by Bill Frist
“Tell us about your interests. What are your hobbies?”
“What about your family?”
“How much do you like watching football?”
“Where did you teach special education?”
“Why did you leave Texas to go to Boston?”
Karyn, poised as ever and smiling with each question fired her way, charmed them all. After about an hour of focused, orderly conversation, my brother Tommy inconspicuously got up and stepped into the kitchen. A moment later, he burst into the living room with a cardboard box raised high in the air, laughing and shouting that all the interviews were over.
“Stop the talking. This is the black ball box,” he explained as he captured everybody’s attention. “We all have had the chance to interview Karyn. We’ve asked her the tough questions. Now is the time for us to vote! If you think she has made the grade, put a white ball in. If not, drop in a black ball. And one black ball means she’s out!”
Everyone burst out laughing. Tommy’s stunt was saying exactly what everyone in the room felt: “Karyn, we love you and you are part of the family.”
In the fall of 1980, Karyn’s parents came to visit Boston. We drove up to New Hampshire to see the New England foliage and spent a couple of days driving the glorious countryside, staying at a small country inn. Karyn stayed in a room with her mother, and I shared a room with her dad. I had carefully planned asking Karyn’s dad for permission to marry his daughter. On the last night, as Mr. McLaughlin prepared to slip into the twin bed across from mine, I placed the engagement ring I’d picked out for Karyn on the wooden bedside table between us. I’d carefully situated the opened box so the ring was plainly visible. I didn’t say anything to Karyn’s father at first, just letting the ring sit there. Karyn’s dad could play that game as well. He saw the ring, but didn’t say a word, waiting for me to formally ask for his daughter’s hand in marriage. After roughly fifteen minutes, which seemed more like an eternity, I caved and asked his permission to marry Karyn.
The next morning, Karyn and her dad took a walk down a secluded country road, and along the way, he asked her straightforwardly, “Are you happy?” He and Karyn talked a bit about our potential future, but he did not tell her at the time that I had asked his consent. That Sunday night Karyn came over to my apartment after work, and we had a quick dinner. Tonight was to be the night! I was finally going to ask.
Trying the same tactic as I’d used with her dad (having not learned my lesson the first time), I carefully placed the engagement ring, in its little blue box, on a table and waited for Karyn to notice. We talked and talked, but she said nothing about the ring; nor did I. I was ready to ask her to marry me, but then, exhausted from working the two solid days, I fell sound asleep. Karyn had grown accustomed to this, but not on the night I was to propose! Karyn called a taxi and let herself out of the apartment. To this day, I’m not absolutely certain that I ever asked Karyn formally to marry me, but she took the ring that night, and it has been on her finger now for more than a quarter of a century. It was simply meant to be. And I’m still trying to communicate a little better!
We were married in Lubbock, Texas, on March 14, 1981. My entire family flew to Lubbock for the occasion, and they had undoubtedly never seen land so desolate. Mother and Dad rarely traveled out of Middle Tennessee. Dad had always said, “A day out of Middle Tennessee is a day in life lost.” When Mother got off the plane in flat, dusty, treeless, brown, windswept Lubbock, she looked at Karyn’s dad and asked plaintively, “Why in the world would anyone choose to live in a place with no trees?”
Worse yet, within six hours of my family’s arrival in Lubbock, a powerful dust storm turned the daylight into darkness, sending tumbleweed and dust in every direction. The Lubbock folks took it in stride, just another day on the prairie. We Frists from Middle Tennessee had thought such phenomena existed only in the movies.
Because Karyn’s and my schedules had kept us primarily in Boston, our parents had never met one another before the wedding week. To help bring our families together in an environment that guaranteed fun, celebration, and informality, Karyn’s parents hosted the clans’ first social gathering at a typical western saloon, Jug Little’s Western Barbecue, complete with well-worn wooden tables, cowboy décor, and sawdust on the floor. By the end of the night, the McLaughlins had all the Frist nieces and nephews, and brothers and sisters, belting out country-western favorites with the band on a makeshift stage. The chemistry was marvelous. The same connection between Karyn and me seemed to pass among our many family members.
Despite the elements (and the barbecue), the wedding took place in the Methodist church, right on schedule. After a brief honeymoon, Karyn and I returned to Boston and set up house in the apartment on Mt. Vernon Street, where we lived for the next four years as I completed my general surgical residency.
To become a cardiothoracic surgeon, one has to complete five years of a general surgery residency and then begin a fellowship in heart and lung surgery. At the time, the fellowship for cardiothoracic surgery was only a year and a half, which was not enough time to have intensive exposure in the nonheart aspects of chest surgery. To gain that experience, an arrangement had been made to send the thoracic residents to England for more extensive exposure in noncardiac chest surgery. So Karyn and I began planning a seven-month stay in Southampton, England.
