Some Fellows of the American College of Surgeons (ACS) come from families with three or four generations of surgeons. A number of these family members go back more than 100 years to the founding of the ACS. Their stories, several of which are featured here, are a testament to the fact that the pursuit of surgical excellence often passes from one generation to the next.
One family of surgeons that includes an ACS founder is the Richter family of Chicago, IL. Three generations of the family have dedicated their lives to surgical practice. Harry M. Richter III, MD, FACS, Rush University Medical Center, acknowledges the vital role his grandfather, H. M. Richter, MD, FACS, played in 1913 as a College founder and Governor (1913−1916).
“My grandfather was attuned to the need for surgical standards in his time,” said Dr. Richter III, who remembers his grandfather as a tall, lean, imposing figure who was deeply dedicated to his profession and patients. His grandfather had a sterling reputation as a specialist in thyroid procedures and surgical care of infants. “Before there was a College, surgeons were on their own,” Dr. Richter said. “The College founders realized that they needed some behavioral guidelines.”
Dr. Richter’s father, Harry M. Richter, Jr., MD, FACS, a member of the department of surgery, Northwestern University Medical School, and surgeon at Cook County Hospital, was a role model for his son. “What impressed me as a child about my dad’s work at Cook County was that patients would come off the street with medical problems, having not seen a primary care doctor, and they would get treated, whether they had money or not. That has always been the role of Cook County,” he said.
“My dad never directed me to go a certain way,” the younger Dr. Richter said. “He just tried to influence me to make wise, practical choices in life.” He considered other careers in math and science, but found surgery was the best fit. In high school, he accompanied his father to surgical society meetings and spent a couple of summers doing research at Chicago’s former Michael Reese Hospital, which, at the end of the 20th century, was a major research and teaching hospital. These experiences clearly left an impression on the young man.
“I could not have chosen more meaningful work,” he said. “It is especially rewarding to see young surgeons develop.” The residents he teaches at Rush give Dr. Richter reason for optimism. “The residents are every bit as committed to becoming good surgeons as we were.”
In Mississippi since the Civil War
The Gamble family represents another surgical dynasty and, like the Richter family, a Gamble family member was involved in establishing the College. “There’s been a Gamble practicing surgery in Mississippi since the Civil War,” said retired thoracic surgeon Hugh A. Gamble II, MD, FACS, Greenville, MS.
The Gamble family’s surgical tradition began with William Gaston Gamble, MD, who ran a practice from his home in Lee County, MS, until his death in 1920. His son, Hugh Agnew Gamble, born in 1876, became a nationally known surgeon who crossed racial divides in the Jim Crow South to provide high-quality surgical care. In 1915 he founded what would become the multispecialty Gamble Brothers Clinic. An ACS founder and later a Governor, Dr. Gamble provided surgical and gynecological care, and his brother Paul handled urologic cases. For nearly 50 years, they built the reputation of the Gamble name in surgical care.*
“Growing up, I was surrounded by medical talk,” said Dr. Hugh Gamble. “Discussions around our dinner table were always about medicine. My dad [Lyne Starling Gamble, MD] would talk about difficult patients and arguments he was having with the hospital, and my mother was a nurse. Doctors have always had arguments with hospital [administrators]. Sometimes the discussion would be about how state and local government were affecting medicine.”
He recalls accompanying his father to medical society meetings in Mississippi. “The Mississippi State Medical Association has always been a strong organization, and I’ve always been active in it,” he said. He also remembers piling into the car with his three siblings to accompany their father on emergency call.
Dr. Lyne Gamble’s dedication to practice reflected lessons learned from his surgeon father. “My grandfather really liked practicing medicine. He had a strong sense of civic responsibility,” Dr. Hugh Gamble said. “He didn’t drive, and he didn’t sleep much. If the phone rang at 3:00 am, he’d have Lewis, his chauffeur, drive him wherever he needed to go to see a patient.”
Dr. Hugh Gamble enjoyed a thriving practice, as he was the only thoracic surgeon within a 100-mile radius in Mississippi. “As a Gamble, you were expected to be as good as those who preceded you. I rarely went through a week without a patient knowing something about my family history,” which had good and bad consequences. “If they liked your family, they liked you, too,” Dr. Gamble said.
