All in the timing
Excerpts from the upcoming autobiography of Atlanta’s first health czar
In 1984, when Charles Hatcher took leadership of Emory’s health sciences center, he had some reservations. As Emory Clinic director, he had known real power, generating millions of dollars to power medical school growth. As chief of cardiothoracic surgery, he had turned Emory’s open-heart surgery program into one of the nation’s largest and most respected. The health sciences center, on the other hand, was a loose confederation of three schools, two hospitals, and a primate center. Despite the reservations, Hatcher took the job and in essence became Atlanta’s first health czar. Among his many career accomplishments, he jumpstarted research at the center and made it easier to access patient care at Emory. Eloquent, always prepared, he made it look so easy—even when it wasn’t.
Attapulgus, GA, roots
Later, when people asked me where I was from, they would look at me as if I were from Mars. For years, I thought it a handicap to come from such a small town with such a peculiar name. I would realize later how fortunate I was. About 400 people live in Attapulgus now, and about 400 people lived there in 1930, the year I was born, amidst the country’s epic slide into the Great Depression. My father’s old-fashioned general store sold everything from tuxedos to wagon-wheels. Times were hard, even for my parents. I went to work on a local tobacco plantation when I was five, opening the gate each time a wagon loaded with tobacco barges arrived, making certain that no livestock escaped, then closing it as fast as I could. I remember the camaraderie. I also quickly realized how little my fellow workers earned. It made a good student out of me: I didn’t want to grow up to be a farmer.
Setting the curve, early
With his Naval Academy acceptance postponed because he was only 16, Hatcher entered the University of Georgia, the proverbial big fish from the little pond suddenly dropped in an ocean of 20 times as many students as people living in Attapulgus. My inorganic chemistry professor joked I must be the most frightened student he had ever had—amusing, he added, because I had set the curve on the state exams. The war over, the Russian threat not yet emerged, I decided to stay at UGA. After junior year, he was accepted to the University of Georgia School of Medicine, which became the Medical College of Georgia. Military life would wait until assignment to Walter Reed where, still in training, he helped launch the hospital’s new open-heart surgery program.
Of perceptions and bourbon
For months on end I was at the hospital before dawn. I rarely got home before midnight. It wasn’t all a matter of hard work. I also realized perceptions would play an important role in advancement of my medical career.
Picture me like a duck, gliding across the surface of the pond calmly, but underneath that water, my feet were kicking like hell. I also made an effort to keep up my appearance. We all worked slavish hours and fairly or unfairly one of the doctors in charge of your future might look at you and judge you poorly if you looked like a slovenly mess. Of course the most important thing is to be a good surgeon, but it also helps to look like a good surgeon.
There were moments that affected me deeply. I joined Dr. Alfred Blalock while he performed an operation to relieve constriction of the mitral valve in the days before open-heart surgery. He slipped his index finger into the left atrium to feel for the adhesions blocking the valve, then carefully instructed me in the insertion of my own finger. I have never forgotten the feeling of having such intimate contact with a beating heart and from that moment I knew cardiac surgery would be a major component of my surgical career.
Blalock, one of the era’s most prestigious surgeons, was so confident in his young resident and fellow southerner that when he developed an abdominal tumor, he asked Hatcher to be one of the surgeons. I was thinking to myself, Charlie, you are really hot stuff. Then Blalock said, “I know I’m going to be on a liquid diet. Do you understand that I want to be on a full liquid diet?” “Dr Blalock,” I said, “bourbon will be included in your liquid diet.” That brought me back down to earth. Instead of being the world’s next great surgeon, Dr. Blalock knew I was the most reliable person to see to the bourbon.
The Emory career that almost didn’t happen
After serving as chief surgery resident at Hopkins, I was flattered by Dr. Blalock’s invitation to remain as faculty and demurred as tactfully as I could. “I’ve never really thought about staying in Baltimore, because I’m an only child and one day I will be responsible for both my parents.” Dr. Blalock said, “Well if you’re going to be in Georgia, I would like you to be at Emory.”
