” And then “Thank you!”

Dr. Oberhelman happened to be in clinic at that time and I found him in the adjacent hallway and whispered to him that such-and-such has transpired and the dean may be planning to “steal” the money. I said, “I’m pretty angry about it and I’m going there right now to ask him for it.”

Dr. Oberhelman warned, “Watch it. I don’t know if you have tenure, and he may fire you on the spot!”

I said, “I don’t have tenure, but he can’t do that. It may not be illegal, but it’s unethical and immoral. I’ll be back.” I headed down to the dean’s office.

His secretary stood up to head me off.

“May I help you?”

“Yes, I’m Dr. Laub and I’d like to see the dean right away.”

“May I tell him what it’s about?”

“Money.”

“One moment.”

She went into the dean’s office, then came back, saying, “The dean’s behind closed doors and cannot see you now.”

“This is urgent. When can he see me?”

“I don’t know.”

So I had my first setback. I tried to hide my expression by putting my head on the counter. I said, “Okay. I’d like to see the person in charge of development, Mr. O’Brien.”

She checked his office and returned. “Mr. O’Brien is busy.”

I said to myself, God. Oh God. I said to the secretary, “Please do me a favor, if you would be so kind. Go into the file drawer and pull out the file on Clair Elgin.” I spelled it for her. “Open it and look in. See if it says something interesting or peculiar that may have something to do with me, Dr. Donald Laub.”

She did as I asked. She held the file protectively close to her chin and looked through it slowly and carefully. As she scanned the pages, her eyes widened, and her expression changed. I had finally gotten her attention.

“Ohh. Ohh. Yes.” She then went into the dean’s office, then into O’Brien’s office, and then returned. “Mr. O’Brien will see you now.”

O’Brien came out, and by that time I was able to get some steam going. I explained that Ms. Elgin had donated three million to Dr. Oberhelman, Dr. Meyerowitz, and Dr. Laub’s projects, and we had not yet been informed in any way.

O’Brien looked uncomfortable and said, “Oh yes. I must admit we diverted it to general funds.”

I remember saying, “that is my money.”

He said, “Oh, I think we’ll be able to get you ten thousand right away.” In a few days another administrator, the associate dean for special gifts, called me to say, “I’ve got ten thousand dollars for your project. You should feel very happy about this.”

I did not respond. I told all this to Dr. Oberhelman the next day in the locker room as we dressed for surgery. Neither of us could credit such behavior. Eventually we accepted it, though still indignant at the injustice, and we both made ironic jokes about it. One day I said, “Harry, we’ve saved Clair Elgin’s life three times: incarcerated hernia, cancer of the kidney, cancer of the lung, severe tenosynovitis, and I’ve given her a face-lift. We’ve taken good care of her in general as good doctors. And the dean took her three million and gave us back ten thousand.” He said, “and we’ve had to scrounge to get even the minimum for our own projects.” I replied, “I think we should go to her home and ask her to change her will.” He said, “uh oh. We may get into trouble.” I said, “let’s get into trouble.”

So we made an appointment with Clair, and we went down newly opened Interstate 280 in Dr. Oberhelman’s station wagon to her home and rang her chimes. Gene Gaynor opened the door and welcomed us. He told us to take our shoes off in Japanese style so we wouldn’t get the nice hardwood floor dirty. We complied, and admired the koi fish and the organs.

Clair came out, invited us to sit down, and asked Gene to give us a cup of special coffee. Then Gene went over and played a few tunes on one of Clair’s five organs, for which we were very appreciative because it was loud, genuine, wonderful organ music.

Clair asked why we had come over. We said up front that we were there to ask her to change her will. We gave her a description of what had happened and declared, “we think we deserve that money, not the dean.”

She told us that we didn’t have to go through the trouble of a house call. “I can handle that with a simple phone call.” She picked up a red phone on the desk that had a direct connection to Jack, her lawyer, and said, “Jack, please change my will to blah blah blah. When it’s ready I’ll drive my motorcycle down and sign it.”

Bam. She hung up. We were overjoyed. Clair could see how happy we were. To do something even more, she gave me her 300 Savage deer rifle with the scope on it and said, “It’s all sighted in.” I couldn’t believe it.

Harry and I got into the station wagon and put the hammer down, speeding along I-280 at at least 90 mph, passing every car. We were so joyous that we drove right up to our boss Dr. Chase’s office and burst into the secretary’s area. Chase’s door was open. We yelled, “boss, we just made three million bucks.”

But lo and behold, an ominous voice came from around the door. Sitting on the couch in there was the dean, who peered around and asked, “where have you boys been this morning? Been up at Clair Elgin’s by any chance?

Medicine, like life, is a trampoline. You go from the highest to the lowest repeatedly. We figured we were fired. But we did own up to it. “Yes, we’ve just come from there.” The dean said, “Well, you shouldn’t have done that. But you do deserve it. It was the best thing to do.” So now we were feeling great again, ever so happy.

Time passed and Gene came to see me again. He said Clair’s investment fortunes had sunk in the depression of the 1970s and her bank called repeatedly for more margin, more margin. Clair was bankrupt and all the money in reserve for Stanford was no more. Clair became despondent and depressed and Gene asked if we could find her another worthwhile thing to do. I said, “Gene, I can’t do that. How can I ever think of something else?” But Gene pushed, “come on boy, you’re the colonel, you’ve got to think.” So about four days later I came up with the idea that Clair should invent 3-D television (1973). Clair did just that: invented 3-D television, protected it with overlapping patents, and formed a company with 25,000 shares going to Gene. Interplast was not in her plans at that time because she was not wealthy at that stage. They moved into a shack-like home in Redwood City and they lived happily ever after until one Saturday morning when she called me.

