On Westray in the Orkney Islands, Scotland

Clifton Cleaveland
Duke University, 1958, A.B., Chemistry
University of Oxford, 1961, M.A., Physiology
Johns Hopkins Medical School, 1964, M.D.

Clif Cleaveland was born and raised in a small town called LaGrange in Georgia near the Alabama border.  He is the oldest child with a sister who is four years younger.  When he was fourteen years old, his family moved to South Carolina.  From a very young age, he wanted to become a doctor.  He graduated from medical school in the mid-1960’s and served as a doctor in the U.S. Army.  After a fellowship at Vanderbilt University, he focused his practice on internal medicine until his retirement in 2004. He is a former president of the American College of Physicians and his work on healthy policy issues has led him to testify before Congressional hearing committees.  He is also the author of two books, Sacred Space: Stories from a Life in Medicine and Healers and Heroes: Ordinary People in Extraordinary Times.  He currently teaches an undergraduate course at the University of Tennessee at Chattanooga and writes a column about health issues for the Chattanooga Times Free Press.  A major influence on his writing and viewpoint about health care was from his experience of becoming very sick as a student at Oxford and receiving medical treatment under the British national health service.  He currently lives in Tennessee with his wife of 50 years.

Q.  What kind of work did your parents do?

My dad traveled for a life insurance company for which he subsequently became a district manager.  My mom was a full-time homemaker.

Q.  How would you describe your parents’ philosophy in raising children?

My dad was away most of the time traveling during the first nine years of my life.  I would see him every other weekend.  He was a hardworking man.  He had not graduated from high school.  He had to drop out of high school during the Great Depression to go to work and earn money.  My mother was a college grad.  The expectations were that I would always study and do well in school.

Q.  What values do you think your parents tried to instill in you while you were growing up?

To work hard.  To study hard.  In living through the Depression in part of a country that was particularly hard hit, they realized the value of education.  They had seen many of their peers in bread lines.  They knew people who had lost their businesses who had to start over.  There was always a big emphasis on doing homework, going beyond what was the minimum required and succeeding in school.

Q.  You said your mom was a college graduate.  What did she study?

She was a chemistry and home economics major at Georgia State College for Women.  Back then, they didn’t trust women to go to the same college as men, so they kept them separated.

Q.  Was one parent more influential than the other in your upbringing?
They had different strengths.  Of course, my mother was the parent that was there all time until I was about nine years old.  My dad was home on weekends and we would sometimes have a few weeks of traveling with him in the summer.  He embodied the work ethic–the notion that you worked hard if you were to get ahead in life.  He had always wanted to be a doctor.  He idolized an uncle of his, who was also influential as a role model for me growing up. He really begrudged the fact that he couldn’t continue his own education.  He was a bright man, but there was no money, so he went to work as an assistant in a pharmacy when he was about 15 years of age and that ended his education.  He always saw me as becoming the physician that he had hoped he could become.  Each parent had different influences.  There were different kinds.  There was the taskmaster that was there all the time.  That was my mom.  The person who would talk more about goals and dreams was my dad.

Q.  Did you become a doctor, because of your father?

I didn’t know anything else to become.  There were very few college graduates.  My mom and dad came from large families.  They were each one of eight children.  Dad’s family had grown up on a farm and I don’t think there was college graduate among them.  I set as an ideal my great-uncle who was a physician.  From early on, I was associated with him.  Starting when I was about six, my first job was going around on weekends with his wife collecting fifty-cent or one-dollar payments from his patients.  I was thrown into medicine very early on.  I never really knew, or considered anything other than I was going to be a doctor someday.  I liked the image that this particular great-uncle presented for me.  It was an exciting thing.

Q.  This was your uncle on your father’s side?

Yes.  He embodied success.  LaGrange was a textile town and like so many other towns, it had been hit very hard during the Depression and you tended to idolize, or emulate the success stories.  In my case, it was this uncle.

Q.  And it was more than his financial success that you idolized.
I spent a lot of time with him listening to stories.  He was a veteran.  He had been a physician in the British Army in World War I.  He did not brag, but he did what were in my eyes exciting and meaningful things.  He was a family practitioner and at that time in a small town he would do surgeries, deliver babies.  I thought he was the cat’s pajamas.  He had an exciting life.  He struck me as being very kind and very soft-spoken.  He was the first role model.  My second role model was quite different.