Emory’s chair of surgery politely told Hatcher he had no positions available and did not anticipate any position becoming available. He added that his son-in-law would be joining the department that summer by previous appointment. Although both the Emory president and the chief of cardiothoracic surgery wanted Hatcher, an Emory future appeared unlikely. In Baltimore, Blalock asked Hatcher to listen in on a phone call to the chair, who protested he had no money, no lab space, and no prospects for Blalock’s resident. Blalock said, “Those are details. You work out the details. Charlie will be there on the first of July.” In American medicine, prestige equals power. And power had spoken. I left for Emory the following June, and you might say I was looked upon as a rattlesnake that Dr. Blalock had just thrown in the chair’s nest.
Arriving in Atlanta, I called cardiothoracic surgery just to check in. The nurse informed me that I was scheduled to operate at 8 a.m. It was only after I completed the surgery that someone mentioned I had just performed Georgia’s first total correction of tetraology of fallot (the definitive open-heart operation which had largely replaced the surgery perfected by Blalock).
The following morning, Hatcher went to the VA Medical Center to assist in the hospital’s first pericardiectomy and found himself taking charge when the senior surgeon made a potentially lethal laceration. My career could have easily been very different had things played out differently. I could have lost that patient, but I did not. I had learned never to let my emotions show. Everyone on the surgical team keys on the operating surgeon, and until that individual manifests fear and uncertainty, the team can function in a routine fashion. That day the nurses and other doctors whispered amongst themselves that I had ice water in my veins. In truth, I was so relieved by the successful outcome I was tempted to suggest the patient be wrapped in a cashmere blanket and that I be sent the bill.
The Emory Clinic was nine years old, with fewer than 50 doctors. I thought it was huge, and I was delighted with my colleagues. If you were going to be a young heart surgeon, 1962 was an awfully good year to start. Within a short period we were doing things that had never been done before at Emory and Egleston.
Building the WHSC
In 1984, when I became director of the renamed Woodruff Health Sciences Center, I quickly realized decisions would ripple far beyond the university. Renegotiating Emory’s first contract with Grady represented perhaps the largest stone tossed into the pond.
In 1985, the newly accredited Morehouse School of Medicine needed access to patients and Grady was the only public hospital in the area. Emory had an exclusive contract, which we had renewed for 29-1/2 years in 1984. Responsibility for all patients at Grady was extremely valuable to Emory. Many felt I was giving away services they had built up for years. But there were also strong reasons to amend the contract. The civil rights movement had produced dramatic changes in the 1960s, the integration of Grady among them. In the early 1980s, Atlanta’s leaders were doing all they could to put to rest the demons of the city’s past. I certainly was not going to stand in the hospital door, keeping out the city’s first historically black medical school.
The Emory dental school presented an administrative problem as soon as I took office. Throughout the nation, not as many people were applying to dental schools. Once the premier dental school in the southeast, toward the end you could make it into the school with a gentleman’s C. I felt that if I were going to lose $2 million a year, I wanted to lose it on something that was a clear-cut plus for the university. Closing a school is certainly the most painful thing any administrator has to do.
Creating a school of public health was probably the most exciting. Though we had expanded our research efforts, we had yet to exploit our greatest asset. Public health was exactly the program to kick-start our relationship with the CDC. We worked it out so the CDC would furnish about 150 faculty to the school at no charge. In turn, more of our graduates have gone on to work at the CDC than anywhere else.
Closing an era
In the early years as head of health sciences, Hatcher had continued to perform surgery. A single event would help me bring to a close my years in the operating room. I had been referred a middle-age man with multi-vessel coronary disease. I concluded the benefits of surgery would be quite limited, even if successful. In six months, he returned very depressed. A professional clown, he was incapable of clown activities. His wife couldn’t stand to see him in this state, and ultimately I acquiesced. Post-operatively he experienced ventricular fibrillation and could not be resuscitated. With heavy heart I made the walk to the waiting room, which was filled with his clown friends who had come in full makeup and costumes to cheer up his family. They broke into tears. I too had tears when his wife thanked me for giving him a chance. I realized I could no longer take that degree of emotional trauma. That would be my last personal effort in surgery.
When I announced my resignation plans as head of health sciences just before my 65th birthday, my friends in administration and the trustees told me, again and again, that no one had even discussed my retirement and that I should be in no hurry to leave. I said, “then my timing is perfect.” -EH