Ronald Anderson and Katherine Liao

00:05 My name is cat Leo. I'm 42 years old. Today is Tuesday, November 12th, 2019. We are in storycorps Atlanta. I'm here with Ron and Ron is my colleague and former clinical mentor.

00:19 Hi, how are you? My name is Ron Anderson. I'm 83 years old today is extra Tuesday.

00:29 November 12th, 2019. We're in story court at Atlanta and I'm here with cat Liao who was a former trendy and now she's going to call leave for about the last ten years at the Brigham and Women's Hospital.

00:49 So Ron, I remember when I was a trainee over a decade ago, and I think it was at one of these ACR conferences. I'd run into lots of people who are at the Brigham and they would ask about you cuz you trained generation the rheumatologist you came to training to an extraordinary time from 1959 that correct through the presents. That's like free MRI free all these Technologies we take for granted. So I was curious to know about experiences from your own training that you remember to this day.

01:22 I think first of all I felt blessed. I had a chance to be a doctor. I I had gone through college without any

01:34 Set goal in mind. I didn't know what I wanted to do. I was not always the most serious student and as things went on I found what I really enjoyed most was talking to people and basically trying to solve problems. And so I thought a different things actually going into Clinical Psychology actual being a minister was something I thought about 4. Of time and medicine. I kind of fell into it in the even though I never been sick and there was no one in my family been sick and the only physician I had any contact with was not a real great role model. I mean bad person but he was

02:24 Elderly and not much fun and serious and stuff. So I thought that maybe I would like Madison hadn't been a serious science student and from the day. I started my school. I absolutely loved it. And I loved everything about it and I quite honestly always felt that that I that I was uniquely lucky and blessed to have this opportunity.

02:56 The the the the people I think I learn the most from

03:04 Was it different levels one was a basic scientist physiology is who's sort of enabled one to learn without memorization. And so I think I got some confidence about how to figure things out and I enjoyed that and then some of the physicians eye.

03:31 Like the best and I thought I won the most from I was probably more drawn by their personal qualities than by the technical facts that they would teach but by the time I finish med school, I wasn't sure what area medicine I wanted to go into. I like everything except for anesthesia and radiology and wake Radiology. They were both in the basement and anesthesia seeing me weather cold. But so I took an internship with a thought maybe I'd be a family doctor and prior to 1968 with in the state of Pennsylvania. You had to rotate to different services. So there was no such thing as a straight medical program Street surgical everyone had to take

04:28 Too much the medicine too much OBGYN too much of Pediatrics two months of the veggie surgery and I went through that experience kind of liking everything. I did I had particularly enjoyed OBGYN when I was in med school, I think some of it was because I was acting because their oldest child was born when I was at a pain med student. So we totally need one to be interested in the field of Obstetrics. And I know well, you know, I think having a child sort of draw your church OBGYN, but it show you through you actually it's going to make you so you work sure you want to go to the Pediatrics.

05:28 And I keep the basis for that was that I really I really love kids and I

05:38 I probably was emotionally more upset dealing with sick kids than dealing with sick adults.

05:47 So so even though I like Pediatrics when I was a nice rotating through Pediatrics, I probably had more fear of doing harm. And I also thought it was somewhat sad that when children had a condition that you knew wouldn't get better. And so the hope for the future wasn't quite as good for them. So I fight I mean, I wouldn't mind doing a little bit of Pediatrics, but I and then then I was very interested in OB-GYN and actually liked obstetrics. And then when I was in kind of ecology, I sort of had a life-altering experience. I was in a large City Hospital in Philadelphia and I was hooked on ecology and I admitted in that months probably about 100 women and

06:47 Third of the emissions were women who had had abortions done on the street. And I think now that I'm probably one of the few active clinicians who cared for women in the era before there was Roe versus Wade, this was I was an intern from 1963 to 1964. And actually Roe v. Wade was passed about 9 years later and

07:17 So every night that I was in call I would admit to women or sometimes three or at least one who had a complication of having a speed of Washington and he was a very frightening experience there. They were critically ill two women died during the time. When was 14 year old.

07:47 Girl, another was a married 39 year old married mother of 12 and they they really had no other option at the time then they had to go to the street and I was aware that people who had family support or who had

08:12 You know the funds available.

08:18 We're able to get abortions are there by going to foreign country or two to range it legally so I might at that time but honestly felt that if my coolant is a physician was to relate to relieve pain and suffering that I probably be an abortionist, but

08:39 I didn't want to do that. I quite honestly don't think I could do an abortion. Not that I'm morally opposed to it as a pet.

