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Charles A. LeMaistre, M.D. - Interview 1

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INTERVIEW I

INTERVIEWEE:     CHARLES A. LeMAISTRE, M.D.

INTERVIEWER:     James S. Olson, Ph.D.,(with occasional comments by Lesley W. Brunet)

DATE:                     May 6, 2004

PLACE:                  Conference Room, Research Medical Library, The University of Texas   M. D. Anderson Cancer Center, Houston, Texas

Table of Contents:

Beginning/Joyce Trapp LeMaistre
Chancellor of UT Austin
MD Anderson: A New Direction
Religious Views
Desegregation in Tuscaloosa
Administrative Policies and Procedures
Friends and Supporters of MD Anderson

Olson:  You met in Alabama.  She’s from Alabama.

LeMaistre:  At the time that I first met Joyce Trapp, I was home for a weekend pass from the Epidemic Intelligence Service in 1951.  We had been working on a rather constant base, and my commanding officer thought it was a little unusual for me to ask for a weekend pass, but my mother was in Tuscaloosa, and I thought it would be nice just to get out of the constant seven-day-a-week work we were doing. 

When I went home, I tried to find out find out [sic] what my mother had to do, and she said, “I’m sorry, son, I have booked all afternoon.  Therefore, you’re here at twelve noon, and I’ll meet you for dinner tonight, but I won’t be free until then.”  The reason for it is I couldn’t tell her I was coming, so there was no forewarning of this. 

So I thought then, well, what am I going to do with the afternoon in a town that I have not been in since 1943 and I neeed to catch up on what’s happened to all my high school and college classmates.  So I thought of one individual who might be available, called him, and he was, so he and I met out on the University of Alabama campus in a little soft-drink store and had a Coca-Cola or something, overlooking a tennis court where some beautiful coeds were playing. 

Olson:  (Laughter)

LeMaistre:  One of them was especially attractive, so halfway through my discussion with him about who’s where, he suddenly noticed I was paying no attention to him and said, “Are you looking at something?”  I said, “Yes, that beautiful young lady down there.”  I said, “Bill, I would like to have a date with her.”  He said, “Look, I’ve known you all your life.  You’ve never had a blind date.”  I said, “Bill, I’d like to have a date with that young lady.  Can you arrange it?” and he said, “I don’t know her, but I know her tennis partner.  I’ll call her and see if she will meet you.”

So he did, and I went back and told my commanding officer I’d like to have another weekend pass the following week, went back over, completely unannounced, called Bill and said, “I would like very much to meet this young lady.”  He said, “Well, I can tell you her name, but she has replied to her roommate’s request that she does not want to meet any fat, old, bald, New York doctor.”  Because I had been at Cornell and Bill had said that—I’d been up there thirteen years, so it was just an assumption on her part that that was where I was from.

So with that, I couldn’t make any headway, and I went back, and the third week I asked my commanding officer for a pass and had to tell him what was going on.  So I got over to my hometown of Tuscaloosa and called Bill and said, “Bill, what time do I meet her?” feeling very positive and optimistic.  He said, “You don’t.  She has gone home for the weekend with her roommate to Birmingham.  You’ve just driven from Atlanta over.  If you care to drive up to Birmingham, she said she will come to the door, tell you hello, and meet you, and tell you goodbye, all at the same time, if you wish to do that.”  I said, “Fine, I’ll do that.”
Well, I did, and I met her and we had a little more time together than she at first announced.  Later on my friend Bill Bates said, “Why were you so persistent?”  I said, “Bill, I made up my mind I was going to marry the girl.”  He said, “You hadn’t even met her?” and I said, “That’s right!”  I told Joyce this story the first night, I said that I had told Bill Bates this, and she said, “I just don’t believe that.  I don’t believe you could do that.”  I said, “Well, I did.”

I got back over to Atlanta and my commanding officer said, “I’m sorry to tell you, you’re going out on a six-weeks mission.  It will be top secret, and you will not be able to communicate with anybody.  You’ll get your orders at a certain point.  I can’t even tell you where you’re going.”  So I disappeared for six weeks.  It happened to have been an epidemic on a Navajo reservation in Tuba City.  I couldn’t figure out how I was going to be there six weeks and not communicate with Joyce, so I turned to one of the wonderful teachers there in the boarding school and said, “You’re going over to Window Rock”—we were in Tuba City [Arizona] —“Would you do me a favor?  Would you buy a present for someone and send it in brown paper, no return address, but mail it from Window Rock?  Don’t bring it back here to mail,” thinking that would meet all the requirements of security.  So he did.  He asked me, “What do you want?” and I said, “Oh, get her a tomahawk or something like that.”  Well, he did!  (Laughter)  When I got back and finally called Joyce she said, “I want you to know I was surprised at the gift you went me.”  I said, “Are you sure it was from me?” and she said, “I don’t know anybody else in the world who would be as crazy to send someone he had just met once a tomahawk.”  I said, “Well, I thought it would get your attention.”  I really didn’t intend for it to be a tomahawk, I was just being flippant with this Harvard-educated Navajo, this wonderful friend, but he thought it was a good idea.  So that started out our relationship.  It took me a year to convince her to marry me, which I did, and we then moved to Atlanta after our marriage. 

Then I was reassigned again back to Cornell and still on active duty with the Epidemic Intelligence Service but doing some work in airborne transmission of disease.  From there the sequence leads through our moving to Emory [University] and then to Southwestern Medical School at The University of Texas at Dallas, and then after six years there, moving to Austin after Dr. [Harry] Ransom asked me to come down and do a study on the potential health manpower for The University of Texas—how could the facilities be expanded to produce more manpower.  Well, that led to thirteen years in Austin, all administrative, moving from executive vice chancellor to deputy chancellor to chancellor.
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Through that Joyce had a new experience.  She was just totally supportive of what I was doing, but we were asked to move into a house that had been renovated—it was a new house, built for Dr. and Mrs. Ransom, who retired, but we had four children and they had none.  So we had to expand it a little bit.  So the big story in the student newspaper was “Cost Over Runs” in what’s now known as Bauer House.  I told Joyce that I didn’t want to be chancellor and have to put her through all of the harassing like that.  She said, “That’s not a problem.  You’ve done a lot with the medical units to expand The University of Texas health facilities, and you have inherited the responsibility for developing three new universities.  Therefore, if you’re going to do that job, we have to do whatever The University wants.  Let’s get the job done by”—this was 1969, I became deputy chancellor.  So we sold our house to The University—our house in Austin—and moved into Bauer House, and Joyce said about the first year we were in there, having four thousand people to a meal, having sixty different visitors in the guest house of Bauer House that ranged from the USC [University of Southern California] swim team that had its reservations cancelled when they were swimming [against] The University of Texas, and since my son was swimming for The University of Texas, he invited them all to come stay in the guest house.  Well, they stayed all over the house, and they were wonderful!  Those swimmers are just the most impressive young people in the world.  There were a couple of subsequent Olympians on the team that I still stay in touch with.  But at any event, I caught them at two o’clock in the morning in the library reading, and I said, “Look”—I remember one in particular—I said, “Look, you’ve got to swim tomorrow against a team that’s pretty good, if you don’t realize that.  Your obligation is to do your best, and if you’re going to spend all night down here—so he agreed, if I would let him take the book with him, he’d go to bed.  He did.  Two others went also to bed.  But they did lose; Texas beat them.  So that was a prophetic remark.

Well, Joyce raised more money in the first year through all of the things she did—from the USC swim team in the guest house we had former Prime Minister Harold Wilson and his lovely wife, the King of the Transka in Africa (150), but sixty different groups like that spending one, two, three [days], sometimes a week, in the guest house while they were visiting The University of Texas at Austin.

So it was an auspicious beginning, but she quieted everything down because of the fact that it was turned into an overwhelming success.  But living in a public house when you’ve got four children turned out to be quite a test for both of us, especially for Joyce, since she was there all day and I was in the office all day.  We had everything from an alleged kidnap attempt on our oldest son to people coming—one of the student newspapers came and picked dup the garbage and went through our garbage just to find out what kind of garbage we had to publish in the paper.  So it was just a total exposure to public life for us.  Joyce took it more graciously than I did, which I have always admired her for.  She had a level head through the whole thing. 

I think, during that period of time, with all the entertainment for people from out of state—we actually were privileged to have some presidents and ex-presidents there, a lot of movie stars visiting The University, celebrities of one kind or another—it was quite a bit of work for her, but she did it so well. 
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After that, when I had difficulty in terminating my chancellorship, finally Governor Allen Shivers allowed me to become a candidate for the position opening up when Dr. [R. Lee] Clark stepped down.  And also at the same time a candidate for the open position of president of the U.T. Health Science Center here in Houston.  The faculty were very kind, and after I went through the process of interviewing and everything, I was actually asked if I would consider both of those.  Since I had three medical schools in my career, I thought I really needed to take a look at what kind of challenge M. D. Anderson had.  Dr. Clark was a very close friend, so we spent a lot of time talking.  I just found it very exciting; he had done so much and done it so well, this was a very solid platform to build on, and I had not the slightest idea of any long-range plans that were there.  There were none, really, basically formulated; I’m sure there were a lot of ideas.

