Barry Alpert

Barry L. Alpert M.D.

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HRT DOC
Barry L. Alpert M.D.

LifeTime Private Autobiography
The experience of sharing your stories in a private autobiography for the family
Copyright © 2022 Barry L. Alpert M.D.
First produced in the U.S.A. in 2022 by Private Autobiography Service, Inc. for the Author’s private circulation.
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I would like to dedicate this book to my grandfather, Dr. Eli
Friedman. His memoir, Dr. Eli, inspired me to write my own story.

CONTENTS
Introduction 9
1. Family: Parents, Siblings, and Grandparents 13
2. New Hampshire 31
3. Harvard 43
4. Medical School 59
5. Residency 71
6. Cardiology Fellowship 73
7. Air Force 79
8. Family: My Wife and Children 85
9. University 107
10. Private Practice 117
11. Retirement 135
12. Me 147
Conclusion 151
vii

INTRODUCTION
After I retired in April 2021, I had the opportunity to reread a selfpublished
memoir, Dr. Eli, by my maternal grandfather, Dr. Eli
Friedman, one of the first pediatricians in Boston in the early 20th
century. Unfortunately, he suffered a stroke and retired in his early
80s. So, to keep his mind active, my grandmother, Edith, had him
dictate his book to her. She transcribed it, had it printed privately, and
distributed it to his kin. Motivated by their act of legacy, I would like to
do the same for my family.
This book is a personal memoir and, characterized by many thoughts
and observations along the way, it goes beyond a simple recitation of
life events relating to a career in medicine. It was written during the
Covid epidemic of 2021 and 2022 and alongside my diagnosis and
treatment for multiple myeloma, and it has been a valuable diversion
from these unfortunate events. More importantly though, it has given
me tremendous insight to my person, and has made me realize just how
fulfilling my life has been.
9

10

My grandfather’s published biography
11

CHAPTER ONE
Family: Parents, Siblings,
and Grandparents
When my father, Joseph Alpert, was in medical school, he had
a close friend named Seymour Shalek who arranged a blind
date for him with his sister-in-law, Tobe Friedman. At the time, Tobe,
who would one day be my mother, was an undergraduate at Wellesley
College. She was exceptionally young at 19 when she married my father,
and my understanding was that they decided to elope owing to the war.
When they married, they actually had two weddings: the first was the
elopement and the second, six months later, was a formal ceremony,
which took place shortly before my birth.
I was born in 1945, in Cambridge, Massachusetts. Following my
birth, and after completing medical school at the end of World War II,
my father spent two years overseas as part of the army of occupation
in the Philippines. During that time, my mother and I lived with my
maternal grandparents, Eli and Edith Friedman, at their house in
Roxbury, Massachusetts.
Back in Boston after the war, my father completed his medical
training as a surgeon at Boston City Hospital in 1947. During that
time, we lived in a duplex in Newton, Massachusetts where I attended
an elementary school down the street. I remember enjoying my early
childhood, but my only clear memories of that time are scattered: being
taken skating by my mother in the late afternoons, and playing baseball
at school with the older kids, sliding into home plate, and scraping my
13