“Doctor, I have severe pain in the rib when I cough. It came on suddenly.” On the phone I was able to diagnose that it was located in a single part of one rib, probably a fracture, in fact a pathologic fracture. A pathologic fracture is one that occurs without trauma, and it can mean a metastasis from cancer of the lung to the rib, a common turn of events. So with my son Ray, I went over to her rather small home in Redwood City, California. Gene greeted us and I went to check out my patient. I put my finger where the pain was located. It felt tender and mushy and I knew what was probably going on.

I had to get Clair admitted immediately to the oncology medical service of the hospital, but on Saturday there wasn’t much going on at Stanford. Fortunately my favorite internist, Dr. William Fowkes, husband of nurse Ginny Fowkes, who had been in my department originally as head of the Physician’s Assistant Program which we had co-founded, was willing to take the patient, but cautioned that nothing much could be done over the weekend. As you know, in medicine at Stanford the physician in charge does not make the final decision on any of the big items. It is the intern who gets his experience by consulting all the world’s experts and then making a decision after seeking approval from his boss. This is standard operating procedure. And so it was that an intern was going to take care of my friend and patient, Clair Elgin. Wisdom was to be acquired using this new case.

Upon arrival at her room on East 2-A, the medical floor of the hospital, however, we found that the intern was off duty and that, for the weekend, the doctor in charge was a medical student who had had little experience. In fact, this was her first serious patient. I debriefed her in detail and said that it was likely to be cancer. She asked what I would advise. I told her she must always preserve hope. She could certainly tell the patient what was found, but she could add, for example, that occasional spontaneous cures do occur and have been documented; that new drugs are around the corner; that more radiotherapy might be possible; that you can never tell if there will be a cure from some new and peculiar regimen. Be rather upbeat about it all.

She said no, that she had decided early in her career that she would always be “honest” with the patient. For example, if there was a cancer she would tell the patient there was a cancer and not try to hide the truth. I differed with her. She differed with me. So be it, I thought. I went home.

The chest and rib x-rays showed a cancer metastatic to the rib, and my young doctor marched into Clair’s room with the x-ray in hand and said, “Ms. Elgin, look right here at this rib. This shows cancer.”

“Oh? What kind of cancer?”

“Well, it’s metastatic cancer, probably from that cancer of the lung you had years ago.”

Clair was ready with the next question. “Doctor, how long do you think I have to live?”

“I’d say about six weeks. You really ought to get your things in order.”

Clair said, “Oh. Thanks very much for telling me so precisely. Doctor, would you mind handing me my purse?”

Clair opened it and took out a little package, which turned out to contain cyanide capsules. “Would you mind giving me a glass of water?” With that she took the cyanide, drank the water, had an immediate seizure, and keeled over.

She was desperately resuscitated and breathed for 24 hours more, but she was already d-e-a-d. That was it.

The young doctor called to inform me, and I was absolutely furious with her. I yelled, “I told you not to do that. Look what you’ve done!”

She stammered some answer I cannot remember.

“Oh! Goddamn it!”

That was the end of Clair and the end of her new company with its 25,000 shares for Gene, but none for Interplast or Stanford.

I was of course quite upset with the fact that a medical student on her first case had done something that I would not do. However, in retrospect, and it wasn’t until 30 years later, I began to think that perhaps she was really right. You have to consider in any argument that maybe the other person is right, and in fact seriously consider it. I hadn’t previously allowed that thought to enter my mind. But in later reminiscing to myself, I remembered Clair instructing, “please tell me when I have about six weeks to live, because I would like to know that so I can do something about it.” I never really took that to heart, never heard what she was really saying. But of course she was saying that she planned to go out with a minimum of suffering. That was her free election. But I didn’t catch it at the time. I did remember that she used up all of her pain pills every time I prescribed them, and now I think she didn’t ingest all of them; maybe she took none of them – maybe she saved them all up, because with the cyanide she also took a handful of narcotic tablets.

The young doctor was indeed younger than me, but age does not confer intelligence, only wisdom. Besides that, her high level of intelligence had by power of deductive reasoning come to the conclusion that truth is pretty much always the best path, even though my thesis was that the human psyche does very well on hope, and perhaps that the patient really knows or suspects strongly that dying is really in the cards, even though the doctor and the patient are both putting up a façade. This intelligent young doctor was not experienced enough to realize that emotions rule over all scientific logic and even at times over physical observable fact. I had known this and was using that experience.

Clair went off into the spiritual world, displaying more wisdom than any of us, perhaps abandoning her beautifully ornamented body. She may have elected not to try another life. Clair was a friend. Not in the sense of a friend I considered “close” or a friend I would ask to dinner or a friend I would introduce at a party, but as a friend who was a coworker, a valuable and essential member of the team, and therefore, an extension of myself. To quote John Donne, “No man is an island, entire of itself; every man is a piece of the continent, a part of the main…therefore never send to know for whom the bell tolls; it tolls for thee (Donne, Meditation no. 17 from ‘Devotions Upon Emergent Occasions’ 1624).” She was someone I employed as a photographer of high ability, and she was an interesting human being with a wealth of experiences, having gained wisdom from her sense of adventure, her willingness to take risks, and as a person of principle who was daring enough to act on her convictions. She reinforced the fact that all people are equal, and moreover that all people have a certain valuable trait which you should acknowledge even though a person may be “strange” and not socially acceptable to the mainstream. Those are the very people you should employ or include as parts of your organization, because they end up becoming the most loyal and dedicated friends. She was an outlier with an irreplaceable persona. There is no one like her.

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