Taking Care of POWs
Dr. Califf: What were your big career moves, and why did you make them?
Dr. Smith: For my first job, I went into the Navy. It was the Vietnam era. I remember wearing black armbands. I remember clearly a whole series of assassinations from Kennedy to Martin Luther King. I remember watching this with my daughter when she was 8 years old, on a black-and-white TV, and she said, "Dad, you grew up in a violent period." It's hard to communicate what those days were like.
I had been in the Berry plan for deferral of service. The option was to go back to NIH and do lipoproteins, or continue with cardiology, and then go in later. I went to Portsmouth Naval Hospital, where I followed legendary figures, such as Jess Peter and Doug Zipes. When I was at the naval hospital at Portsmouth, I took care of the prisoners of war (POWs) when they came back. They either went to Portsmouth or to San Diego. That was especially interesting.
Dr. Califf: Do you mean the American POWs who were returning home?
Dr. Smith: Yes; there was a whole group. Do you remember the group -- Jane Fonda and the Hanoi Hilton? They had been incarcerated for about 6 years.
Dr. Califf: John McCain was one.
Dr. Smith: Yes, and for most of that time they were isolated, and living by themselves. My patient had been an athlete. They were all pilots. These were very competitive, bright, highly motivated people.
They finally got together and set up a university over there. We had anticipated all kinds of problems. We had a guy from MIT who had a course on movies. They studied languages, they had a course on what to do when you get home and find your wife has remarried because she thought you were dead. So they were much better prepared for that than we thought.
I was quite interested in what kept them going when they were isolated. Did they believe in the war? Did they just not want to be broken? When they came back, they weren't allowed to see their families for 3 weeks. The fellow that I took care of ultimately went on to become a Rear Admiral and then ran for Congress. I became fairly close to him. His family didn't know how to let him in. He described how he didn't understand why his son had long hair (he had a crewcut). The children would ask their mother if they could borrow the car, and he felt like he didn't have a role in the family.
The Cath Lab at Colorado
Dr. Smith: I went on to run the cath lab at the University of Colorado, Denver, after Jack Vogel (the previous director) went to Santa Barbara.
Dr. Califf: You were in Colorado before Denver exploded.
Dr. Smith: Before I left, Dick Gorlin said, "One thing I need to tell you is if you get 70% of what you ask for, you are lucky." And the one thing I didn't get was a camera to do radionuclide studies in the cath lab, which I really wanted. We had published in the Journal of Clinical Investigation the first study in man of intact collateral flow. We had done it in the operating room, and I wanted to continue that, but it wasn't there.
Dr. Califf: When you look back now with the skills that you currently have, was there a way you could have negotiated that, do you think?
Dr. Smith: Yes. The ultimate negotiating skill in academic medicine is the threat to leave. I suppose I could have pounded on the table a little more. When I chose Colorado, Yale and Stanford were the other 2 jobs. Yale was great (Larry Cohen was there), but it was very much what I had done at Brigham: coronary disease. Stanford was still doing 2 cardiac catheterizations. They would do the hemodynamics in medicine, and radiology would do the angiography.
I just couldn't understand that. I didn't want to be a part of that. In Colorado, Gilbert Blount had a huge stable of patients with congenital heart disease. There was a fellow named Alex Nadas at Children's Hospital (Professor of Pediatric Cardiology at Harvard). When I was at Brigham, I went over and spent time with him. So I figured I could bring coronary disease to Colorado, because they didn't have a very active program. The exchange would be doing a lot of cath work in congenital heart disease, which I did.
Dr. Califf: I didn't know you had such an interest in congenital heart disease.
Dr. Smith: It's very interesting. Our fellows now don't have the opportunity to see those patients. There is an increasing number of adults with congenital heart disease now.
Dr. Califf: My oldest child's daughter has congenital heart disease. She has done extraordinarily well.
Dr. Smith: That's remarkable.
Dr. Califf: Without really excellent care, she wouldn't have done well.
Dr. Smith: Yes.
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Cite this: Life and Times of Leading Cardiologists With Rob Califf. Guest: Sidney Smith - Medscape - Dec 11, 2013.