Olson:  Why do you think Mr. Shivers looked to you?

LeMaistre:  Well, it’s very simple.  When Governor Allen Shivers was asked to come on the Board of Regents he let me know he was going to decline, so I went and talked to him.  I said, “Governor, we need you.  Here’s why we need you.”  I feel I had something to do with his deciding to accept.  But I did commit to him that I would not leave the chancellorship until such time as he felt comfortable in my leaving.  Well, the first anniversary was in 1976, and he didn’t feel I should leave then, so I asked if I could be relieved of some of the duties there so I could begin to do other things that were needed in the university.  So we did that.  But in 1978 I finally said to him, “Governor, I’m trained as a physician.  I’m very rusty now that I’ve been away so long, but I would like to get back into medicine.  I want to resign the chancellorship and go back as a faculty member somewhere and start teaching again.”

Well, that’s when it triggered in his mind that we had two searches which were ongoing and that he felt I could become a candidate for that and maybe be successful in one of those two positions and agreed that if I was successful that he would not stand in my way.  Because he loved M. D. Anderson, as you know, and I think he was always pulling for me to go there rather than anywhere else.

Olson:  At this time, when Dr. Clark’s tenure was kind of coming to an end—

LeMaistre:  Dr. Clark had announced his intention to resign.  The search was started, and I was chairman of the search committee, which I resigned before I became a candidate.

Olson:  Did Mr. Shivers—I heard that he felt the time was coming for a transition at the institution [MD Anderson].

LeMaistre:  If he did, he did not share that with me, so I don’t know that.  Dr. Clark and I had been seeing each other continuously since 1966—1965 really—because of my duties in Austin, and we became very close friends.  But Lee’s reasons for wanting to retire, as I recall them, as we discussed, was primarily because he felt that he really did not feel he could continue at the pace.  He was getting a little older, and he felt that maybe his health was not as good.  To me, he looked as strong as he did when he was wrestling.  He looked in great shape.  I think he and his wife Bert wanted a little more time together also, because they both were professionals, and they were both operating on different schedules.  So I think that it was pretty much his wish.  I don’t remember anybody ever requesting or influencing his retirement.

Olson:  As I looked through the files, it seemed to me, as we get into 1975, 1976, 1977, that things started just to slip a notch in terms of his ability to pay attention to things and kind of stay with it, as if he was getting a little tired maybe.  Not physically ill, just whether some of the air in the balloon might have just started to leak out a little bit in terms of the enthusiasm for it.

LeMaistre:  That may be so, I don’t know.  My impression, from the standpoint of seeing him in Austin and occasionally visiting this institution, was that the problems were getting more complex, and the comprehensive cancer centers, of which M. D. Anderson, Memorial Sloan-Kettering, and Roswell Park, were looked to as leadership for the development of other comprehensive cancer centers.  That all stemmed from the passage in 1971 of the National Cancer Act, which you remember Dr. Clark was a part of sponsoring with Senator [Ralph] Yarborough and really lobbied very hard for it, along with Dr. DeBakey and the Heart Institute.  They were all there and worked very hard on to get these things passed.  But that opened up new opportunities.  I’m not so sure that the—Dr. Clark had great vision, and I think he was looking down the road and said, after 1977 and 1978, “this is an appropriate time to bring somebody in to plan a new direction.”  That was my impression. 

Now, I don’t know anything about the pace of things.  He had an excellent staff.  Joe Painter, Bob Hickey, all of them were working very closely with him.  There were things that needed some attention, but my goodness, any institution, when you get into it, you look at some things and say, “Is this going to pay off as well as taking that money and reinvesting it somewhere else?”

I talked to Dr. Clark about the things that I wanted to do with what that he had created.  I said, “I don’t think this is going to wind up the way you intended it.  It doesn’t look like it will go.”  Among those were some contracts that had been signed up in [University of Texas at ] Tyler a number of years before, and I couldn’t see that Anderson could fulfill those, so we unraveled them.  I asked Dr. Painter to do that. 

Then Dr. Clark had the dream of feeding the Texas Medical Center and Galveston, including Anderson, with a frozen food facility down on Knight Road, and had gone into construction and built the facility.  It hadn’t begun to operate yet, but had invested a lot of money in it.  When I had consultants come in, the former head of one of the very large food companies who had frozen foods, he indicated to me that this was on an economic scale that would not fly over a long period of time, because the overhead would be so great and the consumer was so limited.  Not limited in terms of what we thought, but limited in terms of what you need for a Tyson or a Swanson or one of the big frozen food things.  So I then began, with Dr. Clark’s full knowledge, to replan that as a research facility because we had so much money invested in it; we couldn’t lose that.  It worked out very well.  That was the first leg on what has now become a major research campus south of here. 
But the transition was very smooth.  Dr. Clark was being exceedingly helpful.  I asked him to stay fairly close and called him frequently.  After the first year or so, he got busy doing a lot of other things, so I didn’t see him quite as much, but still saw him occasionally.  Once he became ill, it was more difficult for him to help, but he was a real blessing and I enjoyed working with him that closely during that period of time.

Olson:  How did Mrs. LeMaistre feel about coming to M. D. Anderson as the new choice for your family?
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LeMaistre:  Joyce LeMaistre was a remarkable person in that she could read me better than anybody else.  She knew before I ever told her that I had this opportunity that it was there and that I was excited about it, so she was always ready to move that family wherever my career would lead us, provided that it wasn’t injurious to the children and so forth.  This wasn’t.  It was a very appropriate time for us to move.  So she was very supportive of it, just like she was supportive of my becoming chancellor when I wasn’t sure I wanted to be chancellor.  I wanted to get back to medicine.  But she lectured me on my responsibilities to follow through on what I had had a hand in creating—the new health units and the new universities.  I guess one would call that in modern-day lingo a “guilt trip,” but she was very convincing.  She felt very strongly about loyalty; she felt very strongly about ethics; and she felt very strongly about the integrity of the family. 

I cannot remember a single time that she was not supportive.  Even the time that we came to Dallas on our first day there in an un-air-conditioned station wagon driving in from Atlanta, and the temperature was 108.  The motel I had rented rooms for us in, the air-conditioning went out the first night.  The next morning at breakfast she looked at me and she said, “We are going to be in air-conditioned quarters, aren’t we?” and I said, “Yes.”  She said, “If we’re not, I’m taking a plane back to Atlanta.”  I said, “No, we will,” because it was very warm there those few days.  But she pitched in and was always positive about that transition.  I think then may have been the hardest move for her though was to leave Atlanta, which she loved very much.  We had a gorgeous home out in the mountains north of Atlanta.  I was very happy there.  I think that if I had chosen to go into administration there, we probably would still be there.  But I did not want to go into administration; that’s why I came to Southwestern Medical School.  They promised me a job without any great administrative overhead.

Olson:  What kinds of things did she like to do with her personal time, hobbies [and so forth]?  I’m not sure she had much time.  (Laughter)

LeMaistre:  Well, we had the four children.  That, of course—her first priority was always the home, and, of course, with that she had the responsibilities.  When we did not have someone to help us cook, and we did not have before coming to Austin, she ran the kitchen and ran the house and all of those things, and looked after the schooling of the kids.  She was interested in art and she painted.  She sculpted.  I have several pieces I cherish very much of her sculpture and her art.  She took a lot of lessons in art and improved that from a primitive painter all the way over to a fairly sophisticated watercolor painter, under one of Texas’ leading watercolor artists.  She enjoyed that very much.  Reading was something she loved very, very much.  She would have two or three books going at any one time.  She had an awful lot of friends; over the years they’ve all stayed together, so she had to have some time for those friends.  She also had the responsibility in my work of making sure that I did the things the way they would be expected of somebody in my position, which took a lot of her time.  It’s hard to realize that you turn somebody loose like myself in that, they forget a lot of the niceties that are supposed to occur, but she always was on her toes and worked with my staff very closely to make sure that if I was supposed to send flowers for something, it was done for us or done for me.  That sort of thing got done.  She was very attentive to the job.  But she did not like really to get into the job.