08:53 But I don't think I'd be comfortable doing that and I so I so I feel that that

09:03 That that that the choice is really

09:08 Is a moral choice but it's someone's personal morals. It shouldn't be a medical decision it it shouldn't be a legal decision and I

09:21 I'm I'm a very bothered by laws which are restricting abortion now because the people who will have the impact or the people who are less able to go deal with this adversity. There are people who don't have family support people who

09:42 Cat

09:44 Choose their care can't go to another state don't have somebody who's there to help them out there usually people who are sort of left alone. But anyway, I went into medicine and I'm also glad I didn't go into OBGYN. That wasn't the only reason that I didn't go into his Dentures & Gynecology. I hope she just liked Internal Medicine board Moore's if you know the long I worked at it. I'm practicing Rheumatology that that is that memory is something that's really like with you. You don't like me cuz

10:29 I don't think they're many doctors who are still clinically active. Now who cared for women in that era Andrew and course he was he was a Pious group. It was a City Hospital which was care for the poor the people who did not have insurance didn't have any option for a doctor. And so so they were the most kind of needy people and but it was a very sad experience and now you know what the way things are going in our country will end up in a situation like that again.

11:15 I'm not very very worried about it. And and I

11:22 You know, I think I understand the pro-life people and I I don't think that they're mean or they're immoral. I think they they don't know and I and I honestly believe that there must be some kind of Middle Ground of understanding. I mean, I am not a terribly religious person, but I've been a deacon in our church for years and

11:52 I am I

11:55 You know, I have a religious faith and I understand why people feel as they do the pro-life group.

12:06 But I also feel that there's a certain amount of compassion for other people that that is really the basic question. And I think that you're punishing those who are least able to to go and care for themselves that it that I think that

12:28 That the move to Kona polish abortion is not fair to

12:36 The most deserving people and I'm able to deal with that on a boar hog of you even though I would not want to do it myself night. I can't imagine a time like that and I hope we never have it right I did. I mean it's something that

13:07 Has really had an impact in the way I think about voting. I I've always felt that that there's anything I can do. It turns out my vote would be to go in systane Rose Roe v Wade that wasn't the purpose of this place about it at an interview. We can say whatever we want. There's no script. I just have these these things here to remind me all the all the things we wanted to talk. So let's talk about you know, your years is a rheumatologist you did your fellowship at the Brigham the late 1960s you established our Rheumatology training program, which is still going strong today and you recently retired after over 50 years in practice. So, what do you miss the most?

14:01 Well

14:03 You know, I miss everything I I I

14:08 Heidi's knocking on your door and honestly I say that I really

14:19 Really liked it. I mean, I basically

14:24 I don't think I'm forward charm that.

14:30 You know what they say about practicing medicine which is which I think is kind of fun is that you never have a perfect day everyday.

14:43 There are few things that are good is a few things that are that are bad. So you never get and kind of an exalted sense of yourself. But but but you never feel that it's hopeless and worthless and you doing you know, it's just say that some of the day she was a windshield some of the days you're the bug but but but I mean the two of you could take Sabbath but but I know what day that I was maybe about 64 and I had a terrible day everything is bad and I really can't seriously thought of retiring but I thought you you know, I'm 64, maybe I can retire and then something happened. That was nice and I remember get evil elevator. So it will maybe seventy what happened in the day. That was bad. And then what good are you doing?

15:40 You know, I I think that

15:47 I think that the thing that I like most about medicine that is that you I think that what is really unique is an opportunity to sit in a room with a patient entrance all problems. And I think that it's very gratifying. I think it's very challenging because you have to know science you have to know battison and you have to know the patient and you also have to be able to sell yourself.

16:21 I don't sell yourself, but but I think that if you're going to be an effective counselor that you have to create faith.

16:33 Before I went to med school, I used to drive a taxi cab and driving a cab. I thought was great training for being a doctor because your income was dependent upon tips. And so you meet people you never met before you have to create friendship. You have to create a relationship. You have to create a certain amount of faith that that that that you're not going to get lost and then Jersey, but I used to drive in the north Jersey area, but and

17:17 And and you also didn't always get compensated equally for the amount of effort that you made but I so I always felt taking care of patients that that that your first shot when you met a patient was that you had to create create some kind of relationship and do that, right? I had your one precious. Why did I happen to pick Rheumatology at him all things? And I mean, my first question was do I douche

17:47 Medicine are you adieu medical field or do a surgical field surgery? I found that I got hungry during scrubs bladder and all I could do was thinking about eating as so I sent you the last thing you need for a surgeon to is somebody who's thinking about poodle all the time and I figured if I wanted to medical field that I could always grab a bite to eat. So

18:20 So then then is I got into a turtle medicine. I really found that I like taking care of patient so I couldn't sure cuz

18:34 But they were several reasons. When is I thought people who hated to see if you can't you're probably probably needed care as much or more than people who had diseases you could easily cure. And so I thought it was more challenging because because he didn't have an easy sure. Maybe you could find three things at beach made of 15% better. So the net effect is that you're about 45% better.

