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0:00 - Chapter 00A: Interview Identifier

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Segment Synopsis: In this chapter, Dr. Leeds sketches his family background and his educational path up to his decision to focus on neuroradiology. He begins by explaining that his father was a pediatrician who ran his practice from the family home, giving Dr. Leeds the opportunity to observe the demands of clinical practice. For that reason, he explains, as well as the fact that he was drawn to teaching and leadership, he always wanted to be an academic.

Next, Dr. Leeds talks about the education he received at preparatory school and in college at Yale College [University, BA, 1948], and why he wanted a broad education. He then talks about applying to medical school [MD, 1953, New York Medical College, New York, NY] and his work for the U.S. Public Health Service as a Senior Assistant Surgeon in Memphis [1955-1957], then he return to New York City, where he had an opportunity to work in clinics.

Keywords:

Subjects: 1. Segment Code - A: Educational Path 2. Story Codes - A: Personal Background A: Influences from People and Life Experiences A: Inspirations to Practice Science/Medicine A: Military Experience A: Professional Path A: Professional Values, Ethics, Purpose

2:13 - Chapter 01: A Good Education and an Early Focus on Being an Academic

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Partial Transcript:

Segment Synopsis: In this chapter, Dr. Leeds sketches his family background and his educational path up to his decision to focus on neuroradiology. He begins by explaining that his father was a pediatrician who ran his practice from the family home, giving Dr. Leeds the opportunity to observe the demands of clinical practice. For that reason, he explains, as well as the fact that he was drawn to teaching and leadership, he always wanted to be an academic.

Next, Dr. Leeds talks about the education he received at preparatory school and in college at Yale College [University, BA, 1948], and why he wanted a broad education. He then talks about applying to medical school [MD, 1953, New York Medical College, New York, NY] and his work for the U.S. Public Health Service as a Senior Assistant Surgeon in Memphis [1955-1957], then he return to New York City, where he had an opportunity to work in clinics.

Keywords:

Subjects: 1. Segment Code - A: Educational Path 2. Story Codes - A: Personal Background A: Influences from People and Life Experiences A: Inspirations to Practice Science/Medicine A: Military Experience A: Professional Path A: Professional Values, Ethics, Purpose

24:34 - Chapter 02: Choosing Neuroradiology at the Field’s Infancy

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Segment Synopsis: In this chapter, Dr. Leeds explains why he chose to specialize in neuroradiology when the field was in its infancy. He notes that he was one of the founders of the American Society of Neuroradiology (ASN) in 1960 and that he was the first individual to receive an NIH Fellowship in this new field. He talks about his mentor, Dr. Tavares.

Next he sketches the state of the field and the challenges involved in diagnosing neurological issues. Dr. Leeds notes that he and Dr. Tavares wrote a book on the veins in the brain; he describes brain angiography and talks about the importance of understanding anatomy.

[The recorder is paused.]

Next, Dr. Leeds notes that three of the original fourteen founders of the ASN are still living.

He then briefly sketches his career track and major colleagues from his 1961, when he was hired as an assistant professor in the Department of Radiology at the University of Southern California at Los Angeles until his role as Director of Department of Radiology and Radiation Therapy at Beth Israel Medical Center in New York [1985-1991].

Keywords:

Subjects: 1. Segment Code - A: Professional Path 2. Story Codes - A: Overview A: Definitions, Explanations, Translations C: Discovery and Success C: Leadership C: Mentoring D: On Leadership D: On Mentoring D: The History of Health Care, Patient Care D: Understanding Cancer, the History of Science, Cancer Research

45:23 - Chapter 03: A Detailed Understanding of Brain Circulation

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Segment Synopsis: In this chapter, Dr. Leeds talks about his early research contributions to neuroradiology. He began his work with a focus on understanding the circulatory system of the brain in detail and he achieved expertise in brain angiography and brain circulation time, which led to other discoveries. He notes that he was the first to do a magnification angiograph and the first pediatric radiologist. He also notes his work on genetic abnormalities and pattern in neuroradiology.

Keywords:

Subjects: 1. Segment Code - A: The Researcher 2. Story Codes - A: Overview A: Definitions, Explanations, Translations A: The Researcher C: Discovery and Success D: Technology and R&D D: The History of Health Care, Patient Care D: Understanding Cancer, the History of Science, Cancer Research

62:18 - Chapter 04: An Evolving Field; Dealing with Patients; Leadership Advice

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Segment Synopsis: In this chapter, Dr. Leeds recalls finding out about an opening for a neuroradiologist at MD Anderson and explains the process he went through to decide to take the position. As his wife, Betty, preferred not to leave New York City, they set up a long-distance marriage.

Next, Dr. Leeds also notes that he wanted to give up chairmanship of neuroradiology at Beth Israel Medical Center and believed that focusing on brain tumor radiology offered a good opportunity for him. He notes that he came to MD Anderson as Head of the Section of Neuroradiology.

Keywords:

Subjects: 1. Segment Code - A: Overview 2. Story Codes - A: Overview A: Career and Accomplishments A: Definitions, Explanations, Translations A: Professional Values, Ethics, Purpose C: Leadership C: Mentoring C: Offering Care, Compassion, Help C: Patients C: Patients, Treatment, Survivors D: On Leadership D: On Mentoring D: The History of Health Care, Patient Care

62:52 - Chapter 05 A New Opportunity at MD Anderson

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Partial Transcript: In this chapter, Dr. Leeds recalls finding out about an opening for a neuroradiologist at MD Anderson and explains the process he went through to decide to take the position. As his wife, Betty, preferred not to leave New York City, they set up a long-distance marriage.

Next, Dr. Leeds also notes that he wanted to give up chairmanship of neuroradiology at Beth Israel Medical Center and believed that focusing on brain tumor radiology offered a good opportunity for him. He notes that he came to MD Anderson as Head of the Section of Neuroradiology.

Dr. Leeds then recalls that he attended the first talk about the new CT technology in the U.S. He comments on the administrations reluctance to invest in the new technology because of the prices, rather than focusing on the revenue it might generate.

Segment Synopsis:

Keywords:

Subjects: 1. Segment Code - A: Joining MD Anderson/Coming to Texas 2. Story Codes - A: Definitions, Explanations, Translations A: Joining MD Anderson/Coming to Texas A: Overview A: Personal Background B: MD Anderson Culture C: Leadership C: The Institution and Finances D: On Leadership D: On the Nature of Institutions D: Technology and R&D D: Understanding Cancer, the History of Science, Cancer Research

0:00

ROSOLOWSKI:

OK, so our counter is moving, and the time is 9:55 on the 30th of May, 2017, and I am in the Historical Resources Center Reading Room this morning with Dr. Norman E. Leeds, who has graciously agreed to come in and talk with me. And just a few details before we start about Dr. Leeds's background. You came to MD Anderson in 1991. Is that correct?

LEEDS:

Correct.

ROSOLOWSKI:

OK. As a professor in the Department of Diagnostic Radiology, with the Kennedy Chair.

No.

ROSOLOWSKI:

No. Not at that time?

LEEDS:

No.

ROSOLOWSKI:

OK.

LEEDS:

It took me a few years to... You have to be elected, right? So they want to know whether you have any value.

ROSOLOWSKI:

OK. (laughter)

LEEDS:

So you have to be here to get it. That's my presumption.

ROSOLOWSKI:

OK, yeah. Well, that makes sense. I wasn't quite sure how that worked. It was --

LEEDS:

No, I came here as head of the Section of Neuroradiology.

ROSOLOWSKI:

Oh, OK.

LEEDS:

And Professor of Radiology, which I had been elsewhere.

ROSOLOWSKI:

OK. And so, again, you've retired twice. The year of your first retirement was...?

LEEDS:

Two thousand three.

ROSOLOWSKI:

Two thousand and three. OK. And your status today, Professor Emeritus, or...?

LEEDS:

I am Professor Emeritus, but not really. I'm just plain Professor, because I couldn't get this [indicates his institutional badge] for Professor Emeritus.

ROSOLOWSKI:

Oh, the badge, right.

LEEDS:

So I had to... I could not be--even though they wanted to give it to me, the Chairman wanted, I had to forego my Professor of, you know, and be just a plain professor.

ROSOLOWSKI:

So that you could be on two days a week.

LEEDS:

Be on--so that I could get... No, I'd get an ID.

