RECOLLECTIONS

Recollection of David Albritton

Thanks for the opportunity to crystallize some of my remembrances of the Professor. Like old family photos in a shoebox, they will disappear forever unless somebody who cares dusts them off and arranges them in an album. The Professor's larger-than-life accomplishments, of course, would be plenty. We are all surgeons, but imagine developing and doing Blalock-Taussig operations with Blalock himself, and making those babies survive before anyone had conceived of an ICU, when vascular anastamotic techniques were just being developed. Who among us goes ahead and starts one of the top surgical departments in the world from scratch. His major accomplishments are well documented and endless.

But you request Vignettes. OED defines this as "a brief descriptive account, anecdote, or essay; a character sketch, or, a small running design, as a vine around a page. The running design was the constant excellence that was the unspoken demand that his own character placed on all of us.

I was helping him with a private case, a massive spleen as I recall, and noting as the case progressed, how his primary incision was just the right length - not longer than necessary, but long enough that we didn't have to struggle - and thinking that was how he did every part of the case, and everything in his life, and thinking why shouldn't I do that too? I recall a Saturday morning conference where a junior resident was proudly detailing one of his first gallbladders, and on coming to the part about actually removing the organ, said he decided to "do it the safe way" (from the top down). The Professor mildly inquired as to what might be the conditions that would prompt him to do it the dangerous way? This became a bit famous. You may have used it yourself on an R-2 from time to time.

One small moment I have recalled often, as that same moment seemed to come up again and again in the course of my daily routine, was as I was intently involved as a senior resident with a "big case" - I believe it was a Whipple - and I reached one of those junctures where you have just finished one tedious element and pause for a moment to regroup for the next phase, -- and I looked up and there was the professor in the dome, quietly watching. He had not announced his presence, but gave me that wise little smile. I of course have a normal surgical ego (huge), but we all must admit to a tiny sphincter-tightening center somewhere hidden in us that tries to control us occasionally when a renal AV fistula complicating aortic occlusive disease defies exposure, or a vexatious bullet, or tumor, has stretched our technical envelope. At those moments the professor in the dome, a metaphor for the meticulous preparation he gave us for the challenges we would have to deal with, has returned, and will continue to return, with beneficial effect.

I really think I got the same little look from him once when Robert Zollinger was visiting, and the Professor took him out to dinner, and needed a resident to round out the party, and fingered me. I would have found the ER less stressful. Dr. Z. relished the opportunity to roast a resident more than he would the finest filet mignon, and as I was fielding this grilling, I recall Dr. Longmire sitting back, saying nothing, with that same little "you're doing fine, kid" smile on his face. I suppose he didn't want oral boards to be any particular shock to us.

My father is 89, and currently healthy, so I thankfully have not had to experience his inevitable demise yet, but when I read the unexpected letter from Dr. Busuttil informing me of The Professor's passing, I suppose the feeling was similar. He has prepared me for one last trial.

David R. Albritton, M.D., FACS
Santa Cruz, California

Recollection of Clyde Barker

It is probable that all academic surgeons of recent generations have many recollections of Dr. Longmire. I remember that my first conversation with him occurred in the 1970’s when I found myself seated next to him during a meeting of the Society of Clinical Surgery. I was surprised to find that he knew of my work in transplantation of pancreatic islets. It was obvious he knew a great deal about the field. I do not recall his mention of his work with you on islet autotransplantion in a totally pancreatectomized patient. Perhaps this case had not yet been done but I believe it was the first conclusive indication that islet transplantation could succeed in a human patient who totally lacked other insulin producing tissue. In any event after my first conversation with him, Dr. Longmire always greeted me by my first name. He also, after meeting her, always recalled my wife’s name and never failed to ask about her. This was an impressive feat of memory which I learned that he shared with other Blalock trainees. For a young surgeon, it was always a pleasant experience.

In 1985, Dr. Longmire asked me to serve on a subcommittee of the Conjoint Council on Surgical Research, which he organized and chaired. His analysis of the dilemma confronting would be surgeon-scientists is as valid today as it was in 1985. It was evident that he strongly believed in the importance of research by surgeons despite the difficulty in finding time and proper training for it. The record of his department in this regard is a tribute to his mentorship of young investigators.

In 1987, I became aware of how close the relationship of Dr. Longmire and my own Chief, Jonathan Rhoads had been. Dr. Rhoads, on the occasion of his 80th birthday celebration selected Dr. Longmire as one of only two visiting surgeons he invited to speak after dinner.

In 1998, I was honored by an invitation to give the Annual Longmire Lecture at UCLA and in 2000 to be invited to give the Longmire Lecture at the Young Surgical Investigators Meeting of the American College of Surgeons. Slides that I used in these two talks conceivably are of interest to you. I enclose hard copies of them and would be glad to send the slides to you if they would be of any use.

Through my association with Rupert Billingham in the 1960’s I became aware of Dr. Longmire’s pioneering work in transplantation. In the early 1950’s transplantation science was a very small club, and Dr. Longmire was a prominent member. In fact Dr. Longmire’s interest in transplantation as I’m sure you know, predates even this early period. As Chief of Plastic Surgery at Hopkins (1946 and 1948) he investigated skin graft rejection in humans. In one fascinating case, he grafted skin from 71 individual donors to a large burned area on the back of a recipient. All of the skin grafts were rejected-one of the earliest demonstrations of the diversity of histocompatibility factors. Shortly after this time, he became known within the small group of scientists working on transplantation for coining the terms homovital and homostatic grafts, defining homostatic grafts as those such as bone in which the surviving donor tissue served as a scaffold for replacement with recipient tissue.

Billingham of course was well aware of Dr. Longmire’s classic experiments with skin grafting in young chickens. With Cannon, in 1952 he showed that skin allografts exchanged between newborn chicks would often survive rather than undergoing rejection that was inevitable for allografts in older chickens. Their work in newborn chicks was an example of tolerance which preceded the classic experiments of Billingham, Brent and Medawar. At the same time his use of cortisone to prolong skin graft survival may have preceded any other attempts at immunosuppression.

As Dr. Longmire became more consumed with his duties as chairman of the new department at UCLA his time for bench research diminished. However, through encouraging younger members of his department he remained important in the transplant field. Paul Terasaki’s early work with Dr. Longmire on blood transfusions to promote tolerance in young chicks and also, incidentally, graft versus host disease was an example of this. Dr. Longmire also supported Terasaki for a fellowship with Peter Medawar in England and with other scientists in France. This led to Terasaki’s development of the microcytotoxicity test in 1959 (in which Dr. Longmire was a co-author) and to cross matching for avoidance of hyperacute rejection. Ultimately their work was important in establishing the field of histocompatibility testing. Another early contribution of Dr. Longmire’s department was the demonstration by Will Goodwin in 1963 that rejection could be reversed by steroid therapy. Dr. Longmire’s interest in transplantation and his support of other young colleagues resulted in UCLA becoming one of the world’s great transplant centers.

Dr. Longmire’s importance as a leader and statesman of academic surgery would be hard to overestimate. I remember him best as a warm and gracious person who always took the time to remember the names and interests of young surgeons. He will be greatly missed.

Clyde F. Barker, MD
Donald Guthrie Professor of Surgery
University of Pennsylvania Medical Center
Philadelphia, PA

Recollection of Wiley Barker

This was a man whom I worked for and with for forty years; several times we shared an office, in the early days as well as in the later days of retirement. And in those many years, this was a man with whom I never shared a cross word.

My career with Bill Longmire began in the bar of the Drake Hotel in Chicago in October, 1948. What follows may sound as though it were my biography, but it will also begin to explain the origin of my devotion to the Man.

I had been in my fifth year out of medical school at the Peter Bent Brigham in Boston – eighteen months as an intern-resident, two years in the Navy (ith an excellent surgical experience), six months in pathology at the Brigham, and was beginning a year's fellowship in the laboratory at Harvard as the Cabot Fellow in Surgery, with the promise from the very recently deceased Elliott Cutler that I would return to the Brigham as Senior Assistant Resident in 1949, and finish as top resident in 1951.

So it was a shock when Dr. Cutler's successor, Frannie Moore stopped by my laboratory to see how my radioactive phospholipids were coming along and incidentally dropped the news that instead of following Dr. Cutler's plan, he would keep the promise to have me finish as Chief, but he wanted me to drop out of surgery for "a year or two to learn some biochemistry - to return to the clinical years in 1956 or so." That would have left me finishing at the Brigham fourteen or fifteen years after medical shool. And I wanted to be a surgeon, not a biochemist.

I immediately paid a visit to Dean Burwell of Harvard, who listened, then scribbled a handwritten note on the back of a letter he had just signed to John Lawrence, the new Chief of Medicine at UCLA (or as Dr. Burwell put it, the new School of Medicine at the University of Southern California at Los Angeles.) Dr. Lawrence wired back that I should get in touch with Bill Longmire, which I did through the good help of Henry Bahnson at Hopkins. Shortly after I told him my problem Henry called me back. He said he had reached Bill in Chicago, and that Bill wanted to meet me - in the bar of the Drake Hotel the next evening at seven.

And that I did and returend to Boston with a promise of a job - later Bill said in an address about the originsof UCLA that is was the first position he really promised. I suspect Harry Muller had really preceded me, but I like to think I was an early appointee, any way.

When I reached Los Angeles, I was a little miffed to find I was to return to the level of a lowly third year resident at the Veterans Hospital. That feeling was soon eased as Bill asked me to skip the fourth year, go on to the fifth year - but then in the fall of 1950, he called me in and said: "We're going to terminate your residency this Decembere." Long pause, as my heart sank. "But we would like you to have you move on to replace John Beal as Chief of the Division of General Surgery as John replaces me as Chief of the Department of Surgery here at Wadsworth." And so I served in that capacity for twenty-five years, first at the VA and then at UCLA.

But it was only after years of close association with him that dared call him "Bill." That moment followed an episiode at a cocktail party for one of the new UCLA faculty. Bill and Jane were having a modest argument about something trivial. Bill had the facts and the strong position, but Jane had the emotional advantage. Finally, as she gave up the high ground, she turned to me and said over her shoulder, "Oh Bill, you jerk!" From then on I had the courage to call him "Bill" in social situations, but until his last days I usually used the professorial title in the hospital.

Bill's calm and professional attitudes were at first perhaps misleading to those who really needed a word of remonstrance, or a bit of education. His voice would drop a bit in volume, but he would clear his throat and begin - and the person to whom he spoke got the message, right then! Bill's gentle manner didn't obscure the point he wanted made. Despite that soft spoken approach, there was one of our residents at Wadsworth who was so desperately afraid he would cross the Professor that he experienced serious gastrointestinal tumult on the days the Professor was scheduled to make rounds on his ward!

I had the privilege of having the Professor operate on me twice. That gives one a slightly different view of a surgeon, but the soft spoken but precise manner he used was of immense reassurance to the patient

It was always a treat to call him, any time of the day and night, to ask a sticky question, for after a brief second or two he would respond without hesitation with just the right guidance - no hemming or hawing - a quiet, professonial answer.

