Say Awe
JOHN STEWARD
URGED MEDICAL STUDENTS TO
PRESERVE THEIR CAPACITY
FOR AWE.
AS A MAN WITH TERMINAL CANCER,
HEÿS FOLLOWING THE
SAME ADVICE.
BY CHARLES CLAWSON
ROY MAFFLY RECALLED THE DAY IN
1990 THAT HIS COLLEAGUE, JOHN STEWARD, RETIRED AS AN ASSOCIATE DEAN
OF STANFORDÿS MEDICAL SCHOOL. þSome of us were
standing around the Office of Student Affairs, when someone dressed
as an old man with a cane and a beard hobbled in, asking in a quavering
voice if he could apply to Stanford.ú Meet John Steward. The former
dean is known by friends as an avid gardener, butterfly expert,
collector of old duck decoys (he calls them floating sculpture)
and weather aficionado (he has a computerized weather station installed
on his roof). But today in early November at Stewardÿs residence
in Palo Alto these earmarks of an active life seem immaterial.
In his living room of dark wood, paintings, books
and a grand piano, he seems a visitor himself, as if the two of
us have met here by chance. He slouches in a leather Chippendale
wingchair and says brightly, þOkay, Iÿll just pretend Iÿm at the
dentistÿs office and you can ask questions.ú Recently a group of
faculty elected to name a lecture hall after him in honor of his
extraordinary devotion to students and the school for 30 years.
He appears flattered and a little surprised. At one point almost
gleefully he exclaims, þIÿm surprised they remember me.ú Told that
a colleague has described his sense of humor as dry and teasing,
Steward blushes and sinks farther into his chair, evidently shocked
by the remark. þI canÿt help you with that,ú he says.
By now many people know that the 72-year-old Steward
suffers from a terminal cancer of the biliary tract.
þThey see me as unusual, I guess,ú he says, þin that
Iÿve accepted this situation with such equanimity. The way I look
at it, Iÿve been so blessed in life, it makes no sense to start
complaining now.ú
Stewardÿs association with Stanford began with his
undergraduate days in 1944 and continued through medical school,
postgraduate training and faculty and administrative roles to 1990.
During the 1960s in Stanfordÿs Fleischmann Laboratory, Steward discovered
what he loves to do: counsel people in an environment of intellectual
curiosity. þIt was very, very exciting,ú he says. He recalls being
around students, in the labs, in the halls, amid engaging conversations
where he taught informally. As he talks, his face flushes occasionally
with enthusiasm. þOne group was trying to culture heart cells in
vitro Ü cells that would grow together, contract and beat synchronously
Ü a tricky thing to pull off in those days. And by golly they
did. And they were so excited.ú
Gradually these small moments of talking to students
began to shape Stewardÿs career. þThe medical students would come
in and talk about their career goals, whether to stay in medical
school or not, and about personal problems they were having. I enjoyed
those talks – in one sense they replaced my interaction with
patients, those close relationships you can develop.ú In 1968 the
curriculum for medical students changed in focus, with fewer hours
spent in the teaching lab and more hours in the classroom and library.
Finding his time with students decreasing, Steward took on the role
of associate dean for student affairs, where he found continued
interaction.
Characteristically, he downplays his accomplishments
as an associate dean, saying, þI was more of a shepherd than anything
else.ú As a dean he helped to diversify the student population,
locate financial aid for students and generally ease the pressures
they felt from medical school. Indicative was his establishment
of the Committee for the Well-being of Medical Students. He helped
create a scholarship program for those medical students who also
wanted to study music. He þshepherdedú admissions and financial
aid policies that drew national acclaim to a program for disadvantaged
minority students. And perhaps most notably, he championed the þflexible
curriculum,ú a unique policy that encourages students to extend
the time spent earning their degrees, allowing them to devote time
to elective classes, the arts (an unusually high number of medical
students are accomplished musicians), hobbies and to generally ease
the time pressures of medical school. The policy reflects Stewardÿs
belief that doctors should manifest a high degree of sensitivity,
which he defined in his 1989 commencement address. There he spoke
of a capacity for awe and awareness of lifeÿs small but fine moments
as being a moral goal, an end in which þlove is the ultimate principle
on which all ethical decisions should be made.ú
This prerogative appears to direct his own interactions.