ROSOLOWSKI:

Oh, OK, OK.

LEEDS:

It's interesting: I had to be selected to be Professor Emeritus, but it has no value.

ROSOLOWSKI:

Oh, interesting.

LEEDS:

You're not considered interesting. (laughter)

ROSOLOWSKI:

All right. Well, this is our first session, and wanted to thank you for coming in this morning. And if it's OK with you, we'll start kind of in the normal place for oral history, and let me ask you where you were born, and when, and tell me a little bit about your family.

LEEDS:

I was born June the 9th, 1928, in West New York, New Jersey. My father was a physician, and worked very hard. He was a pediatrician and general practitioner with a huge practice, and I--that's--that was what I had. My mother was a very intelligent, articulate woman, so I was very fortunate.

ROSOLOWSKI:

And your parents' names?

LEEDS:

Hmm?

ROSOLOWSKI:

Your parents' names?

LEEDS:

Frieda and Jacob.

ROSOLOWSKI:

OK. Now, what do you...? You said your dad worked very hard. Did he have his practice near your home, or...?

LEEDS:

Yeah. It was in the home.

ROSOLOWSKI:

Oh, it was. OK.

LEEDS:

But he was also Chief of Pediatrics at Christ Hospital in Jersey City, New Jersey. And he was really an outstanding doctor.

ROSOLOWSKI:

Now, was that kind of an inspiration to you? Did you feel that that influenced your choices later?

LEEDS:

Yes and no. I'm not sure it... Well, it influenced that I didn't want to do what he did, because I didn't want to work like he did, which was seven days a week, 12 hours a day, and I thought that was... I started there, but I changed to radiology.

ROSOLOWSKI:

OK. OK, so the clinical practice was something that you were--had reservations about.

LEEDS:

Did not--yes.

ROSOLOWSKI:

Yeah, OK.

LEEDS:

But I wanted to be an academic, and I realized that if you practiced medicine, internal medicine, you really didn't usually, unless you stayed in a university--you were a general practitioner.

ROSOLOWSKI:

Why did you want to be an academic?

LEEDS:

I don't know why. I guess I always liked teaching, and leading, and doing things. And I think that means you... Plus I had an outstanding residency, and I felt it would be a shame to go into [private] practice having had such outstanding training. I had unique training, so I was lucky.

ROSOLOWSKI:

Before we get to that point, let me ask you kind of when it was in your early education that you began to realize, yeah, I've got a gift for the sciences, or I'm interested in academic work. How did all that evolve?

LEEDS:

(laughs) I really don't--I don't know. You know, as I was growing I realized that I was better as a--would be better as a doctor than as anything else, because none of the other things seemed to interest me as much.

ROSOLOWSKI:

Did you have outside interests beyond sort of science classes, math, all that?

LEEDS:

Yeah, I did all the sports, like everyone else, I guess, and I enjoyed life.

ROSOLOWSKI:

What were the schools you went to?

LEEDS:

I went to Memorial High School in West New York, New Jersey. And then I went to prep school at Mercersburg Academy in Mercersburg, Pennsylvania for my senior year and part of my junior year. And I graduated with honors.

ROSOLOWSKI:

So this--so you lived away from home during that period.

LEEDS:

Yes, it was very... I must tell you, it was hard. I had gone to camp for many--since I--and didn't think twice about--but being at school and not having family was not easy. I had to learn how to... I think it was a good experience, because it prepared me for college.

ROSOLOWSKI:

So how come your family made the decision to send you to a boarding school?

LEEDS:

Because the--one of the teachers called my father and said I was bored, and that he thought the school wasn't giving me enough information to keep me interested, and he thought I should go to a good boarding school. And my parents, I guess, listened, so I ended up at Mercersburg.

ROSOLOWSKI:

Lucky you that this person called, you know?

LEEDS:

Yes. (laughs) I realized I was not an easy pupil, because the school--you know, it's a regular high school, and some of the children are bright, some are average, and some are below average. So since they teach, usually, to the lowest common denominator, it can be boring in public school. Not all public schools. My kids did go to such a public school, because the edu--you know, the standards that kids in my--where we lived, which we chose, had very bright kids, so it taught at a higher level. In fact, some of the parents--I was on the School Committee, so I--they complained that the teachers taught at such a high... See, it was the opposite of where I went to school. They taught at a much higher level, so that kids really learned something.

ROSOLOWSKI:

What school was this?

LEEDS:

This was in Chappaqua, New York, Horace Greeley High School. Was excellent. Both my kids went there.

ROSOLOWSKI:

So how did this experience at prep school...? I mean, you said it was emotionally hard, and socially. What about academically?

LEEDS:

No, academically, it was a very strong academic program, and did prepare--as they said, it prepared me for the rigors of college. I mean, it was a tough program at Mercersburg.

ROSOLOWSKI:

So tell me about selecting your college.

LEEDS:

Well, I... (laughs) I think I made a mistake. (laughter) How's that? And you'll say, "Well, what...?" Well, I went to Yale. Why I chose Yale people have asked. I really don't know why I decided I wanted to be a Yalie, but for some reason I did. That was my first choice.

ROSOLOWSKI:

Why did you think it was a mistake?

LEEDS: Because New Haven is a small city. You know, Harvard is in Cambridge. Cambridge is very nice, compared to New Haven, and Harvard College is broader, and who knows what I would've been. I mean, you get... You know, you have to learn it's your exposure, and I think Harvard College is really better. I mean, I hate to say this, but I think it's true.

ROSOLOWSKI:

Well, it may be better for you.

LEEDS:

And I think Princeton was nicer to be at, and actually Mercersburg was a prep school for Princeton, which I could've gotten into, but I had chosen Yale, and no one would've... And I can't say--I can't complain. It was a--I had a good education. I met very nice people. I enjoyed myself. But as I got older I realized that I had made a mistake. So I had a little more understanding for my children, based on what happened to me, that not always picking what's among the best, and focused on it, is the correct thing.

ROSOLOWSKI:

So what about the education there? How did you find yourself evolving there, and your interests developing?

LEEDS:

Well, that--then I really began to think about premed, I think partly, I guess, because of my life's experience, but also for what I could do. Seemed like medicine was the right thing for me.

ROSOLOWSKI:

Were there certain types of sciences, or certain types of classes, that you were more attracted to than others?

LEEDS:

No, I really did try to take a broad education. I studied Russian literature, and I had a varied program. I majored in psychology, but which was, again, a poor major, I decided, because psychology is commonsense. I mean, when you look at everything in life, most of it is commonsense. I mean, I took business courses later on as I got ahead. The chair at Montefiore wanted us to learn everything, so I took the course in business, another colleague and I, the two more senior people, to learn. And I learned business. It's commonsense. Most things require experience and common sense. And, I mean, I think that's a factor of life, which I've tried to teach my children, that the broader your experience, the broader your common sense is. So you want a broad exposure. And I think I had that at college. I mean, I was not overwhelmed with the sciences. I took everything.

ROSOLOWSKI:

That also seems to be very common. I mean, many people who kind of went through college in earlier generations talk about their education being very broad, and, of course, that really has changed now. People specialize really, really early.

LEEDS:

I think that's--by the way, I think that's a mistake.

ROSOLOWSKI:

Really?

LEEDS:

Yeah. I think... I think understanding everything is--you know, being exposed is critical. It's like, I use my son as [an example]. I mean, he's the last one I would have thought, but the thing that influenced him, and made me realize why Columbia was such a good school, was because he had to take that core curriculum, so he learned about music and opera, and he... And the museums. So he was very interested in everything. And I realize now that that's very [important]. Today, I mean, social studies and all, which are important for thinking, are not... I don't think the educational system of teaching people earlier is better. It doesn't make you a better doctor. It doesn't make you a better scientist. Doesn't make you a better anything. I think a broader education is critical, and I think that's missing now. Remember, I'm probably one of the most super-specialized people, but it all came later. So it came. I didn't need to sub-specialize. I got sub-specialized, is what I'm saying. So why did I need it before?

ROSOLOWSKI:

It was sort of a natural progression.

LEEDS:

It just happened, yeah.

ROSOLOWSKI:

Right, right. While we're--you mentioned your son. Tell me your children's names.