He recalls that in about the ninth grade, he was required to take a foreign language. “I chose Latin because I knew a lot of doctor words were in Latin,” Dr. Gamble said. “I knew from that point forward that that’s what I wanted to do. I never considered anything but becoming a doctor. I would have been miserable doing anything else.”
He recalls, as a boy, walking past his father’s office after school, that there would always be a large group of patients who couldn’t afford to pay for services. “My dad had a cabinet of drug supplies, and he would give away samples to patients,” he said. “My grandfather basically ran a clinic for free. That pure charity was replaced with federal involvement. Now programs like Medicare and Medicaid have had a significant impact on access to care, and there is an endless supply of rules and regulations.”
Defying Jim Crow
Like the Gamble family, the Green family defied the Jim Crow laws of the Deep South. The Green family established a clinic in Ruston, LA, that continues to thrive. Marvin Green, MD, FACS, who became a Fellow of the College in 1935, spent much of his time making house calls to patients of all income levels and racial backgrounds. Dr. Marvin Green eventually realized that a centralized surgical practice resulted in the best patient outcomes. He traveled across the country in search of experts who would relocate their practices in Ruston.
“I grew up hearing stories about my grandfather from all different kinds of people,” said John M. Green, MD, FACS, a general surgeon at Carolinas Medical Center, Charlotte, NC. All of the stories had a similar theme. “A family member had been treated with compassion and skill and held my grandfather in high regard. Many times they had no way to pay and brought him eggs or meat from their farms. Every time I walked into the clinic that bore the family name, I saw his portrait in his [ACS] robe.
“I grew up in the back hallways of the clinic my grandfather established,” he continued. “At one point, I know he personally paid the nurses to keep the local hospital open. It was always exciting for me to visit my dad at work and see that environment.”
“My grandfather grew up on a farm. His parents were sharecroppers, but he understood that education was important. He didn’t go through a formal residency, but he learned procedures by taking several trips to the Mayo Clinic in [Rochester,] Minnesota.” The younger Dr. Green would spend his vacation days during college in the operating room (OR) with his uncle, Marvin T. Green, Jr., MD, FACS.
“My relatives were my early mentors, and they all truly inspired me. I also looked at my medical school chairman, John C. McDonald, MD, FACS, and my residency chairman, [a Past First-Vice-President of the ACS] R. Phillip Burns, MD, FACS, and so many others along the way, almost like family members.
“Clearly, I had some great role models,” he said. Several members of his family are medical practitioners. His father, James D. Green, MD, is a retired radiologist; his brother Andrew E. Green, MD, is a gynecologic oncologist; and his father’s first cousin, M. Ragan Green, Jr., MD, is an orthopaedic surgeon. “It was not unusual for people to bring us fresh vegetables because my grandfather had operated on one of their relatives,” said Dr. Jim Green. Today he strives to deliver the same type of patient-centered care. “I get the same sense of satisfaction as my mentors did in solving complex problems,” he said.
A family of surgical accomplishment
Like the other surgeons profiled here, ACS Executive Director David B. Hoyt, MD, FACS, grew up in a family defined by surgical accomplishment. His father, Walter A. Hoyt, Jr., MD, FACS, was an esteemed orthopaedist in Akron, OH, who helped establish the musculoskeletal curriculum at Northeastern Ohio Universities Colleges of Medicine and Pharmacy (now the Northeast Ohio Medical University) and founded Summa Health System’s Walter A. Hoyt, Jr. Musculoskeletal Research Laboratory in Akron.
His colleagues described Dr. Walter Hoyt, Jr., as a charismatic man of substance and humor, a surgical mentor, and a jack-of-all-trades. He served as President of the ACS Ohio Chapter (1964−1965).
Dr. Hoyt’s grandfather, Walter A. Hoyt, Sr., MD, FACS, became a Fellow in 1921 and served as director of the orthopaedic departments at Akron City Hospital and Akron Children’s Hospital. Dr. David Hoyt’s father and grandfather were both honored by the American Academy of Orthopaedic Surgeons for their groundbreaking achievements—his father for his work in emergency medical services, and his grandfather for his work with antibiotics.
