Medical school recollection

Mechanically inclined

	Photo: courtesy of James Chandler

	Chandler (second row from bottom, center) and classmates from Stanford University School of Medicine, Class of 1958 (photographed in fall 1955.)

As a boy, James G. Chandler liked fixing things, typically bikes, motorscooters or cars. As a man, he thought a career as a surgeon -- as he saw it, a "people mechanic" -- would suit him perfectly. It turns out his instinct was good.

After medical school, Chandler, MD, class of '58, completed residencies in surgery and pediatric surgery at Columbia Presbyterian Medical Center and then served at the 3rd Marine Battalion Hospital in Vietnam (1966-67) and the Naval Medical Hospital in Oakland (1967-68). Next he joined the faculty at UC-San Diego, spent five years there and then moved to the University of Virginia, where he served for more than a decade. In the '90s he was medical director and vice president for clinical affairs of Shiley Heart Valve Research Center and medical director of the medical device company Valleylab. These days he's a clinical professor of surgery at the University of Colorado.

And despite surgery's reputation as one of the most grueling of professions, Chandler has pursued plenty of interests. While on sabbatical in 1974 he scoured the archives of Monticello and the National Library of Medicine researching the medical care of presidents. He just might have a book in him on the topic, Chandler admits.

Stanford Medicine's Joyce Thomas interviewed Chandler by phone at home in Boulder, Colo.

What were your early interests?

Chandler: I was mostly interested in fixing bicycles, motorscooters and automobiles. But I realized that wasn't going to be as intellectually challenging as I would like. So I raised my sights and decided to be a "people mechanic."

When did you decide on medicine?

Chandler: Early in high school. I'd had an opportunity to visit with a friend's dad, a surgeon who had gone to Stanford, and watch an actual operation. However, I didn't go into medicine thinking "Oh I'd like to be a doc taking care of people." I was thinking "I want to make people well by operating on them."

Which class did you like the most?

Chandler: Anatomy. It's three-dimensional. You learn to picture yourself, for example, standing inside the chest with the "ceiling" above and the "floor" below. It's key to becoming a good surgeon.

The least?

Chandler: Public health and tropical diseases.

During your years at Stanford what was the biggest "story" in medicine?

Chandler: Transplantation and open-heart surgery.

As a student you worked with Dr. Norman Shumway and others. Were you thinking then that Stanford was building a foundation for the first heart transplant [which Shumway performed about a decade later in 1968]?

Chandler: No, not heart transplant. I was thinking of kidneys first. I was trying to develop acquired immunological tolerance by injecting maternal spleen cells into newborn pups and later transplanting the maternal heart and both kidneys, one organ each, into the necks of three pups. Dr. Victor Richards was sponsoring the work and Drs. Frank Gerbode and Norm Shumway, who had just arrived at Stanford from the University of Minnesota, gave me much needed technical coaching. I thought of Dr. Shumway as a buddy; he was more approachable than Dr. Gerbode, who was very much the professor. Retrospectively, the principal benefit of the study was to give me a considerable head start in surgical skills, which is probably what Drs. Richards and Shumway had in mind.

	Photo: courtesy of James Chandler

	Jim Chandler at the office.

Why did you choose your specialty?

Chandler: The tangibleness of surgery appealed to me. I can see an internist managing a patient's diabetes as a laudable goal but, for me, it doesn't have the personal impact of operating on a patient. Moreover, as a concentration in medical education, surgery has all the advantages: First the student takes a clinical history and examines the patient; the attending joins in and elicits additional findings. Then the student talks with the resident and plans lab work. In the operating room, if the surgeon is interested in teaching, the student is positioned where he can see and be included in the table conversation and maybe even contribute by putting in a few skin sutures. The patient is seen again on succeeding days and typically is sent home free of the problem while the student is still on the service. Surgery is short-term comprehensive; there's no other field like it.

On Match Day what were you thinking before you openedthe envelope? Or was there a Match Day?

Chandler: Yes, there was. [The match started in 1952.] I was confident that I was going to match with Columbia Presbyterian in New York but I was concerned about how I was going to do among all those boys from Harvard, Princeton and Cornell. I also applied to Stanford but did not rank it high; I knew that the medical school was about to move. Originally, I had planned to return to Stanford later to work with Dr. Richards, my hero and surgical touchstone. But he wrote me that he was not going to move to the new campus. Anyway I had met my future wife, a nursing student, so I wanted to stay at Columbia.

When did you think now I am really a doctor?

Chandler: Early in my internship and I thought, wow, this is fantastic!

What is the biggest medical school change since you were a student?

Chandler: First, lifestyle concerns. Constantly you hear that students don't want to go into surgery, for example, because the lifestyle is too arduous. A second change is the equal number of women in medical school. And, third, there are fewer second-generation physicians. Their physician fathers were overburdened; they became oppressed by fee reductions and almost silly paperwork. Since HIPAA, it's worse. My son wouldn't have any part of it.

What advice do you have for current Stanford students?

Chandler: My advice to current students is medicine is a great field. Enjoy the privilege of being part of it and don't sweat the lifestyle.

James Chandler's personal favorites:

Book – The Jefferson-Dunglison Letters, ed. John M. Dorsey, MD, (University of Virginia Press), letters between Thomas Jefferson and Robley Dunglison, MD, the first full-time academic physician in the United States and Jefferson's personal doctor
Movies –"Dr. Zhivago" for its music, photography and compelling story about a doctor-poet in revolutionary Russia
Music – Mozart, almost anything at all
Pastimes – Amateur auto mechanic, formerly (cars are too complex now)
Places – Most recently the Allied Normandy beaches.

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