Q.  Who was that?

She was a black lady who was a practical nurse.  Her name was Charlie Brewer.  LaGrange was a terribly segregated town and most of its African-American population had menial jobs and lived in abject poverty.  She had an accent from outside the South and she was frequently a babysitter for me when I was growing up.  I don’t know if she recognized that I was perhaps brighter than kids my age, but I can recall times when we would listen to the radio and I was five, six and seven at the time and the news was always of the War, Europe and the Pacific.  We would talk about what we heard on the news.  We would read the newspaper together.  My first real sense of justice and equanimity came from her.  She remained a very powerful force in my life until she died.  Even after I was grown and married and had children of my own, I would stop to see her when our family would drive through LaGrange.  She was a model of intellectual curiosity.  She was the first adult whom I thought really took me seriously.  She explained to me, for instance, what Nazis were.  She explained why Hitler had to be defeated.  Here was a lady who was mistreated because of segregation, but who had a sense of universal justice.

At that time, people did not stay in the hospital very long.  They would oftentimes be sent home to have a private duty nurse at home.  She was highly sought as a nurse to come in and take care of people convalescing in their homes.  She made extra money by babysitting.  Sometimes my mom would go out of town and travel with my dad when he was on the road.  Charlie Brewer would spend maybe three, or four nights.  She would have her daytime work, but then she would be at our house at night sleeping over and looking after my sister who was much younger than I.  She and I had conversations that were almost adult.  They were really important to me.

Q.  How would you describe yourself as a child?

I was a nerd. I was an outcast, kind of a loner.  I tried very hard to be accepted by my peers, but I always felt like the odd man out.  I was physically clumsy at that time.  I was tall and skinny, totally uncoordinated.  I was aware that I was much smarter than most people my age and I would deliberately answer questions wrong in class, so that I could feel like one of the gang.

Q.  What kind of activities did you do?

I read.  I had terrible vision.  I was severely nearsighted and that was not picked up until a school screening in the seventh grade.  I read voraciously.  I spent time with various aunts and uncles in Atlanta.  I had an uncle that I would spend some time with on his farm in LaGrange, but I always felt really like the odd man out in my small group of peers.  I wanted to be like them, but I felt like I never could be.

Q.  Do you consider that the most challenging aspect of your childhood?

I think so.

Q.  In one of your columns, you wrote about your Aunt Mary and you said going to their farm at the age of five was your first sense of self-worth.

That was a magical place.  She’s still alive.  She’s a 104 years old and I see her three or four times a year in Georgia.  She and her husband had a small farm on which they raised chickens.  They did not have children, and I was sent up there.  I went by myself on a bus at age five, and right away I had a job.  The job was to grade eggs, so I would join my uncle and aunt and a couple of helpers collecting the eggs.  It was an egg operation and then you would grade the eggs by size and weight.  You would put a strong light behind them to make sure the egg had not been fertilized yet and package them and put them on crates and they would go off to the market.  They lived far enough away that there were not that many visits, but I absolutely thrived every time I visited the farm, usually for a long weekend.  Once, or twice I would spend an entire week there.

That farm and that relationship were absolutely vital.  There was a quiet and gentle wisdom and affection in that household that was really special for me.  I never heard a loud or an angry word there.  I knew that they were remarkably in love with each other.  The moments there were priceless in my growing up years.

It was stability.  There was so much drinking in LaGrange among the parents of my peers.  I was appalled by it.  From very early on, I did not like being around where loud drinking was involved.  I guess I sought out places of serenity.

We moved when I was at the beginning of high school to Columbia, South Carolina.  That was a good move for me, because it was a bigger social group.  It was a bigger high school.  I really had my first ever friends in Columbia.   There were some people who were kind of like me, who weren’t athletes, who liked to do things other than sports.  I played in a school band.  I wrote for the school newspaper.  It was a different kind of environment.  Although there were some problems (it was still a very racist society), it was a fresh start for me.  In some respects, it rescued me from my hometown.

Q.  How would you describe yourself as a teenager?

The teenagers that I was thrown in with were a much wilder set than I was.  At that time, you could get a driver’s license in South Carolina at fourteen.  So at age fourteen, many of them either had a car, or their parents’ car.  There was a fair amount of wild behavior, a lot of drinking, but I had this quiet, little group.  We would go out, drive around, make the drive-in scenes and date and such, but we were not (for whatever reason) drinkers.  We basically stayed out of trouble.  We were never arrested.