When we came here, she felt very strongly that the Texas Medical Center could be a very beautiful place.  What you see, where the Melcher Fountain is, was Joyce’s dream to begin the landscaping of the Texas Medical Center.  Of course, we did, and Leroy and Lucille Melcher were willing to put in that beautiful fountain that’s there, and so this became just a kind of Garden of Eden for the cancer patients.  Dick Wainerdi, as president of the medical center, thought it was a very good idea and did the beautiful plantings of the esplanades.  Dick and Angela really transformed the appearance of the Texas Medical Center so that I think it’s a lovely medical center now, although very concentrated.  Every spot that they can, they have beautified.  I think Dick Wainerdi and Angela, in particular, both need to get credit for that.  I’m very proud of the fact that Joyce launched out and helped me find money to do that sort of landscaping here. 

But she was doing it for the patients; she was very patient oriented.  Her mother had died of breast cancer.

Olson:  Oh, she did?

LeMaistre: And so Joyce just knew what it was like to go through a very serious kind of cancer.  But she cherished the friendships she made here in Houston.  When she could no longer live in Houston, she told me, she said, “The one thing I really regret is that I’m going to be leaving so many friends behind.  I’ve got to go to a drier climate for my asthma, so I’m going to go over to San Antonio.  Although I’ll have our children and grandchildren there, I just have so many close friends [here].”  I said, “They’ll never disappear.  They’re like all the others that you have accumulated over the years.  They’re going to remain there,” and they did.

Olson: They stick, huh?

LeMaistre: They did.  They stuck all the way through.  They were the ones that were right on the front line when she finally got her fatal cancer. 

Tape 1 of 1, Side B

Olson: A courier was delivering in a little blue and white—were they delivering chemo?

LeMaistre: Yes.

Olson: Was it a little kind of a picnic [basket]?

LeMaistre:  Yes. 

Olson:  Is that what it was?

LeMaistre:  Yes.

Olson:  Okay.  I was just wondering.

LeMaistre:  That’s the system they have in San Antonio.  It’s really an integrated system wherein her oncologist is also head of the hospice, he’s also head of the home care [unit]—he’s medical director, not head, but he’s medical director—so he’s got an integrated program for cancer patients.  So if they can stay at home, they can be totally supplied with all the drugs they need, and then the home nursing service is also part of the whole scheme.  Everything is integrated all the way through.  Joyce never had to go to a hospice because of that.  Her last days were in Methodist Hospital, but we knew they were going to be her last days, and so we admitted her to that really for what would be a final episode there. 

She was the kind of person I think that took tragedies and turned them into positive things.  For example, when her inability to breathe in the Houston air—it was called adult asthma, it really isn’t, it’s acid burn of the lungs from the atmosphere—we went up to Colorado, and I saw her do so well up there.  She was beginning to get toxic side effects from all of the bronchodilators she was taking, so they stripped out her medicines and she was just like a mountain goat, like she was twenty years younger.  So I said, “Okay, we’re building a house up here.”  That’s why we have the little place up in Colorado still.  She did very well and we were up there a great deal of the time until she developed cancer, and then I had to have her back in a place where I could access M. D. Anderson, where she was diagnosed and operated upon.

Then the teamwork between the San Antonio oncologist and Anderson was just unbelievable.  Dr. John Cavanaugh here was the ultimate quarterback.  Dr. Taylor Wharton had been her gynecologist for years, and when it came to medical treatment, of course the internist and Gynecology, Dr. Cavanaugh, was the logical one and did such a superb job.  The oncologist in San Antonio and Dr. Cavanaugh here were in constant communications, and so it just worked out beautifully. 

Her reaction to her cancer was one of the most fascinating things in that she and I had the privilege of being together literally twenty-four hours a day, seven days a week, for over two years, because I had retired, of course, when she developed her asthma.  We talked about everything about the family.  We both have never hesitated to talk about the inevitability of death of both of us, and she just talked about it, said, “What are you going to do if I die?  Where are you going to go when I die?  What are you going to do about our relationship with our grandchildren?  Will that change?  What if you predecease me, how do you think I ought to do?”  All of this got talked about thoroughly.

What I didn’t know was because of her very, very devout Christian devotion and ethics, she had been making interpretive notes all along from the time she got cancer till the very end.  They are really quite remarkable to read, because she would read scripture, but then she would interpret it as to what God’s purpose was in this--and it’s always a positive purpose, I don’t find any negative words in there—as to why this—she used the word “trial,” as the Old Testament did so frequently—but she would always interpret that.  That was what was used at her memorial service by my son Bill, who gave the eulogy for her.  It’s very impressive, because she never discussed a word of it with me, but she put all of these sheets into her Bible.  After her death I read those for the first time.  It showed me the real depth of her Christian life, because everything that happened, Joyce would interpret it in terms of her beliefs.  She was not originally a Presbyterian when I married her, but I had been in the Presbyterian Church and she decided that was the place that we were going to raise our family, in the Presbyterian Church.  Her view of predestination comes through about as strongly as any sermon I’ve ever heard of the subject because she interpreted it in terms of why.  Why is this happening?  Why me, God?  Why, and what am I supposed to do with this opportunity?  I went back over these notes in terms of when they were written and where we were in the medical situation, and she was taking that opportunity—and then I realized what she did with it, which was always positive.

For example, her last visit with all of the grandchildren and the children was on Thanksgiving of last year, 2003.  Leading up to that she had a number of notes on the value of the family and what were responsibilities within the family unit were.  But after that, when she had all day long—and I was amazed at her stamina at that point in time, because she’d been on some very toxic medicines—but she just floated through the whole day happy as she could be with all the children and grandchildren around.  The next morning I went in and I said good morning to her, and she said, “I’m a little sleepy this morning.”  So that day passed, and the next day she was a little more sleepy.  By December 5, when I tried to wake her—we had moved her back to the hospital and I tried to wake her in the morning.  I slept in every night except the night before, so I came in from outside, and I was going to wake her and say, “How did you do last night?  How did things go?” and I couldn’t wake her.  So I started watching her vital signs, and at nine o’clock she had a lengthening of the period between breaths, and by the time we got to five minutes to twelve she stopped breathing.  But just as peaceful as it can be.  She had pretty well interpreted the event of death in her notes, some of which I have not shown to other people, primarily because they’re very private and personal, but as coming with great serenity, and hers did.  I think that it’s been a very rewarding experience for me, as a physician, to actually live through with one patient the whole sequence.  We had known for two years this was not going to be cured.

Olson:  When was she first diagnosed?  Was it--?

LeMaistre: Oh, goodness.  A wonderful M. D. Anderson [doctor] diagnosed it.  We had some atypical pap smears.  They were not deemed to be pre-malignant, but they were atypical.  They bothered Dr. Ruth Katz, a pathologist who does most of the pap smears.  Because they bothered Dr. Katz, because of the great respect that all of us had for her, including Joyce—Joyce told Dr. Wharton, “Taylor, I want to get to the bottom of this.  At my age, I think you ought to start with the cervix.  If you don’t find out what’s causing this there, keep on going, and remove the uterus, and if you don’t find it there, the fallopian tubes and the ovaries.  But please find out what’s causing this.”  So Taylor did exactly that and took a number of biopsies of the peritoneum and other places.  Of course, the beautiful way they do pathology here, they cut every section here, and they have more than one person reading it, everything was completely negative for three or four days until they found two little pinhead sized lesions deep in the endometrium of the uterus that were malignant, pinhead sized, one of them.  The other was pinhead sized but seven pinheads long, very tiny, both of them.  It was at that time we knew that we had a problem on our hands, and the decision was split as to whether she should be treated or not.  After pondering for a while, we all decided she should go ahead and be treated with chemotherapy.

Olson: Can I stop right there?  Just for my own personal knowledge, what was the issue about why decide between treatment or no treatment at all?

LeMaistre: Well, many of the cases like this, when all of the cancer had been removed, the physicians here have pondered whether to risk the toxicity of first-line chemotherapy, because we were going right with Taxol to begin with, and with what’s called cisplatinum, one of the others.  It was potent chemotherapy, and they were looking at risk versus gain in this.  They had had so many patients that did so well without chemotherapy.  But taking the other side of this, there were some cells that were out into the peritoneum that were found in the saline washings.  These were free cells there but no evidence of any invasion.  So it was a toss up.  What do you do in this [situation], and we came down on the side of going ahead and treating it.  And everything went beautifully for a long while.  After her first dose, which was a little difficult, she tolerated the chemotherapy very well, and we went through the whole course.  She remained well for quite a long while. 