“In my dad’s days, orthopaedists did it all,” Dr. Hoyt said. “They treated trauma patients. They treated joint problems. They were very involved with their community.
“My father was a mentor by example,” Dr. Hoyt added. Dr. Walter Hoyt, Jr.’s, life was devoted to his profession, and Dr. David Hoyt understood that reality. “He wasn’t able to attend all my school events, but I would see him every evening, and he would help me work on my school projects. I remember entering something in a science fair, and my dad was completely absorbed in the project.
“He was just a kind person who taught me by example,” he said. “He used to say proudly that he was operating on a patient when I was born. He may not have had the time to give me hands-on lessons in life, but he was always there as an example of the kind of person I wanted to become.”
When he was about seven years old, Dr. David Hoyt recalls getting in a verbal scuffle with a neighborhood kid. “Doctors do all their work for free,” he told the other child. “You don’t have to pay for anything they do for you in the hospital.” He learned, of course, that he was incorrect, but his claims reflected his early exposure to the dedication that a physician brings to the profession.
After Dr. David Hoyt graduated from Amherst College, MA, he wanted to write and express himself creatively, so he moved to New York, NY, where he wrote a play. Later he composed a book of poetry. “I was waiting for my life to begin,” he said, “and I decided to pursue meaning through the arts. What I realized in the year that followed was that to be an effective writer, you need to understand life,” he said. Through his father’s example, he knew that he could make a difference in other people’s lives through medicine, which spurred him to take premedical courses. A few months later, he entered medical school at Case Western Reserve University, Cleveland, OH.
He had difficulty choosing a specialty. “I finally decided that surgeons have the most fun,” he said. “It fit my personality, and helping patients was part of the deal. Surgeons have to lead, and they have to think on their feet.” After graduation, Dr. Hoyt headed to California for his residency and practice. “I wanted to start out on my own in a place where nobody knew about my family,” he said. He enjoyed a long and successful career as a trauma surgeon, serving as executive vice-dean of the School of Medicine; chairman, department of surgery; and the John E. Connolly Professor of Surgery at the University of California, Irvine.
Education lays the groundwork
Education provides the foundation for all surgeons. A high school education probably would have been sufficient for a farmer at the turn of the century. But unlike his father, Leonard Wright Edwards, MD, FACS, wanted to be a physician. To raise money for his medical education, Leonard Edwards drove an ice truck. By choosing a medical career, Dr. Edwards began a pattern that has endured for three generations of surgeons in the Edwards family.
Dr. Leonard Edwards graduated from Vanderbilt Medical School, Nashville, TN, in 1912. He became a part-time demonstrator in surgical anatomy and an assistant in the department of surgery at the Vanderbilt Medical School. Soon after that, he joined renowned surgeon and Vanderbilt clinical professor, Duncan Eve, MD, FACS, in private surgical practice, and together they founded the Edwards-Eve Clinic in 1938, today known as the Edwards-Eve Clinic Association. A pioneer in vagotomy and antrectomy surgery, Dr. Leonard Edwards established an approved residency training program in surgery at Saint Thomas Hospital in Nashville.
Leonard’s grandson, William Hawkins Edwards, Jr., MD, FACS, a vascular surgeon in Nashville, jokes that he was “preordained” to become a surgeon. His father, William H. Edwards, Sr., MD, FACS, was a busy vascular surgeon, two of his uncles were surgeons, his aunt married a physician, and his mother was a nurse. “I started working as a scrub nurse at the hospital when I was 16, as soon as I got my driver’s license,” said Dr. William Edwards, Jr.
Like his father and grandfather, Dr. William Edwards, Jr., attended medical school at Vanderbilt University, where he sometimes felt pressured to live up to his family’s legacy. His memories of his grandfather are strong, but they are of him as a grandfather, not as a surgeon. “I heard that he had a bad temper, but I never saw that side of him. My grandfather was self-taught in a lot of things,” he said. “He taught me the value of education.
“My grandfather was a railroad doctor, ahead of the game on managed care,” he continued. “Railroads employed a large number of people, and the Edwards [-Eve] Clinic took care of their surgical needs through a process that worked like managed care.”