Nancy and I had a special opportunity to be with him in those early years. Someone organized a Sunday evening "session of the arts" at Jack Pressman's home - actually in the studio of Jack's wife, Claudette Colbert. Those who wanted to paint, painted - I did some ceramic work. But it was Bill who was the star. As most of you know, one of Bill's still lifes is displayed in the offices of the American College of Surgeons in Chicago.

Later we had the privilege of touring New Zealand with Jane and Bill - and a couple of other delightful friends, even though they were surgeons from USC, Bill Mikkelsen and Fred Turrill and their wives.

We all know these things about Bill. We all know the way he was esteemed, admired, loved and emulated throughout the surgical world. I should say "medical" world and I would like to add one further vignette to explain.

As you know, Bill left UCLA for a brief term of duty as Chief Surgical Consultant for the Air Force in Europe. During that period away, I was sitting as the surgcial service representative at the Wadsworth Dean's Committee meetings, which in those days had representatives from USC as well as UCLA on the Committee.

After one lengthy session, the chief of medicine at USC stopped me and said: "When will Dr. Longmire be back? You know, when Bill is in town, medicine all over Los Angeles goes a little more smoothly."

That was the aura that helped make this man one of the most important medical people of our times.

Bill, our beloved Professor ("of difficult surgery"), we'll never forget you.

Wiley F. Barker, MD

Recollection of John Beal

During the early 1950, interest in transplantation of tissues and organs was attracting increased attention. This was also at the time that the faculty of the Department of Surgery was developing. Bill was interested in having his department participate in the activities of the Los Angeles Surgical Society. Accordingly, he prepared a presentation relating to the Transplantation of the Adrenal Glands, using cats as the models. To determine how well adrenal glands would survive if transplanted to the brain, we adrenalectomized two cats and placed the adrenal glands of each cat in the brain of the other cat. The presentation of these cats was made to the L.A. Surgical about a week later. In order to amplify the presentation, Bill had the two cats brought in cages to be seen by those in attendance. Of course, the cats seemed to be perfectly normal as the transplants survived for about a month. The presence of the cats enhanced his excellent presentation of the topic.

At about the same time, a well-respected surgeon in Alameda (forgive me for forgetting his name) reported replacing the stomach after total mastectomy, utilizing the ileo-cecal portion of the intestinal tract. Bill and I discussed this and thought that it had merit. Soon after, we had a suitable candidate with carcinoma of the stomach at the Wadsworth Veterans Hospital and Bill performed a total mastectomy with ileocecal replacement. The operation went well and the patient recovered. However, his post-operative course was marred by an intra-abdominal abscess which required drainage. We discussed this at length and proposed that the interposition of a segment of jejunum might be less hazardous and work as well. Bill had me search the literature to determine if such a procedure has been previously performed. I found that the Japanese had performed total removal of the stomach in dogs with replacement with a segment of jejunum with survival of the animals, but there was no report of its use in humans. As a result, we undertook this operation in about eight males over the next several weeks with good results. The operation was subsequently reported and published appropriately. I describe this to underline the care with which Bill Longmire undertook and planned complicated procedures and to emphasize the range of his interests.

John M. Beal, M.D.
Valdosta, Georgia

Recollection of David Bloom

I have several indelible recollections. First and foremost is the professionalism and supreme competence that Dr. Longmire consistently exhibited. He was, to my mind, always fair, steady, and balanced in his patient care, teaching, and administration. As a resident, I would, on a yearly basis, collect my thoughts and plans on a small piece of paper and meet with him anxiously and a little bit in awe. We would go over my list, he would offer his thoughts, and then he would clear his throat and say something like "Well, I guess that about covers it, Dave. Thanks for coming by," and that would be the incontestable cue that our meeting was over. He always maintained a level of impartiality and fairness that one might describe as "detachment." (Detachment is one of the four core descriptors in our Longmire Society Certificate. This term puzzled me at first, but I came to understand it and appreciate it over the maturing years of my residency and career.)

During our UCLA residency, the third year resident spent a three-month period as the professor's private resident. This was naturally a rotation of great anxiety and our residents' grapevine contained many anecdotes of residents who "failed" this rotation and subsequently fell off the ascending pyramidal residency ladder. My first case with Dr. Longmire on this rotation was a colostomy takedown. We began the case after my determined efforts to present The Professor with a perfectly prepared and worked up patient. We scrubbed together silently and walked into the operating room as my tachycardia increased. I prepped, we draped, and Dr. Longmire picked up the knife in his customary fashion. He began the incision with my anxious and uncertain efforts as first assistant no doubt under his scrutiny. After a few moments, he put down the knife, reached across the operating table and grabbed both of my wrists gently, looked me in the eye, and said "Now Dave, I'm used to the very best help: keep both hands moving." I got the message, my anxiety level began to decrease in time, and over the next three months I found gradual but steady increments in my responsibilities within the operating room.

Another favorite anecdote concerns a fellow resident who served on the private service at another time. My fellow resident was growing quietly more and more impatient with his role as first assistant inasmuch as the professor rarely gave up the knife or the scissors. On a complicated biliary tract operation the professor was challenged with the placement of a particular suture. As he kept trying to get the suture placed just right, my fellow resident finally offered a suggestion "Dr. Longmire, I think that stitch might be more easily placed from my side of the operating table." At this Dr. Longmire said, "Well then, if I have much more trouble I'll just have to come over there and place it."

Over the ensuing years of my second residency in Urology, my four years at Walter Reed, and my subsequent time here at the University of Michigan, I never failed to keep in touch with Dr. Longmire, although it did take me a good number of years to get comfortable calling him "Bill." He insisted on this in our correspondence and at meetings. Somehow the transition occurred, although I still always felt a tiny nugget of discomfort. In his retirement he seemed to enjoy my papers, particularly the historical ones which I would send, albeit with irregularity. My letter writing, however, must have fallen off at one point because when I saw him at one of our San Francisco Longmire Society dinners he said to me "Now Dave, has your pen gone dry?"

Many thanks, Bill, for your vision in seeing this task and taking it up so admirably. Our stories of these formative experiences bind us together and help perpetuate the culture that has framed us and will define our successors.

David A. Bloom, M.D.
The Jack Lapides Professor of Urology
Associate Dean for Faculty Affairs
University of Michigan Medical School
Ann Arbor, Michigan

Recollection of Paul Damus

Thanks for your letter on Dr Longmire. For people of that age one is accustomed to expect death but when I saw the article on it in the Times, since I didn't know of his illness, it was sort of a poignant shock that made for a melancholy day of remembrance. Unfortunately, the Professor was on sabbatical when I was on the private service, so I didn't have as close contact as others, helping him with only a few of the movie stars, tycoons, and others who sought him out. Small talk with him was not possible but I found he liked to be interviewed, so to speak, and in that format he would talk freely about his past including Sepulpa, Hopkins, Blalock (he always called him "Al" and nothing else), and other distant topics. He never discussed politics, personal problems, or the people he worked with. He told me once he sometimes had anxiety in picking residents because he had a fear that if they turned out poorly that he and the institution would be diminished. Perhaps he was talking to me indirectly.

I have two remembered episodes. There was meeting held in which each department head was to discuss a (self chosen) case in which there had been some major complication for which he was responsible and how it had been handled. One by one they got up and related some horrendous mea culpa. One had divided a major artery leading to death, another had resected too much bowel, or removed the wrong gland, missed a cancer, etc. It was all very gloomy and disheartening. The professor was last. His case was a Whipple that had gone astray. Fistulas, bowel obstruction, chest tubes placed in the liver, then in the spleen, uncontrolled hemorrhage, on and on, but each disaster was met with courage, resolve, hard work, an ingenious manouver, until the patient left the hospital in good shape, sent a note of gratitude, and had donated money to the hospital. He got a standing ovation. He knew how to play the game, too. I last met him at a Longmire society meeting 10 years ago. I asked him what he was doing in retirement. He matter of factly said he was mainly helping Jane; take care of the house, doing most of the vacuuming and other heavy chores. Being the professor gave him no airs.

I've been in several prestigious institutions and known many department heads. But when the word "chief " is used I have only ever thought of one man who really deserved the title. I was so privileged to have been there. Thank you for the work you are doing to preserve his memory.

Paul Damus, M.D.
Director, Cardiac Surgery
St. Francis Hospital
Roslyn, NY

Recollection of Merril Dayton

I was saddened to hear of Dr. Longmire’s recent passing. It seems that some influential people in our lives we think will live forever. Certainly, I think it would be fair to say that the impact he has had on all of our careers will live forever.

Dr. Longmire was the consummate professional. From the first time I met him when he stepped onto an elevator at the UCLA Medical Center to my last association with him at one of the recent American College of Surgeons meetings, I always felt that he was the model of an academic surgeon.

Dr. Longmire stepped down from the Chairmanship while I was in my residency training at UCLA, but his influence was significant and persistent. At any Saturday Grand Rounds in which he was in attendance, when the Professor spoke, the debate ended. His surgical opinion was so highly valued that we all knew better than to argue with him about any point of general surgery.

It was my privilege to work closely with him on the Blue Surgery Service where I had an opportunity to take care of a number of very famous people who were Dr. Longmire’s patients. He was held in great respect and reverence by even the famous and well healed.

Operating with Dr. Longmire was always a real learning experience. Dr. Longmire would not usually turn the case over to you until he really trusted you. Thus, it was a great moment in a resident’s life when he would hand the scalpel or needle driver to you and essentially say, “I trust your surgical ability.” I recall the time we were doing an injury-related common bile duct reconstruction. I read up on the case and really felt I was prepared. At the appropriate time in the operation, he handed the instrument to me and had me do the case. It was one of my great thrills in residency.

Dr. Longmire wasn't fast or flashy as a surgeon but he was efficient, sound and made few mistakes. His judgment was legendary and sometimes surprising. I recall one patient whom I thought should undergo a Whipple operation, but after Dr. Longmire felt the tumor and its extent of involvement it was very clear to him that this operation should not proceed. When I questioned him about that, he simply said, “Dr. Dayton, anybody can make a decision to operate. It takes a real surgeon to know when not to operate.” I’ve never forgotten that.

As a Chief Resident, I scrubbed with Dr. Longmire on a large number of complex and very difficult cases. During one of these long operations, Dr. Longmire was in a good mood and began talking about his own residency at Johns Hopkins. He stopped himself at one point in the operation and talked in detail about his experience with Alfred Blalock. With an intensity in his eyes that I had rarely seen, he began speaking with a sort of hushed excitement regarding the very first Taussig-Blalock shunt that had ever been performed. He was Dr. Blalock’s chief resident for that operation and he stated with excitement in his voice, “I’ll never forget when we removed the vascular clamp from the shunt anastomosis and saw the baby turn pink from his cyanotic blue right in front of our eyes. It was one of the most exciting days of my life.” It was then that I realized what a remarkable man Dr. Longmire was and what enormous contributions he had made to surgery.