Then about two-and-a-half-years ago now, she began to get a little discomfort in her abdomen, not severe pain, but just discomfort.  So we came back, and Dr. Wharton checked her out, and indeed we did have some cystic masses, two as I recall that were rather small—one on the surface of the liver and one over in the right upper quadrant.  That began then another series of treatments with the same drugs.  We quickly realized we weren’t getting anywhere with those, so we began the first of a sequence of drugs to try to find an effective drug.  She moved all the way on through to get intestinal obstruction in the small bowel and had to have all of the consequences of the kinds of drainage and all the things you do.  So her course was not a pleasant one, but she never complained about anything.  She I felt was a model patient in that she exchanged very directly with all of her doctors.  They would ask how did she feel, and she said, “I can tell you this, I don’t feel good, but I don’t feel as bad as a lot of cancer patients,” things like that.  So they kept pretty close tabs on her.

Interestingly enough, toward the end of her course we were getting ready for another course of chemotherapy, and Dr. Cavanaugh wanted to try a regimen that he thought just might have some effect, and lo and behold after two courses of this particular regimen the blockage in the small intestine melted away.  But she was pretty far along at that point in time, and that wasn’t the major problem any longer.  The disease had pretty well spread through the entire abdomen and liver.  So it was downhill from there on, and to have continued that would not have brought about any kind of decent remission.  So she elected, with her oncologist here and over in San Antonio, not to continue any more treatment.  That was about November of 2003, late October, early November, something like that.

But she’s the kind of person that you always would like to have as a patient, because she was a no-nonsense patient.  She was intelligent, she got herself informed on all that was going on and discussed it very frankly with the doctors, and the decision was very clear.  We never had any difficulty.  I don’t recall her ever putting off a decision, just here are the facts, how do they add up, what are the options, and I’d take this one.

Olson: I had kind of interrupted you when you said for about two years you knew things weren’t going to work.  Or did you want to say something about the way she approached death?

LeMaistre:  I’m sure that she had more of a reactive depression than I saw, but when we were discussing this I said, “Joyce, it looks to me now that we are almost certain to have only the option that we can stabilize this disease for periods of time and then have to retreat.”  She said, “You mean I’m going to die of this disease?” and I said, “Yes, I think that’s a very direct way of putting it.”  She said, “Well, that has its advantage.  I know really what is going to take my life.”  And she turned to me and said, “You don’t know,” and laughed.
(Laughter)
She was able to turn it around so that you never really knew whether or not this was the kind of thing where she was laughing on the outside and crying on the inside.  A very brave lady.

Olson: I’ve noticed in some of the files some letters I think—you know Bill Bright?
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LeMaistre:  I know Bill well.

Olson: Yes.  Could you talk about your own religious faith, if I’m not invading personal space?

LeMaistre: No, no.  My religious faith is the faith of my mother.  My father died when I was five, so my experience with him was limited.  My mother had six children—at the time of his death—to raise and send to college, so she did the logical thing to move to Tuscaloosa where the state university was located.  She was a teacher, and therefore all of us were going to get all of the education we could possibly stand.  (Laughter)  In the process, she taught at home, and she also taught lessons of the Bible at home.  A good example, I think, was her lesson on humility to my next-oldest brother and myself.  We thought we were very good tennis players in high school, and we competed successfully at the state level.  The next morning, when we came in for breakfast—our mother would always get us up early—we came down to have breakfast with her, and she said, “Well, I’m very proud of both of you,” and didn’t say any more.  Then we started jabbering as teenagers do about “My, that was a good serve,” “My,” so and so, “My, you did that well,” “Yes,” my brother actually beat me in the finals.  So we were kind of jawing.  She said, “You two think you’re pretty good tennis players, don’t you?” and we said, “Yes, m’am, we’re very proud of what we did.”  We had a clay tennis court, and so we went out onto the clay tennis court, and my mother took me on first.  I was trying hard.  I did not win one game in two sets—not one!  The next set was my brother’s.  She had already played two sets; he had not.  And he was the better tennis player.  He won one game out of two sets, and he was trying. 

So we all three came back in then for a late breakfast after that, and she said, “Do you two think there is a lesson in what we just did?”  So we acknowledged we understood completely without another word being said.  (Laughter)  Our pride was put in our pocket forever by that.  I think my brother to this day says until that time he really never was aware of the fact that he was so prideful about things that he accomplished.  But he said, “I never, ever called any attention to anything I did after that.”  That’s the kind of lesson she would teach, and she would always be able to give you—if you were inquisitive about it—a biblical reference of some kind.  She was a Scottish Presbyterian; her maiden name was McLeod.  She taught us in the home the interpretive lessons of scripture, which are very helpful, because we got the scripture in Sunday school and church, and that continued all through our young lives.  It was never required that we go to church—it was understood we were going to go, and there was just no point in discussion.  So I’ve always felt that that foundation was just irreplaceable in my life. 
The things I grew up with, in terms of lessons in Christianity, I recall very vividly.  While I was still living at home with my mother, the trial of the Scottsboro boys for the alleged rape—the trial was in Tuscaloosa, and my mother took us downtown in the car just to show us the barbed wire on each side of the street leading up to the courthouse where the National Guard was out just to protect those young men who were ultimately acquitted of any wrongdoing.  Ultimately. 

Olson:  It took a long time though, didn’t it?

LeMaistre: Then she took us all to church—it did take a long time—where the preacher, who was one who knew he would be in hot water for doing this, but felt he was constrained to preach on the principle involved here of equality and justice.  He got pretty roundly criticized for that, and guess who had him to lunch the next Sunday?  My mother. 
(Laughter)
With all of us present.  No words said.  No “I’m inviting him because he’s having a hard time,” not that at all.  She wanted us to know how she felt about him, backing his Christian ethics. 

I guess there were several episodes like that that occurred.  The same preacher preached beautiful sermons on what now I would recognize as desegregation, and those were preached long before Brown vs. Alabama.  So were ingrained into this in terms of our respect for other people and our feeling about social conditions and so forth.  The impact on the family was so great that my brother was one of the ones who stepped forward and lead the desegregation in Tuscaloosa.  That was not a popular role for him because—

Olson:  What was his role?

LeMaistre: He was a lawyer, and he was president of a bank, the two positions that you want to protect your reputation, but he felt that somebody had to take the leadership.  He lead the peaceful desegregation of that town.  There was lots of cross burning, lots of other things like that, but nobody flinched.  They continued on, and within just a short period of time things began to go in the right direction.

Olson:  What town was that?

LeMaistre:  Tuscaloosa.

Olson:  Tuscaloosa, okay.

LeMaistre:  But that’s an example of the faith that was installed by our mother into all of us.
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My experiences later on—Bill Bright and I first became friends when I was chancellor of the University of Texas, and we were having a great deal of trouble with insurgents coming from outside who were not students—like the Weatherman and all of the people that were coming in to try to disrupt the academic process.  That was their goal.  I had many discussions with the Board of Regents and they agreed we would not tolerate it.  In 1969, when I was deputy chancellor, the regents voted to ask the legislature to allow armed police, the first armed police on any campus in the State of Texas, but thoroughly trained by the FBI, by the Department of Public Safety, by the local police, in what was called an academy.  They [U.T.] set up the academy, which was copied by a lot of other people.  So we had our own police starting in 1969, two-thirds of whom were students.  It’s pretty hard to turn a class over and look at a fellow student who is a policeman and say, “You’re a pig!”  They knew better than that.  So things got quieted down, and the students never were any problem at the University of Texas.  Read the newspapers, and you won’t see that.  There was never any real problem.

For example, when they [The U.T. students] protested the Cambodian invasion, they wanted to express their opinions.  They were not violent.  Five thousand students gathered on the mall, sat there, asking to be allowed to march and then come back and disband.  Well, at first the local judge said, “No, you can’t do that.  It will cause disruption.”  I went to Frank Irwin and I said, “Frank, I read this differently from the way the judge does.  You tell me if I’m correct, but I think we ought to ask the judge to allow them to march.”  He said, “How are you going to protect them?”  I said, “I talked to the fraternities here.  They will form a cordon two deep on either side.  Although they don’t agree with them, they’ll protect them, and they’ll march them down and bring them back and disband.”  Well, I had appealed to all of the churches there to help us with this situation.  Not a one stepped forward.  I then turned to a group called Campus Crusade.  It was relatively new on that campus.  I said, “Will you help by organizing the Greek fraternities?” and they said, “Yes, we’ll be glad to do that.  We’ll also get some others to help because we think this is a just cause.”  Well, they did.  The judge relented, let them march, and came back and sat down and disbanded.  It was over. 

The great lesson learned there: Bill Bright and his Campus Crusade grew like topsy on that campus.  Students respected it highly.  Incidentally, Bill died this past year.

Olson:  Oh, I didn’t know that.

LeMaistre: Yes.  I continued with them because they were interested in the same goals of getting the students on campus to look at the possibility of any church life, any kind—it was nondenominational.  My interest though was in having these students help on the campuses all over the country when there were outsiders planning to come in and do violence.  We had that experience.  Fortunately, by the time we had it we had enough armed police to stop them.  We were part of the team that stopped them south of the Capitol when they were going to march through the Capitol and tear it up and come on up to The University of Texas [at Austin].  And they used gas [to stop them].  I mean, they were riot trained and everything, so they were very good. 