I had good teachers all the way through school.  I had some remarkable teachers all the way back to first grade.  My first grade teacher is still alive for instance.  In Columbia, there were a couple of teachers who really took me to a different level as far as the challenges they laid out.  It became something more than just doing very good homework.  They laid out some expectations and said, “You could do better.  You can be more than you think you can be.”  Because of them, I tried out for a scholarship to Duke and got it.  That was another important jump for me.  My surviving lifelong friends are the ones I made at Duke as an undergrad.

Q.  How much did you excel in high school?  Were you top of your class?  

I don’t know.  I didn’t make anything other than an A.  South Carolina had state competitions once a year in which you would be nominated to represent your school.  I always got an outstanding award in English, Math and Science.  So I was right up there with the best students in South Carolina.  I was probably one of the top three, or four students in a class of 220.

Q.  Do you think you excelled because of the encouragement from your high school teachers and self-motivation?

That, but also there was kind of the expectation of my parents.  It was never a demand, but I knew the expectation was that I was to bring home A’s.  An English teacher and a math teacher in high school were the ones who really opened up the idea that it’s more than grades.  It is the excitement of engaging in a subject.  The first subject to *really* take off for me was English literature.  I had an English teacher in the twelfth grade.  I had always loved to read, but she just made literature take off and soar for me.

Q.  How did she do that?

She really encouraged my writing.  When I would write an essay for a class assignment, I would get notes back saying, “Why don’t you try this?  Why don’t you try that?”  I would completely rework the essay and send something else in.  That opened up some fresh possibilities for me where it was not simply performing to get a grade, but doing something because you generally loved to do it.  High school was where the idea of learning as pleasure really began to form.

Q.  At what age did you know for sure you wanted to be a doctor?

I never entertained any other thought, so I took all the science I could.  When I went off to college and was a chemistry major, I loved literature and continued literature, but I knew that I did not see anything to change that notion.  I would write term papers on medical subjects.  I recall writing a term paper in the twelfth grade on the advances of treatment of prostate cancer, of all things.  Nothing else ever competed.  If someone mentioned, would you like to be a college professor, an architect or an engineer, I wouldn’t know what they were talking about.  I had one frame of reference.

The remarkable thing is that once I got into medicine despite some times in medical school that were grim and driven by memorization, I got to do what I love for 36 years.  I was lucky.  A childhood obsession that had no basis in fact, or in any kind of tested aptitude turned out to be something I love doing.  I liked listening to stories and so much of medicine (and this is not a term unique to me) is helping people repair their fractured narratives. The diagnostic part was a challenge.  Picking correct treatments was a challenge, but seeing the same people year after year after year and hearing their stories grow and watching their lives grow and change was a privilege.  It still gives me chills to think about it.  I was *incredibly* lucky.

Q.  Did your family travel a lot?

Not a great deal.  We would go to Daytona Beach, Florida, for two weeks every summer when my dad had his vacation.  We would take weekend trips to go visit relatives in other towns in Georgia.  We made one trip to Washington, D.C. in 1942.  It was in the summer.  My dad had to go to a sales meeting, even though it was World War II.  We went with him and spent a week there.  It was a weird time, because Washington was locked down.  There were blackouts every night.  There were searchlights going over the city.  Of course, it was never going to be attacked, but there was a sense that you were in a war zone.  There were large balloons suspended by cables over the city to intercept enemy aircraft.  It was a visit to the capital of the country, but it was also a city living under the threat of military attack.

Q.  You got a full scholarship to Duke, right?

I had a tuition scholarship.  Tuition at that time was $350 a year.  My parents helped me with the rest and I would work odd jobs and get spending money with that. I had four years at Duke and I loved them.  I did not want to stay in town and go to my hometown university.  I wanted to get away from home.  Duke University was far enough away that it met all of my needs.  I had a close group of friends that I developed there that I still keep.  I soaked it all up.  I went to my first symphony concert there.  I went to my first operatic performance there.  I heard internationally famous speakers.  I heard theologians in chapel who–I didn’t realize at the time–were quite famous.  I drank deep the whole undergraduate experience and just absolutely *loved* it.  Wow, I loved it.  I loved my summer jobs, too.  I had great summer jobs.