18:59 So it came to have to oncology and a trivet ology which were the two most hopeless Aries medicine and I happen to like Rheumatology because kind of dependence on physical exam and then there's some people that I had worked with in the field Rheumatology that I particularly liked and I figured over the years that makes things to think things will be much better. So

19:29 And then then I found it. I really that I did I

19:36 You're really like teaching.

19:40 And it was funny cuz because people told me many many of my colleagues said, you know, the only reason you like teaching is you like to interact with peers, but when there's an age difference.

19:55 When you don't talk the same language when they were a generation of the way you can't relate to them anymore or is it?

20:07 You won't have the same relationships and

20:13 I didn't find that to happen. I I take a lot of occlusal relationships are hard based on a common goal the common purpose.

20:26 Common set of interests and

20:31 Delete we may have different tastes in music and things like that and it and could have lights out of there too. And I I I I enjoyed people of different age groups and it's always been finding me to work with younger people.

20:46 Try to anyway that there was one of the reasons I enjoyed it greatly and now you're working will see you retired from Rheumatology. And then the Brigham couldn't let you go. So now you're back working with the medical resident to her. Even I'm feeling that there is a generation gap there when I try to help you don't light.

21:12 I think that there's truth that there's two Aries that you want to teach you want to teach technical medicine and then you want to teach how do you be a physician?

21:24 And I think that technical medicine and most tests and in most ways that they great house staff and students are are they technically confident do they don't know the stop, but if you're right, if you're up if you're well-functioning clinician, then you also know how to

21:47 Use the skills to make people feel better and guide them through difficult situations and

21:56 I see that.

21:59 When I came back to teaching I don't teach technical edit. I don't teach science and eat any more and I don't feel responsible for of but in terms of history and physical somebody who has appendicitis has the same symptoms now if they had back in 1840, I mean be there no new advances and how do you feel when you receive your swollen joint or that and then how you interact with patients is I think a very important thing and

22:35 When you teach in the traditional sense you like when you precept.

22:41 What you do is you going and you you talk to the resident or fellow who's worked up the patient they go and present it and then you deal with the technical aspects of how do you take care of them? So what this job is done is giving me an opportunity to sit in with people when they are doing histories and physicals and explaining things and I think there's a lot that that you can add.

23:11 Beehive I practiced 50 years. I never had somebody critically watch how it is doing it. But I think there's a lot of things which you can serve and alive. It's cost-effective. I mean examples. Can you give some examples?

23:32 Ways of ask Well Service thing is a light that I think that if you stab was your personal relationship with a patient of mediately?

23:43 That is a lot easier to explain anything because you have two patients confidence that you don't have to convince the patient that that you're interested or caring or anything. If you do that early on that when you give advice there are more likely to follow your advice. There's some other things is never give advice on till the end of the visit cuz if you give advice early you may change your advice based on your physical or you may change your voice based upon having another $4 or something else comes back. Then you have to tell you already told him a then you say don't pay attention to a pay attention to be and then you have to drink twice as much time talking about babe. So I

24:39 And then doing a physical Sam this just so what you put you really want to do is you take a history and then you decide what part of the physical exam.

24:59 Do you want to do and so you sort of shoes that and then other little things like always do a physical exam the same way because if then then you don't forget things and if you always do it the same way you could talk to the patient when you're doing your physical. You don't say let's see she likes you more than the belly if you always do it the same way then I think that's safe time. You know, I too late for us by then though.

25:39 I think that that is an interesting area and you know, it's kind of an area of growth that you end up saying or thinking that you tell these new future doctors over and over and residence fight. Are you think?

26:05 I think that of the doctors I work with 90% want to be kind and want to be nice. There are few probably don't go into the unfortunately, but but I think a lot of them are not comfortable and showing their humanity and

26:29 That they somehow feel that a doctor should be dominant should be all-knowing should never be in doubt how if you read always slurs.

26:46 His PO Equanimity switches his speech she gave when he went to Hopkins University Pennsylvania and went to Hopkins. He said there's no aspect apenas issue more important than to be sure of yourself. And if you ever show on certainty than you've lost the patient and I think written into the fabric of a lot of medical education and a lot of role models and I think some of it is kind of gender-based that that I think that the dominant male sit down listen to me. I know what I'm doing.

27:36 You still there? I don't think

27:40 It's as dominant as it was when I started but but I think to be comfortable and explain to a patient that you're uncertain about certain things and to tell them how you're trying to solve things.

27:56 I find patience patience will tolerate all kind of uncertainty and

28:04 This directions if they understand that you're trying and that you're thinking so I think that's something that that is not.