LEEDS:

My children's names are Frederick G., or Rick--he's called Rick--and Patrice G. She's called--I call her Patti. Her kids (laughs) call her Patrice. And they're both very well-educated and have achieved.

ROSOLOWSKI:

Neat, neat.

LEEDS:

So I'm very proud of both of them. And they both went to excellent schools, so--

ROSOLOWSKI:

It sounds like education is a huge value, both in your family--your parents' generation, your generation.

LEEDS:

Yeah. Well, I think it's critical. I mean, I think I wouldn't be where I was, and I don't think I would've had all the... That was the one advantage Yale gave me. I mean, I--it sort of sorts you out. When you go to a better school, and you apply for things, you have a better [opportunity]. No matter what everybody tells you, which is babble, it makes a difference. When somebody sees Yale or Harvard or Princeton, they see an Ivy League, they somehow have an expectation that you are selected. I mean, there--people make choices, and there are clues, and one of the clues is if you go to Ohio State, it's not--Ohio State is excellent, but still, it doesn't say anything about you. But if you go to Yale or Harvard or Princeton or Brown or Columbia, you're sort of labeled as an achiever. Huh? I mean, people are impressed.

ROSOLOWSKI:

Yeah, they are. They are.

LEEDS:

And I can't say it hasn't... I'm saying that because I'm sure it helped me at many steps in my education.

ROSOLOWSKI:

Now, your next step was medical school, so tell me about selecting your medical school. Oh, and just for the record, you graduated with your BA in 1948, correct?

LEEDS:

Yes.

ROSOLOWSKI:

OK, and then your next move to medical school, tell me about your choice.

LEEDS:

Choice was where you got picked. You know, I came at the most inopportune time, because I graduated in--if you looked, I graduated from college in 1948. This is when everybody was applying because of the war. We had people--I think the largest number of applicants. For example, George H.W. Bush, who's now--was in my class at Yale.

ROSOLOWSKI:

Really?

LEEDS:

But he was--I'm not a child, but he was five years older than me, because he was in the service, and I was lucky enough during the war not to be drafted. So I had all these people--I mean, getting into medical school there were many more applicants. When I got into college, I guess it was easier, because (laughs) everybody was going into the services, so it was--so that way it was easier. But when I went to medical school it was harder. So you, you know... And I think the thing that helped me was I went into the service, and--public health service, which I selected over going [into the army]. I got drafted. I was a medical resident.

ROSOLOWSKI:

So I have your years of public health service 1955-57.

LEEDS:

Yeah, well, that's when I had to--they drafted me. They called me and said I had to choose--I had to go in the service. So I... But fortunately, I had finished medical school, so they took me out of my medical residency, which was at Montefiore in New York, and I went in the service, and I said, I don't really want to be a medical resident. I want to choose another specialty, because my best friend had been Chief Resident at Montefiore, and I went making calls with him. That's what I meant. We would go out with... I was married, and he was married. The women would talk, and I'd go making calls with him. And I watched the way... And after an outstanding medical residency he was doing general practice, like my dad. So I said, why should I become a specialist and end up doing general practice? So that was why I made a decision to change specialties. Why I chose radiology, I--don't ask me. I don't know.

ROSOLOWSKI:

Can I ask you another question, though? Because I'm curious of... You know, did--what was public health service like? I mean, how did that...? Did it have an impact, or...?

LEEDS:

That was great. Yeah, it was great. I enjoyed it. It was a two-year vacation.

ROSOLOWSKI:

Was it really? (laughs) What did you do?

LEEDS:

Yeah, well, I served in New York City, and the--it was really lucky. I was given a choice of New York City or Memphis, Tennessee. Well, not being very practical, I had never been to Memphis, so I said to my wife, "Why don't we go to Memphis?" And my wife said to me, "No, no, no. I want to continue my education. Let's stay in New York City."

ROSOLOWSKI:

Your wife's name?

LEEDS:

Bette. Beatrice Gordon Leeds. Gordon. Beatrice Gordon, and otherwise known as Bette.

ROSOLOWSKI:

OK. And what was she--what was her program at the time?

LEEDS:

Bette was a... Well, she had to support me, because I was [an intern and a resident]. We didn't get paid in those days. So I graduated from medical school and got married at the same time. Bette was a senior at Wellesley, and then she went to work as a schoolteacher, so she supported me. And she wanted to stay in New York City. Well, we always lived by discussion, and I knew, since she was doing the working, really--I mean, I was in the service--that I chose New York. And it turned out to be the best choice, because we got an apartment. We lived in an apartment, actually, as--I was in Riverdale in New York when I was a resident in medicine, and I could stay there during the service. So I--we stayed in our apartment, and I worked in the outpatient clinic. I started because I was the newest guy in the surgical clinic, for which I was not ideal, but I didn't have a choice. That's where they put me. So you either would adapt or you suffer, right? So I adapted.

But then the opportunity came to go work in the medical clinic, which I did, and then they actually offered me to go to the hospital, because Staten Island Hospital was a major public health service hospital. The only reason I didn't want it was it would be an hour-and-a-half trip from where I lived, and since I was not going to go into medicine I didn't see any advantage in going to the hospital and traveling, so I stayed at the clinic, which was nice, and I actually stayed two months longer, because it paid well. This is where we made some money, because I hadn't anticipated this. But in the service you got paid, so I got more money, because I was a captain, I guess. That's what doctors were in those days. And I did get--and then I chose radiology, and I was lucky. I got probably one of the best residencies in the country, Columbia Presbyterian Medical Center, which is part of Columbia University's medical school, and Columbia Presbyterian had an ideal program in radiology, and that's where I got my start. And actually the founder of the American Society of Neuroradiology was my--one of my teachers at Columbia [Juan Taveras, MD].

ROSOLOWSKI:

Now, you said you have no idea why you selected radiology.

LEEDS:

No, I don't. I just--I thought, I like seeing... I watched the radiologists work, and it was solving puzzles. Radiologists look at things and solve puzzles. And I thought that sounded interesting. I read the book, and it seemed a lot of math. And I had been good at math until I got to college, and I found I wasn't a great mathematician. So I wondered whether I would make it, but I did. I did very [well].

ROSOLOWSKI:

What about looking at the visual images? Are you a visual thinker? Is that easy for you?

LEEDS:

I guess I am a visual thinker. I like puzzles.

ROSOLOWSKI:

Yeah. I mean, you're interested in art and sort of visual complexity and all that.

LEEDS:

Yeah, so I loved [radiology]. And then I got into neuroradiology. Now, I chose it because it--the clinicians--you know, [came to neuroradiology for answers to problems.] I'd been through everything. I didn't get there until I'd been through everything in radiology. We rotated through each... In fact, we were the only radiology program--it's now standard--that had all the subspecialties.

ROSOLOWSKI:

Oh, really?

LEEDS:

So I--yeah, it was probably the only program in the country. I mean, I didn't know that at the time, but that--I was lucky. And I got to neuroradiology last, after pediatrics. And I said to my wife, "You know, I really like neuroradiology."

ROSOLOWSKI:

What was it that was grabbing you about that?

LEEDS:

I'll tell you, it was very simple: one, it was the person, Dr. Taveras; and two, the fact that the neurosurgeons couldn't do a [ ] thing until they went over the images with Dr. Taveras, and I felt you were therefore very important to your colleagues to making the diagnosis. So I said, "This is what I want to be." So I was lucky. That's what I said to you. I was there at the inception. There was no American Society of Neuroradiology. It was formed by Dr. Taveras. In fact, it started in 1960. And he asked me if I wanted to be a Fellow. He had--I was the first NIH Fellow in Neuroradiology.

ROSOLOWSKI:

Wow.

LEEDS:

That's not because I was--there were other Fellows, but they were in Europe. There were no programs in America until Dr. Taveras started that program at Columbia. So he asked me. I went, and everything--my wife and I did everything together, because we worked together. So I felt it was--since I was going to have to spend two years--I was only counting on three years of radiology, but I told her I thought in the long run neuroradiology would be a better specialty for me for the future, for our future. I stressed "our." You use the right term, you have a better chance of winning, right? (laughter)

ROSOLOWSKI:

Strategic man there.

LEEDS:

Right. Well, no, and she--Bette supported it. I explained to her why. I mean, I didn't just come in and say, "This is what we're doing."

ROSOLOWSKI:

Now, what was your reasoning at the time?