Q.  What were they?

I worked in a Sears store one time, helping stock new shelves.  I worked in a gas station as a manager of a service station for a summer. Then I had the greatest job between my junior and senior years.  I worked at Yellowstone National Park at a gas station, got to enjoy the park, make a lot of money, and I met my wife there.  She was working in the food services in the park.  She was two years behind me in college.  She was going to Purdue in West Lafayette, Indiana.  We married three years later.

Q.  How did you find that job at Yellowstone?

We had a college placement person named Fanny Mitchell.  She tried to interest people in working in national parks.  She said you’ll never forget the experience, so I bet 200 people from Duke would leave each year and go work in the Tetons, Yellowstone, or Glacier.  She got me a job at Yellowstone where I took a one-week course after I got there and learned how to service cars.  That’ll make you feel secure when you go in and take your car in for repairs.  (Chuckles)  I worked in the summer of 1957.  It was a glorious job.  That was the first time I had done anything that smacked of adventure.  It was the furthest away from home I’d ever been.  I was in a different environment.  I didn’t know many people.  I was taken very much by the beauty of the park.  On days off, I could see things that tourist don’t get to see.  I could get into the inner parts of the park.

Q.  At what point in your development, did you stop feeling that awkwardness that you talked about earlier in your childhood?

Probably in college when I had friends that I felt completely comfortable around.  I did not have to try to be somebody I was not.  I think there are still vestiges of it.  I still feel kind of like an outsider even today.  A tight group of male and female friends in college was the first society in which I really felt I was a part.

Q.  What do you think was the biggest influence during your undergrad years?  

I had some literature and history professors at Duke who opened up for me the idea of really serious scholarship.  They were *wonderful* teachers.  They were demanding and again the emphasis was on writing.  I could not get by with a sloppy essay, or semester paper.  So I got caught up in the intellectual excitement, or challenge.  It wasn’t a challenge.  It was just fun.  I had a course in European history.  I can still remember some of the classes and some of the discussions.  I placed in an advanced English class as a freshman and that professor just lit up my circuitry.  He had expectations of us.  That was the first time I learned to read critically, really learned how to analyze the text not only for the pleasure of reading it, but for seeing how it worked.  Most of my inspirational teachers were outside my major, chemistry.  Chemistry was hard work. I did it and by time I finished I knew a lot of chemistry, but there was still a lot of grinding hours in the lab.  That was before calculators.  Calculations would take hours some times.  We didn’t have instrumentation so that meant many, many hours in the lab.  As a chemistry/pre-med major, I would be in the lab generally from two to five, four or five days a week every year in college.

Q.  What do you enjoy reading?

I love reading contemporary fiction.  Walker Percy and Wendell Berry are writers I have always enjoyed.  Ann Tyler is a writer I very much admire.  Margaret Atwood.  Alice Munro.  There was a time in my life I was very nearsighted and was taken to a doctor that upon reflection was a quack in Atlanta.  He told my parents that I should not be allowed to read.  If I read, I would go blind before I was twenty years old.  For a dreadful eighteen months of my life, I was prohibited from reading.

Q.  How old were you?

I was eleven and twelve in the seventh and eighth grade.  I would listen and take notes in class and do my exams off of that, but I had a note that said no outside reading.  Fortunately, eventually I ended up being seen by another eye doctor and he said all of that was rubbish.  I simply needed stronger glasses and I could read again.  Since reading had been such a vital part of growing up solitary, that was a very painful time of not being able to visit my books.

Q.  For the Rhodes Scholarship, who encouraged you to apply for it?

About ten days before the deadline, I had never heard of it.  I didn’t know what it was.  The dean called me in and said, “This is something you ought to apply for.”  I said, “What is it?”  He said, “It’s a scholarship and you can start medical school in England.” My parents were going to be hard-pressed.  I could go to medical school, but it was going to be hard and I would have to go to the University of South Carolina.  I quickly put an application together.  It was too late to apply in North Carolina, so I sent my application to South Carolina which you could apply in the state of your college, or the state of your residence.  It was not too late in South Carolina, so I went for the state interviews.  That was a pleasant experience.  I went to the district interviews three days later and I felt like I was back in grade school.  The people were so smart and so accomplished.  I truly felt that I did not belong there, that it was some dreadful mistake.  When they called everybody in and I was one of the four, I thought I was going to pass out.  I remember spreading my feet apart and leaning my back against a wall, so I would not collapse.