Although there are some similarities between today’s health care system and practice at the Edwards-Eve Clinic, surgical practice has changed substantially. “We’ve gotten away from physical diagnosis,” Dr. William Edwards, Jr., said. He shares some of Dr. Hugh Gamble’s concerns regarding the future of surgery. “With diagnostic tests, we have displaced much of that human interaction. When my grandfather was a surgeon, physicians ran hospitals,” he said. “Then professional administrators took control of the hospitals, and many physicians have been sidelined.”
Surgery is a young person’s game, Dr. Edwards’ uncles tell him today. A practice requires tremendous stamina and physical effort, he said, but it is often hard to convince a surgeon that it is time to quit.
In Germany, before WWII
Some surgeons featured here traveled an unobstructed path to their profession. This was not the case for Walter J. Pories, MD, FACS, whose family’s surgical tradition began improbably, in Germany right before the start of World War II. Retired surgeon Dr. Walter Pories—founding chair emeritus, department of surgery; professor of surgery, biochemistry, and kinesiology; and director, Bariatric Surgery Research Group, Brody School of Medicine, East Carolina University, Greenville, NC, and Second Vice-President of the College—escaped Nazi Germany at nine years old in May 1939, five months after Kristallnacht, the “night of broken glass,” November 9–10, 1938, when a wave of violent anti-Jewish pogroms swept throughout Germany. His daughter, Susan Pories, MD, FACS, chief of breast surgery and director of the Hoffman Breast Center, Mount Auburn Hospital, and associate professor of surgery, Harvard Medical School, Cambridge, MA, says her father rarely speaks of his experiences in Germany but does have clear memories of Kristallnacht and the yellow identification badges that German Jews were required to wear.
As a youngster, Dr. Walter Pories spent summers with his aunt and uncle, who shared a medical practice in a small town approximately 21 miles from Dachau, and these experiences exposed him to the physician’s ability to heal. Josef Seidl, MD, was a family practitioner and his wife, Johanna Seidl, MD, was a pediatrician. Josef Seidl was Catholic, but Johanna was Jewish. Although Johanna converted to Catholicism, the Nazis generally did not recognize such conversions. The couple opened a general medical practice clinic attached to their house, where they delivered babies, made home visits, treated patients of all ages, and managed to stay in Germany for the duration of the war.
“We honestly don’t know how my aunt and uncle and their children survived Nazi Germany,” Dr. Susan Pories said. “Their clinic was across the street from a monastery, and the monks may have protected them.”
Dr. Susan Pories is grateful that her father reinforced the positive aspects of surgical practice. “He started taking me on surgical rounds when I was very young,” she said. As an undergraduate at the University of Vermont, Burlington, Dr. Susan Pories majored in art and English education, then taught and volunteered at a free clinic in Burlington. Aware from a young age of the meaning and purpose that the surgical profession gave her father, however, Dr. Pories never gave up the idea of pursuing a similar goal, and her father always taught her that gender should not be a barrier to pursuing a surgical career. She eventually decided to enter medical school, enrolled at the University of Vermont Medical School, and completed a residency in general surgery at the Medical Center Hospital of Vermont, Burlington. She went on to pursue an oncology fellowship at the New England Deaconess Hospital in Boston, MA, and ultimately focused her practice on breast cancer.
Four generations of change
Like Drs. Hoyt and Pories, Stephen Unger, MD, FACS, and Joshua Unger, MD, FACS, considered other options before deciding to pursue a career in surgery. Growing up in the 1960s in Miami Beach, FL, Dr. Stephen Unger considered becoming a hippie. Instead, he followed the lead of his dad and his grandfather and became a surgeon. Dr. Stephen Unger has had a distinguished surgical career for the past 35 years, at Mount Sinai Medical Center, Miami Beach. He has practiced general and vascular surgery and has specialized in advanced laparoscopy and complex dialysis access surgery.
His son, Joshua Unger, MD, FACS, originally opted for a career in computer science and worked for six years at the National Aeronautics and Space Administration’s Goddard Space Flight Center, Greenbelt, MD. “I spent whole days not talking to anybody,” he said. “Then one day I went with a friend to a local hospital, and I got a good feeling there.” He decided to take night courses and apply to medical school.