Another cherished memory of mine is the opportunity I had to meet with the Professor halfway through my second year of surgery. Up to that time, I had considered an academic career but had very little mentoring or encouragement to embark on such a career. I received a telephone call from Dr. Longmire’s secretary asking if I could meet with him at 2 o’clock on the sixth floor. I was understandably nervous at such a meeting because I was unaware of any mistakes I’d made or problems for which he would need to talk to me. As I entered his office, he was gracious and gentlemanly. He invited me to sit down and told me he had something he wanted to talk with me about. At that point he said, “We are very pleased with the progress you’ve made in your residency in the first year-and-a-half.” He went on to explain that he believed that I had real potential as an academic surgeon and said that he would like me to consider doing two years of research with the plan to continue in academic surgery after the research years. It was one of the great thrills of my life to realize that he even knew who I was, let alone that he felt that I might be a candidate for an academic career. I did two years of research with Charles Code at the Center for Ulcer Research and Education in West L.A. and my career was changed forever because of that meeting with the Professor. It was also my privilege to return to Los Angeles a few years ago as the invited speaker at the Longmire Symposium where I had an opportunity to present the Utah series of ileoanal pull-through procedures that represented one of the largest series in the country. I had a chance to sit at Dr. Longmire’s table that night at dinner at the BelAir Hotel and he expressed his personal pride in my accomplishments as an academic surgeon. After all those years, he recognized that he was still the mentor and I was his lifelong student.

The final thing that I could say is that William P. Longmire was a very noble and gracious human being. I never saw him do anything that was petty, small-minded or vindictive. He treated his patients wonderfully and they all adored him. He was not malignant, mean-spirited or inappropriately intimidating in any way. I always felt that he was the perfect gentleman and a great man who could associate with people in all stations of life with comfort. Without question, few people have impacted my professional career the way the Professor did. I certainly felt a sense of loss with his passing. The American surgical community lost one of its great fathers. Thank you for the opportunity to reminisce a little bit and remember the impact of this remarkable man.

Merril T. Dayton, M.D.
Professor and Chairman
Department of Surgery
Buffalo, NY

Recollection of David Follette

I started Blue Surgery on October 24, 1973 Dr. Longmire was schedule to make attending rounds at 7am, I came up the elevator and caught him watching his watch around the corner so as to be at the 7th east nursing station at 7am exactly. As interns we learned quickly that Longmire stood for precision whether, this was for rounds, doing a cholecystectomy, liver resection, or dealing with a family. He was truly amazing in that he was able to use the House Staff as a true extension of himself- both in surgery and in taking care of his patient. He taught us very early on that patients need to relate with "their" surgeons. The new group approach so often used today to meet work hour restrictions was not the way we were taught. But like all of us he was not perfect. I recall one night during those two months waiting with the "private" residents (PGY-IV) by the phone in the Wilson Pavilion at UCLA. Dr. Longmire call the R-IV every night at exactly 9pm regardless where he was to check on his patients. This night he was in Saudi Arabia and had forgotten to set his watch back to the correct time. The poor Resident did not move from the nursing station for three hours until the call finally came!

Dr. Longmire was a man who taught by example and had the unique ability to let his student grow and gain confidence and yet stay in touch with will that was going on at all times. This is a rare quality for a leader in the field of Surgical Education. We all will sorely miss this unique style.

David M. Follette, M.D.
Professor
Department of Surgery
UC Davis Medical Center

Recollection of Erik Fonkalsrud

One of the true “giants” in American, as well as International Surgery and Medicine, has passed away. I shall always be grateful for the opportunity to complete my General Surgery residency at the UCLA Medical Center during the very early years of the training program. The 68 residents in General Surgery who were fortunate to have trained at UCLA under Dr. Longmire’s guidance during the 20-year period from 1956 to 1976, as well as those who trained after his retirement, all hold him in the highest regard with deep affection. He was admired, respected, and loved by residents, as well as patients and colleagues.

“The Professor” as he has been respectfully called by his residents over the years, embodies the highest meaning of this title. By his gentle example and great support, he encouraged us to raise our performance to a higher level, and be the very best that we could be. With his foresight regarding the opportunities and patient needs in surgery, he recommended that I pursue further training in Pediatric Surgery, and then return to UCLA to develop one of the earliest divisions in this field in a University Hospital. His remarkable judgment and wisdom made those around him admire and wish to emulate him. He was always considerate, with a remarkable logic and fairness, which conveyed the impression of giving the most thoughtful and calm consideration to all matters brought before him, often seeking opinions from junior colleagues.

Dr. Longmire was a man of extraordinary integrity, extreme gentleness, and high principles. It is rare that one encounters a physician who is simultaneously a very gifted operating surgeon, remarkably innovative surgical scientist, superb teacher and mentor, very effective administrator, clear writer, and the founder of an exceptionally fine department. He was almost always available in the hospital, and it was difficult for those of us around him to understand how he found the time to accomplish so much to benefit surgery nationally and internationally. “The Professor” leaves us with a tremendous personal legacy of setting our goals at the highest level and working tirelessly to achieve them. His gentle charisma has influenced residents and students to their highest performance by his example, not by demands. His life has been characterized by concern and care of others whether they were patients, residents, colleagues, or friends. The attributes of humility and dignity have been personified for us all by his daily life style. For all those who have had the privilege of having an association with Dr. Longmire at UCLA, he shall always be “Our Professor”.

Eric W. Fonkalsrud, M.D.
Emeritus Professor and Chief of Pediatric Surgery
UCLA Medical Center
Los Angeles, California

Recollection of Julie Freischlag

Dr. Longmire was still operating when I was an intern in 1980-81. He was quite a master. I watched him close the common bile duct with silk - only he could do that and get away with it. He then became an emeritus professor and we all were delighted when he came to conferences, grand rounds or morbidity and mortality conferences. When he spoke, it was like E.F. Hutton - everyone would hush and turn their heads towards him and listen to every word.

When I was offered the Johns Hopkins Chair position, I phoned Dr. Longmire and told him. He said that he already knew that - that someone had already called him about it. He congratulated me and said:

"It is very good for you Julie, to get this job. It is good for UCLA as we are finally sending someone back to Johns Hopkins! But, most importantly, this is really good for Johns Hopkins!"

He made me feel great.

Julie Ann Freischlag, M.D.
Chair, Department of Surgery
Johns Hopkins University
Baltimore, Maryland

Recollection of Noboru Harada

I served as a research fellow to Professor William P. Longmire in the Department of Surgery at UCLA for two years from 1978 to 1979. I investigated under his directions, the important problem of the elevation of gastric acidity following diversion of bile from the duodenum. In this work, I made the original observation that the mere creation of a blind ended jejunal segment resulted in gastric acid stimulation that was increased when bile was diverted from the duodenum but that the diversion of bile from the duodenum was not the only factor involved in gastric hyperacidity. I was also able to show that such hypersecretion was not due to the release of gastrin. In also made some original observations on the possible immunologic etiology of sclerosing cholangitis, a poorly understood disease that seems to be increasing in incidence.

I remember Professor Longmire, as a tall man with a straight back, gray hair, and friendly eyes. He had a low, deep, powerful, and charming voice. Every time at our meeting over the experimental data, he listened to me report the processes of experiments patiently with a smile. When the data was beyond his expectation, he often fell into deep thought, saying “I can not believe it, I can not believe it”. He looked just like a naughty boy confused about something, and that impression of him will always stay with me.

I had the good fortune to meet Professor Longmire, and that influenced me greatly in pursuing my clinical research work in hepato-biliary pancreas field in Japan. It was with great sorrow that we heard of the death of Professor Longmire who made great achievement as a world pioneer in the surgery of hepato-biliary panceas field.

I would like to express my sincerest thanks to Professor Longmire in the memory of the great exiting two years I spent together with him at UCLA. I would like to pay my last respects for the soul of Professor Longmire.

Noboru Harada, M.D.,
Emeritus Professor,
University of Shizuoka, Japan

Recollection of Jonathan Hiatt

In the summer of 1972, as a college junior, I had the extraordinary opportunity to spend a student research fellowship with Dr. Longmire at UCLA. Our projects were concerned with hepatic revascularization and surgical anatomy of the porta hepatis. When I presented my work to the other fellows at a seminar on a warm August afternoon, Dr. Longmire sat in the front row, listened patiently, and explained the rationale for the projects in greater detail. When he included a portion of the work in a paper of his own the following April, he invited me to attend the presentation as his guest. That meeting, my first, was the American Surgical Association.

I was eager to return to UCLA for the following summer as well. But Dr. Longmire was taking a sabbatical to serve as President of the American College of Surgeons, so he sent me across to the Wadsworth VA to work with Eric Wilson, then a young vascular surgeon. I owe much of my subsequent career to Dr. Wilson’s support and guidance but might never have met him and secured his friendship had not Dr. Longmire, at the height of his power and influence, found time to help a premed student to get hold of a summer job.

A few years later, while a senior resident on the Blue Service at UCLA, I made rounds with Dr. Longmire on his private patients each day. He treated his resident as a colleague and often shared stories as we walked the halls. But once at the bedside, his manner became formal, always compassionate and caring but eminently dignified and professional. So my surprise was palpable when one time, during a routine postoperative visit, a patient invited Dr. Longmire to make a selection from a box of chocolates, and the Professor accepted the offer with delight. He ate the chocolate right then and there, and as we left the room, he confessed to me that See’s Candy was his downfall.

Another time on the Blue Service, I assisted when Dr. Longmire performed an emergency hepatic resection on a young woman who presented in shock from a ruptured adenoma near the hilus of the liver. It remains to this day the boldest operation I’ve ever witnessed. With deft stokes and no delay, Dr. Longmire excised the large tumor, hoisting it free, then remarking, “Gentlemen -- we have some hemorrhage,” as calmly as one might order a soda. For him, of course, the bleeding was at most a minor contest, and it was controlled in short order.

Legend has it that Dr. Longmire was quite fiery in his youth. I was never a witness to this aspect of his character, even during an operative case when he referred to a certain hemostat as a Crile and was told by the freshly-minted scrub nurse that the clamp was in fact a Kelly. “Young lady,” he said, never stopping his work, never looking up, “I’m much too old to be taught the names of instruments.” During another case, Dr. Longmire was struggling, just a little, to intubate a bile duct when our intern, an eager fellow, chimed in to suggest an alternate approach. And then another. “Young man,” the Professor said, never stopping his work, never looking up, “You’re only hurting yourself.”

Dr. Longmire had a wealth of pithy aphorisms which he dispensed at appropriate moments. Two of my favorites: “Pin-sized incisions for pin-headed surgeons” and “Never ask a question for which you won’t like the answer.”