Q.  Why did you think you received it?  Because you didn’t have any expectations?

A couple of reasons.  The Russians sent Sputnik into orbit a few weeks beforehand and I think all of a sudden the Rhodes Selection Committees were aware of the need to nominate more scientists.  In my year, a couple of us did medicine.  There were two, or three physicists.  There were more science people than usual.  Otherwise, I don’t know, because I still remain baffled.  I won’t challenge the decision, because it opened up chapters in life that I would not have known.  I don’t know if I wrote a good essay.  I didn’t feel like my interview was particularly strong.  Among the people who were nominated in my district in my year, one is a professor at the University of Virginia, one was editor-in-chief of Time Magazine, the other one was a Wall Street investment attorney and a general in the Army Reserve.  And then there I was.  This is not false modesty.  I guess things came together.  Probably there had to have been somebody who was my advocate who was on the committee, otherwise I can’t explain it.

Q. Once you got to Oxford, how much of a culture shock was it, since it was your first time abroad?

Surprisingly little.  First of all, I arrived and got very ill.  Our group went to the Brussels’ Worlds Fair and I contracted a severe salmonella infection and put in a London hospital for two weeks.  I was weak and wobbly when I got to Oxford, but I was immediately in class.  I started medical school there, so I was thrust into dissecting a cadaver and doing biochemistry and physiology that I didn’t have time to worry about acclimatization.  I had to finish getting well and getting my

strength back, but I was busy from day one and that was a good thing.  I was in a small college and contrary to the stereotypes of the British being the distant, I found a very warm and welcoming place.  My tutor was a very warm and friendly teacher.

I was too busy to have culture shock.  The work was demanding, but it was also a lot of fun.  I *loved* anatomy.  In American medical schools, you did anatomy in six weeks and moved on.  I did anatomy over two years.  I did biochemistry, physiology and histology over two years.  If you’re not in a rush, they are very enjoyable courses.  Those were the first science courses where there was the time to enjoy them.  I also liked the Oxford notion that you worked in the morning, afternoon or evening, but never all three.  I played intramurals at Duke, but I could be on college teams at Oxford.  I rowed.  I took up field hockey.  I played badminton.  I learned to play squash.  I had a wonderful time.  I spent three years there.

At the medical program at Oxford, you took exams after two years and I qualified for the first bachelor of medicine and surgery degree.  Then I stayed a third year and took a B.A. in physiology.  Along the course of the first two years, I developed a real affection for neurophysiology.  I entertained the notion of wanting to be a psychiatrist, or a neurologist.  The third year fit, because it had a lot of time spent on neurophysiology.  After the three years, I came back to Johns Hopkins and entered as a third year student in what was a five-year medical school program.

I married after my second year at Oxford, and my wife joined me at Oxford.  They had relaxed the restrictions on marriage for Rhodes Scholars.  She had a good time at Oxford also.

Q.  During your time at Oxford, did you travel a lot during those first couple of years?

Yes, I hitchhiked a lot.  England was still trying to clean up its air.  The smog in London was a problem for me in the winter, so I hitchhiked to France and Switzerland one break.  The next vacation I hitchhiked throughout Italy.  The summer vacation between my first and second year I did an anatomy course in London and then the next year, more travels to Germany, France and Italy.

Q.  Do you think the travel changed your attitude in any way?

It was really vital.  I spoke some French and I would usually hitchhike with one person that I knew, sometimes on my own, but it was a sense that I could make do with speaking another language.  I had also learned how to travel very cheaply.  I visited places that were still bombed-out ruins.  London still had bombed-out ruins.  As someone who had followed World War II closely as a young child, it really meant a lot to me to visit Rome and Florence and various landmarks in France.  Of course, Normandy was not as developed at that time.  It was a very important linkage for me with World War II that I had thought and read about and just the excitement of traveling, seeing and doing things nobody else in my family had the chance ever to do, except my great-uncle who had been in France in World War I.