I visited a lot of other campuses where they had trouble.  I had friends who were presidents and chancellors of these campuses.  They did not have the same favorable experience that we had.  But I still, to this day, say we probably could not have done that without the help of Campus Crusade.  I continued on to correspond with Bill and his wife up until several years ago when Bill became increasingly ill with I guess it was probably pulmonary hypertension.  I’m not sure what happened, but he did have a breathing problem.  So it was a rather intimate relationship and friendship. 
I also had the same kind of relationship with R. C. Spoul, who had a ministry to the kind of bright young people that college graduates become.  I think he’s done a fabulous job, and I correspond with him occasionally, not as much as I did when I was in an official position. 

Tape 2 of 2, Side A

Olson: --in general and then at M. D. Anderson in particular.  Was there resistance?  When Brown vs. the Board came down, did universities feel right away, too, that was going to require changes in the way whites and blacks interacted?

LeMaistre: Well, I think everybody felt that way, because this was now the law of the land.  There wasn’t any question there had to be remedial changes.  I was in Atlanta at that time, I was at Emory, just starting there.  Atlanta planned ahead and had a number of potential black leaders and some black leaders who were very prominent and very capable, and that was a very smooth transition in Atlanta.  I wasn’t aware that the problem was serious when I moved to Dallas, but I must admit that I was in Dallas only for the six years that I taught there in the early 1960s.  On the campus of The University of Texas at Austin, the problem was pretty much I think deflated by people like Darryl Royal, who recruited black athletes and was kind of a little bit of a leader in this.  Prior to the time that Darryl came there, I don’t recall the first black athlete.  Herman Sweat, I think, and I’ve forgotten the years, but I don’t know if that was Royal’s era or his predecessor’s era.  But Darryl went with athletic ability, regardless of the color of skin, and he insisted that they be good students. 

As an example of that, when Earl Campbell was recruited, Darryl called me and said, “I’d like for you to meet Anne Campbell, Mrs. Campbell,” and I said I’d be happy to.  I didn’t follow high school football so I didn’t know much about Earl, but I met Mrs. Campbell.  She was a lovely lady.  I said, “I’m so happy that your son is coming here,” and she said, “I’m very happy, too.  But you know why I’m happy?  Because Royal is the only one who didn’t offer me anything, and in talking to my son, did not induce him with anything.  But everybody else had been offering us the moon, and I knew there must be something wrong with that.”  A very strong Christian lady.

I met Earl and Earl said, “I don’t know whether I really ought to come to the university, that may be too hard for me.”  I said, “Well, Earl, you know, Darryl’s the only coach in the country that’s got a brain coach—Lan Hewitt—and he’s there to help you if you have trouble.  I don’t want to persuade you to do something you shouldn’t do, but you may want to try it, see whether or not that would work and the kind of courses you want.”  Well, he came, and he wanted to take journalism, which is not an easy course at Texas.  That’s the one where all the lawyers go to learn how to write a brief, to be very candid about it, because most debate had been done away with and English composition has been turned down so frequently in most colleges and universities.  It had a lot of bright students in it.  Earl at first made C’s and then he moved on up to B’s and was really quite a bright student, did very well. 

He and I remained friends all the way through his career.  We had to laugh kind of looking back on things and the kinds of things he feared, but he’d never been given the opportunity to prove himself, and he did such a remarkable job both as an athlete and as a human being, and a very decent student. 

That sort of thing—you know, in the Southwest if you can show the quality of the person who is an outstanding black athlete you can pretty well solve the problem, because most of us are sports fans, maybe some of us too much.  I was not really aware of that.  The disparity in the student participation in the entering class bothered me a lot, but it bothered everybody else, and they were trying to go out and finally the university took the bull by the horns and created scholarships for minorities.  That began to get the percentage up.  But they had to go to a lot of things that would be called affirmative action, and affirmative action in some people’s minds is unfair to the whites or to other groups.  So be it, that is true.  There is no question in my mind there were many discriminatory practices there.  But we had to find some way to get the situation to where it is today, which is better—still not perfect—but it’s going to take a long time to solve these problems.
I was aware of everybody in The University of Texas System everywhere trying.  I admit that they weren’t as successful as quickly as they hoped they would be.

Olson:  I went to talk to Paul van Neville.  He said he thought that the integration at Johns Hopkins was really a product of the Civil Rights Act of 1964 and Medicare, more basically, that a lot of funding coming from the federal government to hospitals is—

LeMaistre: Sure.  Paul’s right.

Olson:  Is he?  Okay.

LeMaistre:  In the medical area, that’s certainly true.  I do think that the Civil Rights Act of 1964, which was of course one of Lyndon Johnson’s landmarks, Head Start, and some of the other things that were long-range programs, I believe all of those have paid off in spectacular fashion.  I would hope that we can move to the point where we’ll remove all controversy from this by providing opportunity.  If a white student fails, so be it.  If a black student fails, so be it.  But they need to have the opportunity.  I’m one, if we could afford it in our society, I’m very much in favor of universal collegiate access.  I learned that because we modified one of Dr. [Harry] Ransom’s programs, Ken Ashworth is the genius behind it—where we offered admission to any high school student who had a Texas high school diploma regardless of ACT or SAT and they could come and take twelve hours of freshmen work in the summertime.  If they got a C or better, they were regularly admitted.  More of those students graduated than those that were regularly admitted—a higher percentage—because they’re motivated.  they didn’t necessarily turn out to be A students, but they graduated, and that’s the goal.  This world is not run exclusively by A students.
(Laughter)               [JSO: was this a reference to Prez Bush??]
We’ve got a bunch of C students around, and they’re really quite good.  A few generals that I recall are really at the bottom of their class at West Point, and they turned out to be really great for this country. 

I think Paul is right in the medical field.  There are a lot of things that aided and abetted that.  This has never been a problem with Anderson.  It wasn’t when I came here, and I don’t recall that Clark ever talked to me about it.  I think I once looked at the data, as crude as it was, because nobody had good data on who was white, who was black, or who was Indian, or anything like that, when I came here.  But it was quite apparent to me that we not only had a great number of minority employees, we had a lot of minority in very important positions, and that has continued to evolve.  I don’t think anybody ever really pays much attention to it now.  At least they didn’t in my last few years, and I have heard nothing to the contrary in all the years since Dr. Mendelsohn came here.

Olson:  Could you talk to me a little bit about the evolution of tenure at M. D. Anderson?  I’ve read a lot of letters back and forth between the clinicians and the basic scientists….
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LeMaistre:  Did you read any of the correspondence between Dr. Clark and myself?

Olson:  Yes.  (Laughter)

LeMaistre:  Lee came into a meeting of what was lovingly called the Med Heads, all of the presidents of the medical campuses, and just dropped a bombshell that he thought that contract tenure was a good thing.  It would be known as term tenure and that his faculty had voted in favor of it.  I said, “Well, if your faculty wants it, I think they—“
Olson:  About what year would this be?  1967?

LeMaistre:  Somewhere between 1967 and 1970.  I can’t pin it down.  After that, all the other medical heads said that’s fine, if that’s what your faculty wants, do it.  Well, I had to take this to the Board of Regents, with Dr. Clark, who was helping me with it.

Olson:  Was the term going to be five years or seven?

LeMaistre:  We had five-year renewal on deans and I think it was seven [for faculty].  They were given notice for more than a year in advance on when their evaluation for restatement of tenure.  I think that’s the way it read.

Olson: So you went to the dean?

LeMaistre:  I went to the Board of Regents, and of course the university was taken back by this.  They did not think it was a good sign to have a medical institution of The University of Texas System having what in effect was term tenure and reevaluation.  It was to be a guarantee of the right of free speech through your entire career.  Well, we had to point out that if that’s what tenure really was, that would not be a problem.  But now we have turned tenure around into you’ve got to publish, you’ve got to do all of the other requirements, and so it is job security basically, and therefore it has to be looked at in terms of how the faculty thinks that’s best applied.  If they think reevaluation of a faculty member for their productivity, in terms of their job security—because they’re going to have freedom of speech guaranteed, no matter.  That’s no longer an issue.  But that’s what tenure was originally created for.

