This article seeks to describe a great U.S. patriot, a leader in military and vascular surgery, a teacher extraordinaire, a pillar of our medical school, and a personal friend, retired U.S. Army Colonel Norman Minner Rich, MD, FACS, DMCC. The authors of this article have been privileged to work at his side for many years as members and leaders of the faculty at the Uniformed Services University of the Health Sciences (USU), Bethesda, MD. In addition, our frequent “lunches with Norm” in the USU cafeteria gave us insight into what influenced his career choices and what personal characteristics led to his extraordinary accomplishments.
The early years
Norm was born January 13, 1934, in Ray, AZ, a mining town in the Sonoran Desert. His parents, George and Leona Rich, were civic leaders, teachers, and owners of a community store. In addition, his father coached the Ray High School basketball team. The name “Rich” originated from the Croatian name “Kauzlarich,” shortened as many were in those days to foster assimilation.
Our frequent “lunches with Norm” in the USU cafeteria gave us insight into what influenced his career choices and what personal characteristics led to his extraordinary accomplishments.
One of Norm’s early family stories was about his grandfather, who at the time was living in Jerome, AZ, another mining town, around the turn of the 20th century. The town jail just happened to be attached to his grandfather’s living quarters. At that time, explosives were being used to mine tunnels beneath the town, causing homes in Jerome to have unstable foundations and resulting in a phenomenon called “slippage,” as these damaged buildings began sliding down the hillside. The jail actually detached itself from Norm’s grandfather’s (Mr. Kauzlarich’s) home and slid more than 220 feet, landing in the middle of Hull Street. This jail remains as a tourist attraction in Jerome with a plaque bearing the name Kauzlarich on the “jail that got away.” Fortunately, no one was occupying the jail as it tumbled to a new location.
As an active young man, Norm was fond of riding wild burros in the desert, even naming one of his favorite’s “MD” for medical doctor (see photo). Another favorite activity was mountain climbing, especially the nearby Teapot Mountain. On one occasion while attempting to climb the sheer cliff side of that mountain, Norm fell several hundred feet, his fall broken only by cholla cacti. While the cacti may have saved his life, their embedded thorns in his body remain as a lifetime reminder of that fateful fall.
The importance of mentorship
One of Dr. Rich’s early mentors and role models was Otto E. Utzinger, MD, the local surgeon for the Kennecott Copper Company, now headquartered in South Jordan, UT. Like Dr. Rich, Dr. Utzinger attended Stanford University, CA, as an undergraduate, entering the military shortly after graduation to serve in World War I.
Another notable mentor was Emile Holman, MD, FACS, a faculty member at Stanford during Norm’s undergraduate years. Dr. Holman, a Rhodes Scholar, served honorably during both World Wars, and planted in Norm’s mind the idea of repairing war-related vascular wounds. Later, as a resident at Letterman General Hospital (now known as Letterman Army Medical Center), San Francisco, CA, Dr. Rich came into contact with Carl “Matty” Mathewson, MD, who served in the U.S. military during World War II and was chief of surgery at San Francisco General Hospital, CA. Matty became a lifelong friend and contributed to Norm’s belief that mentorship is an important core value for a surgical leader.
Military career and a test of character
After graduating from Stanford Medical School, CA, in 1960, Norm began his formal military career as a first lieutenant in the U.S. Army. He completed his internship at Tripler Hospital (now the Tripler Army Medical Center) in Honolulu, HI, and was assigned to Letterman General Hospital for his surgical residency, which he completed in 1965.
It was at Letterman General Hospital on the first day of his surgical residency that he had a severe test of his integrity. Dr. Rich was assigned to perform rounds on all the surgical patients and to give a full report to the hospital commander. This particular hospital commander, Colonel Kamish, had the distinction of surviving the Bataan Death March in the Philippines during World War II, and as such, he was a tough, no-nonsense, and somewhat difficult commander. Dr. Rich later described how the colonel sat behind his desk and listened without comment to the extensive report from this brand-new resident on all the various patients. When Norm finished with his oral report, Colonel Kamish said, “How is general so-and-so doing up on the VIP [very important person] ward?” Norman was taken aback, completely surprised to learn that the hospital had a VIP ward and embarrassed that he had failed to visit a general under his care. For a brief moment, he was tempted to tell Colonel Kamish that the general was doing well and sends his regards. But instead, he decided to simply tell the truth, informing his commander apologetically that he was unaware that there was a VIP ward and hadn’t visited the general. Hearing that, Colonel Kamish scowled and simply told Norm that he was dismissed.
Dr. Rich left that meeting feeling depressed, concerned that his career was over and that he had disappointed the colonel. As he walked down the hall, he ran into a senior resident, who asked him how things were going. He poured out his story of having missed seeing the general up on the VIP ward. The senior resident told him that Colonel Kamish always conducted that “test” on new physicians to see who would tell the truth. Those who confabulated were sent packing. When relating this parable, Dr. Rich emphasized that honesty and integrity are essential traits for all surgeons, young and old.
