S T A N F O R D M D

Spring 2000

 

For Alumni
Stanford
MD

 

On the Cover

Bridging Disciplines to Squelch Cholera. 

Cover illustration by Calef Brown.

Stanford Medicine, published quarterly by Stanford University Medical Center, aims to keep readers informed about the education, research, clinical care and other goings on at the Medical Center.

 

HONORABLE
ALUMNI

 

Each year the Stanford Medical Alumni Association chooses one or more alumni to honor with the J.E. Wallace Sterling Distinguished Alumnus Award FOR OUTSTANDING SERVICE to the medical profession. The most recent recipients, Norman Rich, MD, class of 1960, and Donald Tsang, MD, class of 1957, received their awards in November 1999.

 

BY ROBERT TOKUNAGA


NORMAN RICH:

EXPECT THE UNEXPECTED

MORE THAN 45 YEARS AGO, a young University of Arizona student and his father took a scorching 75-mile drive from their home in the now-extinct copper-mining town of Ray, Ariz., to hear a speech in Phoenix. * That young man, who went on to graduate from Stanford University School of Medicine in 1960, was Norman Rich and the man he and his father heard speak was J.E. Wallace Sterling, then president of Stanford University.

Now, decades later, Rich is one of the two recipients of this year's Stanford Medical Alumni Association's Distinguished Alumnus Award, named for J.E. Wallace Sterling.

Rich, who retired in 1980 as a colonel after a 20-year career in the U.S. Army, has been chairman of the Department of Surgery at the School of Medicine of the Uniformed Services University since 1977. The federal medical school, located in Bethesda, Md., where Rich and his wife, Lois, live, now produces about 20 percent of the physicians in the military.

A renowned expert on vascular surgery, Rich, 65, has published more than 300 manuscripts on the subject, authored or co-authored five books and continues to travel around the world giving lectures.

"I was extremely pleased and a bit overwhelmed," Rich says about receiving the Sterling Award. "It means the world to me, especially since Dr. Sterling had a very significant impact on my professional life."

Rich still remembers how his father, George Rich, was so impressed with Sterling's lecture that he turned to his son and said, "You better transfer to Stanford." The younger Rich had been considering transferring out of Arizona to complete his undergraduate work, and it was Sterling who swayed him to decide on Stanford instead of an Ivy League school.

It was Rich's parents, both of whom were schoolteachers, as well as mentors like Carleton Mathewson, MD, of Stanford's surgical residency program, who inspired Rich's interest in teaching medicine.

Mathewson, a 1984 recipient of the Sterling award, served in the U.S. Army during World War II and helped develop the first surgical training program for the military at San Francisco's Letterman Hospital in 1950. He also influenced Rich's decision to join the Army soon after graduating from Stanford medical school.

Initially, Rich had no intention of making the Army a career, but he found there were plenty of opportunities in the army for a surgeon with academic interests. This was true even in 1965 when he spent a year in An Khe in the central highlands of the then-Republic of South Vietnam.

"We were in the middle of the jungle surrounded by the enemy most of the time," Rich recalls. "We periodically took hostile fire, had people coming out of tunnels in the middle of our compound and got caught in monsoons that pulled tents from out of the mud." Still, Rich's academic interests flourished.

At Mathewson's suggestion, Rich began compiling a thorough vascular registry -- a historical database of the hundreds of cases he saw while in Vietnam. The registry itself, which later grew to thousands of vascular cases, plus the fact that he was one of the first physicians to return from Vietnam in 1966 drew interest within medicine, and Rich found himself lecturing on his experience at medical schools and conferences in the United States and abroad.

He had often imagined he'd enjoy a career in academic medicine and these lectures helped whet his appetite for it, Rich says. His first academic appointment came in 1973 as an associate professor of surgery at George Washington University in Washington, D.C. Then, in 1976, Rich was named professor of surgery at the newly opened School of Medicine of the Uniformed Services University of Health Sciences and a year later he became the chairman of the department. The school's first class graduated in 1980 and Rich has been there to see every class of graduates since then.

His experience in Vietnam taught him to expect the unexpected, Rich says. It's something he still teaches his medical students. Because military physicians diagnose and treat diseases rarely seen in the United States, commonly encounter cultural, language and religious differences and often operate within a sociopolitical infrastructure in violent flux, they can count on being surprised.