In his later years, Dr. Longmire retired from active practice and spent a portion of his time at the VA, where he helped the residents with their cases and attended the weekly morbidity conference. His comments were always cogent, illuminating the issues at hand, the words chosen with care to minimize offense but never tolerant of muddy thinking or slack judgment.

He was for me, and for generations of UCLA residents, the physician by which others were measured, the consummate scholar, scientist and surgeon. Was, and is.

Jonathan R. Hiatt, M.D.
The Dumont-UCLA Transplant Center
Division of Liver and Pancreas Transplantation
David Geffen School of Medicine at UCLA
Los Angeles, California

Recollection of John Jones

It has been 26 years since I last scrubbed with Dr. Longmire, but it is amazing how often I think of him. Every time I tied a knot on the bowel, I can hear him tell me “not too tight, so that it won’t necrose.” Every time I do a Whipple and leave a T tube in the common duct with a limb across the choledochojejunostomy to stent it, I remember him telling me how he thought this was most helpful for subsequent cholangiography, stenting, and as a safety valve. I remember helping him perform two Whipple operations in succession in one day, after which I was exhausted but he hurried off to a conference, full of energy. He was such a stickler for cleanliness and I remember that he had quite an impressive lecture on fingernail hygiene.

These experiences and countless other lessons he gave us in surgery have proven over the years to be great and lasting gifts from which I have greatly benefited and from which I have learned to appreciate more and more as my surgical life has drawn out. As residents, I do not think we fully understood how lucky we were to have learned from literally the best in the world.

But, the real reason I have come to admire this man so much, in retrospect, was the manner in which he treated the residents and interns. He was a gentleman’s gentleman. He was such a contrast in character to so many others in similar authority because of his genuine kindness, patience and ability to teach without humiliating. Those Saturday morning M&M conferences could be both treacherous and embarrassing, but I never remember Dr. Longmire to be demeaning. He never publicly put us down for mistakes, even though we often deserved reproach for being such idiots.

He may have been president of all the prestigious surgical organizations in the world, he may have been the best and wisest biliary and liver surgeon ever, and he may have received every surgical accolade possible, but above all of that he was a downright kind and decent man who helped me and all of my fellow cohorts at such a critical time in our lives. The world of surgical training needs more Bill Longmires; we were lucky to have worked with him.

John C. Jones, M.D.
General, Thoracic, Vascular, and Laparoscopic Surgery
The Surgical Clinic of Central Arkansas
Little Rock, Arkansas

Recollection of James Maloney

All of us in the course of a lifetime during parental guidance, during formal education, in personal and professional life continually fail to meet our own expectations and those others have of us. In view of my personal shortcomings the following is astonishing:

In 45 years in which Bill Longmire was my boss, I cannot recall a single occasion on which he suggested that I do something that I wasn’t doing, or that I stop doing something that I was doing.

What an incredible demonstration of his leadership! He molded my professional career for a lifetime and did so in a manner so subtle it permitted me to credit myself for what in fact I owe to him.

James V. Maloney, Jr., M.D.
Los Angeles, California

Recollection of Michael McArthur

One is hard pressed to identify the most significant, most important or most memorable recollection of time spent with Dr. Longmire. For me, however, a major event occurred while not in his immediate presence but at the time unknowingly within the sphere of his influence. During my Internship year at UCLA, while waiting in the office of a surgical attending and former Longmire surgical house officer, I was drawn to a framed diploma, indicating membership in the Longmire Society. It portrayed, as all former residents know, the “Iron Cross” representing Sir William Osler’s concise description of the qualities characteristic of the ideal physician – “the art of detachment, the virtue of method, the quality of thoroughness and the grace of humility.” At that moment I had an incomplete understanding of those modalities. However, over the ensuing seven years with Dr. Longmire, I gained an understanding of those values and in all the years thereafter I have aspired to them, however imperfectly, both personally and professionally. Now, on reflection, I have come to see that Dr. Longmire was the living embodiment of those qualities of the Society that bears his name.

A more personal recollection is of an event which occurred in the year following my Chief Residency while I served as an Associate Professor in the Department of Surgery. Dr. Longmire had taken a year’s sabbatical leave and I had the “opportunity” to follow his patients, to receive kind referrals and to serve as an attending on the Surgical Service. One seemingly endless day, after assisting the Chief Resident with a difficult hepatic resection, followed by a bile duct reconstruction and, finally, another major hepatic resection, I was leaving the hospital quite late in the evening and responded to an overhead page. I was asked very politely if I would consider returning to the operating room to assist Dr. Longmire with an extended hepatic resection, an operation he had envisioned, the details of which I had been exploring in the laboratory. We eventually finished that operative procedure at 4 AM. Several hours later, during surgical rounds, I encountered Dr. Longmire who rightfully observed - “Mike - our patient looks better than we do.”

Words cannot adequately convey the extent or power of the very positive influence Dr. Longmire and people of his stature impart not only to mere mortals, including yours truly, but to institutions, to professions and to the course of events. What word or words of acknowledgement do you choose? He was intellectually gifted, highly motivated, an accomplished technical surgeon, rigorously attentive to detail, exceptionally organized, and gifted in both the written and spoken expression of his thoughts and ideas. He was a true leader, personable yet retentive of the formality required of an individual in his position – yet all the while quite human. He had and will have my everlasting admiration and affection. He was my Hero.

Michael S. McArthur, M.D.
Tyler, Texas

Recollection of Donald Mulder

I’m glad you have decided to pull together some recollections of former residents and trainees which reflect the important influence the Professor had on our lives and future careers. I’m enclosing the two brief vignettes which I presented at his family memorial service in May.

The first one speaks to his sensitivity to the feelings of residents and younger colleagues, and his determination to help them succeed by opening doors of opportunity.

It was in the early 1960’s and I was co-author on a paper with Dr. Longmire which had been accepted for presentation at the American Surgical Association. The meeting was held at the Homestead in Hot Springs, Virginia, and Dr. Longmire had invited me as his guest. It was quickly apparent that this was a classy resort, and I felt rather out of my element to say the least. But he proceeded to arrange for us to play a round of golf with several of his prominent surgical colleagues. As we were getting ready to get out on the course he sensed my obvious uneasiness, and pulled me aside and quietly slipped me a $50 bill – just in case I needed some spending money! Now I wasn’t at all sure that I had seen a $50 bill before, but I was certain I had never owned one! But in that unassuming and thoughtful gesture he had put me at ease and we had a wonderful time!

The second episode also relates to the early years when I first became a faculty member. Each of us would be assigned as the attending physician. As part of our responsibility we would make daily ward rounds with the residents and medical students and see all the patients whether they were the residents’ (then call the “ward” patients) or those of the other faculty members including Dr. Longmire. The Chief Resident on this particular occasion was Bob Watanabe, and he proceeded with his entourage to the bedside of one of Dr. Longmire’s patients and began to present her particular problem to the rest of the group. It was apparent that this elderly but feisty lady from the old school was tolerating the group’s attention, although it was also quite clear that she considered herself Dr. Longmire’s patient and that we were somewhat of an intrusion. So as Dr. Watanabe began to listen to her chest with his stethoscope, she reached up and took hold of his coat lapel and peered at his nametag and blurted out – “Watanabe, Watanabe, what’s that mean in English!”. Without a moment’s hesitation, Bob slowly straightened up to his full 5 feet, 2 inches and with a gracious smile responded, “Watanabe in English means Longmire!” Her quizzical look suggested she wasn’t convinced, but we had all we could do to keep from laughing. But when Dr. Longmire heard about this he showed another wonderful quality – that of a great sense of humor about the whole episode.

I’ll remember Bill Longmire for many things but these are among my favorites.

Donald G. Mulder, MD
Professor of Surgery
UCLA Medical Center
Los Angeles, CA

Recollection of Harry Muller

My first contact with Dr. William P. Longmire, Jr. occurred in 1944 shortly after I arrived at Johns Hopkins as a surgical intern. He was called to the emergency room to see a patient and I found him to be a no nonsense, strictly professional surgical resident. Although senior to the rest of the housestaff, he had stepped aside to allow two junior residents to serve six months each as chief co-residents before they entered the armed services. I was impressed by the logical and methodical approach with which he took the patients’ history, examined him, and prescribed a course of treatment. I was continuously impressed with him as a person and a physician throughout the remainder of our association at Hopkins until he left for UCLA in 1948 to assume the position as chairman of the department of surgery there, as well as after I arrived in California to join him.

William P. Longmire, Jr. was born on September 14, 1913 in Sapulpa, Oklahoma where he spent his early life. He was one of four children, two of whom died in early childhood. His mother was a grade school teacher and the daughter of a Missouri state court justice. He served as president of his senior class at Sapulpa High School and achieved a most acceptable scholastic record but became a more highly motivated student after he entered college at the University of Oklahoma. His own interest and propensity for hard work attracted the attention of a number of his instructors, one of whom was Dr. Aute Richards, chairman of the department of zoology. He was impressed with Dr. Longmire’s studies in the biological sciences and strongly encouraged him to apply for medical school at Johns Hopkins, the only school to which he submitted an application. In college, he was elected to Phi Beta Kappa and was chosen one of the ten outstanding students...

The recollection is quite extensive, please click here to view the "pdf" file.

Harry Muller, MD

Recollection of Theodore O'Connell

I was a Super Chief presenting to M&M a case that I had done. The operation was done in a different and could be said unproven and unorthodox way. As soon as I presented the case, it was like blood in the water to the sharks and everybody from all corners of the room got up to ask what was I thinking? How could I do something that was not in the textbook? How could I do something that was not standard of care, etc. While I was being ripped to shreds by all the surgical members of the audience, I kept on looking at Dr. Longmire sitting in the first row who just had a smile on his face and was nodding his head up and down but no other action came from him during this medley. When the commotion finally settled, Dr. Longmire stood up and calmly turned to the audience and said, “Well actually that was not Ted’s idea but I told him to do it that way.” Immediately there was silence in the audience, which was then followed by a chorus of creative and innovative thinking, why couldn’t I have thought this way, etc. A complete change in their attitudes from when they had thought that the idea was engendered by me and when it came from Dr. Longmire. Dr. Longmire simply smiled and sat down. I think he enjoyed luring the audience into this trap and waiting to see how much they would say when they did not know who the author of the procedure was – the resident or “The Professor.”

Theodore X. O’Connell, M.D.
Assistant Chief of Surgery
Chief of Surgical Oncology
Clinical Professor of Surgical Oncology
UCLA Medical School
Los Angeles, California

Recollection of Robert Ozeran

I first met Dr. William P. (Bill) Longmire in 1956 when I began a surgical residency at Wadsworth V.A. Hospital, which was one of the major teaching hospitals of the “new” UCLA Medical School. I was impressed by his brilliance, calmness and kindness to the house staff and students. I remember one time when one of his senior residents was working elsewhere when he should have been at the hospital. He was sharply disciplined, but given another chance. I felt this showed the humanity of Dr. Longmire.