After finishing his general surgery residency in 1965, Norm was assigned to serve as chief of surgery at Fort Bragg, NC. Soon thereafter, however, he found himself on a month-long voyage on an uncomfortable ship headed toward An Khê in the Republic of Vietnam. Arriving in Vietnam with little if any battlefield experience, he was disheartened to find that his mobile army surgical hospital unit was inadequately equipped to perform any sort of major operations; the equipment would arrive later. The first night after arrival, he was asked to see a Vietnamese patient who had been shot through both femoral arteries and was in dire straits. Using only Halsted mosquito clamps, rubber bands, and 6-0 silk sutures, operating in a tent with only a kerosene lamp, in 101-degree temperatures and nearly 100 percent humidity, Dr. Rich was able to bring both arteries back together and achieve bounding distal pulses at the end of the operation. The one lesson that Norm often repeated as he talked about his first operation in Vietnam: “We preach contingency, and we practice contingency!”
While in Vietnam, Norm began collecting different wound penetrating elements, which are now on display in the National Museum of Health and Medicine, Silver Spring, MD. These artifacts include bullets, spears, and punji sticks. Later, he would take these wounding elements to medical conferences to explain the nature of their harmful capabilities and therapeutic interventions (see photos).
Dr. Rich also conducted groundwork ballistic wound studies using high-speed photography and gelatin targets, investigating how high-speed bullets caused cavitation and wounding even some distance from the path of the bullet. He became an expert on military wounds, and the techniques he developed saved many troops from limb amputation or death. Later, he would be sure that his junior faculty and students knew the difference between “shrapnel” (last used in battle in World War I) and “fragments” produced by modern high-explosive devices.
Norm gained recognition throughout the world as a military physician who pioneered lifesaving vascular repair following traumatic injury. While in Vietnam, Norm began collecting data on all vascular injuries and later established the Vietnam Vascular Registry while stationed at Walter Reed General Hospital, Washington, DC. This registry—now housed in the National Archives, St. Louis, MO—contains thousands of entries and is still accumulating data on survivors of vascular trauma during the Vietnam War.
Norm did a vascular surgery fellowship at Walter Reed General Hospital from 1966 to 1967 and became the chief of vascular surgery and head of the residency training program in 1967. At one point, Norm was both a fellow in vascular surgery and head of that training program. In the early 1970s, Dr. Rich participated on the planning committee for the new USU. President Richard Nixon signed the legislation that created the school in 1972, and its first graduating class was in 1980. Norm became the founding chairman of the department of surgery in 1977, retiring from that position in 2002. Thereafter, he served as deputy chairman and senior advisor to the two subsequent chairs, U.S. Army Colonel David Burris, MD, FACS, and U.S. Navy Captain Eric A. Elster, MD, MC, USN, FACS, coauthor of this article.
Vascular trauma and his lasting legacy
As mentioned previously, Dr. Rich became known for his work in repairing injured arteries during his time in Vietnam. Later, he worked with Frank Spencer, MD, FACS, American College of Surgeons (ACS) Past-President, to compose the most recognized book on vascular injuries. Dr. Spencer had become an expert in treating vascular wounds as a young surgeon serving in Korea. Early in the Korean War, there was a strict rule forbidding the attempted repair of war wounds involving most vessels, and anyone who attempted such a repair was subject to a possible court martial. Dr. Spencer was fully aware of this rule but nonetheless proceeded to repair an injured femoral artery with success. Eventually, the “court martial rule” was removed, and Dr. Spencer went on to do a number of limb-saving operations in Korea and elsewhere. He later stated that he told his team, before the attempt at his first repair, that if they were unsuccessful, a court martial could be expected, but if they succeeded, they would probably be given a decoration.* Dr. Spencer became the perfect mentor for Norm as they worked together to write their book, Vascular Trauma, published in 1978. Dr. Spencer’s risk-taking in Korea changed the face of vascular surgery forever.
Norm and Kenneth Mattox, MD, FACS, wrote a second edition of Vascular Trauma, and the third edition was recently edited and published by Todd Rasmussen, MD, FACS, and Nigel Tai, MD. Drs. Rasmussen and Tai are working on the fourth edition.
Dr. Rasmussen has been one of the many benefactors of Norm’s mentorship over the years. He and W. Darrin Clouse, MD, FACS, became well-known throughout the military medical system after reporting the results of their vascular operations in Balad, Iraq, carefully following up after each case and producing excellent, reliable data. Dr. Rich was, and is, very proud of their efforts, unique in the annals of warfare.†
A key example of Dr. Rich’s international leadership was the 1990 Uniformed Services University Surgical Associates Day, which featured all of the local leaders of surgery, some of whom Norm had recruited for the faculty at USU, including Charles Rob, John Hutton, Don Sturtz, Harry Shumacker, Leonel Villavicencio, Bill Drucker, Daniel Rignault, and Stan Minken (all MD, FACS) in attendance. There also was military faculty at that time, including Dr. Burris (Dr. Rich’s successor as the department chair), Bill Bolger, Peter Rhee, Gage Ochsner, Mike Marohn, and Mark Bowyer (all MD, FACS). Others who were particularly distinguished from outside our university included Michael DeBakey; Bill Blaisdell; Francis Moore; Ben Eiseman; Carleton Mathewson, Jr; and ACS Past-Presidents George F. Sheldon, Olivier Beahrs, and David Sabiston (all MD, FACS).