28:16 Knowing so to speak or where I think a lot of young doctors don't feel comfortable in letting patients know that they're on certain your takes a certain amount of confidence before you can think of that you don't have confidence but there's so much we don't know that we can say that all we have to say that all the time.

28:49 Do very well with a doctor approve?

28:53 Expresses that they're not sure are you I think there's a difference between on between uncertainty and actually laughed like a confidence that that I think you can be very confident that you're uncertain, but I will do what I say is look at these are the things you know that I know and these are the things that I that I don't know and

29:28 You know, if a certain sense once you make a decision you make once you make a diagnosis and you stop thinking so I so I tell them yet. You know, I don't know what you have. So you're really in a good situation because you'll know that I'm always thinking.

29:48 You know what I've seen of you that's so true that I took care of her for 18 years, and I never knew what you had.

29:58 I mean I knew what was going on. But it but I never had confidence that I could pigeonhole her and then was specific diagnostic step to make sure we have no time to talk about another very important topic. And so even though you passed on the Torches Fellowship director after I started your wife RV was always so welcoming presents for all the new fellows and young faculty. We all miss her very much. I just saw it was wondering whether you know, you'd like to share a story about her how she spoke to your career or anything else.

30:43 Get a virus if I was fortunate and she Barbie and I

30:48 Work we're actually married 56 years and

30:57 And

30:59 And every Everything which we hoped would happen before we got married did.

31:06 I mean, I mean just exactly the way we planned it, but you know the kind of goals that we had were things that we met.

31:21 And they work, you know, they weren't Light Fight financial goals or Sports Quirk action of success and obvious things, but but in

31:33 Terms of a relationship with our family and our kids in

31:38 Being able to nurture people. I think everything happened that we'd hope would happen if she Barbie I think that

31:55 We never had any arguments about ultimate goals or work votives or values. I think we we really shared all those things and know there were there were differences about how to get there and how to do things but I

32:19 But I always felt that she had the welfare of others.

32:24 Be a special with you. Why would she and she she really was very involved in in the nurturing of

32:40 Fellows and residents that that we'd worked with over the years. I mean she really cared about him and she

32:52 Do them. She like them sheeps tried to help them out in any way that she could and I

33:03 And it was at age.

33:08 Who said she honestly cared about people?

33:13 And you don't seem interested because I know because I talked with her own kids about her and like like Barbie Barbie Barbie grew up in an era before women had the opportunities that they have now her mother and father. Well, actually she was born during the thirties and Barbies parents told her when she was young. She said that we actually hope that you'll be able to go to college and every could send you to college but

33:50 If it comes with choice that your older brother's going to go to college.

33:55 And you'll have to work as we can only afford to send one person to a to a to a college she

34:06 Also grew up in Arab that she had to she was far from from from her job when she was pregnant because she showed she was pregnant.

34:19 This isn't well-known, but but

34:22 Yeah that Arrow if give a woman appeared pregnant and they

34:29 Were they usually had to leave their job?

34:33 Oh, and she had a job in a bank at the time and it was some ridiculous thing and

34:44 Here we did if you think about it, but that's but that's what we were nothing. But but but when we both have our girls.

34:52 Knew that

34:57 She

35:00 Race, I'd help.

35:04 That they both girls that they could do whatever they wanted to do in life that they felt that made it turned out once a lawyer wants a doctor, but they both felt growing up Dad.

35:19 That there were no restrictions based based upon their gender and that any opportunities available that they would have her son David felt the same way over run by the woman in the house there was funny because he's because he's actually split between the two girls. And so it was Susan David Nancy and they were there there they were all uniquely enough different that they didn't tend to have to compete with each other. But but I think she was just a a very caring or drink person and Ike and

36:17 I was very happy when you take the ice cream out of the refrigerator before you serve it like like I'm a 3 minutes before you eat and she was 15 minutes. We had the same thing with cheese. Like I was 15 minutes. She was 2 hours, but you know, it was for your model for us to rent through both clinically and then I think you know, I still remember as a fellow starting and watching you and Barbie and Barbie greenia saw that you were always so happy. We are all just came through.

37:12 That was cheap. Really. I mean she she Shear she has a really care for the fellas, but I was program director. We used to Everett. We went to your house and that's why it's Lyman reinstituted that that that that at the time and I

37:35 I'd

37:37 You know, I do I think we were we were we were very fortunate and and that that even though she had a difficult illness that at the time of death.

37:52 Geyser is felt that we had issues that had not been resolved that were floating or G. I wish I'd done this differently or I'd done every every thing that I think we did everything we've done in life was worked out well and

38:14 You don't ever feel good about it.

38:26 I serve a different matter than being depressed.

38:35 Well