Q.  Are there any lessons you’ve taken from your Rhodes experience into your life?

The close one-on-one teaching was the hallmark at Oxford.  It’s really influenced my teaching style.  It made it very personal and has made me very comfortable in very small group settings where there are two or three medical residents and maybe one medical student.  I’m really caught up in my columns, or write a lot about health care reform.  Being taken care of as a patient and then as an onlooker in the British national health service during its early years was vitally important.  It helped me throw off some residual narrow-mindedness and be more aware of (I know this is trite) being a citizen of the world and having responsibilities to the world.

Q.  Did you feel more pressure to be greater or more successful now that you were a Rhodes Scholar?

Various of us feel kind of a burden, or an obligation to do super things.  When I first came back from Oxford, I wanted to be a professor of medicine.   I wanted a career in academic medicine, and I fully planned that all the way through medical school, internship and residency.  Then I was in the U.S. Army for my two years of military service.  That was an important time, because I recognized the thing I loved most of all was looking after lots of sick people.  I realized my true talents lay in clinical practice.  I gave academic medicine one further look.  After the Army, I did a research fellowship at Vanderbilt and it confirmed I was happiest at the bedside and not at the lab.  Even the Army was part of the educational experience.

Q.  What years were those?

1968 to 1970.  I stayed that entire time at Fort Knox, but you very much aware of the war, because we were on the air evacuation route from Vietnam.  About two or three days after someone was wounded or terribly sick from malaria, they were under our care at Fort Knox.  It was *extremely* busy.  We were shorthanded.  I had chaotic responsibilities and large numbers of patients.  I absolutely thrived in that environment.  That’s when I realized the sheer pleasure of seeing a lot of patients with a lot of different complaints and trying to figure out what they had.  I still feel a sense of obligation.  When you land a big scholarship, or fellowship of any sort, there is a sense of payback.  I keep trying to do it.

Q.  What qualities, or aspects of the Rhodes that the Rhodes committees wanted in the scholars do you still cherish or hold in the highest?

The sense of public service which I’m still doing and enjoying.  Public service not as a burden, but as an obligation that you can also find great satisfaction in.

Q.  Did you have that belief before you became a Rhodes Scholar?

Yes.  I don’t know quite why, but I think it goes back to Charlie Brewer, conversations with her.  It also goes back to late-night conversations with my Aunt Mary and her husband.  We would have very serious conversations about World War II and after the war.  We would talk politics and the sense you were expected to do something to make the world better.  Those were (again it sounds very trite) the seeds of expectation that were planted.  The Rhodes simply reinforced that.

Q.  How do you think you handled obstacles or failure as an adolescent?

I didn’t fail much.  But when I did, I felt a sense of shame.  I would keep a low profile in challenging, or threatening environments, so I would dodge failure.  I had great fear of being publicly embarrassed.  I would at times be a target for people, because I was awkward and much taller than everybody else.  I would get picked on socially.  I would go to the sidelines and keep a very, very low profile.  That was one way I would put up with embarrassment, threats or obstacles.  The obstacles I sensed were social.  They were never academic.

Q.  Was there any point in your life where you rebelled?

Ah, no.  (Chuckles)  I was a good, dependable son.  There were times when I bit my cheek when I should have rebelled.  For instance, when I was about nine years old on a Cub Scout campout an older boy threatened to kill me and held a knife to my neck.  I was scared to death and when I reported it to my parents after we got back, they said to me, “Oh, we know there was no such.  We know his family.  He would never do that.”  Especially after that, I kept quiet.  I did not report threats, or outrageous situations.  I kept my own counsel.  I basically didn’t trust any adults.  In some respects, I felt like a little old man even as a child.  I did not confide in any adults.  I tried to sort problems out myself.  I was appalled at about age 14 when I was invited to a party and the parents who were there served mixed drinks to everybody.  I did not take one.  The aversion I had to drinking was from seeing so many out-of-control adults around growing up.  I would never have told my parents about that particular event.  If I were bullied at school, I would never tell them.  I would keep my own counsel there.

Q.  You wouldn’t even tell any trusted teachers about that?

It was a time when teachers were older figures and you just didn’t know what to do.  For instance, in the recesses in my grammar school, if you were a boy, you would never go to the bathroom.  Because if you went, your head would be stuffed in a urinal, or toilet.  You might be assaulted by older boys.

There were no social promotions at that time, so that in the third and fourth grade, I shared classrooms with sixteen-year-old boys who were thugs.  You learned to control your bladder, and if you needed to go to the bathroom, you would ask the teacher during class if you could be excused.  She would want to know why you didn’t go to the bathroom during recess, and you couldn’t even tell her that.