So we went through all of this, and the Board of Regents sat back and said, “No, I think if the faculty prefers to do it that way that’s what ought to be done.”  So that’s how it began.  One president out at The University of Texas Permian Basin considered doing this on that campus.  I don’t recall the full details of that.  But it worked well here.  I checked on it several times to make sure it was being fairly applied, and the faculty was doing a good job of that.  All the time I was here I was very much aware of the fact that it could become controversial, with a few mistakes and a few things that weren’t fairly done.  So the Vice President for Academic Affairs always kind of monitored it just to make sure it was going [fairly].  When I proposed the Faculty Senate here, that was the culmination of trying to really get the M. D. Anderson faculty to look more like an academic faculty.  The reason that was timely was we were clearly past the clinical phase that they had to start with because there wasn’t much research money available when Dr. Clark started this thing.  But now we’re the leading research institution in the world, and therefore we should be governed by the faculty—they ought to have the opportunity to govern on the basis of their academic standing as well as their clinical prowess.  That’s when we began the Faculty Senate.  It had an interesting start.  A lot of faculty were opposed to it; they thought it was a waste of time and they didn’t really need it.  I had a lot of critics.  Then some members of the faculty took—I think, as we talked, they took this very seriously after I charged them with some things that they didn’t expect.  Then there were others who wanted to use it for their own particular purposes.

Olson: (Laughter)  As always.

LeMaistre:  But that’s in every faculty senate.  I couldn’t get upset about that.  People expected me to, but I’d seen so many faculty—I’d been in faculty senates which had that happen.  It’s up to the faculty to pick and choose what their priorities are.  But in any event, I’m very pleased with what this faculty has done.  I think they’ve done a magnificent job of keeping up with their academic responsibilities, both in terms of tenure and in terms of the Faculty Senate. 

Olson:  Was that term tenure unique to M. D. Anderson?  What about the other medical schools?  How did they work their tenure?

LeMaistre:  No, they had just the same tenure as the university.

Olson:  Is that right?

LeMaistre:  No, this was the only one.

Olson: Oh.  Very interesting.

LeMaistre:  I think it’s remained that way.  I haven’t followed the others that closely.

Olson:  The faculty started that?

LeMaistre: Dr. Clark, Dr. Hickey, and Dr. Painter were all a part of it being started.  You’d have to ask Dr. Painter, who would be the one to contact, to verify what the roots were.  I got this in a presentation, for an agenda , at the committee meeting at the system level; I got the condensed version.  I just asked Dr. Clark twice, I said, “You’re sure the faculty did this?” and he said, “Absolutely.”  I don’t know whether Joe Painter was with him or not, somebody was, and I said, “You know, that sounds unique”—I think I used the word unique, and I think they thought I meant suspicious, but I didn’t, but they quickly verified it.  So I didn’t look back; I had the word of people I trusted that the faculty had approved it.  When I came here, I asked a few people if they remembered that approval.  Some of them did, some of them didn’t.  I’m not sure everybody was involved in it.

Olson:  I think he wanted lifetime tenure about as much as he wanted hoof-and-mouth disease out there on the ranch, Dr. Clark.

LeMaistre: Lifetime tenure would be highly in appropriate for this institution.  There are people who come to this institution and can contribute at a particular opportunity in cancer at a given time and place, and that opportunity changes.  There was an opportunity that would be a high water mark on tenure in evaluating Dr. Jordan Gutterman.  He wisely took advantage of funds to develop interferon, after that, he goes back to some other research that has to be evaluated by the faculty as to its merits within the context of what the M. D. Anderson’s research mission is doing.  It has the great value of not letting an individual researcher go chase money and do anything with money.  “Well, I’ve got a million dollar grant to go out and study butterflies and their cancer.”  Well, that may or may not be appropriate, but the faculty makes that judgment as to whether it’s wasting space and time and resources.  That’s why I think it’s good to have the faculty riding herd every few years on all of us, and I think anybody that isn’t willing to stand the light of scrutiny in terms of their current performance really needs to reevaluate whether they really want to be at Anderson, because Anderson is moving forward and evolving and changing constantly.  With change has got to come change in personnel sometimes, either additions or substitutions.  And indeed, almost anybody can walk out of here and get a high paying position in cancer anywhere in the world.  This is the most sought after faculty still.
I can give you several examples of where they got four times as much pay as we were compensating them, but being a state institution we have to stay within some bounds.  Although I must say I’m very proud of what’s been done for this faculty, in terms of their life long careers and the retirement.  I think it’s superb, and I attribute that design to Dr. Clark.

Olson: The PRS?

LeMaistre: The PRS.  We embellished it a little bit when we came here, but it was Dr. Clark’s plan.  We just made it a little richer in some ways than retirement, and we also put the control into the hands of the faculty, whereas there had been a lot of the administrative control prior to that—necessary in the early years—but I continued to chair it with the power of veto, but never had to.  The faculty was always very responsible.  We got outside consultants; they ran it like a business and did it very well.  They were always interested in the retirees to make sure they were being taken care of; they had a committee on retirement with the problems of people in retirement, and they were willing to make adjustments for people who were having difficulty in retirement, unexpected things happened to them.  So it was a very, very wonderful operation.  But the template was Dr. Clark’s—central administration of all income from professional services.  That is not practiced in the UT System.  It’s usually through the department chairman.  The department chairman who gets the most money elsewhere from the MSRDP usually has the power of the money.  Here the money is centralized, it supports the basic science faculty and supports the retirement plan of all.  So it’s actually for the whole institution.  It’s very unique.  They [the clinicians] are very generous with their income.

Olson:  Can I show you something?  This is a letter, and let me explain a kind of a difficulty I have here.  This is a letter from Dr. Becker to you in 1989.  It is about protocol research and Dr. McKelvey and kind of oversight and things.  One thing I’m interested in, and the story is going to have to be told, but I’m having a hard time getting my finger on it.  Dr. Becker makes this—he is posturing a little bit in the letter sometimes.  At one point he says, “No one in this institution need be reminded of the disasters that occurred in the regulatory areas and the cost to us in the pre-Bodey McKelvey era.”  What kind of thing is he referring to there?  Take a look, please.

LeMaistre:  [Quoting from the letter] “and to rediscuss the need for permanent appropriation….”  All right.  Okay.  This is beginning to click.

Olson:  Ring a bell?  (Laughter)

LeMaistre:  Well, the first sentence is beginning to put it in light.  (reading letter to himself)            It’s a classic Becker letter.

Olson:  (Laughter)

LeMaistre:  One of the most colorful characters we ever had here; one of the most talented.
This was an argument over space.  What he brings in in the latter part of that first paragraph is the fact that prior to Gene McKelvey, and to some extent Gerry Bodey, there were people who really ran wild in terms of acquisition of enormous amounts of space for research that wasn’t required.  Some people had four times as much as others to do roughly the same kinds of things, so there was a lot of inequity.  So it had been pretty much regulated by whoever had the grant and was big enough to assert “I’ve got a seven million dollar grant and you’ve got a one million, I get seven times as much,” this sort of nonsense.  Gene McKelvey and Gerry Bodey put together a kind of basic allocation of space to look at fairness throughout the institution and research resources and then had a reserve that you could allot to people who justified their need for more.  This was all at a time when space was very tight.  We hadn’t really gotten all of the research buildings going; we were desperately trying.  That is referring to the fact that within the institution there was a lot of research that went on that took up too much of the resources of research.  Second, the regulatory thing is just an allusion in there.  Fred had a deep concern that perhaps there was not enough oversight of clinical research, there was not enough oversight of the transition from bench to the bedside, and that there were those who wished to hold things for a longer period of time to perfect them beyond when they really ought to be in clinical trials.  Somebody had to enter judgment over those things.  So he was champion of an office for protocol research where the committees of the faculty come together and judge these issues.  So it was both the internal regulation—and I recall very vaguely him mentioning something about the NCI had questioned one of the research programs that maybe had too much research, and they (NCI) were paying too much for necessary space or necessary equipment.  So all of this comes in from inside to the basic concern to outside, people who have the responsibility to monitor the expenditure of dollars that they grant.  So that’s what’s behind that.  But you read the latter things, one-two-three-four-five, you find out that his people are being constricted, and that the expansion of clinical oversight, which I was pushing very strongly—I came here the first year, I did nothing really but concentrate on basic research.  I visited with all of the basic scientists and said, “What did you come here to do and what are you doing?”  And if they were two different things, I said, “Why?”  “Well, that’s where the money is.”  I said, “Well, if you had the money, what would you do?”  “Oh, I’d go back and do X instead of [inaudible.]  The people who were recruited here to do certain things weren’t being allowed by the circumstances of too little money to really accomplish that.  So this became kind of a cause celebe to get the basic science faculty solidified.