LEEDS:

Just what I said to you. I thought it was a new specialty. It was--and it turned out I was right, because I was there at the foundation.

ROSOLOWSKI:

Now, let me ask you, because I was actually doing a little reading online about the history of neuroradiology, because this is my first--

LEEDS:

See, I am... I... See, that's something I know. I was there at the beginning.

ROSOLOWSKI:

Well, that's why I wanted to ask you, because, you know, I think today, I mean, people make a lot of assumptions, because we're living in a context where there have been a lot of discoveries. But what were the challenges of neuroradiology that you were confronting at the time? I mean, what was this field looking at in terms of discovery territory?

LEEDS:

Well, (laughs) this is a long... All the things that attract people today, you know, the tools--AMR and so forth--were not--nothing was in existence. I mean, that was the other--it was a challenge to make the diagnoses. We did mostly angiography, and we were better at it than anybody. Taveras was really better, and so I learned. I was probably superior to some of my teachers who had more experience in neuroradiology, but not experience in angiography, than I had. Because I started, you know, doing angiograms all the time. I mean, when people talk--I did thousands of angiograms, so you learn the anatomy, which, by the way, is still critical. I still use the things. And I actually did work in some of the exciting physiological problems with angiography that then translated into all the other things that followed. [We also performed pneumoencephalography, which disappeared after CT.]

ROSOLOWSKI:

Now, what were some of the physiological challenges you were looking at? I mean, what were some of the things you worked on?

LEEDS:

You know, what... In the brain, we looked for stains, in tumors. I actually wrote a paper, which then became a book, with Dr. Taveras on circulatory changes, and not--and pointed out that the veins were really more important than the arteries in identifying tumors. That's, you know, a book. Unfortunately, the book came out when CT came out, (laughter) so it sort of--

ROSOLOWSKI:

Eclipsed it, yeah.

LEEDS:

But still, it helped me. And people talk about... Angiography was complex, but nobody understood it.

ROSOLOWSKI:

Now, how does it work? Because I actually can't even visualize what you were doing when you do an angiography, angiogram.

LEEDS:

You injected the carotid artery, which was the main [artery to the brain]. The artery's mainly to the forebrain, not the hindbrain. And we looked for circulation: circulation time, stains, slow veins, fast veins, early veins. We identified early veins, slow veins, all of which I described in my book and several of my earlier papers, which later have profound significance. So understanding it was simple when CT and MR came, because I knew all that, because I had [performed cerebral angiograms].

[The recorder is paused]

ROSOLOWSKI:

OK, we're back after just, like, a 30-second pause. So this was all during your residency period.

LEEDS:

No, fellowship.

ROSOLOWSKI:

Fellowship period, OK. And just so your... Let me just go back, because residency was '57 to 1960, and then your fellowship period at the Neurological Institute of Columbia was 1960-1961.

LEEDS:

Yeah, it was actually, you know, later in '61, so it was almost the two-year fellowship that was required. I got a job, so they allowed me to leave. And that's why I went to USC. I wanted to live in California, I thought.

ROSOLOWSKI:

OK. So obviously this was just amazing training. Is there anything you want to--else you want to say about that fellowship period that was so key?

LEEDS:

No, it... Well, it prepared me--that's why I became a founding member, because I was the 14th member. There were 14 members selected, and these were the greats in American and Canadian neuroradiology, picked by Dr. Taveras. And I got picked because I was there, so I was the youngest, and I was the only Fellow.

ROSOLOWSKI:

So did those folks become kind of your network later on? I mean, was that...? That must've been really significant.

LEEDS:

Oh, yeah. I know all of them. Yes, very well. And they're all dead, except... There are only three of us--this is interesting--three of us alive who were founding members. The other two are not practicing anymore, so I'm the only one practicing still. And we all shared this--believe it or not, the three of us shared an office at the Neurological Institute. They were my teachers, but I was thrown in with them, because I was the Fellow.

ROSOLOWSKI:

So you mentioned Dr. Taveras as being really significant. Are there any of these other folks that really were key?

LEEDS:

They were all significant.

ROSOLOWSKI:

They were all significant?

LEEDS:

Yeah. Gordon Potts [MD] was... He ended up [ ] at Cornell. He left Columbia and went to New York Hospital, and then went to Canada, at the big university in Toronto, which ran five hospitals, and we were still friends. And Norman Chase [MD], who was a resident with me, but ahead of me by two years, was Head of Neuroradiology at NYU, and then became Chairman of Radiology at NYU. So those were the three: Norman Chase, Gordon Potts, and me. So it was--yes so we were the--we were like brothers then. I mean, there were very few of us. I mean, it was--yes. I began this specialty is what I'm saying. That's my good fortune. It's [luck]. Better to be in the beginning than the end.

ROSOLOWSKI:

So tell me about taking the position in California.

LEEDS:

That was--it was a wonderful job. It was the University of Southern California, Los Angeles County General. It was a totally different. I went from a private practice of [neuroradiology,] neurosurgery and neurology at the Neurological Institute, to a [ ] city hospital in Los Angeles. Why did I leave? It was very silly, but I left because I--one, I got a little homesick for New York. But more importantly was most people were not very academic. They enjoyed California. It was hard to get people to work. They enjoyed the weekends and so forth. And I must say my wife and I had a wonderful time in Los Angeles. We had made very good friends, which we ended up giving up. But I thought my career was not moving. I was separated from everybody, because the West was like [a wasteland]. It still is--not as... The Western part of academics is not as populated as the Eastern section.

ROSOLOWSKI:

Now, it sounds to me like you really had a lot of ambition in your career. I mean, you were thinking about career and advancement.

LEEDS:

But that's what I said. But man, everybody--that's why I said to you, that's why everybody wants to be a chairman. You know, that's your goal. It's like being in the Army, you want to be a general. Everybody's focused. And it becomes a--it's something you think about. And I moved up to that, but when I got there I found out it wasn't what I [wanted]. I mean, it's administration, and a lot of nonsense, whereas doing neuroradiology was really being in the center. And I enjoyed--and I found out it really wasn't important. It took me a long time. Until I did it, I didn't realize I didn't like it. And when I had the opportunity, and then they called me from here with the job to come, and I thought that was exciting, to deal with [earlier]. And I tried to explain to my wife I was not leaving New York--I was leaving because I had the opportunity to come to the preeminent cancer center to learn--to deal with brain tumors. And I've been grateful, because I know more about brain tumors now than anybody alive, as well as knowing more about neuroradiology than anybody.

ROSOLOWSKI:

Now, there were obviously a lot of years intervening, because you left--

LEEDS:

Not that many, actually.

ROSOLOWSKI:

Yeah?

LEEDS:

No, not that many. I went from--I went from USC--

ROSOLOWSKI:

In '63.

LEEDS:

--to Philadelphia, and found that they had--the bad choice was Graduate Hospital was a disaster. It was nothing there. And then my friend came from Columbia as Neurosurgical Chair at Children's Hospital [Philadelphia, CHOP], which is one of the great centers, and I--he wanted me to come to Children's. So I worked part-time at Children's, being the first neuroradiologist at the Children's Hospital of Philadelphia, which is probably still the preeminent hospital in pediatric radiology, which I really loved. So I did that with Ken Shulman [MD], and--who was the Chair of Neurosurgery--and I really enjoyed it. And I worked at Albert Einstein Northern, which was fine. It was more of a private practice, but we had some outstanding [cases]. I trained some outstanding residents.

ROSOLOWSKI:

That was '68-74.

LEEDS:

Yeah. No. No. No.

ROSOLOWSKI:

No?

LEEDS:

No.

ROSOLOWSKI:

OK.

LEEDS:

Nineteen sixty-four to 1968. That's when I moved to Montefiore. And I moved to Montefiore in, I think, [ ] '69, and stayed there through 1985. But I left because Montefiore offered me a job with one of the best radiologists in the country, Harold Jacobson [MD], who later became President of the American Board of Radiology, President of the RSNA, and President--you know, he was really one of the--of the American Board. He was preeminent. And I enjoyed working for him. He was really, I should say, very outstanding. I've had some outstanding... First was [Juan] Taveras [MD], then was William Seaman [MD], who was my Chair at Columbia, and thought I shouldn't be a neuroradiologist, but a chair in radiology. He was wrong, but I respected him and liked him. And then... And then, after that, I took the job, as I wanted to be a chair, so I went to--in New York City, to Beth Israel Hospital. And I really didn't like being a chairman, because I was bored.