I was not totally alone in that respect.  There were one, or two other somewhat quiet males and females.  If we could have linked up and learned how to talk to each other, or even share any thoughts at all, maybe we could have comforted each other.  I would draw a parallel when I read about bright kids in terrible urban schools.  I know exactly how they feel.  I was a white kid in a white school in a segregated community, but I felt as much as an outsider as if I had been African-American.

Q.  And that again was not only because of your physical appearance, but also because of your intelligence.  

I was aware too early on, and this led to a lot of boredom.  In retrospect, it probably would have helped me if I could have skipped a grade, or two.  When I would go to the library in LaGrange, I read all the boy books early on.  I started reading adult books when I was in the third and fourth grades.  It was the loneliness of being smart.  I didn’t show it, but I was a lot smarter than my peers.  It sounds stilted, but I also had for whatever reason a different ethical compass.  I don’t know where that came from.  Part of it was Charlie Brewer, part of it was my Aunt Mary.  I would be sent off to church and Sunday school.  My parents wouldn’t go.  Maybe I took seriously some of the admonitions I had then.  I’m not a particularly religious person now, but the combination of the hellfire and brimstone from the Baptist church and then the examples I saw of frequently out-of-control adults.  I was never abused as a child, but I don’t think people really knew what to make of me.  I felt very lonely.

Q.  What values would you instill in a child today?

Reading to children is absolutely crucial.  It’s a bonding experience.  It’s a time when children feel especially valued.  Being open.  Having lots of time to spend with kids, listening to them, talking to them.  You don’t have to talk down to them.  You have to be willing to talk about anything with them.  The value through our own children is that of very open communication.

Q.  What’s your opinion about what some call permissive parenting?

We were kind of old-fashioned.  We had rules.  We had curfews all the way through high school.  We had table manners that were insisted upon.  If people badly misbehaved, they got swatted on their bottom.  We never spanked many people, and I guess spanking may be out right now.  Each boy had one, or two times when it went beyond being sent to their room or given a time out, where they would get a hand delivered to their bottom.  I don’t think there was a harsh set of rules, but the boys knew when mealtime was and they had to be at mealtime.  Those values were particularly reinforced by their maternal grandparents.  Our boys (while I had scattered bit of time with my Aunt Mary) spent weeks and weeks in the summertime on the farm of their maternal grandparents.  The rules and set of disciplinary boundaries that we set were modeled after my wife’s parents than after my parents.

Q.  What would you say to someone whether they are young, or old about creating  a meaningful and useful life?

We have ten grandchildren.  They range from six months to age fifteen.  An idea that I repeatedly come back to is the notion that there is a sense of obligation for the privilege of having a home, a family, food and educational opportunities.  Whatever you do, hopefully it will have a useful dimension, either bringing pleasure, learning, insights or challenges to other people.

Q.  You’re retired from the medical practice, but you still teach.

I stopped clinical practice in 2004.  I was almost 68 at the time.  I got tired.  I was still on call every fourth, or fifth night and every fourth, or fifth weekend.  The sleep loss finally began to take a toll.  I stopped that and since then I’ve been teaching a history of science course at the local university.  It’s a course I’ve been able to design.  It’s been one of the most pleasant things I’ve ever done.  I love preparing and the whole teaching experience.  I write a column for the local paper every other week on health policy and health matters.  I like that lot.  I’m putting together another book of family stories, but they are being fictionalized.  They are tales that I have been entrusted with by some cousins and people.  I’m almost obligated to get them into print even if there is not a publisher and it’s a privately circulated memoir.

Q.  What are the three things you loved about your medical practice?

The privilege of being inside other people’s lives and helping them through various traumas.  Secondly, the privilege of being in a field that changes so rapidly that you are constantly stimulated to keep up.  I’m still keeping up.  Third thing was finally finding a field where I can bring it all together, where the peculiar talents, skills or insights, the science, the literature– everything–came together in one pursuit.

Q.  How did you bring the literature part into it?

My notion is that almost any bright person with a Merck manual could do the technical side of medicine.  Literature, by letting you see all the compressed lives at a safe distance, enriched my feel and feeling for all sorts of individuals.  In some respects, I never met a stranger in practice, because I met so many of them in literature.