knee badly on the asphalt. I remember that my childhood hero at the
time was the trash collector!
In 1952, we moved to Laconia, New Hampshire where, as a
physician, my father aspired to be a small-town general surgeon. As
a result, I grew up in a town of 14,000 people in the Lakes Region,
central New Hampshire. However, we often still drove to Boston, a
two-hour journey, to visit, and stay overnight with my grandparents,
particularly for all of the Jewish holidays, such as Rosh Hashanah, Yom
Kippur, and Passover.
My mother was a very complex woman, both as a person and as
a mother. I have to admit that when I was growing up, she was very
supportive of me, particularly in contrast to my father, who worked all
the time and was very distant.
I have an early memory of her from when I was in middle school.
At the time, chino pants were all the rage, but the most popular colors
were hues of royal blue, red and orange. Regardless, I was so desperate
to fit in that I invested in two pairs – blinding orange and shrieking
yellow – which, of course, looked absolutely hideous on me and left
me feeling terribly embarrassed. Fortunately, my mother came to my
rescue with some dye that transformed the pants into a more muted
green and brown. She saved me (from social ridicule, anyway).
My mother was the parent I could confide in without feeling
embarrassed. When I entered my teenage years, I experienced my share
of adolescent angst. “Can I take a girl to the dance who’s taller than
I am?”; “Is it alright to take an underclassman to the prom if I’m in
eleventh grade?” As absurd as they sometimes were, I took my social
dilemmas to my mother and she was very helpful in dispensing advice
on such matters and quelling my doubts.
Over the years, we also did activities together. When I was a boy,
my mother taught me how to play ping pong. She also enrolled us in
a mother–son ping pong competition, from which we were eliminated
in the first round. That said, I do not know if these shared pursuits
brought us closer together. I often think she included me in these
activities because she wanted to do them herself. Through the years, she
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was involved with many intellectual endeavors, including the League
of Women Voters, World Affairs Council, and Great Books, and often
ended up bringing me along.
My mother was a very intelligent woman. Unfortunately, she never
harnessed that intelligence into something functional. She went to
Wellesley and graduated at a young age with a desire to become a
doctor, but her parents dissuaded her. At the time there were very few
female physicians, and she probably would not have been a very good
doctor because she was never focused. When she met and married my
father, she began giving birth to and raising children instead. So, it was
a life that really never went anywhere professionally.
There were six children in the family, each born approximately
three years apart. I sometimes have the feeling that my father’s master
plan was purposely to keep my mother pregnant, but the irony is that
motherhood was not her suit. There was nothing motherly about her
at all. She was generally not sympathetic or compassionate, and she
really just focused on herself. Instead of attending to us herself, she
had a mother’s helper who came from the state school for the mentally
challenged down the street from our house. Ultimately, my mother was
just not cut out to be a mother. Perhaps she should have been a doctor.
My family had moved to New Jersey when my father changed career
direction and became a vascular surgeon at Newark Beth Israel Medical
Center. After all my siblings had grown, I encouraged my mother to go
back to school. She earned a master’s degree in teaching from Columbia
and began a career as a high school math teacher; however, she could
not control her classes and students took advantage of her. Ultimately,
she resigned and ended up tutoring math privately.
By then, my parents had divorced. Initially, my mother stayed in
the house in New Jersey, but she later remarried and moved to New
York with her husband, Mort Gerson, settling near the World Trade
Center. She was living there on September 11, 2001, when the Islamic
terrorists crashed the planes into both towers. My mother’s apartment
faced the Hudson River, not the World Trade Center itself, so she did
not see the crash and missed the news. She and her husband, Mort,
15

were mystified by all the white ashes wafting down and they had no
inkling of what they were. Because they did not listen to the radio or
watch TV, they had, in addition, no idea that they were supposed to
evacuate their home. It was only on September 13, when the National
Guard knocked on their door, that they decamped to New Jersey.
My mother’s self-centeredness, unfortunately, extended to the way
she treated my wife, Judy, and our children. When we got married,
Judy went out of her way to be a dutiful daughter-in-law. We would take
her out to dinner and bring her gifts, but no matter what Judy did, my
mother never acknowledged her gestures or thanked her. Essentially,
she abandoned our family, focusing on herself.
My mother died in Sarasota on November 19, 2021, at 95. I have
little sadness. As Camus said, “Today Mother died, or maybe it was
yesterday. I don’t know.”
If my mother was not very directed, my father was the opposite.
He was laser focused to the point of obsessiveness when it came to his
medical career, and while my mother was a late night person, my father
was up at 5:30 in the morning to do rounds. Not surprisingly, my
parents had very little time to actually connect, and in truth, I never
witnessed much interaction between the two of them, which may later
have affected my relationship with my wife, Judy.
When I was young, I remember my father being very active in my
life. He played baseball with me in the back yard, helping me hone my
skills in batting and pitching for Little League baseball. He also taught
me how to play golf when I was seven, but as I grew older, he played
less of a role in my life. Each spring, symbolically, he took me to a
fishing camp in northern Maine for a week, but I never really bonded
with him. He appeared so distant, and there was no warmth. I never
saw him laugh, and he never shared any intimate feelings with me.
As time passed, there was more distance. I never received plaudits for
my academic success. He never consoled me when I was wait-listed at
Harvard. This later extended to my life after leaving home. Although
he did visit me once in St. Louis during my internship, he never praised
me for my successful career. He even failed to ask my advice when
16

he received a pacemaker—which was my specialty—in his later years.
Our phone calls were sporadic and uncomfortable. I was a person who
needed praise, and he proved very disappointing to me on this point.
His distance, however, probably became a driving force as I later built
my career.
As I have said previously, he was thoroughly involved in his
professional career, and as a youngster, I tried to be a part of it. When
asked if I wanted to go to the hospital with him to do rounds, I agreed,
but all I did was sit in the waiting room, waiting for him to be done. In
contrast, when I was in practice, I took my son Craig with me on my
rounds and introduced him to patients as “my consultant.”
Essentially, I spent my whole life trying to please him and never got a
response. When he was on his deathbed, dying of natural causes, I did
not, unlike my siblings, fly down to Savannah, where he had retired
with his wife, Jane, to say goodbye. I do not miss him. Unfortunately,
I hold him up as a negative example of a father.
In the end, I think my parents were thoroughly incompatible, and
I have often thought that my father used his medicine as an excuse to
be away from home. Looking back, I also believe that my parents had
their own separate lives.
I had five siblings. After me came Marc, who was three and a half
years younger, and when we were children, he was my family playmate.
We challenged each other to long Monopoly games and to tickle
fights, but as we grew older, however, we each went in completely
different directions. We lived only seven miles from a ski area where
I began skiing at the age of seven, often skiing two or three times a
week. I still ski to this day. While I immersed myself in skiing, Marc
became passionate about candlepin bowling. He developed a love of
science fiction and ended up going to MIT, which says a lot about how
differently our personalities and predilections evolved.
Unlike me, he hated sports, and our pathways and personalities
turned out to be so different, even though, ironically, we both became
physicians. I was fortunate in that I loved what I did, but I do not think
Marc ever developed a passion for medicine. He was very good with his
17