ROSOLOWSKI:

So I'm looking for the Beth Israel--

LEEDS:

That was 1985.

ROSOLOWSKI:

Oh, here it is. Yeah, '85-91.

LEEDS:

Right, and I was also, at that time--it didn't--I was Professor of Radiology at Mt. Sinai, because that was the academic... Again, you had to be [ ]selected [ ]. They had to agree. And I actually was on the faculty senate at Mt. Sinai. And then the opportunity to go to MD Anderson came, and I decided to take that.

ROSOLOWSKI:

Now, before we get to the MD Anderson piece--

LEEDS:

No problem.

ROSOLOWSKI:

--I'm wondering, were there sort of intellectual landmarks during this period, when you're at these other institutions, where you felt your thinking or your discoveries about neuroradiology changed?

LEEDS:

No, it was just progressive, right.

ROSOLOWSKI:

Just progressive.

LEEDS:

Progressive, and experienced. I mean, Children's was a great experience for me in neuroradiology, and at Montefiore I ran the program, and I worked with two great people, two giants. I was very lucky. And my predecessor couldn't get along with those giants. But I [did]. One was Harry Zimmerman [MD], who was probably one of the greatest neuropathologists, and we became very close friends.

ROSOLOWSKI:

And you've published papers with him. I remember his name.

LEEDS:

Yes. Right, I did. He was--he was one of the [best]. He trained the chairs in neuropathology at Mass General, at UCLA, I mean, University of Pennsylvania--I mean, so you get the idea. He was one of the best neuropathologists. And then the other was one of the great neurosurgeons, Leo Davidoff [MD] [ ] who was a Cushing-trained neurosurgeon. Cushing was really--[one of the great] neurosurgeons, when glorified in their early years, if you were a Cushing-trained neurosurgeon, you were special. And Leo Davidoff was a Cushing-trained neurosurgeon, and Harry Zimmerman had--knew him very well. He had the office next to Cushing at Yale. When Cushing retired at the Brigham and came to Yale Medical School, Zimmerman was the neuropathologist at Yale, and had the office next to Cushing. So he told me many Cushing stories.

ROSOLOWSKI:

I got the feeling that there were a lot of big personalities in the field.

LEEDS:

Yes.

ROSOLOWSKI:

You know, so--

LEEDS:

And Dr. Davidoff, who's one of the great neurosurgeons, and we became good--believe it or not, we--I was told by Dr. Jacobson he was difficult. I had no problem with Dr. [Davidoff].

ROSOLOWSKI:

I mean, why was he considered a difficult person?

LEEDS:

Because he... (laughter) I don't know, but he [was] imperious, and so... But I didn't have that problem [with him]. He treated me very well, so I never forgot him.

ROSOLOWSKI:

Tell me a little bit about the research that you were doing, how it was evolving over these years.

LEEDS:

Well, most of it was, really--is research that I did, that I accomplished, was first in angiography, and I was the first one to do magnification cerebral angiography, which I wrote [about].

ROSOLOWSKI:

What does that mean?

LEEDS:

Making things bigger. In other words, we would separate the head from the film and from the X-ray machine, so that caused enlargement. Well, it was also--because it was done that way, it was bigger and sharper [ ]. We saw things we couldn't see any other way. And we did that. I did angiotomography, because that was very critical. So I did a lot of understanding of--and I understood because I wrote that original--you know, sometimes you've got to do a lot of the work from which comes many things. I understood circulation time, and, after all, what's critical with the vessels is the circulation. And so I learned that, and that was--I've written, what, two books, and that's when I stopped writing books, because you don't make enough money to warrant the amount of effort that goes into writing a book. I mean, it really is a challenge to collect the cases, to make the cases, to write it, to put it all together. And you have to read a lot.

ROSOLOWSKI:

So this was not books that you edited where other people were contributing; this was your effort start to finish.

LEEDS:

These are--this was a book Dr. Burrows and I did. Burrows was in--he was [in] Southampton in England, and we wrote this book. Oh, by the way, how long are we going to work today?

ROSOLOWSKI:

Until 11:30. Is that OK?

LEEDS:

OK.

ROSOLOWSKI:

OK. I mean, I'm fine if you need--

LEEDS:

Yes.

ROSOLOWSKI:

OK, good, good.

LEEDS:

That's what I was planned for, so that's--

ROSOLOWSKI:

No problem.

LEEDS:

Yes, ma'am.

ROSOLOWSKI:

OK, good, good. So tell me, you know, the circulation studies... Well, let me just observe, you know, it's something that I've had conversations with other people about where they--you know, they talk about being in at the beginning of a field. They have to do a lot of basic stuff. Sometimes they have to build equipment. They have to do everything from scratch. And they talk about the value of that, because it enables you to understand a system in such detail. And that's kind of what you're telling me here.

LEEDS:

That's... Yes, but I didn't build it. I mean, but you have to--

ROSOLOWSKI:

No, no, no, of course, not, but that... Yeah.

LEEDS:

I review... Look, anything you do a lot of, you learn. You should--let's put it this way: you should learn. You don't necess... But by [ ] reviewing the hundred normal angiograms, which I did to develop circulation time, I began to understand what circulation time meant. We studied the arterial phase, the intermediate phase, which includes the capillaries, and then the venous phase. So there are really three phases. And we timed it, and we wrote what the--I think it was 4.27 [seconds]. See, I never forgot that--is the normal circulation time.

ROSOLOWSKI:

So what is the significance of circulation time, when we start coming to--

LEEDS:

Well, if it's too long it's not good, and if it's too short... But it's what happens... Children have a shorter circulation time than adults: 4.27 is normal. After six seconds, it's bad. Your circulation time is longer than 6 seconds, not good.

ROSOLOWSKI:

And so this is something--is it a diagnostic thing, that if cancer can--

LEEDS:

No, it's just learning. It's just--

ROSOLOWSKI:

It's just learning.

LEEDS:

It has... It has... But in doing that, I learned when things occur. So we described the early veins, early filling veins. I mean, the things I described in that book with Taveras were all new, literally, that the veins were the things that allowed us to localize the tumor.

ROSOLOWSKI:

Interesting.

LEEDS:

No one... Well, I got up and I said the neurosurgeons used two things: stains--means abnormal circulation--and shifts, vessels being displaced. But we added the more important thing, which was the localization, which the veins did for you [defining the tumor localization].

ROSOLOWSKI:

Interesting.

LEEDS:

Which no one had described until we did all that. So it's all--most neuroradiologists don't understand it. I mean, I had to go through writing that book and learning to do it. Do you follow? [ ]

ROSOLOWSKI:

I do, absolutely.

LEEDS:

I mean, it was--that was my--instead of building, that was my structure was the [ ]... And that stood me... I mean, we described it in angiography. I had described it in MR. So the newest things in MR are all interrelated. I mean, none of these things are wasted. In fact, they--you begin to understand critical things that no one else can do. Because I didn't depend on other people. These were... Well, the circulation time was not mine; it was Torgny Greitz, who was a great neuroradiologist from Sweden. And believe it or not, we became friends, because I went to learn how to use a catheter. We didn't use catheters. We used to use very [direct sticks]. Everybody today uses catheters for angiography. We did direct sticks of the carotid. That was what--it was [how I] started, and that's what I learned at Columbia. And then I realized I had [to learn to use a catheter]. So I told Dr. Jacobson, [ ] "I want to go to a place that does the catheter angiography." I mean, I didn't have to learn how to do it. I wanted to see how they did it. Come on, I stuck arteries all the time. I would know how to do it once I saw what they did. I didn't... You know, you don't need the experience if you understand. So I went to UCSF [to work with Dr. Hans Newton.]

ROSOLOWSKI:

What was the advantage of the catheter over the direct stick?

LEEDS:

Because you go into four different arteries. And, you know, one was sticking in the groin, and the other was going in somebody's neck. So it was easier to do--use a catheter. So I watched the way Newton did it at UCSF, and I learned. It took me a week, and I was lucky. You know, again, luck. Torgny Greitz was in UCSF that week that I was there, so we spent a week together. I mean, I didn't know him from the man in the moon, but he was one of the greats of neuroradiology from Sweden, and we spent that week together. We used to have dinner every night, so he knew me and I knew him. You know, I knew... And I learned a great deal. And [we have remained friends].