* * *
I’D ALWAYS DREAMED OF FLYING A PLANE ACROSS THE OCEAN, SO I figured our stint in England would provide the perfect opportunity. Not only did I want to do the flying myself, but I wanted to do it in an old 1954 twin-engine airplane that I’d bought for twelve thousand dollars the year before I had met Karyn. I’d made a number of improvements on the plane, upgrading its safety and modernity along the way, equipping it with new, more powerful engines (replacing the old 150-horsepower ones with 200s so it would stay in the air, if I lost one), a new paint job (silver to replace the faded and chipped green original paint), and more up-to-date radios (the old organ grinder radios had gotten impossible to repair). I even changed the call signs painted on the fuselage to 314KB to signify our March 14 wedding and our initials—Karyn and Bill.
Karyn, too, had always been fascinated with flying. She began taking flying lessons shortly after we started dating. While still working as a flight attendant, she went every day she was in town to the wonderful, small airfield in Norwood, Massachusetts, to take lessons from Mr. Jack Mellon. He was the ideal flight instructor—a former military man, with highly polished black shoes, an accomplished and disciplined pilot, professional, and a perfectionist. That’s why Karyn always called him “Mr. Mellon.”
All this goes to say that Karyn was able and willing to fly the Atlantic with me. But the best-laid plans occasionally are shuttled to the side—which is exactly what happened when we learned Karyn was pregnant with our first baby. We joyfully altered our plans and flew commercially to England, where we were to live for the better part of a year.
I had told Karyn what a great opportunity going to England would be for the two of us. We would likely have our own car to drive, and she dreamed that we might be able to live in a quaint English cottage, maybe even rose-covered. The MGH residents who’d previously been to Southampton had shared with me the rejuvenating experiences they had had with their spouses in England. They especially enjoyed having more personal time together, traveling the countryside on weekends, and spending evenings together, the sort of “regular-life” things that the days at MGH never allowed us as residents. It all sounded idyllic to me, so I reflected that to Karyn—maybe with a bit too much imagination.
When we arrived, reality set in. The car, a ten-year-old yellow Ford Escort that each MGH resident rotating through just passed on to the next, was waiting for us at the airport. The driver’s-side door was bashed in, the left headlight was broken, and the passenger door was permanently locked closed, necessitating entry either through the window or through the other side. This was not a good first introduction to England. I loaded
our trunks into the vehicle, as Karyn inched her way across the driver’s seat to the passenger’s side. I drove an hour through the countryside to Southampton and pulled up, with pregnant wife and much anticipation, to our new home.
The house was not one of the charming, rose-covered cottages we’d dreamed about, but rather a drab, cement-block apartment right on the hospital grounds, directly across from the busy Emergency Room. To top things off, just after we pulled up, I volunteered to help a neighbor push his stalled car; we got the car rolling, but while doing so it ran over the brand-new camera we’d purchased to record our experiences in England!
We made the best of the living accommodations. Karyn quickly replaced the stiff, institutional bedsheets and pillowcases stamped, with big bold letters, property of southampton general hospital, with something a little more homey. Indeed we did have a lot more time to spend together and made a point each weekend to journey to a new region of England. We loved hosting across the countryside our close friends from Nashville, Barry and Jean Ann Banker and John and Missy Eason, and Karyn’s mom and sister Trisha and her husband Ike.
Professionally, I held the position of senior registrar, similar to being chief resident in the United States, first at the old Western Thoracic Hospital, which was a single-story, hundred-year-old facility originally built as a tuberculosis sanitarium, and then later at the more modern Southampton General Hospital.
Encountering a wide variety of heart and lung cases was a magnificent experience for a budding young surgeon. I treated pathologies that doctors rarely see in the United States, including diseases such as advanced-stage asbestosis, prevalent among British workers from long-standing exposure in the nearby Southampton shipyards. More than two decades later on the floor of the U.S. Senate, as I was trying to reform the American litigation system on asbestosis, I’d think back to those long, bloody, excruciating operative cases for end-stage asbestosis—a graphic reminder both of the horrors of the disease and of the importance of tort reform, so that those in need could receive help quickly and fairly. In the 1990s a handful of greedy lawyers were abusing the tort system, putting millions of dollars in their pockets rather than in the pockets of those injured who deserved help. (We lost that battle to the trial lawyers.)
My experience in England provided great opportunities for personal growth in leadership and responsibility. The senior registrar assumed major responsibility and performed all of the surgical cases; he or she ran the surgical clinics, made all major clinical decisions, and generally acted and performed as an attending physician would in the United States. That’s why the MGH surgical residents cherished their time at Southampton: They were in charge. They grew. And they came back with experiences to share with others at MGH.
This became the first of what would be many experiences in my life of going overseas to learn and observe and gather medical experiences from others, initially in the developed world but later more commonly in the underdeveloped world. Through serving others abroad, we can learn how to better serve at home.
What I found at Western Thoracic Hospital seemed foreign and strange. I could not believe my eyes the first few days in the OR; the excellent English surgeons were tackling cases just as complex as the ones we faced at the MGH, but doing so in a tiny, crowded, ancient, ill-equipped operating room devoid of the advanced technology and sophisticated monitoring that we were so reliant on in Boston. No Swan-Ganz catheters—no measuring wedge pressures, no atrial wires—but their results were just as good as the ones we achieved, or better. How could that be? I would wonder. Instead of the latest gadgets, the doctor and nurses relied on careful physical exams, just like the ones Dad would do. I soon figured out that attentive nursing and old-fashioned, thorough physical examinations of the patient would provide as much practical clinical information as all of the elaborate (and horrendously expensive) equipment we relied on back in Boston. Are we too obsessed with technology in the United States?