When I joined the faculty at the V.A. Hospital, I saw a deeper side of him. He was a kind and noble man, concerned and fair. He was also a brilliant researcher and innovator. Following his retirement, he continued to attend the surgical conferences at the V.A. and was an inspiration to the students. He was special.

Robert S. Ozeran, M.D.
Los Angeles, California

Recollection of Henry Pitt

William P. Longmire had many wonderful attributes that were universally acknowledged by all who worked with him. Three that I would like to highlight were his expertise as a surgeon, his open mind, and his wonderful ability as an international ambassador. My close association with Dr. Longmire was from 1979-1985 when I was a junior faculty at UCLA. When I came to UCLA, he was 66 years old and had already stepped down as departmental chairman. However, he and Bill Traverso had recently published their landmark paper on the pylorus preserving pancreatoduodenectomy. At that point Dr. Longmire was clearly one of the most famous hepato-pancreato-biliary surgeons in the world, and he was still busy clinically in his late 60’s.

When I performed my first “classic Whipple” as a new faculty person, Dr. Longmire asked in his unassuming way if I had preserved the pylorus. The paper reporting this important modification had been published only a few months earlier, and I was not yet aware of the publication. Dr. Longmire encouraged me to try preserving the pylorus that day, and I have done so routinely for the subsequent 23 years. More importantly, we published a larger series from UCLA a few years later, and I convinced my subsequent colleagues at Hopkins of the value of pylorus preservation. Other presentations to national and international audiences helped to establish pylorus preservation as a standard operation.

Dr. Longmire was a superb technical surgeon. He did not seem to be operating quickly, but every move was purposeful. His two “favorite” operations were the total gastrectomy and the pylorus preserving pancreatoduodenectomy (PPPD). When he approached 70 years of age, he was still an excellent surgeon, but he decided that he would no longer operate when he was 70. His “big” operating day was Monday. On the Monday of the week that he turned 70 he did a total gastrectomy followed by a PPPD and was finished by 4:00 p.m. Both patients did beautifully. Like an athlete who retires at the top of his game, Dr. Longmire finished his operating career when he was still the best.

Even in his 70’s, Dr. Longmire was very open to new ideas. We shared many hours discussing sclerosing cholangitis, benign postoperative strictures, cholangiocarcinoma, pancreatic cancer, chronic pancreatitis and other pancreatobiliary topics of mutual interest. He was always interested in the data and encouraged further analysis and new theories. One perfect example of Dr. Longmire’s open mind came when he and Jane attended a Christmas party at our house in the early 1980’s. Our oldest daughter, Laura, had received a PC Junior that year when they first came out. Dr. Longmire spent most of the party playing with her on her new computer. A week later he had his own PC Junior and was encouraging everyone to follow his lead.

A few years later, a special event was held at UCLA in honor of his career. Dr. Longmire was a great international ambassador, and his friends came to Los Angeles from all over the world. Unfortunately, Dr. Longmire had just been admitted to the hospital with bowel obstruction. However, he came to the scientific session that day in his hospital gown with the IV running and NG tube in place. Prior to the banquet that evening at the Beverly Wilshire Hotel, he received extra fluids and had his IV and NG removed. He came to the banquet in a suit and tie and gave an after dinner speech thanking everyone who had gone to so much trouble to be there for him. His legend certainly grew that evening as he returned to UCLA for more IV fluids and a new NG tube. Dr. Longmire clearly was a master surgeon with an inquisitive mind who was greatly admired by colleagues from all over the world. Many of us were privileged to know and follow him.

Henry A. Pitt, M.D.
Indiana University School of Medicine
Indianapolis, Indiana

Recollection of Jack Roth

I came on the scene as a resident after Dr. Longmire had stepped down as Department Chair. However, he was still very active clinically, and I had several rotations on his service. I am sure you will receive many anecdotes reflecting his impeccable surgical judgment, technical prowess, and innovative spirit.

However, I have two recollections that stand out because they show his respect and kindness toward the residents and his humility. I was a fourth year resident at the time and had assisted Dr. Longmire on a descending colon resection for cancer with primary anastomosis. The patient had a prolonged ileus with some abdominal distension. I obtained an abdominal film that evening and noted a markedly distended cecum which had increased dramatically from the previous film. It was the weekend, and Dr. Longmire was traveling and could not be reached. As you can imagine I had considerable trepidation about operating on the Professor's patient, but it was clear that if a cecostomy tube was not placed, perforation was imminent. I discussed it with the Chief Resident, and we went to the OR that evening to place the tube. The patient did well and by Monday morning had bowel sounds. I was in the OR Monday but received a page from Dr. Longmire at the end of the case. I answered it somewhat nervously. However, the Professor told me we had done the right thing and expressed his appreciation and gratitude for taking care of his patient! There was an audible sigh of relief from me, but I was also impressed with his thoughtfulness in communicating this to a lowly resident.

A second episode that happened shortly after this emphasizes these same traits. We all remember that Dr. Longmire insisted that the residents (at least the males) wear ties at all times when not in the OR. This rule was never violated. Even on the weekends, proper attire was required. One Sunday morning I was scheduled to round with him at 8:00AM. I was there early with a clean white coat and tie. When Dr. Longmire appeared, something looked amiss. Then I noted his shirt collar was open and there was no tie. He greeted me and without a second thought began apologizing profusely to me for not wearing a tie that morning. He had either forgotten or had left his home in a rush. It was the only time I can remember him not wearing a tie. Of course I just nodded understandingly, and we began rounds. Although these are brief recollections, they emphasize a consideration and gentility that is uncommon.

Jack A. Roth, M.D., F.A.C.S.
The University of Texas MD Anderson Cancer Center
Professor and Chairman, Bud Johnson Clinical Distinguished Chair
Department of Thoracic & Cardiovascular Surgery
Professor of Molecular & Cellular Oncology
Director, W.M. Keck Center for Cancer Gene Therapy
Houston, Texas

Recollection of Frank Spencer

I interned at Hopkins 1947–48, and then spent a year (48–49) inn the Cardiac Catheterization Laboratory. During those two years Bill was widely admired and referred to as the “Professor of Difficult Surgery.” This was not only very true but something of an understatement because he had the remarkable facility of approaching difficult problems, which he had not seen before, and developing a solution.

His demeanor in the Operating Room never changed, remaining calm, concentrated, seldom raising his voice. My understanding, though this is anecdotal, is that when the position as Director of the Plastic Surgery Division became vacant, Bill was asked to assume that position with no more training than he had had during his Hopkins residency. This clearly showed the widespread recognition of his ability to approach and solve difficult problems.

My home was originally in the Texas Panhandle. When he accepted the UCLA chairmanship in early 1949, I went and asked, “Can I go with you?” He immediately accepted; so five of us arrived at UCLA in the summer of 1949, Bill Longmire and Harry Muller, Wiley Barker from Boston, and Richard Lockwood and myself from the Hopkins house staff. We were promptly labeled by the California surgeons as the “Wisemen from the East”!

At that time the UCLA School of Medicine simply existed on blueprints. Fortunately the Wadsworth Hospital was a superb hospital; so we were assigned there. I had an excellent 18 months as a junior house officer with good colleagues and extensive clinical experience. John Beal was the Director of Surgery. We saw Bill for periodic staff rounds.

During one of these rounds with about 20 people, an episode occurred that characterized Bill so well I have never forgotten it. The chief resident presented a puzzle with a patient with a colostomy to be closed, but there was uncertainty about whether the distal anastomosis was open or not. A variety of opinions were expressed by the audience, most of whom were staff surgeons. He then told the resident that we should proceed to another case. The perplexed resident replied, “You haven’t told me what to do.” Bill gave a classic reply; “You have had enough advice; he is your patient, so you make the decision.”

After 18 months Bill asked me to leave the residency and help start a surgical laboratory. He had just obtained some monies for this. I was the only person, I think, in the Department with any laboratory experience. Harry Muller and I, with two or three assistants, started the Bay District Surgical Laboratory in January 1952. We had a very busy, enjoyable time for the next six months. I actively participated with Harry Muller and Frank Damman in pioneering experiments on banding of the pulmonary artery.

A vivid memory from those six months was the famous operation upon Claudette Colbert’s dog who had a benign tumor in the neck, considered inoperable by the veterinary surgeons. Bill agreed to operate. I gave the anesthesia. The dog recovered uneventfully, though I understand the history has widely varying accounts of the procedure and its complications. Needless to say I spent great effort in being certain that all went well.

During that laboratory time I was often called to assist Harry Muller and Bill when doing cardiovascular cases at St. Johns in Santa Monica or at Harbor Hospital. Harry Muller was doing a coarctation at St. Johns one afternoon when he tore a large right intercostals with serious bleeding. This was controlled by digital pressure but clearly was very dangerous. Harry Muller simply commented, “Call Dr. Longmire,” after which we stood and patiently kept pressure on the aorta for about an hour until Bill arrived. Without much comment, he repaired the problem, after which the operation proceeded uneventfully.

We loved California, purchased a small house in Van Nuys in the San Fernando Valley, and considered it home. The Korean War abruptly disrupted this, calling me into military service with the US Navy with only a few weeks notice.

I subsequently had a productive clinical experience for a year at the Naval Hospital in Oakland, California, operating upon patients from Korea with vascular injuries, and was then assigned to the Marine Corps in Korea. There we instituted the arterial repair of casualties in combat, in contrast to the previously unchallenged policy of mandatory ligation. In retrospect I consider this my one contribution that benefited more people than anything else in my professional career. These studies would not have been possible without the excellent training I had had in vascular surgery at both Hopkins and UCLA.

I had every intention of returning to UCLA but construction was still delayed on the hospital, now approaching four years since I first came to California in 1949. When I returned to the East Coast about six weeks before the end of my two years of military duty, my professor at Hopkins, Alfred Blalock, contacted me and said that he wanted me to return to Hopkins and complete my chief residency there. He commented, “I’m sure UCLA will build a hospital but by the time it gets built, you may be an old man!” Bill Longmire had volunteered for service in the European theater and could not be contacted. I was so fond of UCLA and Bill Longmire that I postponed accepting the Hopkins offer for three weeks while getting advice from different senior surgeons. All of them told me that I should take the Hopkins offer. UCLA at that time was still a plan without a track record while Hopkins had widely respected training in both General and Cardiothoracic Surgery.

This ended my UCLA California experience, but I always maintained a fondness and a connection with the school. This was the home where I really grew up and provided me great opportunities. Jim Maloney and I were the two chief residents at Hopkins, 1954-55. During that time Bill returned from Europe and offered the position I had vacated to Jim Maloney.

Jim was skeptical of California as he was a native of Rochester. I told him with great confidence that he would probably find it so enjoyable that he would never leave. This certainly proved to be true!

Bill Longmire had few equals as one of the real surgical giants of his generation.