ROSOLOWSKI:

What were some of the things you learned from him?

LEEDS:

Well, I didn't learn... I... Well, I learned a lot about his life and things, but I--I mean, he had written the first paper about circulation time. It had actually been published in Acta Radiologica, and I had read it, because that's where I developed... [ ] you know, I'm reviewing it, and I learned it, and then it was great to meet him, because he was considered one of the greatest, and we became very close friends from then on. You know, you get to know somebody in a week, eating dinner with them [and sharing ideas].

ROSOLOWSKI:

Absolutely.

LEEDS:

--every night.

ROSOLOWSKI:

Well, and with huge areas of commonality like that.

LEEDS:

Yeah, we became very good friends, Torgny and I.

ROSOLOWSKI:

Now, tell me: how did you build on this understanding of circulation? What other research did it lead to?

LEEDS:

Well, it led to... You know, it's--you're doing all those angiograms. All of them have circulation time. And then I looked at all the changes that occurred. Remember, I--and I was also the first pediatric neuroradiologist, because I was at CHOP, and we did angiograms. In fact, I gave a talk at Yale [on infectious disease of the brain demonstrating varying forms of meningiomas].

ROSOLOWSKI:

And CHOP is...?

LEEDS:

Children's Hospital of Philadelphia.

ROSOLOWSKI:

Of Philadelphia, OK.

LEEDS:

It is--which is still one of the preeminent... In fact, I'm going to send them some money. I was so impressed with what new things they're doing for kids and things--

ROSOLOWSKI:

Oh, really?

LEEDS:

--that... Yeah, they--I'm still on the list. I get their paper, I guess, because I was there for years. And, I mean, I saw things in pediatrics that were totally different--you know, the circulation time, etc.--which I described in many... So I did all the stuff on inflammatory diseases of the brain, which are totally different, and I think my first--one of my first talks was an invitation to Yale Medical School to talk about inflammatory diseases of the brain. (laughs) And someone foolishly asked me if this was the way to [diagnose] inflammatory disease.

What a question! You know, it shows naiveté. I said, "No, no, the lumbar puncture and the history is still more [useful]." I mean, the angiography is helpful, but I pointed out why it's helpful. You can distinguish some of the [meningitis cases] with the--but the angiography was just interesting, and I did it, because you're at a children's hospital, and those are... You know, each thing has its own [diseases]. We have tumors. Children's Hospital, inflammatory diseases were more important and things. So... And I think I did the genetic work on the--what was it? Was... The genetic [chromosome] was 13/15 genes, and what abnormalities. I wrote this with one of the scientists from University... We noticed they had narrow interorbital distances as a hallmark of [these entities]. [ ]

ROSOLOWSKI:

Seeing the...

LEEDS:

Let me--it's identification. It's--your brain is o... I was there at the beginning, so I did a lot of the new stuff, because I knew what the old stuff was. And I think most of the vascular changes, I'm the father of. I don't get the credit for all of it, but a lot of it is based on the observations that we made very early on [in neuroradiology, since I was there early on]--

ROSOLOWSKI:

Interesting.

LEEDS:

--in this. I mean, I'm ahead not because I'm smarter, [ but] I was there first, and if you don't make 'em, you don't make 'em, so...

ROSOLOWSKI:

How was the field evolving in general at the time? You know, technologically, I mean, all these different ways.

LEEDS:

It was evolving. Angiograph--

ROSOLOWSKI:

Fast, or...?

LEEDS:

No, it just... It's just time, and it's... I think we had high-quality people, were interested in neuro, and, you know, it became a choice. I don't think it's a choice anymore. I think a lot of people like interventional radiology more, but in that--in those days it was everything. We stuck needles in people. We did air studies, which I'm glad [are no longer being performed since CT].

ROSOLOWSKI:

What's an air study?

LEEDS:

Pneumoencephalography.

ROSOLOWSKI:

Yeah. I mean, that's--I read about injecting air into the brain. What was the reason for that, and why? What were the pros and cons?

LEEDS:

Pff... (laughter) No, people didn't like it. Patients usually said, "I'd rather commit suicide." They did not like... But, you see, that's what show--your statement shows a lack of understanding. It's good because what is the brain? It has ventricles. So with an air study, you see the ventricles. You fill the subarachnoid spaces with air. So you learn a great deal with an air study, but it has--it makes sense when you think about it in terms of angiography, because you have a lot of the same things which we use on angiograms, which told us how big the ventricles were. We didn't need to do an [PEG]. I mean, if I had to choose, I'd rather do an angiogram.

ROSOLOWSKI:

What--was it painful? I mean, why didn't the patients like the process?

LEEDS:

They did complain. They got headaches. They vomited. It was not a pleasant study. I had patients tell me they would rather commit suicide than have an air study. The one thing it did do is it told you about dementia. I once got a judge for dementia to study in Philadelphia, and when we injected the air he didn't feel a thing. They don't feel it. They don't know that... I mean, it was just interesting that they have a total lack. But everything has a value. Air studies have a value. But you have to understand them. I mean, they can kill... We used to--we did what we called fractional pneumoencephalography. We took out the fluid, subarachnoid fluid, and injected air. Neurosur--when I wasn't at Children's, sometimes they did an air study without me. And they would just [remove] fluid and inject air. You know, we did it positionally, because you want the air to go someplace, you have to keep it there. Otherwise, it... (laughs) You know, air moves!

ROSOLOWSKI:

What's the point? Yeah.

LEEDS:

So, I mean, it was just a joke. The neurosurgeons didn't understand. They all--they damaged children. Oh, another thing I learned was you don't do an air study in children under three months. The first--I first had one, and we had to revive him. I almost lost three kids, and then I realized you can't do an air study below three months [of age]. Well, it took me... You know, when you're founding, (laughs) you'll find out what you shouldn't do, as well as what you should do.

ROSOLOWSKI:

I was curious when you said that the surgeons were going ahead and injecting the air themselves. Is that what you...? Am I interpreting that correctly?

LEEDS:

When I got there, they did all these things.

ROSOLOWSKI:

So, I mean, was that--

LEEDS:

[ ] Ma'am, you have to understand, we had to fight a battle. They didn't want to give [up procedures to the neuroradiologist].

ROSOLOWSKI:

That's what I was getting to.

LEEDS:

Well, I--when I started doing angiograms at Columbia, one, they got paid for it. You know, money is also--you know, if you get money, you like things, right? They didn't want to give me those, but a couple of them were very helpful and said, "No, no, no, we need the neuroradiologist." So I was the fellow. And I pointed out to them, "You don't have to be here and hang around. I do--I know what I'm doing it for, and I'll answer your question."

ROSOLOWSKI:

So that was--that was what I was trying to get to. You know, this being a new field, it was kind of like you had to assert what is my territory, what is my value here.

LEEDS:

I had--exactly. Well, I made that--when I went to Montefiore, when I came to Montefiore to run the program, I did the same thing in Los Angeles. I did the studies. I took over all the studies from them. But when I got to Montefiore--you know, at Los Angeles County they weren't getting paid, so (laughs) no one objected to my doing angiograms. Do you follow what I mean?

ROSOLOWSKI:

Mm-hmm, absolutely.

LEEDS:

They didn't object. When I got to--when I went to, let's say, Philadelphia, there was not a problem. At the graduate hospital they were happy to have me do the studies. They didn't have to be there. The chair of Neurosurgery at the University of Pennsylvania was the chair, and he was happy that I did them and explained it to him.

ROSOLOWSKI:

How long did it take in the field before people accepted--

LEEDS:

It took a while. It was not... They didn't want to give it up, because it's money in the bank.

ROSOLOWSKI:

So it wasn't purely an intellectual issue, "I don't know quite--we know just as much as you do." It was a financial issue throughout.

LEEDS:

When we started, it was a financial issue. The surgeons wanted to do it. They didn't want us to do it, not because they didn't... Well, they did think they were better. They believed that. But one of them, who was the best neurosurgeon around, said, "Let Leeds do it." So it took me... I missed my first five angiograms [and then I succeeded].

ROSOLOWSKI:

Oh, really?