Although he had expected a career in academia, Rich did not expect it to be in the military. "I thoroughly enjoyed being involved in and with the military, and one year just kind of led to another, and then the Uniformed Services University medical school developed, which was an exciting opportunity," Rich says of his career.

Among his achievements is "surviving 40 years in the federal system," Rich jokes, but the greatest achievement was serving his country. "It's been a privilege to meet so many people from so many countries under so many different circumstances and from so many different backgrounds," says Rich. "I never could have done this without being in this situation."

 

DONALD TSANG:

MASTERFUL TEACHER

AND ARDENT LEARNER

IN 1968, THREE YEARS AFTER becoming a staff surgeon at Kaiser Permanente Medical Center in Santa Clara, Calif., Donald Tsang, MD, decided to give even more of his time to medicine. He joined the Stanford clinical faculty to teach surgery residents who rotated through Kaiser Santa Clara and Santa Clara Valley Medical Center in San Jose. * Tsang, a member of the class of 1957, decided teaching was a great way to give back to his cherished profession. What he didn't expect was the tremendous amount of knowledge he would get in return, he says.

Tsang discovered that teaching wasn't just about imparting knowledge --- it was also part of his own continuing education. "It actually kept me thinking all of the time, and I continued to learn by teaching the residents," says Tsang.

The residents he taught, however, feel they got the better end of the deal, for they were taught by a great instructor of surgery and a wonderful person.

"Every resident who has worked with him is in awe of him," says Luther Cobb, MD, one of Tsang's former residents. "He's the smoothest technical surgeon you could imagine and the most patient teacher I've ever seen."

"I tried to put myself in the resident's position and thought about what would be stimulating to me if I were in training," Tsang says of his teaching strategy.

Cobb still marvels at Tsang's ability to teach the intricate and delicate art of surgery. "Of course, he never put a patient at risk when teaching surgery, but he gave the resident a feeling of being independent while training," says Cobb, now a private practice general thoracic and vascular surgeon in Arcata, located in the northern California coastal county of Humboldt.

"Dr. Tsang could take a second- or third-year resident and make him think he's doing the procedure while Don was actually in control of the surgery the entire time," Cobb says.

"I tried to have them make decisions and guide them along as to whether they were the best decisions under the circumstances," says Tsang, who received a 1989 Bloomfield Award and a 1991 Kaiser Award -- two School of Medicine awards for excellence in clinical teaching. "I allowed the residents to at least think about the situation and how they would solve it if I were not there at all. That's what they're going to have to do after they've completed their training."

Annette Chavez, MD, another former resident who was taught by Tsang, says his teaching method put the residents at ease. Tsang often answered his students' questions with questions. Eventually, after a series of questions from Tsang, the students figured out the answers themselves, says Chavez, who ultimately joined Tsang as a surgeon at Kaiser Santa Clara.

This thoughtful use of questions was a method he developed early on in his teaching career, says Tsang, a recipient of the 1993 Santa Clara County Medical Association's Award for Contributions in Medical Education.

A lot of thought goes into coming up with questions and the thinking and learning process continues with the exchange of questions, comments and -- eventually -- an answer. And what surprised Tsang is how frequently the answer he and the student came up with was different from the answer Tsang would have given when the question was first asked.

Quite often a resident would ask a question that Tsang had never thought of or ask why something had to be done a certain way. Everyone, whether teaching residents or not, should always ask themselves, "Why do I do it this way when another way may be better?" Tsang says.

The constant questions from residents "always kept me on my toes and was one of the things I really enjoyed about teaching," Tsang says. "They would bring up points that I had not even thought of." In essence, both student and teacher ended up learning something new.

Tsang, now 67, retired last June after 34 years at Kaiser Santa Clara. He and his wife, Lenore Sheridan, MD, a retired internist, live in Portola Valley, west of Stanford. Although his full-time surgery and teaching days are over, Tsang, who is still on the clinical faculty at Stanford, remains open to the teaching and learning process. "I told them at Kaiser that if they're shorthanded, I'll go in to work with the residents," Tsang says.

As they say, "You're never too old to learn." SMD