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THE WONDERS
OF RETIREMENT
EHR we had installed in the office which does not “speak” with year veteran of the clinic) who, to my surprise, chose to leave with
the hospitals’ EHRs) and while I made peace with creating elec- me. In January 1980 we set up a practice restricted to the Medical
tronic progress notes, I drew the line at CPOE. I felt as if I were Center which has morphed into San Antonio Infectious Diseases
being asked to replace a ward clerk. I was open to someone con- Consultants – a group soon to grow to 11 physicians in four loca-
vincing me that patient care would truly be improved by these tions. The current senior physicians in the group (Luis, Richard
“innovations,” but, alas, no one did. It just made sense that this Fetchick and Carl Berkowitz) remain among the best doctors I have
was the time to hang up the stethoscope and leave for safari with worked with during my career.
a clear head.
MEDICAL CENTER EXPANSION
LONG, INTERESTING JOURNEY When I came to the Medical Center in 1978 the landscape was
It had certainly been a long and interesting journey. I am part
certainly different. Methodist Hospital had only a two-story
of the early boomer generation, born in 1947 and raised in Brook- north tower and the south tower; Women’s and Children’s Hos-
lyn, N.Y. In 1964, I was the first in my family to go away to college pital, the START Center, Christus Santa Rosa, Medical Center
where I was not in the 50 percent of my class who identified them- Towers, Lifecare, RIOSA, MASH, Kindred and Texsan did not
selves as “pre-med.” It wasn’t until the following summer that I de- exist. Methodist Plaza was under construction. St. Luke’s
cided to pursue medicine. Our long-time GP had died that year Lutheran Hospital had just opened with three oddly configured
and when I needed to see a new physician I was struck by the con- floors. There was only one Physician’s Plaza. There was no Trans-
trast between him and the recently departed Dr. Stein. Corny as it plant Institute at MSTH (which was Community Hospital) and
may seem, I felt that emulating my childhood physician would be there were no, now ubiquitous, parking garages. The medical
a noble path to pursue. Though I was a year behind in pre-med school had not crossed Medical Drive and it was Bexar County
studies, I was able to leave college after three years, graduate from Hospital, not University Hospital.
Harvard Medical School in 1971, and, by 1978, complete resi-
dency at Columbia, my military obligation and an ID fellowship Back then, physicians could smoke – even cigars — in the hos-
at the Hospital of the University of Pennsylvania. pital and have their coffee brought to them in the nurses’ station.
There were some physicians who behaved openly like petulant,
Having been introduced to the Southwest by Uncle Sam (he sta- spoiled little boys. They would scream at and belittle hospital em-
tioned me in El Paso to guard the border during the Vietnam ployees and expect no one to correct their behavior. That has come
War!), we (Alice, now my wife of 46 years, and I) chose to settle in to be seen by all for what it is, totally unacceptable.
San Antonio after we spent two miserable winters in Philadelphia
with small kids at home. I love when I meet provincial Northeast- We did not know of HIV, we only put scopes into the GI tract,
erners, who upon hearing we live in San Antonio (to which they we had no cardiac stents – nor statins, and transplanted no organs.
have never been) ask, “Do you like it there?” as if we wouldn’t have Everyone was not hooked up to a monitor. We were just learning
left if we were unhappy. that CAT scans could be done of more than just the brain and who
knew of an MRI or PET? There were no cyber knives, and only
I joined Chuck Lerner, who was desperate for help, at the Diag- humans, not robots, did surgery.
nostic Clinic where we shared his small office. Jack Williamson
and Gordon Bilbrey gave me my first hospital consult — a diabetic If you were an “FMG” it meant that you had graduated from
patient with end-stage renal disease and a gangrenous infected foot medical school in Mexico — or north of the Red River! The di-
needing amputation, not antibiotics. Little did I know that stop- versity in the medical community that has since occurred has added
ping antibiotics, rather than prescribing them, would be the “bread many fine new physicians. Family practitioners and internists ad-
and butter” of infectious diseases! For the first year and a half, mitted their patients and there were no hospitalists. Residents and
Chuck and I saw consults all over the city because there were no fellows remained at the university, BAMC or Wilford Hall even
other ID MDs, exclusive of the university and the military. That though we, in the private sector, knew we had wonderful clinical
came to an end when Luis Cisneros opened his downtown office material to contribute to their training. Everyone took ER call and
and Bruce Wood came on staff at Northeast Baptist. most hated it. In the Medical Center, I recall there were six gas-
troenterologists, two pulmonologists, seven cardiologists, 10 radi-
I became a partner in the clinic in 1979 but at the same time ologists (without digital imaging), two nephrologists, an
decided it was not where I wanted to spend my career. With trep- endocrinologist (every primary care doc could take care of diabetes)
idation, I went to explain my decision to leave to Chuck (an eight- and three hematologist/oncologists, to say nothing of the surgical
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