We had Fred Becker already recruited as vice president for research, and so I told Fred, I said, “Fred, I want the strongest research faculty we can afford.  If we haven’t got the money, we need to crystallize how much money it will take.”  Fred did a magnificent job, and everybody pitched it and recruited.  There was never any question if Becker called up and said, “I’ve got somebody named Josh Fiedler here, and he needs to talk to the President of this institution,” he was in the office in two minutes.  But Fred had total support in that all the way through.  But this is a part of it.  He felt strongly that Gene McKelvey was very talented and that the clinical people were putting Gene down because Gene was a clinician now gone into administration.  That’s kind of like faculty going into administration, you know.
(Laughter)

He still had to teach, so therefore he got to push a pencil.  That was what McKelvey was doing.  McKelvey was giving up something he loved very much to do this because he knew it was important.  So Fred was trying to set the template whereby I would back him on the claim for more space and the whole thing.  But in doing so, he mentions the other.

Olson: These disasters are not—I thought maybe he was talking about what was going on in DT in some of those earlier years.

LeMaistre: He would—I can’t speak for Fred.  I don’t know what he was talking about.  I would say that he felt that the imprimatur of Developmental Therapeutics upon the right to consult on chemotherapy before any other faculty member outside of Developmental Therapeutics was allowed to give it (chemotherapy) was wrong.  I felt it was wrong.  Fred didn’t do away with it; I did.  I broke the mold.  It was my first real antagonistic move with Developmental Therapeutics.  Then later on, of course, the other circumstances you know about.  Really Developmental Therapeutics is a title, but that was because of the circumstances of the way something was handled.  But I could not understand why this faculty should not be as up to date on chemotherapy as the group doing the research on chemotherapy, developed for the purpose, when they had nothing but MOP back in the beginning, and they did a magnificent job of development.  J. Freireich is a genius in chemotherapy, and J.’s a good clinician.  But I always felt J. ought to be focused on research.  That’s when, after Dr. Krakoff and J. got into problems, I wanted to fund him with some soft money and a lot of other money over a period of years to begin to do the mop up on the adult leukemias. We did the same thing in pediatrics, of course, but J. was for adult leukemia.  And it worked beautifully.  He took that money and spread it out to people who would do something with it and handle it beautifully. 
This, in reference to DT, was at that time a little late because in 1989 DT had already become pretty much integrated into the faculty.

Olson:  I thought he might have been just sort of throwing back, looking back a few years.

LeMaistre:  I think it was.  I don’t think that was a timely problem in 1989.  We faced that, as I recall, in the early 1970s [early 1980s?].  I talked to the head of pediatrics—

Tape 2 of 2, Side B

LeMaistre:  --different ballgame in pediatrics.  So with somebody as strong as Jan van Eyes in this, I felt we just would go over.  Being president here is not always being popular.
(Laughter)

Olson: I’m sure.  Can I ask you one question?  I have a friend of mine.  She died recently of a Waldenstroms [macroglobulinaemia] and was treated here.  While she had the Waldestrom, she was operated on for a kidney sarcoma, unrelated.  It turns out when they left her, they left a bleeder in her, the surgeons, and they had to go back in again several days later.

LeMaistre:  This was a kidney sarcoma?

Olson:  Yes.

LeMaistre:Okay.

Olson: Her husband was an attorney, and, of course, they were quite upset about what they considered malpractice and so on.  But they came down to talk to the people here at Anderson about it and were quite taken aback by how forthright the institution seemed in just wanting to address what their concern was and this is what happened.  They were kind of surprised at how noncombative it seemed to be with them.  I was wondering, does the institution—has an approach been developed for those kinds of issues.  I was just interested in kind of what that is.

LeMaistre:  First you know, we have a committee made up of outside people—lawyers, housewives, clergy, others—who oversee any kind of human experimentation, first.  That kind of template has been felt to be so very strong here that it has supported the attitude that a patient ought to be told everything, good and bad, and that goes for a patient’s family.  Under HIPAA, they (the doctors) are allowed to talk to the patient’s family (only with the patient’s permission), which they may not be.  But the open—carrying your record around—some records get so heavy the patient has to wheel them around.  But that was a part of Dr. Clark’s template of saying, “The patient needs to be an informed participant in this, and they need to know everything, good and bad.” 

I had many calls from trial lawyers, always saying, “I have Mrs. So-and-so sitting here in my office.  They have been induced by another attorney to sue M. D. Anderson, and yet she tells me she was cured.  I’d like just to know what Anderson’s side of the story is before I take this case.”  Well, I looked at the record and I called him back. It’s one of the most prominent trial attorneys in the world.  I said, “I’m going to read from the record, and if you want copies of this, just tell the lady sitting there that I will be glad to furnish copies to you or to her.”  So I read from this, and it says: “The patient was informed that her cancer was incurable and that we had a new protocol for this and that it was available—she qualified for it—if she chose to take it.  But there are risks involved,” and I read the section on risks and all the way through the thing.

Well, it turned out that this actually was a remarkable event, because this was the first patient ever really cured of that particular disease.  But, the patient had an aberrant artery that ran from the aorta back into the spinal cord, and a high dose of chemotherapeutic agent got into the spinal cord, and she was paralyzed from the waist down, but cured.  I said, “Now the sequence of that is she remained here with rehabilitation at TIRR [Texas Institute for Rehabilitation and Research] but remaining here.  We supervised her until she was able to walk, and she was on outpatient and rehab and no charge was ever made for those.  So here was a patient who received a cure who, due to circumstances beyond our control, too much of the drug got into the—and she knows this.”  So he turned to her and said, “Did you know all this?” and she said, “Yes.”  He said, “Well, what are you doing here?”  I could hear it, and she said, “Well, my lawyer told me I could get a lot of money from this, and it comes from insurance and it wouldn’t hurt M. D. Anderson.”  He came back on the phone and said, “I got my answer.  I’m not taking this case, and I’ll be glad to defend Anderson if you wish, at no cost.”

But we’ve had an open policy, even with trial lawyers who call in, to say, “Here are the facts.  If we did something wrong, we’ll be glad to adjudicate this.”  I have never had a single case go to trial when we had a fair opportunity to explain what went on.  We do make mistakes, but a lot fewer mistakes than other places, but they occur everywhere.  I saw a mistake in Joyce’s case.  There was an error in timing, could have happened anywhere.  But to have it happen at Anderson, when it happened, everybody got alarmed about it.  You would have thought it was the biggest fire drill in the world!  The people who were doing this didn’t even know who I was at that time; these are people I had not met really here.  They were just going to make sure it never happened again.  She had a premedication, they waited too long to give her the Taxol, it was something as simple as that.  There was a good, valid reason for it having happened, because the infusion team that was to give her the Taxol, all of them were tied up in an emergency—somebody’s life was at stake.  Well, Joyce wasn’t happy about being sick, but when she found out that the infusion team—she said, “Well, that’s understandable.  I’m sure glad that they didn’t leave the other patient, because they did do a good job on the other patient.”  But that sort of thing, it seems to me, if you just are honest about it and lay out the risk, and if the patient has been educated as to what the risks are, it’s never really much of a problem.

Olson: Right.  I guess as an attorney, her husband’s an attorney, he just sort of expected some stonewalling and delaying and he said, “We got in there and they just said, ‘Yes, that did happen.  We’re sorry that it happened,’” and that was it.

LeMaistre:  We always covered our faculty with malpractice insurance.  We did that primarily in the recognition that even the best faculty in the world can make a mistake, especially with the load these people carry.  I’ve always been very proud of how few lawsuits are ever brought here, and it’s not just out of gratitude, it’s out of knowledge.  The patients here are well informed.

Olson:  Are there few compared to other places?

LeMaistre:  Yes.  I’d rather not tell you where the other places are.

Olson: Okay.  That’s all right.

LeMaistre: Last time I looked, of course.  It’s getting on in years now; it’s eight years ago. 

Olson: My daughter made a comment once to me that the best insurance—she’s a physician—against malpractice is a good relationship between a physician and a patient.

LeMaistre:  And an educated patient.  If the patient knows what the facts are—they sometimes forget them, but you can say, “Now look, here’s what we went over.   You now look at this differently in the light of the fact that you did have a complication, because that’s what that word means.”  I’ve had one say, “Well, yes, I read all those words, but I didn’t pay much attention to them then, but I now understand I was warned and I had the right to discuss that, because nobody rushed me through this.  [Inaudible] I had that piece of paper to sign, it was explained to me.” 

Something else unique about the place, I learned that it was best for the vice presidents to be prepared to settle anything the day it happened, before the sun set.  So I empowered every vice president, regardless of which area they had, “If the cost goes above ten thousand dollars, call me.  But you’ve got ten thousand dollars you can apply anytime—as many times as you need in a day’s activity—to solve the minor problem, and I’d rather have good will than to have anybody bargaining whether it ought to be eight thousand or ten thousand in there.  You have the authority, you can go and do it.”  It worked well, because everybody was still fresh on the experience and it didn’t linger a few weeks and then somebody get festering anger over not having something done.  They went back over it, explained it, went through it, and if there was some financial loss on the part of the patient, it could be as minor as somebody who came in from Podunk, Kentucky, for an appointment and nobody was here to see him, they went to a medical meeting.  That was expensive to the patient.  Now I don’t know how much went for that sort of thing.  The vice president didn’t have to tell me what they used it for, I just assumed they would not spend it on their own frivolity or something. 