For instance, after surgery on the lungs, it is critical to get the patient to take deep, full breaths and to cough to keep the small air sacs of the lung from collapsing. In the States, for almost all postoperative lung patients, we used a portable machine that was rolled up to the patient’s bed every four hours and would “nebulize” or aerosolize a medicine called a bronchodilator, to keep the sacs open and make the patient cough. Such contraptions are expensive, and a highly trained respiratory therapist is required to deliver the treatment.
Naturally, after my first lung case at the Western Thoracic, a right upper lobectomy, I scratched out what to me was a routine order for a “nebulizer every four hours with bronchodilator.” Later that day, on evening rounds, I found to my astonishment the patient sucking on a thick, sixteen-inch-long, red rubber hose inserted through a cork that plugged a polished, white earthen pot containing eucalyptus—Mother Nature’s equivalent of the cough stimulant. How primitive! Guess what? It worked. I couldn’t help wondering, Why use costly high tech, when low tech does the job? Does our lack of attention to appropriate use of technology explain part of the 30 percent of the U.S. health care dollar that is “wasted?”
My professional experiences opened my eyes to more than just the variations in surgical techniques. While working in England, I discovered firsthand the pluses and minuses of socialized medicine, where government collects the funds, government determines how much is spent, government owns the hospitals, and government hires and controls the doctors and nurses who provide the care—for everyone.
The advantages I experienced included low out-of-pocket expenses to the patient, with many medical services made available at no direct cost to the patient at all. For everyday health-care matters, the socialized system seemed to work seamlessly. When people got sick, they received basic care. Everyone, rich and poor alike, had his or her own assigned general practitioner. And, though they were not trained as long as the internal medicine specialists on whom so many of us rely in the States, the care by the GPs was excellent for 90 percent of the typical medical problems most people experience. It’s gotten to the point it’s impossible to find a family practice doctor in the United States.
Our first son, Harrison, was born at Princess Anne Hospital in Southampton. Karyn’s prenatal care by the general practitioner was superb; he’d make house calls to our flat, where he’d join Karyn for tea. At the time of delivery, we just had to show up at the hospital. Paperwork seemed nonexistent; I don’t even recall having to sign any paperwork as we were admitted. After twenty-four hours of labor, Karyn required a Caesarian section because of failure to progress, and again the care for the delivery was superb.
But then we began to notice a difference. One of the downsides of socialized medicine at the time was inadequate funding for nursing care. Karyn was told to stay in the hospital for a week because of her incision, but beginning the day after birth, it was Karyn who had to roam the halls to find clean sheets each day to change both her and Harrison’s bed (quite uncomfortable with her abdominal incision!). It was Karyn and her mother, Kathryn McLaughlin, who had come to assist with the new baby, who together carried out all the basic nursing functions. If times are tough, the central government simply cuts the budget for health care, rationing what each hospital gets, and the hospital has no choice but to make do with the resources available. You take what you can get in times of rationing. You have no voice, and you have no choice.
I was also struck by the cultural differences in the British patients and their families’ attitudes toward disease. In England, as long as everyone was getting about the same health care, even if it wasn’t the best and the latest, no one seemed to complain. Americans expect more of their health-care system. My English patients were more accepting of the fact that there are limits as to what modern medicine can accomplish. For example, when I operated on a patient with lung cancer, if there was some minimal spread of the tumor discovered at the time of surgery, that would be the absolute end of therapy. I would tell the patient and their family that surgery
was all that we had to offer, and share with them the statistics showing that the patient would unfortunately not live beyond a few years because of the spread of the cancer. The patient and his family understood and accepted this. They didn’t ask what more could be done; they didn’t ask for a referral or a second opinion.
But if I had operated on that same patient in the United States, we would have immediately recommended radiation therapy and, if indicated, chemotherapy to fight the cancer. We would routinely offer the latest scientific breakthroughs and medicines and the latest technology to fight the cancer. We doctors would not give up! And most patients would be much more demanding, expecting to get whatever latest therapy is available. Back at home, the normal questions would be: “What experimental therapy is there? Can’t I get an extra year of life with some new treatment? There must be an investigational clinical trial somewhere that I could enter.” The contrast was striking to me.
The rationing of health care was overt in England, whereas in the United States we had (and have) a much more covert sort of rationing based on ability to pay and on varying access to insurance. For example, in England, as senior registrar I was responsible for keeping the list of heart surgery patients whom we would treat over the following month. It would be over a hundred patients long at any one time, listed one to one hundred in order of how long they had been on the waiting list. We operated on two cases each day from the list, starting with the names at the top unless there was a clear-cut emergency. After 4:00 P.M., we were not allowed to do any more cases; the operating rooms closed, and the surgical staff went home. We started afresh on the list the next day. By the time I got down to patient number seventy or so, I noticed that some of the patients had died waiting.