Frank C. Spencer, M.D.
Professor of Surgery
Physician Director of Patient Safety
NYU Medical Center
New York, New York

Recollection of Ronald Tompkins

Each of us have special personal memories and can identify personal attributes of Bill Longmire which are our touchstones with the man. He was typified many years ago by the members of the Longmire Society as having humility, thoroughness, method and detachment. But these qualities define mostly the surgeon and do not project the image of the whole person we came to know.

That he was modest, undeservingly so, is part of the charm associated with his professional and personal life. When I arrived at UCLA after spending several years of training with another, rather bombastic, surgical chairman (who always made his feelings quite well-known), it seemed very unusual to witness Bill’s quiet effectiveness. It seemed out of place for a surgeon, let alone a surgical giant. When I asked the UCLA residents if Dr. Longmire ever became upset or angry with their performance in the operating room, the response was “Oh, yes! When he clears his throat, you are in deep trouble!” Imagine that power! If he caught cold the entire housestaff would collapse.

Another of Bill’s strong attributes was his frugality. He was very much in touch with costs and resource allocations, but this did not seem to interfere with his natural generosity. Shortly after arriving at UCLA, I was put in charge of the student teaching program and not long after, Bill’s secretary called to schedule a meeting to talk about the program. It was to be a “luncheon meeting” she said. At last, I thought, a real California power lunch and a chance to see how they do business here! I imagined a huge spread of flavorful, if not exotic, food laid out in his large office for all the attendees to enjoy and I arranged to arrive hungry, as usual. The first thing I noted was that there were no other attendees. The second was that there was no food in sight. Assuming it would be catered, I sat down, rather subdued, in front of his desk while Bill reached down into the lower right drawer and brought out a thick file marked “Students”. He went back into the drawer and brought out a brown paper bag. As he put the bag on top of his desk, he looked across at me and said “Where’s yours?” I stammered something about not eating lunch most days but he knew better. “Here” he said, offering me part of his lunch, “have some of mine.” He was frugal, but instinctively generous. I don’t remember what we had to eat that day, but his generous example remains a strong memory.

As chairman, he had a gentlemanly way of governing the department which was amazing to me. I did , however, see a hint of armor beneath the velvet during one of the early monthly Division Chiefs meetings. I had been asked to present some new aspects of the student program for approval and was then invited to stay on for the rest of the business meeting. During this portion, one of the Chiefs began to push his agenda to obtain more resources for his program and became more insistent and argumentative as Bill tried to steer him into a less passionate discussion. At last, this Chief said “I am making an issue of this because, around here, the squeaking wheel seems to get the grease!” Bill looked directly at him ( I can’t remember if he cleared his throat) and said “Yes, and sometimes the squeaking wheel gets replaced.” The fellow quieted immediately and was silent the rest of the meeting. During coffee later, I observed Bill going up to him and apologizing for speaking to him in that tone and promising to look into the situation the next day. What an object lesson of chairmanship that was.

The latest characteristic of Bill’s which has inspired me was his incredible courage. He kept on through the slowly advancing and debilitating course of his final disease with such dignity and courage that one could only wonder at it and be awed. He was to me and others an example of how to handle one of the worst situations that life can throw at you and still maintain a sense of self and self-control.

I will always remember my discoveries of his great qualities as a boss, a teacher and mentor, a role model, a patient and above all, a very good friend.

Ronald K. Tompkins, M.D.
Professor Emeritus of Surgery
UCLA Department of Surgery

Recollection of Bill Traverso

The head of the pancreas is the pacemaker of chronic pancreatitis. Dr. Longmire taught me this principle in 1975. Others claim to have described it in the 1980s. It is such a reliable principle that if the head of the pancreas is not involved in chronic pancreatitis, something else may be amiss like neoplasm, autoimmune pancreatitis, or continued alcohol abuse that is occult. No credit is given to Dr. Longmire for this contribution, yet it forms the very principle for which the resection of the head of the pancreas for chronic pancreatitis is based. In his eloquent handwriting and characteristic artist sketches he drew a picture of the pancreas one day in Radiology to illustrate the pacemaker concept. How I wish I would have kept that scrap of paper I carried for weeks in my lab coat!

As a third year medical student Dr. Longmire would take his turn teaching us during our surgery core rotation. Coming prepared to hear about surgical diseases and technique to the Professor’s Medical Student Conference I was surprised to hear his topic on “why participate in surgical organizations”. During his discussion he suggested that all young surgeons join their local medical and surgical societies to “get coordinated”. In today’s language Dr. Longmire was suggesting that we network. Once the city and state societies have been joined, then one could choose moving on to regional and national societies, the epitome of which was the American College of Surgeons. Many years later as a member of the Board of Governors of the American College of Surgeons I kept hearing the term “The Longmire Rule”. Here Dr. Longmire had revamped the terms of office to a maximum of two three-year terms for the Board of Governors. Once networked, it was apparent that a few surgeons rose to indefinite periods of control. Dr. Longmire had evidently learned that strength was in diversity. That strength was in diversity as well as networking.

Christmas time at the Longmire home was an opportunity to visit for a select few residents. What was even more precious were the works of poetry that the professor would write about each resident. He had woven some stanzas of pentameter into a delightful summary of each resident that attended the one party that I attended. I asked Dr. Longmire for a copy of his statement about me, but somehow he avoided answering. Later on in the evening I asked Jane if she could help me and she personally interceded asking for a copy of the poem. Even this request seemed to go unanswered and today these verses remain lost.

Several years after residency I can remember attending a Longmire Society dinner in San Francisco. Dr. Longmire had been retired for several years and Don Morton told me that Dr. Longmire had given me as much a quantity of money to do canine pancreatic research when I was a resident that equaled the amount of money given to him by Dr. Longmire to establish the Division of Surgical Oncology!

At the end of my internship year was a Department of Surgery celebration for the graduating residents. The interns disliked one of the chief residents (Dr Longmire liked him) so much that they decided to present him with a 50-pound bag of fertilizer in the form of cow manure. The bag was slipped under a dining table adjacent to Dr. Longmire and unfortunately by accident small holes were created in the plastic bag allowing some of the odor to emanate. The party went on and the odor became stronger and it was fairly obvious when the intern presented this present to the graduating chief resident which intern had actually purchased or actually had brought the item. Dr. Longmire never said anything harsh in public about anyone, but when he inquired about this particular intern, he was told that he was leaving the program to serve in our nation’s military. “Oh, where is he stationed?” The resident replied “Why, I believe Guam, Sir.” Dr. Longmire sighed and simply stated, “I guess that is far enough away!”

Perhaps reading this recollection has allowed you to remember one of your own. Send it to us so it can be added to this collection of recollections.

Recollection of Michael Trede

William Polk Longmire, Jr. –The German Connection

There are several ties that link Dr. Longmire to Germany and German surgeons. To begin with, his ancestors had emigrated from Westfalia to Oklahoma in the 19th century. Following WWII, Longmire was one of the first to reach out a helping hand of reconciliation to his German colleagues. In 1950 he spent some two months at the University Clinics of Marburg, Hamburg, Freiburg, Heidelberg and Tübingen. There he delivered lectures and demonstrated, with meticulous technique, operations which, at that time, were new territory in „Old Europe“: the resection of aortic coarctation, mitral valvulotomy and the Kausch-Whipple procedure for pancreatic cancer.

German surgery had indeed been manouevred into a position of isolation. Following WWI, German surgeons were ostracised and banned from the International Surgical Society for 14 years; one year later the new Nazi regime not only expelled surgeons of Jewish origin (most prominently Rudolf Nissen), but also fostered a climate of self-sufficient isolation, even before WWII ended all further contacts. Thus, in spite of surgical icons such as Sauerbruch (and, in some special areas, because of him!), German surgery was far below Anglo-American standards, when Longmire visited again in 1952-54 – this time as an officer of the US Air Force.

Longmire’s cooperation and life-long friendship with Fritz Linder, who had in 1951 taken on the new and challenging chair of surgery at the Free University of Berlin, will never be forgotten. In Berlin, Longmire performed the first Blalock-Taussig anastomoses in Germany. Together with his co-workers – notably Jim Maloney and Don Mulder – he was invaluable in developing open-heart surgery at Linder’s department from 1952-58. Linder himself was invited to spend several months as visiting professor at the nascent UCLA in 1953. And then, for more than two decades, Prof. Linder sent some eighteen of his associates to spend a year (or more) doing research at UCLA. It was my privilege to go there in 1959-60. What I learnt there about cardiac physiology and extracorporeal circulation and the friendships forged along the way (with Eric Fonkalsrud and the Chief himself, among others) have enriched my life (surgical and social) ever since.

Above all, I came to love and admire William Longmire – the surgeon and the man. He was personified equanimity both in the operating room and at surgical meetings. He was absolutely sincere and, at the same time sensitive and caring in his encounters with others,
modest and just and – if necessary – firm. All of us, who were fortunate enough to cross his path, will remember him with both respect and affection.

The honours bestowed on William Longmire in Germany are impressive and richly deserved: Honorary Member of the Deutsche Gesellschaft für Chirurgie, Honorary Doctor of Medicine of Heidelberg University and Member of the German Academy of Sciences, Leopoldina.

An obituary for William Longmire in the Bulletin of the German Surgical Society ended with a familiar quotation from Hamlet. In this case it fits:

“He was a man, take him for all in all, I shall not look upon his like again.“

Michael Trede, MD
Mannheim, Germany

Recollection of Hugh Trout

Given the circumstances of the UCLA location and me being an East Coast kid, I remember being impressed with how little I knew about Hollywood and how frequently Hollywood came to the doors of UCLA, particularly if Hollywood impresarios were critically ill.

My internship started in July of 1967. There was a new rotation at St. John’s Hospital in Santa Monica, and I was the first intern to rotate through that hospital from UCLA. Dave Sprong, Bill Pollack and Tom Reid were the mainstays of the General Surgery Department there. David Sprong had been a resident at Hopkins under Dean Lewis, Halsted’s successor, and he had several stories to tell about Dr. Welsh, who founded Hopkins. My brief experience at St. John’s was really capped by my watching the then-Governor Ronald Reagan have his TURP. I remember in the operating room, when he was rolled in, he was the same affable, gregarious all-enveloping individual that he appeared to the public as President. I’m not a particular fan of his policies but I sure would have liked to be invited to have dinner with him. I subsequently had the occasion to operate on someone who was the White House chef when President Reagan was in office and he said that, when Mrs. Reagan was not in town, he vastly preferred to dine alone. I have ever since been intrigued by the fact that someone who could have dinner with almost anyone in the world if he so chose would opt for dinner alone.