Norm was in his long, white coat up in front of the packed Sanford Auditorium, with guests from all over the U.S. and the world. He knew everyone, greeted old friends, and conducted a full day’s program with the confidence of a maestro leading an orchestra. From this meeting, it was obvious that Norm was an exceptional surgeon, a leader of his specialty, and a friend to all who were looking for a role model to emulate.
Lunches with Norm
Those of us lucky enough to sit with Norm around the lunch table at noon often were treated to little-known surgical history tidbits, while discussing a variety of topics. Norm has a phenomenal memory and can recite all sorts of amazing and entertaining stories. He has personally been the physician to many generals and admirals, as well as movie stars, politicians, and newsmakers. He knew President Dwight D. Eisenhower and told the story of the president’s frequent cardiac arrests at Walter Reed General Hospital, where he finally succumbed to his heart disease—despite the heroic efforts of his cardiologist, Robert Hall, MD, who spent months at his bedside, resuscitating him repeatedly. (President Eisenhower had more than 30 successful resuscitations before ultimately dying of heart failure.)
Norm has a phenomenal memory and can recite all sorts of amazing and entertaining stories. He has personally been the physician to many generals and admirals, as well as movie stars, politicians, and newsmakers.
Norm also was a member of the team that provided surgical care to Sen. John C. Stennis, who had been severely injured in an attempted armed robbery and was successfully treated at Walter Reed General Hospital. The senator was among countless patients who were fortunate enough to have Walter Reed as their hospital and surgeons like Norm as their caregivers.
Norm also knows surgical history like no other. He used to tell us about the early days of Mexican military surgery, when soldiers were told to bring their girlfriends or wives with them to serve as their nurses when and if they became wounded, as absolutely no military medical care was available at the time. He was able to connect the dots between historical events, medicine, and key leaders in our field. As an example, he told us the whereabouts of the key to the Bastille, the infamous state prison in Paris, France, that was overthrown at the beginning of the French Revolution in 1789. The key still is displayed at Mount Vernon, VA.
He taught us unique history facts, such as why we call President George Washington’s home Mount Vernon. The reason is that President Washington’s half-brother, Lawrence, inherited the Little Hunting Creek Plantation from his father in 1743, and later Lawrence changed the name of the estate to Mount Vernon after Admiral Edward Vernon, his beloved former commander in the British Navy. (Before the American Revolution it was fairly common to have Americans in the British military, including Lawrence Washington.) Admiral Vernon was an ancestor of Mrs. Mary Rob, the wife of Dr. Rob mentioned previously—a wonderful teacher and surgeon and a former faculty member at USU.
The list of Norm’s accolades is almost endless. He has published more than 300 manuscripts and has been the author or coauthor of five books. He helped found a number of important organizations and has served as president of many, including international societies of high repute. He was named an ACS Icon of Surgery in 2018 and awarded the inaugural ACS Distinguished Military Lifetime Achievement Award in 2019 (see photo).
But if we were to characterize Norm, sitting at our lunch table, the first observation of a newcomer would be that Norm was quiet and tried not to overwhelm us with his knowledge or reputation. He often sat silent, but when he spoke, his comments always were right on target, germane, interesting, informative, and historically correct. He never was argumentative or confrontational. He rarely said a negative word about anyone, and he seemed to be friends with everyone he met. If a young surgeon needed help advancing academically, writing a paper, or getting advice to treat a challenging case, Norm often had a solution. He has mentored and helped countless among us in our various careers, for which we truly owe him a debt of gratitude.
In a professional lifetime, there are rare opportunities to work with someone like Norm on a daily basis. He is the best friend, best teacher, and best mentor anyone could have.
In a professional lifetime, there are rare opportunities to work with someone like Norm on a daily basis. He is the best friend, best teacher, and best mentor anyone could have. Memories of those countless lunches, enjoyed over many years, are a highlight of our professional lives, for which we will always be profoundly grateful.
All of the stories included in this article were passed on from Dr. Rich. We would also like to thank M. Margaret Knudson, MD, FACS, Medical Director, Military Health System Strategic Partnership ACS, and David B. Hoyt, MD, FACS, ACS Executive Director, both for their support of military medicine and their role in maintaining the tradition of quality set by Dr. Rich.
The contents of this article are the sole responsibility of the authors and do not necessarily reflect the views, opinions, or policies of USU, the Department of Defense, the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. government.
*Spencer FC. Historical vignette: The introduction of arterial repair into the U.S. Marine Corps, U.S. Naval Hospital, in July–August 1952. J Trauma. 2006;60(4):906-909.
†Clouse WD, Rasmussen TE, Peck MA, et al. In-theater management of vascular injury: 2 years of the Balad Vascular Registry. J Am Coll Surg. 2007;204(4):625-632.