LEEDS:

I didn't stick the [carotid artery]. You know, it took a while, and then I did it. Then I was very good. But, you know, again, I remember doing a baby, a little baby, at Children's, and I spent the morning. And I had a rule: three tries and you're out. I did not stick people incessantly. So I did three tries. If did not get in., I said to them, "Not a problem." I didn't realize... I said, "We'll do it tomorrow." So they brought the child back tomorrow, and it went in in one stick. Why you don't get in? I have to tell you--you don't know. Either you're not ready, the patient's... Whatever it is... You know, that's why I believe in the three stick. I never went over three sticks.

If I did three sticks in a carotid and didn't get in, I stopped. I explained to the patient. If there were plenty of people to do it, I would tell the patient, you know, "Someone else is going to try." "Why did you?" "Because I'm very good at it, but I can't--I wouldn't write you a guarantee that I'm going to hit the artery." I mean, I'm going to hit it before anybody else now, but I can't tell when I'm going to miss. Like that one I missed on the three sticks came--little baby--came back the next day and I went right in. So, you know, is there a reason? No. I don't know what it is, but it happens to you. And once you know that, I don't feel guilty. I don't want to punish the patient. If I can't get in in three, I'm not sticking anymore, because I'm not happy, and I'm not comfortable, and I shouldn't stick anymore. So I stopped.

ROSOLOWSKI:

Interesting, interesting. So you have no kind of suspicion about what's different from one day to the next.

LEEDS:

I don't. I do everything the... No, ma'am. I follow the same... It's like reading them: I don't make many mistakes, but I'm sure I made some. But I'm as good as anybody, and better than most. So I have a great deal of confidence in myself now. But no, missing is not--you know, I have done [over ten thousand angiograms].

ROSOLOWSKI:

Yeah, I mean, it's a biological system. (laughs)

LEEDS:

Well, no, I learned a lesson. My wife had the baby. The worst thing was the resident's IV. When I saw my wife's arm with all these black and blue, I said, "Sweetheart, how did you let them do that?" I was really angry at her. It was a female resident, and I think she was just trying to prove she could... There's a time to stop. I said, "After..." I said, "You do not allow them to make more than three sticks. And it doesn't--it's not--and you can tell them it's your husband's rule, and he's a... You can blame me, dear." I was really angry. I didn't say anything, but I was angry.

I mean, doctors should know that. If you can't get in, it's not because you're bad; it's just not your day that day, whatever it is. Either you're thinking about an argument you had with your wife, or you're thinking about a party or you... You know, whatever the distract--there's always a distract... You know, we're normal human beings. Things happen, and you have to understand none of us--and I know more than most--are perfect. And I'm as good as it gets, but you've got to know when to stop. It's like when somebody makes a mistake, you have to be careful what you say to them to--you know, in training them, because it can have a terrible impact [on the trainee]. [ ]

ROSOLOWSKI:

Tell me about that. Yeah, tell me more about that.

LEEDS:

Well, you know, if you start hollering or complaining, or... You're badgering someone. I mean, people don't like making mistakes, particularly people below you, and so you have to be very cautious in how you train them, because most people feel badly when they can't [perform]. That's the other thing that I think makes you miss, because you become more [anxious]. You know, it's normal: you get more anxious. If you get more anxious, you're not quite as good. And I think, well, you know, it took me a while. I'm not a child, and I know I've learned, and I continue to learn. Do I make mistakes? Absolutely, but I try to correct them. I don't try to keep--do the same things. I do try to correct my errors. And I think when someone does something, it may be better to talk to them later. [ ]

ROSOLOWSKI:

When they have a little distance on it.

LEEDS:

Yeah, give everybody a chance to cool down, because, you know, it's all psychological. And you're angry because [you] missed. They're--they have anxiety, and that's why they did these things. And some are just stupid. [ ] But the way to correct it is if you are overzealous in correction, it's worse. So I try to correct things later, OK, without, [upsetting the person you're training]. Because everybody's unhappy when they make mistakes. All of us. I'm unhappy, and they're unhappy. And I think--that's why I said three sticks, because I find after that, you know, you're so anxious, because you don't want to fail, that I... That's why I learned bring them back the next day. It's not fair to the patient.

ROSOLOWSKI:

Sounds like a good rule, yeah, yeah.

ROSOLOWSKI:

+ You had started a while ago telling about, you know, getting the call about coming to MD Anderson. Let's go back to that. Tell me how that all happened, that you made the decision to come here.

LEEDS:

Well, I got a call from Jack Edeiken, MD. I knew Jack, vaguely. Jack Edeiken is one of the world's--was--I shouldn't say--was one of the world's great bone radiologists. His daughter works here still. And his daughter-in-law now works here, in Radiology. And she became a neuroradiologist, his daughter-in-law. But Jack called me and said, "There's an opening at MD Anderson." And he was picked--Gerry Dodd [oral history interview] was the first Chair of Radiology here. And actually, I was very friendly with Gerry, because Gerry was a very close friend of Jack, and Jack Edeiken became, when I came down here, became my best friend, and we were very close friends ever since I came here. Well, he called me and said, you know, "We have an opening." And I said, you know, "I don't know."

You know, so I talked to him. I had to talk to him. I think I--he called me a couple of times. And I finally said, "OK, I'm going to come and look." Because I told my wife, she said, "Texas? You've got to be kidding." For once, she was really angry at me. And when you're married as long as I was--you know, we had two kids and so forth... I mean, there were jobs I didn't take, or look at, because I couldn't move. I mean, you know, when your kids are in school, it really--you know, I learned you can't move, because the kids suffer. And no matter how important it is, it's probably more important not to move, although sometimes, you know, the job is so good you... Anyway, so he called--and he called me a second time, and I did, I came down. And, well, and then I had written one of my first papers with Sid Wallace [oral history interview]. Sid Wallace [MD; oral history interview] was number two to Gerry Dodd [MD].

ROSOLOWSKI:

Yeah, I interviewed him.

LEEDS:

And I knew Gerry Dodd well because we had been in Philadelphia. When I was in Philadelphia, at Albert Einstein Northern, and the Children's Hospital, I knew Jack and Gerry and Sid. And Sid and I had written one of these great papers on cavernous carotid artery branches, which no one knows anything about. But we had written that paper. So I said, "OK, I'll come..." They want--I was one of the Philadelphians--I was very big in their eyes, because I was a Philadelphian--I was from Philadelphia. That was--to them, they thought it was the greatest. (laughs) So it was an advantage. It's--like I said to you, you know, certain things fall in [place].

So I came down and I looked. You know, I didn't know anything yet. I knew enough about MD Anderson, but I didn't realize, you know. And I started to think about it. And since I was a chairman, I--and I really wanted to give it up. And I was leaving Beth Israel, because I wasn't happy there, and because I didn't like the president of the hospital. And I thought, gee, a change. I didn't want... And I decided I didn't want a chair. I didn't want... There were several chairs available to me when I was looking, but I really didn't want a chair. And I thought doing brain tumor neuroradiology might be exciting, because I brought a, you know, a new approach, an understanding. So I decided I wanted it. [ ]

ROSOLOWSKI:

Wasn't going to ask.

LEEDS:

And I said to him, "This is what I want." So he said, "This is too much [money]," Sid said to me. So I said, "Sidney, then I can't come." I said, "If I can't get what I need, my wife is going to be unhappy, and if I don't get what I need, her unhappiness will outweigh whatever offer you make." So I said, "I'm sorry. Go to the rest of your list." I, by the way, turned down Harvard Medical--Mass General to be [head] of neuroradiology, because Taveras offered me that job. I said, "How much do you pay?" He told me. I said, "Juan, my wife will divorce me." I told you, we had a great relationship. She gave in, I gave... You know, we talked everything out. And I said, "I can't go. If you're not going to pay me enough, my wife's not going to be happy, and I'm not going to be happy." So it's the same thing. So I went home. I think two or three weeks later he called me and said--Sid said, "We'll meet your price if you can come in December." I said, "Let me just go home and talk to my wife, and then I'll call you." But I said, "I believe I'm coming, since you've..." And I did. My wife was not happy since. [She was teaching reading in New York City]. So she lived in New York and I lived in Texas.

ROSOLOWSKI:

Oh, really? So you--she stayed in New York.

LEEDS:

Well, because I--wait, you know. It wasn't give or take.

ROSOLOWSKI:

Yeah, no, I understand.

LEEDS:

She had a job, like you. And she liked her job.