“My parents never pressured me to become a surgeon or a doctor,” Dr. Joshua Unger said. “But now that I am in practice, my dad and I work like partners. He’ll often ask for my opinion regarding a patient.”
Joshua’s grandfather, the late Harold Unger, MD, FACS, became interested in being a physician from his own father, Jonas Unger, MD, a general practitioner who delivered babies and performed appendectomies in New York, NY, and later moved his practice to Mount Sinai Medical Center.
Dr. Harold Unger was an early adopter of vascular surgery in Miami Beach, having studied for a month in Houston, TX, to learn procedures for treating aneurysms from the late Michael E. Debakey, MD, FACS. He also was one of the pioneers of immediate breast reconstruction after mastectomy, which at the time was controversial.
Patients often tell Dr. Joshua Unger today that they felt connected to his personable grandfather. “He was always well-dressed, the perfect gentlemen in every interaction. He could connect with anyone from any walk of life,” he said. Dr. Harold Unger always had a joke to tell patients. When Joshua’s father, Stephen Unger, would see a patient first, for example, Harold would step into the office and say to the patient, “I’m covering for my father.” “My grandfather and father had very different personalities, but they were both very professional, very driven, always without being egotistical. Both my father and grandfather instilled in me the idea that your first priority is to take good care of your patients,” Dr. Joshua Unger said.
“My dad is an eternal optimist, just like my grandfather,” Dr. Joshua Unger added. “I am more of a second guesser about medical decisions, and it has been wonderful to have him as a senior partner. He is always available and not bothered if I call to ask for advice at all hours of the day. He has come in to the OR a few times in the middle of the night to help me out with a case.”
“Shameless” in seeking father’s advice
Paul Kunkel Davis, MD, FACS, a cardiac surgeon, Christiana Care Center for Heart & Vascular Health, Newark, DE, often turned to his surgeon father—William S. Davis, MD, FACS, Camp Hill, PA—for counsel. “I was shameless,” he said. “I would call my dad and ask his opinion on a case. He loved getting those calls, and I learned an awful lot from him.”
Dr. Paul Davis has surgical influences in his blood. As a resident, Dr. William Davis joined the Camp Hill, PA, practice of Paul Augustine Kunkel, Jr., MD, FACS, whose daughter he eventually married. The late Dr. William Davis retired from practice at age 70 and “missed it every day of his life until his death 12 years later,” according to Dr. Paul Davis.
“Around age 12, it dawned on me that becoming a surgeon was doable,” said the younger Dr. Davis. “It occurred to me that if I did well in school, I could get a job as a surgeon.” A surgical profession was the preferred route for the young man. “My dad would often say that not being a surgeon is like trying to practice medicine with your hands tied behind your back,” he said.
Paul Davis has only positive memories of his namesake, Dr. Paul Kunkel. “My grandfather was bigger than life. He was a farmer who went to college at 16. He was a genius of a guy,” he said.
“Both my father and grandfather were unflappable people,” he added. “I never saw either of them lose their temper or fly off the handle. My dad always said that you are the person you are when the chips are down in the OR.”
Both men had a sense of sacred responsibility with respect to patients. “That was the driving force of their lives,” said the younger Dr. Davis. “They took their jobs very seriously. I’d like to think I am carrying on that legacy.” In many ways, he is. Dr. Paul Davis regularly travels to Nigeria to render cardiac surgical care to the indigenous populations.
Each family’s story is unique, but they all reveal the powerful influence one generation of surgeons has on the next. All of the surgeons profiled in this story had the good fortune of growing up in homes with mentors who watched and guided their growth and development on the path to successful surgical careers.
“It’s the example that parents live that sets the stage for the young person trying to find life’s meaning,” Dr. Hoyt said. “I sometimes think that imparting those positive values to our young people is the biggest challenge we face as a society.”
*Trotter MC. Hugh Agnew Gamble, MD, FACS: A legacy to the College. Bull Am Coll Surg. 2014:99(12):43-48. Available at: bulletin.facs.org/2014/12/hugh-agnew-gamble-md-facs-a-legacy-to-the-college. Accessed February 19, 2016.