Olson: (Laughter)

LeMaistre: They never did.

Olson:  I have a little thing here on that Ti Li Loo case.  Could you tell us about that?

LeMaistre: I don’t remember the details of it.  You’ll have to let me read some stuff that will bring it back to me.  I just remember how highly respected Ti Li Loo was.  His personality and his culture was different, and those are the major factors in the controversy that I recall, but I don’t recall anything in detail about it.  But a great guy and a real contributor here.

Olson:  Did he come out of NCI?

LeMaistre:  Yes.  I’m sorry, I just don’t remember that one.  I could review it if you want to go into it in detail.

Olson:  I can get some more documentation on it.  I guess he was suspended.  It involved a problem with the protocols.

LeMaistre:  It was clearance of protocol, wasn’t it? 

Olson:  Yes, I think so.  Yes. 

LeMaistre: I think he was sufficiently reprimanded, and I think he carried a—he actually went back to NCI, didn’t he, after this?  Because I think he was still a little piqued that he was not fairly treated in his mind.  But you don’t—there are people who are so confident of their ability here that they don’t feel rules apply to them, and a lot of the regulatory stuff is pure nonsense.  I proposed to President Carter, when he wanted to save 10 percent of expenditures at the NCI, that the easiest way would be to go and take a look at the records and find out what information that had been gathered the previous year was used, and if it wasn’t used, cut out that part of the regulatory thing.  I had it calculated up, because it was costing this institution over a million dollars a year to just simply fill out the regulatory things just for NCI, one agency.  His staff took a look at it and said, “Well, you know, that would really defeat the purpose.”  I said, “What are you talking about?” and he said, “Well, it would be a morale factor for the ones who were gathering that information.”  I said, “I thought you were interested in saving money.”  They said, “Well, you know, there’s a cost in this.”  I met with all of his brain children from Georgia—President Carter.  I was about to say Clinton but I meant Carter.  They just didn’t have the courage to go ahead and try to implement something.  I think it was more of a political statement than it was something they really wanted to get done.  But I went all the way to Washington to talk to him, and I kind of didn’t like the fact that they heard it all and felt it was a doable thing but didn’t really want to undertake it.

Olson: But then what would that agency do?
(Laughter)

LeMaistre:  Well, it’s kind of like my proposal for the IRS [inaudible].
(Laughter)

Olson:  What’s your time frame for today?

LeMaistre: It’s 3:15.  I can go on till 4 [o’clock].
(Interruption)
Return to the Top
Brunet:  You were talking about Nellie Connally.

LeMaistre:  Nellie Connally has always been a supporter of this institution.  I have known Nellie and John Connally very well since he was governor, and actually, at his request, chaired a committee for him and did some other things in the medical area—the eradication of tuberculosis, for example, in the state, and Nellie was a part of that.  So these were people I had been acquainted with.  They were also well acquainted with Dr. Clark, very fond of Dr. Clark.  But Nellie and her family have just taken the leadership in so many events to raise money for worthwhile causes here.  Nellie participates in the Board of Visitors, never misses a meeting, to my knowledge, is very active.

I’m picking out on the first page Nellie Connally and Ben Love and then we’ll move to LeRoy [Melcher] and then Tex and Debra [Moncrief].

Olson:  I don’t think I have the Alkeks here either on this list. 

LeMaistre:  If I might suggest, we probably ought to do this in separate sections, too—look at Margaret and Ben Love, the Alkeks, the Moncriefs, the Melchers, with maybe some other people also.  I think pretty much—do you work with Pat Mulvey much in Development?

Olson: I haven’t.  A good person to talk to, do you think?

LeMaistre:  I’d ask Pat, over the years, give me a list of the outstanding supporters in philanthropy for M. D. Anderson.  I think all of those people might be bunched together in a paragraph ((???))).  Allan Shivers, for example, do you need to--?  You’ve got a special niche for him, I’m quite sure.

Olson: Yes.  But I was also wondering, is there anybody else sort of of that political influence that has been a great friend to the institution?

LeMaistre:  A. M. Aiken, Senator Aiken.

Olson:  Oh yes, Senator Aiken. 

LeMaistre:  He was a good friend of Dr. Clark and of mine.  That’s really a tough one, but I think it really is warranted because this institution couldn’t have reached the pinnacle it’s reached without the philanthropy that’s occurred.  And that isn’t to belittle the little five-dollar giver or something like that, because they’re the bread and butter, but for the big task these are the people who rose up.  You’d have to go back into antiquity to get for Gimble and all of those in the Gimble Building.

Olson: Right.  This list here I kind of started with sort of 1978.

LeMaistre:  Yes, I think so.  I’m adding Aiken because he was a part of 1978 for me, too.  A. M. Aiken and I, he treated me the same way he did Lee.  He’d look you in the eye and say, “Don’t ask for any money you don’t need because I’m going to give you everything for M. D. Anderson you ask for.”  But he started that with Dr. Clark.  I used to go with Dr. Clark to the appropriations committee, and A. M. Aiken after the presentation would always say, “Now, Dr. Clark, I want to ask, is there anything else you need.  Now don’t tell me anything that you don’t really need because I’m going to give you anything you ask for.”  He’d say that in public.  People were shocked.

Olson: I was going to ask you about that because I had a former vice president of finance up at Sam Houston said one day—is it the LBB?

LeMaistre:  The Legislative Budget Board.

Olson:  --that he heard Aiken say that.

LeMaistre:  Actually he said it before Senate Finance. 

Olson:  Senate Finance, okay.

LeMaistre:  The Legislative Budget Board is different.  He’s on that.  The point is he always said this during testimony on this.  If Dr. Clark made a brief presentation and only asked for half the world, he always would have this folksy approach, and I could never tell from his approach what he was really talking about on the budget he had submitted to me because it sounded—for example, the whole justification of Science Park was as an environmental park, because it was timely.  That was only part of the picture, but you would have thought the whole thing was going to right the world of all of the evils ruining the environment, and that wasn’t its purpose at all.  It was the veterinary division and the research division of cancer, and sure, they were in a lovely part of the state, in Buescher Park, but it never got off the ground as an environmental center.  It became a great research center.

Olson:  Well, this guy said it was kind of frustrating for him.  “We went in there with kind of fear and trembling,” he said, “when we were going to ask for money.” 

LeMaistre:  Well, all of us did.  Lee never did because—he did in other committees.  He didn’t have friends like that (Aiken) on all of them.  He had to work hard to get money out of the House committees.  But I would say—if you can get a final list of the outside people and maybe just let me dictate something and send it to you.

Olson: Okay.  That would be great.  Yes.

LeMaistre: Now the role of all of the rest of these people in here, I can give them vignettes on them the same way, if I could just get a copy of the ones you want.  For example, I’m not able to place C. P. Simpson and Anna Croche (?) Simpson.  They came before my time I think.

Olson:  They gave about a million dollars before your time.  Like I say, I was just plucking them off my—

LeMaistre:  That’s where Pat Mulvey will help you.  If we can get Pat’s extension, I’ll call him and tell him I’m going to ask him to do this.  (((Jim—did you ever reach Pat Mulvey?)))
There are a lot of people on here that you don’t really need to mention.

Olson:  If you would scratch them off, that would be fine, too, for me.  I’d appreciate knowing which ones—

LeMaistre: (inaudible)
(Interruption??)

LeMaistre:  There are a lot of stalwart figures, but I’m looking at this in terms of contributing to the progress and change at Anderson.  I’m not looking at those that had great careers here from the standpoint of doing “their” thing.  If there’s somebody like Louise Strong, Louise was appointed I think she was the first person to be appointed to an endowed chair, - and she has just blossomed as an investigator and is one of the most highly regarded oncology researchers in the world, right?

Brunet:  Right.

LeMaistre:  I think so.  Just the kind of way that—we didn’t have an awful lot of—we had some very great women here with Dr. Clark but we didn’t have a lot of them.  We began to push the Louise Strongs and Margaret Kripkes and then over into some of the other areas, I think we got the strongest contingent of women oncologists in the world.  We have Eva Singletary.
B:  (inaudible)  She was just named as the head of some professional organization, and she was the first woman ever to be named.

LeMaistre: I’m not surprised.

Olson:  I’m interested here, Dr. LeMaistre, I guess kind of in people that you think had a central role in the institution or whose science had a larger impact that made a contribution in oncology.

End of Tape 2