ROSOLOWSKI:

Yeah, no, I wasn't being judgmental at all.

LEEDS:

No, no, no, but, I mean, I wasn't judgmental. I figured she really liked what she did, so I understood. It wasn't me. She liked--and she wasn't prepared to give it up. So we worked it out. I was fortunate enough to be able to travel, as the head of the section, so I left early on Fridays and came back at--Monday at 9:30 in the morning, on the earliest flight from New York to Houston, because I found... She would come. No, she was willing to do the [travel]. But I didn't have enough of her. It was a lot of work, because when she came, you know, I made the bed. I cleaned--had the apartment cleaned, and so forth. And she was gone. You know, she worked in a school system. She couldn't come late, or come... So she left late on Friday, because she had to wait until school was finished, and she had to be back on Sunday. So it was easier for me to travel than for her. So I did it. So we did it for a while. You know, I understood. I had no... I mean, she wanted to work, and she enjoyed what she did, and she was a--she had an EdD in Psychology of Reading. So I just did the traveling.

ROSOLOWSKI:

And sometimes when you're doing a long-distance thing like that, the time that you spend apart really enables you to focus on your work, so when you're together you [are more connected].

LEEDS:

No, no. But yes, but I still missed her, and I think she found she missed [me]. In the beginning she was angry at me, but then when she saw me she was happy. So I realized it was that she wanted the work, and it was that we both--it was not easy for me being here without her. And I did miss her, terribly. But I understood. There are two of us. So I made the trip, and I traveled every other week. I came to New York.

ROSOLOWSKI:

Well, that's something. A lot of men wouldn't do that, you know?

LEEDS:

Well, I had... (laughter) We didn't have a choice. Well, the kids were away, and I had... No, I love my wife, so I did it, without complaint, because I understood... And, you know, holidays she came, and summers she came, but... And she finally took a sabbatical and came. But otherwise, she was busy doing her thing, and I understood. So I... You know, when you live together a long time, you have to make adjustments. She made them for me; I made them for her.

ROSOLOWSKI:

Absolutely. So tell me about why you felt the opportunity at MD Anderson was too good to pass up.

LEEDS:

Because it was--I could suddenly look at brain tumors. I mean, brain tumors is one of the things that's a challenge, and always was, but I didn't know as much about them, because we never... I mean, we did them, but most of them in those days died, so it really didn't matter, in a sense. But I thought it would be exciting to really [learn about brain tumors]. And when I got here, I did. And then I also learned head and neck [tumors] when I got here, because that was part of neuroradiology. And since I was the section head, I had to learn it.

ROSOLOWSKI:

Now, you said that you brought a different perspective, because your experience was quite different. What was that? I mean, what--

LEEDS:

Well, because I understood all these things these other people didn't... Well, I don't think they still understand how much smarter we were. I mean, you know, I was--I've been there from the beginning, so I've seen the mistakes. I've seen the advantages. I was actually at the first talk at--on CT in the United States, was at the Einstein [neuroradiology] course, and I was professor at the Einstein, so... But I had [to shorten my talk] about advances in neuroradiology. It was a good talk, and they made me cut it in half because they wanted half my time for Dr. [James] Bull from London to talk about CT. And I was talking about magnification, which I told you, subtraction, and angiotomography. Those were the... Which were good. But compared to CT, I mean, it was revolution--you know. We heard--we sat there and heard the talk. I suddenly realized I was at the beginning of a new way of looking at the inside [of the brain]. We'd looked at the surrounding [brain]--the vessels, the ventricles, the subarachnoids--but we didn't look at the brain. All of a sudden, we could see the brain. It was revolutionary.

Three of us walked out and--three top neuroradiologists--and we said, "There's--this is something new." One of them said, "They stole my idea." (laughter) And we really laughed. They didn't steal my idea! I had no concept of it. But I realized the two old [elders]--Dr. Jacobson, who was a great bone radiologist, and Milton Elkin was a great GU radiologist, who was at the Einstein--these were two of the presidents of the RSNA, the best society, and the American Board of [Radiology]. They didn't understand--they weren't neuroradiologists. You know, we understood. They thought it might not... I was about to buy a--we were bidding on a machine with the chair, which--we had a chair, because Dr. Potts developed the Potts chair for rotating the patient so we could move the air around the ventricles. And this was a chair--and had tomography, so you could slice through things. So it was really revolutionary. But it cost as much as the CT, and was obsolete once the CT was there, because the ventricles, because of the fluid in the ventricles--you could see. So you saw the ventricles, and the brain.

So we recognized--again, it was knowledge. We recognized that it was new. And when MR came, I mean, we recognized the advance of MR over CT. So I was there for both. But a lawyer once asked me, he said, "You came after CT and MR. You know, how can you be an expert?" (laughs) You know, I didn't know how to address this idiot, because he was a defense counsel. He was trying to challenge me anyway to tell--you know, that I talk about these things.

ROSOLOWSKI:

What was the situation where you were...?

LEEDS:

I was defending a case. He didn't understand. What does a lawyer know? I don't know anything about the law. What do they know about medicine? And they read a book and they think, you know... And I've--I don't hesitate to tell them so-and-so was great, somebody said that's wrong, because I then say, if they asked me, from that--then they say, "Well, you think Dr. Josephs is great." I said, "Yes, he is." They said, "Well, he says this, which is in..." I said, "Wait, I didn't say I believe everything Dr. Josephs said." I said, "You know, I'm an expert myself. I disagree with things he said. Doesn't mean he's not great, or this book is not good, but there are mistakes." And I don't hesitate to say that, I mean, if I think so. And I think, you know, my CV tells you that I know a little something about the specialty.

ROSOLOWSKI:

Absolutely. Sure. So, I mean, we were talking about, you know, the opportunities that MD Anderson allowed. I assume that MD Anderson was very interested in having all the newest technological stuff, and...

LEEDS:

Well, we had to... It... Not necessarily. They had their first MR, and, you know, they really--I tried to explain to them I think it wasn't [enough for our patients]. Dr. LeMaistre [oral history interview] did not understand. You know, it's expensive. Do you know that three months after we bought a new MR, or added a new MR, it was full? In three months, the schedule went from nothing for that, because you had an MR, you know, to be full. You realize we can fill a scanner in three months, you're making a lot of money after that. They didn't understand... I kept explaining it to them. And they finally got a COO who I explained... He understood. He said, "You fill it in three months?" I said, "Yes." He said, "We got to buy a new [MRI]."

ROSOLOWSKI:

Who was this? The chief operating officer?

LEEDS:

Yeah, I forgot--

ROSOLOWSKI:

Yeah, we'll think of it.

LEEDS:

He got axed.

ROSOLOWSKI:

Oh, he did? (laughs)

LEEDS:

But he was the one who understood. I talked to people at Montefiore about things. They did not--they just heard the price, and it scared them, without realizing that if you have the unit and you're charging, it [generates income].

ROSOLOWSKI:

Yeah. How long will it take to make up the...? Yeah.

LEEDS:

You make--it more than makes up... They didn't... This COO understood that if you could fill it in three months, we better get more. He never argued with me. But LeMaistre was very, you know... I sent Gerry Dodd down. I couldn't--I--you know, we argued for it. But it took us a while to get enough going. I mean, it was a battle. They don't want to spend the money, because they don't understand that if it generates money then it's worth doing. What gives you a name or a reputation, and so forth.

ROSOLOWSKI:

And makes research possible, too, in other areas, absolutely.

LEEDS:

Exactly, right. So it was--no, it wasn't... No, we had to fight for equipment. I had to... Well, I was here at the beginning. You know how many we had? I mean, we had... (laughs) Yeah, we have about 20 now. I mean, we have an infinite--I had to fight for people, I mean, to add a person. And remember, every person generated money. I mean, our section generated the most money in the department.

ROSOLOWSKI:

Really?

LEEDS:

So, you know, not because we were better, but MRs are expensive.

ROSOLOWSKI:

Right. We're almost at 11:30, so do you want to close off for today, and then we can schedule another session next week or the week after?

LEEDS:

Yes, ma'am. Yes.

ROSOLOWSKI:

OK, great. Well, I want to thank you for your time, and let me just say I'm--

LEEDS:

Thank you.

ROSOLOWSKI:

--sure--turning off the recorder at about 27 minutes after 11:00.