þHe took everything to heart,ú says friend and former student, Stanford
professor of medicine Tom Raffin, MD. þHe was the most thoughtful,
most kind, most caring dean Iÿve known. When you came in, he would
rush out of his office to shake your hand and slap your shoulder.ú
Roy Maffly, MD, a retired Stanford professor of medicine who worked
with Steward in the Deanÿs Office, remembers his colleagueÿs devotion
to students. þHe would get to know them during medical school orientation
and follow them to graduation. When students were ill, he was at
their bedside. He did lots of things Ü like improving the student
lounge Üto make their environment more comfortable.ú
Looking back on his career, Steward says now, þI
donÿt think Iÿve had any big impact. I just did what seemed needed.ú
His early retirement years were spent working as
a volunteer at a local AIDS clinic. There he studied and practiced
clinical medicine again for the first time in two decades. þEventually
I got discouraged by the pressure to see patients in a very short
period of time. You donÿt dare stop and say, ÎHow are you feeling
with all this going on?ÿ ú
The question was one he could ask as chair of the
HIV commission for his church. þWhereas in the clinic youÿre concerned
with the physical journey of a patient, this commission focused
on the spiritual journey.ú
Searching for how to describe the experience, Steward
pauses. þOver the last two months, Iÿve had the opportunity ¹ no,
the privilege of personally facing a life-threatening illness. On
one of the church retreats a man who was very close to death said,
ÎYou know, for me having AIDS has been a blessing.ÿ At first I wasnÿt
sure Iÿd heard him correctly. Then he expounded a little and said,
ÎI was rushing through life, not noticing.ÿ He said, ÎNow all sorts
of little things are very special. I look at the sunsets and the
color of trees. Theyÿre beautiful and Iÿm inspired by them.ÿ Now
I feel the meaning of his words. Iÿm beginning to pay attention
to things.ú
þMusic means more to me now. Art does. Scenery does.
And my friendsÿ efforts to reach out and empathize and be supportive
are just overwhelming. Life in general has changed, it feels like,
from black and white to Technicolor. I always thought that the way
to depart was to have a sudden massive heart attack on the tennis
court. But, wow, what I would have missed.ú
þNow Iÿm enjoying giving possessions away. I just
got rid of a Chinese hand-carved chest Iÿd gotten in Hong Kong when
I was a flight surgeon. Also, Iÿm an honorary grandfather for an
almost-three-year-old boy. I think about that young family, how
I can help. Mostly I think of what resources I have and how close
friends might benefit.ú
Of his few regrets is that he didnÿt spend his early
retirement documenting how students utilize their extra time in
medical school. Heÿd hoped to publicize the findings to encourage
other schools toward similar programs. þI never did that. Iÿd like
to think that someone will some day.ú
He searches the room around him and his eyes widen.
þOh. One thing I would wish for, what would improve the quality
of my life drastically, would be to have a new New Yorker
magazine every day.ú With that Steward hurries from the room to
retrieve a book of The New Yorker covers.
Looking in a closet he is unable to locate the book
and says, þOh, gosh. Now I am beginning to worry.ú
POSTSCRIPT: ON NOVEMBER 29, 1999, DR. STEWARD WAS
UNABLE TO ATTEND THE RECEPTION HELD IN HIS HONOR. There, friends
and colleagues came before a makeshift podium and told how John
Steward had influenced their lives. (The event was videotaped for
his behalf.) Heÿd known their names when they were undergraduates.
Heÿd given unrecognized gifts, such as a drinking fountain for people
who walked þthe dishú behind campus. Joe Sachs, MD, ÿ85, now a writer
and producer of the popular TV show þER,ú spoke of how the flexible
curriculum had allowed his success. Lawrence McEvoy, MD, ÿ92, described
Dr. Stewardÿs ministrations when he (McEvoy) suffered a debilitating
illness. Charlotte Jacobs, MD, director of the Clinical Cancer Center,
spoke of the flexible curriculum as a legacy and thanked him for
introducing her to Stanford. þBesides that,ú she said, þI just want
to thank you for your joie de vivre. Itÿs permeated all of
us. We wish you were here with us.ú SMD
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