I came over to UCLA in August. Shortly thereafter I was told that Dr. Pressman, the former chairman of the Department of Otolaryngology was critically ill from carcinoma of the pancreas and that Frank Sinatra was flying him back from his second home in Barbados. When he arrived I was told that Mrs. Pressman, who Dr. Longmire referred to as Claudette, wished to have the IVs started each morning and removed each evening because she didn’t want Dr. Pressman to have an overnight IV. This was one of my many tasks that month, and I performed it with some annoyance. Since Dr. Longmire was giving the order, however, it was a pretty easy decision to mute my minimal frustration. At any rate, after a successful near full month of my personal IV service, I rotated off the service. One of the parts of rotating off the service that I most enjoyed was the knowledge that I no longer would have to be starting and removing this IV every day, which was becoming an increasingly difficult task as Dr. Pressman ran out of veins. Shortly into September, it became apparent that Claudette was not happy with my successor as the IV-starter. Dr. Longmire soon approached me with a request that I resume my duties as IV-starter because that’s what Claudette wanted. I did so until he died. I finally became aware that Claudette Pressman was also known as Claudette Colbert, one of the major Hollywood stars. Aside from being demanding about the IV, she was a nice older lady who seemed attentive to her husband (as was his nurse Millie, who others said was more than just a nurse to him). Millie and Claudette seemed to get along quite well. Bizarre by my standards but I suspect not uncommon in the Hollywood of that era, and perhaps today as well.

Later in the year, a patient named John Ford came into the hospital with a terminal malignancy, although it was in its earlier stages at that point: he an unresectable carcinoma of the colon. Shortly after beginning my history and physical, the phone rang and he answered in a brusque tone of voice and said, “Can’t talk to you now, Kate. My doctor is here.” The same thing was repeated two or three minutes later, except this time, it was Duke that he hung up on. I subsequently came to realize that he had hung up on Katharine Hepburn and John Wayne in order to talk to me. It seemed strange then but, as we all come to realize, if you are in pain you surely want your doctor happy and outsiders, even those as important as John Wayne and Katharine Hepburn, aren’t going to be particularly helpful. It never occurred to me at the time that John Ford was more powerful than John Wayne or Katharine Hepburn, but he was an extraordinarily powerful director in Hollywood (and was pretty much responsible for John Wayne’s successful career). Ford is also noted for many of the movies shown about D-Day since he was the cameraman who went in on D-Day and recorded almost all of the surviving footage. He never told me that story and I, unfortunately, learned about it only after he had died.

Another somewhat memorable occasion was when Dr. Longmire’s secretary called me and said that I needed to get Dr. Longmire to see a consult and she gave me the patient’s name, and I went down to Dr. Longmire in the operating room dressing area and said, “Dr. Longmire, you’ve got a consult to see, a Miss Lee.” He seemed not at all interested in my message or being bothered. I then amplified and gave her full name “Miss Gypsy Rose Lee.” He looked up and said, “Well, I guess I’ll go see her.” I said, “Would you like me to come along?” He said, “No, I think I can handle it just fine, Hugh.” I never got a chance to meet her.

I remember once at a dinner party that Dr. Longmire had invited me to as a senior resident and Dr. Sherman Mellinkoff, the Dean of the Medical School, was there at the same time. I remember Dr. Longmire going up to Dr. Mellinkoff and asking him if he had a chance in the next day or two to see a Mrs. Jones on 6 East but that it was not urgent. I noticed that Dr. Mellinkoff left the party a little bit before I did, and both of us were leaving fairly early. I want back to the hospital only to encounter Dr. Mellinkoff seeing Mrs. Jones. I was impressed by how much collegiality Dr. Longmire had accumulated through the years with all of his contemporaries. I thought he was masterful in his interpersonal relations with other faculty members, particularly the senior ones. I believe these traits contributed substantially to Dr. Longmire’s great longevity as Chairman but also for people like Dr. Mellinkoff, who served as Dean from 1962 – 1986, one of the longest serving deans of a medical school in the country.

It was my impression that Dr. Longmire was Dr. Blalock’s clear-cut favorite of all of his chief residents and that Hopkins actively courted Dr. Longmire on several occasions to come back and assume the chair of surgery. To my knowledge he evidenced little interest in wanting to return to Baltimore even though I think his tenure there had been quite happy and productive.

Dr. Longmire was remarkably astute as to where his skills lay. He had clearly been an innovator in thinking about coronary artery disease and in plastic surgery as well, but he evolved to believing that his skills were best applied in the field of general surgery, more specifically in the complicated hepato-biliary pancreatic world. He was a master surgeon although did not, I think, enjoy leading residents through operations. I think he thought that we would learn more by watching him than by him trying to help us fumble through a case. In this regard, I suspect he was probably correct.

When I was the third year resident and serving as the Chief Resident on Dr. Longmire’s service, we had a patient with hepatobilliary obstruction. An arteriogram had been performed and a cohort of twenty to thirty residents and fellows had gathered in radiology. Doctor Longmire instructed the group that the patient had intrahepatic obstruction and would need a liver lobe resection followed by a Roux-en-Y bypass (called a Longmire procedure, though I never heard him describe it as such). From the back of the room a voice exclaimed “extrahepatic”. Dr. Longmire, without acknowledging the interruption, reemphasized the intrahepatic nature of the obstruction and was clearly poised to move on to the next problem. The voice, however, was not to be silenced and repeated the statement that the obstruction was extrahepatic. Doctor Longmire looked up over his glasses and said, someone scathingly, “why do you think that Doctor?” The very junior Assistant Professor of Radiology, Joe _, came to the view box and pointed out that the two small arteries to the common bile duct were separated in an abnormally wide fashion and that therefore the obstruction was extrahepatic (at that time no one on the surgical side knew that the common duct had two parallel arteries). Doctor Longmire snorted, made no further comment and the entire group, absent Doctor_, proceeded to make afternoon rounds. As you would predict, at operation the next day, the common bile duct was dilated and the appropriate operation was performed. Postoperatively, Doctor Longmire made no comment to me about his failure to diagnose the patient properly or about Doctor _ insight. As far as I could tell Doctor Longmire had no idea as the name of the angiographer and evidenced very little interest in learning his name.

About three weeks later, however, we had another patient who needed an arteriogram. Doctor Longmire told me he wanted an arteriogram and, with a slight grin, suggested that we should get Doctor _ to do the study. My analysis at the time was that he had met somebody in the radiology suite who had been willing to tell him the truth, even at the risk of embarrassment, and had been correct in his diagnosis. What was, and still is, fascinating to me was that he was reluctant to confide in me in his attempt to learn more about Doctor _ but, notwithstanding his reluctance to confide in me, he was determined to learn about people who would allow him to take better care of his patients.

While he obviously did not relish ever being incorrect, I think it was always apparent to me that he was always willing to be exposed as being politically or scientifically incorrect if it would further enhance his ability to take care of sick people. In other words, the patient came first, always. Of some additional interest, Dr. _ is generally now nationally and internationally regarded as one of the true pioneers of interventional radiology with numerous substantial contributions to this field.

The final story that I remember that illustrates two traits in Dr. Longmire that I almost never saw and don’t think that they were, in general, part of his makeup. He was planning to go to South Africa, I think, for six weeks and said to me that he had three patients on the service and wanted two of them to be alive when he got back. This was a aspect of the of levity that I never experienced before or after, and I responded, “Which two?” and he said, “Up to you.” I said, “Dr. Longmire, Mrs. Smith has diffuse peritoneal malignancy and is terminal.” He said, “Oh no, she doesn’t; that’s not correct at all.” That was the other trait that I had not previously experienced, which was that he had operated on her the week before and was ignoring what I had observed which was that it was patently obvious that her peritoneum was studded with small malignant tumors. I said, “Could I do a peritoneal tap?” He said, “Sure.” I did and it came back full of malignant cells. When I informed him of that, he said with a twinkle in his eye, “Well, I guess that makes your decision-making a little easier, doesn’t it.” As I recall, I was able to get two of the three to live until he got back, but Ms. Smith wasn’t one of them.

Hugh Trout

Recollection of Ryoichi Tsuchiya

At the end of his lecture at the general scientific meeting of the Japanese Society of Gastroenterological Surgery, held in Tokyo on July 16-18 this year, Professor Ronald K. Tompkins informed that our great surgeon and teacher of the gastrointestinal surgery, Professor William P. Longmire, Jr. passed away on May 9, 2003. Praying for the repose of Dr. Longmire’s soul, I would like to call to mind his tremendous contributions to the surgical department of Nagasaki University Hospital where I had chaired until 1990. Many of the Japanese general surgeons knew his name by reading his paper Intrahepatic cholangiojejunostomy with partial hepatectomy for biliary obstruction presented at Surgery 24:264,1948 when he was Associate Professor at Department of Surgery, Johns Hopkins, and went to UCLA as the first Professor of Surgery in the new school at the age of 35.

In 1968, he chaired Presidency of ACS at his 55 years old. He had been invited three times to the general scientific meeting of Japan Surgical Society as a special lecturer, in Kyoto 1973, Fukuoka 1978, and Sendai 1985, respectively. At the first visit he spoke about ‘primary bile duct carcinoma’ and at the second visit he reported and discussed ‘the surgical treatment of pancreatic disease.’ At the third visit he explained ‘ACS and graduate education in surgery’ and at the general assembly the honorary membership of Japan Surgical Society was bestowed to him according to his great contributions to the society and Japanese surgeons. In 1978, my associate, Dr. Noboru Harada, was accepted by Dr. Longmire as a research fellow at the department and worked for two years starting September 1, 1978. After attending Chicago meeting of ACS, I visited Dr. Longmire’s office in UCLA and made a lecture on endoscopic needle aspiration biopsy of the pancreas and also watched Dr. Longmire’s operation.

From April in 1979 each of six young surgeons in my department visited the department in turns of every two months and joined the rounds and observed operations. On August 30 and 31, 1979, I presided over the scientific meeting of the Japanese study group of biliary disease and invited Professor Ronald K. Tompkins as a guest speaker on behalf of Dr. Longmire. On September 1, 1980 another colleague of my department, Dr. Toshimitsu Miyamoto, started to study for two years under the guidance of Dr. Longmire, replacing Dr. Harada’s position. Just before the 1985 general meeting of Japan Surgical Society in Sendai we cordially invited Dr. and Mrs. Longmire to visit our department of the Nagasaki University Hospital and they accepted. Dr. Longmire kindly made a round and gave us many precious comments on April 1, 1985. Our colleague escorted them to attend the meeting in Sendai. Being trusted and respected throughout the world, Dr. Longmire was truly an Ambassador of American College of Surgeons to the international surgical community and he was a real scholar, teacher, and surgeon. His great personality will be cherished by those who knew him very well.

Ryoichi Tsuchiya, M.D.
Department of Surgery
Nagasaki University School of Medicine
Nagasaki, Japan

Recollection of Joseph Van De Water

Dr. Longmire's influence over me has been immense. Memories of my many contacts with him between 1961-1966 and the ones at least yearly therafter will always be with me. From the first time I saw the Professor, I knew I had met a great surgeon and a true gentleman.

In the operating room he was at his best as though conducting a great symphony gracefully, effortlessly and quietly without any fanfare; before you realized it, he would have reached the end and been on the skin. The decorum in his room was always one of respect for all participants - especially the nurses and the anesthesiologist - and business-like with no unnecessary conversation. If he sensed the latter a quiet "ahhemm" as he cleared his throat would remind us that we were in the operating room. He had a strict, but unwritten, protocol for every operation, so that it went like clock-work without a single wasted motion or forgotten step. One day he walked into our room during the closure of a radical mastectomy and quietly stated "where is the skin graft?" -- immediately without a word, we reopened, took wider margins and used a skin graft for the closure.

During those early years he was already a United Airlines million miler, traveling frequently as a very active Governor and later President of the American College of Surgeons. However, he would immediately return to L.A. to make his early morning patient rounds and to keep up with his busy O.R. schedule. I can't remember him ever taking any vacation time. We appreciated his involvement with national and international surgical affairs and surgeons (especailly with Dr. Fritz Lindner of Heidelberg) and to his ever-increasing renown. Occasionally he would share some of his thoughts with us when we were gathered in the conference room above the O.R.'s drinking coffee between operations. I especially remember the day he told us that it was time for academic surgeons to drop our elitist airs, recognize our community surgeon colleagues and join organizations like the A.M.A.

Much of what we acquired from the Professor was unwitten and unsaid. It was learned by his example, perhaps because we were a small tight group with intense respect for him and a fierce loyalty going both ways. The Chief Residents were his closest colleagues, often with more influence then faculty. I remember him returning a day early from a national meeting in order to be present when one of his Chiefs was presenting at the L.A. Surgical Society. It was thought that he wanted no outside rotations, lest he lose some influence over us. Respect for what was assumed to be his wishes was returned to him with punctuality (one of our young faculty used to receive his hard stare as he routinely came to Saturday Morning Conference a minute or two late) (one morning while making my rounds I noted a fresh dressing on one of his patients - when I caught up with him, he said nothing - he didn't have to - he never again beat me to any of his patients when I was on his service), wearing a coat and tie for conferences (an elsewhere-trained faculty person learned that lesson one morning, when the Professor had him go out and get his coat before returning to Grand Rounds), not wearing greens outside the O.R. area, not arguing with him, (when I once did that and suddenly realized my error saying "you're right"--he simply in a quiet voice said "thank you") and even postponing marriage until completing the residency (but he and his gracious wife, Jane, would meet and remember our girl friends and later our wives as they did my Nancy, asking about our children, etc. for the next 37 years).

My fondest recollection of the professor and Jane was their visit to me here in Macon, Georgia in 1983, when I was Chief of Surgery at our then struggling community hospital. It was with enormous pride that I introduced my Professor as Grand Rounds speaker to the assembled residents and attendings. I will always remember both of them, especially when I look up to the emblem for the original Longmire Society containing the words Humility, Detachment, Method and Thoroughness.

Joseph M. Van De Water, M.D., FACS
Chief Resident in General Surgery and
Cardiopulmonary Surgery 1965-1966

Recollection of Dick Welbourne

I am not in very good health so I cannot write as I would wish about my great friend and colleague. In 1968 he visited my department at the Royal Postgraduate Medical School (London University) and, through the Deans of our Medical Schools he invited me to UCLA. Many reciprocal visits were arranged later, all paid for with great generosity by the Americans. It was the start of a most warm, happy and educational collaboration between our Medical Schools.

When my wife and I first arrived in Los Angeles – a hazardous journey in those days of aircraft hijacking – we were met at the airport by Bill and Jane and welcomed most warmly. A typical memory of our good friend is of Bill’s anxiety then that our lodgings would be comfortable and suitable for our requirements. He came personally to inspect our small but very adequate apartment and attended most carefully to our smallest request.

During this and many further visits to UCLA in the following years, we were always invited to Bill and Jane’s beautiful home where we had the good fortune to meet surgical families from all over the world. Bill was the most generous host, a wonderful surgeon, a wise yet humble man full of courtesy, consideration, and good humour. He wrote regularly to us up to the end of his long life. We surely don’t need to add that Jane was “the Hostess with the Mostest.”

The co-operation which Bill facilitated between great surgical departments was a huge source of strength and commitment during the last years of my surgical life. The world is a poorer place for his passing. We miss him.

My very best wishes go to all Californian doctors and surgeons who follow in his good steps.

Richard B. (Dick) Welbourn, M.D., FRCS, HonFACS
Professor
Berks, England

Recollection of Samuel Wilson

When Grand Rounds were held on Saturday mornings at 9 a.m. in the large conference room adjacent to the Chairman’s office, Dr. Longmire was almost sure to present, attired impeccably in a white coat and waist coat, clearly in charge and not at all shy with regard to criticism of the residents’ treatment although always in a gentlemanly manner. One morning I do recall an irritated Dr. Longmire ordering a surgeon who was smoking, not at all uncommon in the 60’s, to extinguish his cigarette or leave the room. That was the last time I recall anyone smoking at Grand Rounds.

On another Saturday morning I arrived for Grand Rounds only to find that the program had been cancelled. In fact the only two surgeons present were Dr. Longmire carrying his usual weighty briefcase and myself, a second year resident. In the elevator on the way down, I said to Dr. Longmire words to the effect “They should notify us when the conference is cancelled.” Dr. Longmire looked at me for a moment and said, “It’s amazing how much work you can get accomplished in an unexpected hour.” To this day I always carry work ready to do should I find some unanticipated free time.

After I returned from the Air Force to work at Wadsworth VA, Dr. Longmire asked me to help staff the GI Service along with Dr. Tompkins and Dr. Passaro. Drs. Longmire and Tompkins took four months a year, Passaro and I got half time duty at two months per year. During this interval, Dr. Longmire served as President of the American College of Surgeons and I undertook many of his responsibilities incurred by the heavy travel schedule on behalf of the College. Once he left me a young man with bleeding esophageal varices secondary to portal thrombosis from polycythemia rubravera. Dr. Longmire’s exploration revealed no patent vein suitable for portal decompression and he performed a splenic artery ligation in an effort to decrease flow into the portal system. He left the patient postoperatively with me warning that if variceal bleeding reoccurred, little could be done. Sure enough this happened no sooner than he was on the plane and I was left with a difficult decision. We reoperated on the patient and fortunately found a single gastric varix spurting blood at the gastroesophageal junction. It was a simple procedure to whipstitch this and bleeding stopped. On his return Dr. Longmire expressed surprise that his patient had been reoperated on and when told of the findings simply smiled and moved on to the next patient. I do think he understood that sometimes a little good luck can go a long way in surgical outcomes.

On another occasion, Dr. Longmire recruited me to work with him on the influential Study on Surgical Services in the United States which was sponsored by the American College of Surgeons and the American Surgical Association. Dr. Longmire’s assignment was to analyze the effect of the method of surgical reimbursement on patient care. In retrospect a task of this enormity would require today millions of dollars and regiments of personnel to complete. Dr. Longmire asked Charles Lewis, a distinguished professor of public health to help design our study and I recruited Jon Hiatt to work with me. Indeed we were able to reach certain conclusions and even a publication. On our several excursions to hospitals to obtain permission to review medical records, I would drive in my small Toyota with a very nervous passenger, since Dr. Longmire was a steadfast Cadillac owner which he viewed as being safer. He liked to talk about the beginning of UCLA and his time in general practice in Sepulpa, OK. He firmly believed that all surgeons would benefit from a year in family medicine to better understand the general practitioner’s role. The event that I think had most influence on UCLA’s medical student teaching, however, occurred when Dr. Longmire and I went to appear before a board at the Kaiser Sunset Hospital to obtain their permission to review medical records of patients that had appendectomies, cholecystectomies, and hysterectomies in order to assess their outcomes. In those early days of HMO acceptance, it was unusual for the university especially the distinguished professor to have any interaction with the Kaiser Permanente Medical Foundation. The board viewed us quite suspiciously since no doubt they thought we were intent on proving the evils of managed care—were we to have been so successful! Indeed they quite firmly denied us permission to review the records of Kaiser patients. On the way out I was quite depressed about the entire situation, but Dr. Longmire, on the other hand, was most intrigued by the teeming numbers of patients in the hallways of the large Sunset facility. He turned to me and said, “Eric this is where we should have our medical students and residents in training.” Indeed that’s what occurred. I learned from Dr. Longmire never to dwell on disappointments but always look to future accomplishments.

When he served as a distinguished physician for the Veterans Administration, Dr. Longmire would regularly attend the Friday afternoon Morbidity and Mortality Conferences at the Wadsworth Veterans Affairs Medical Center. He listened intently to the cases and when invited would make cogent comments but clearly deferred to Drs. Gordon and Passaro as the conference leaders. On one occasion a discussion ensued as to the best surgical approach to obtain control of the aortic neck in a ruptured aneurysm. After much discussion about control at the diaphragmatic hiatus versus control at the aneurysm neck, I asked Dr. Longmire what did he think. Dr. Longmire looked at me, thought for a moment and said, “Eric, I don’t believe I have ever operated on a ruptured aneurysm.” At that moment I realized that when most surgeons would have freely volunteered advice without regard to the depth of their personal experience, Dr. Longmire was not embarrassed to admit the limits of his experience. I learned from observing the Professor at these conferences that one’s advice was most valued when levened carefully, only when asked for and rendered absolutely truthfully.

Lastly, when I was invited to go to Los Angeles Harbor-UCLA Medical Center in 1982, the administrator had offered me the choice of a Los Angeles County or UCLA salary line. Having been in full time Federal service until that time, I had no idea which to take. I went to see Dr. Longmire, who displayed an amazingly detailed knowledge of the benefits and retirement plans each employer offered, advising me that County’s retirement plan had been weakened and that the UC system’s was now substantially stronger. At 39 years of age, I was not as concerned about retirement as I have become lately, and I took his advice which has turned out to be the best decision in my academic career.

Samuel E. Wilson

Recollection of Ronald Worland

I remember in 1969, when I was interviewing for a position as an intern in the general surgery program at UCLA, I had an opportunity to be queried by Dr. Longmire following rounds on the blue surgical service. He asked what my future plans were and I told him that it was my desire to become a reconstructive surgeon. I told him that I had wanted to do my general surgery away from Rochester, and then eventually return to the University of Rochester to complete my studies under Dr. McCormick.

I was later informed that it is not good to indicate to a Chief of General Surgery that you plan to go through his entire general surgery program and then not utilize this training, but go on to become a plastic surgeon.

Several years later, when I was interviewing at Johns Hopkins Hospital, I learned that Dr. Longmire had been the first Chief of Plastic Surgery there. I found this to be extremely interesting, and I understood his acceptance and consideration of my future plans during our first encounter.

In spite of my plans to become a plastic surgeon, Dr. Longmire accepted me into his program, which I finished in 1975. I spent many hours working with this academician and hero of hepatic surgery. I never, ever saw him raise his voice but occasionally, if he was significantly distressed, I remember well his clearing his throat, which was equal to three or four expletives from the average general surgeon.

There has never been a finer gentleman in the field of general surgery than Dr. William Longmire.

Ronald G. Worland, M.D.
Medford, Oregon