hands and majored in biology and electrical engineering. Because of
his manual dexterity he chose to be a surgeon after medical school at
Penn; however, he never had the same drive to succeed as I did.
As I got older, I felt that I needed or wanted to have more sense of
family. At a certain point Marc and I addressed our relationship and
became closer. We exchange phone calls every several weeks and have
visited each other at our homes, with Judy and I going to his house in
Pennsylvania and his summer place on the Jersey Shore, and the two of
us, in the past, inviting him and his wife, Hillary, to Nantucket.
Jon was six years younger than I and athletic, and we played baseball
together, but I really did not connect with him until he was in college
at Johns Hopkins and I visited him for a weekend when I was in med
school. We both enjoyed skiing and went on an Italian Alps ski trip
together. I maintained a connection with him in Philadelphia when
I was a cardiology fellow, Marc was a med student and Jon was at
Wharton for his MBA. I also visited him when he moved to New
York City for his first graduation job at Drexel Burnham Lambert.
Unfortunately, we later drifted apart. I only speak to Jon concerning
family business and do not interact with his wife, Laura.
Charlie was next in line. He was the golden boy of our family and
linked the older and younger halves of the family—me, Marc and Jon,
and Bess and Jeff, respectively. He was valedictorian of his class and had
a wonderful group of friends, particularly his next-door neighbor, Jeff
Wilson, the son of my parents’ best friends. He went on to Dartmouth
because of his love of the outdoors. However, during his first semester
he was invited on a Dartmouth Flying Club airplane ride to see the
dawn and died in a crash. The last time I saw him was at the Harvard–
Dartmouth football game, where he was playing trombone in the
Dartmouth band. What a loss to the family!
After Charlie, was Bess, the black sheep of the family. She had
many psychological problems and surrounded herself with friends
of questionable character. I believe she was the most affected by my
parents’ ultimate breakup, although she was not close to either. My
father was distant and stern, and my mother was not feminine enough
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to develop a strong mother–daughter relationship with her, so she
was, essentially, alone in her troubles. Ultimately, she dropped out of
school, only later getting her GED. My father, because of his guilt,
provided her with a job at his hospital and supplemented her income.
She later married Ed, who was a laborer. He hurt his back and became
disabled. Later, he tried to do computer repair, but this also failed, and
he, essentially, remained at home on the couch. Her marriage has been
barren, both psychologically and physically, as she has polycystic ovary
disease and is sterile. Now, she has a major office job in the transplant
coordination center at my father’s former hospital in Newark. From
a family point of view, she is isolated, for as Marc and I have forged a
special relationship, so have Jon and Jeff, the youngest.
The youngest was Jeff, 17 years younger than I, and we got to know
each other when he grew older. Since I skied with my son Josh, who was
close to his age, we invited him on two ski trips to Utah and Taos, and
Josh has remained friendly through Facebook. Jeff went to University
of Vermont, and then received an MBA from Thunderbird in Phoenix.
Subsequently, he joined a truck leasing company in San Francisco,
where he ascended to president. The business has been acquired by a
large firm and he remains there to help run it. In the beginning of the
2008 recession, he was almost bankrupt, and my father supported him
and his wife, Lisa, financially. Owing to their business background and
MBAs, Jeff has more recently joined forces with Jon in several business
ventures.
He was also the only one of us to have a close relationship with my
father, and, among all the dysfunctional relationships in our family, he
has taken the mantle of peacekeeper in our family affairs. After our
parents’ deaths he called himself “the Switzerland of the family.” He
has also been named the executor of their estates, reflecting his role as
mediator in the family.
I loved my maternal grandparents, Eli and Edith Friedman, known
to us as Gram and Gramps. They were my major source of support
in my family. Both of them doted on me and were completely nonjudgmental.
In their kind eyes I could do nothing wrong. Even as a
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child, I found them to be such a source of comfort. My grandmother
was also the focal point of the family and she kept us all together,
particularly through celebratory Jewish holidays at her house.
I particularly remember Passover. Since my grandfather had studied
to be a rabbi at Yeshiva before medical school, he was very knowledgeable
about Judaism and would lead the Seder meal, reading the Haggadah
in Hebrew and then providing his own translation. Traditionally, there
are two parts of the ritual; one is completed before the meal, and then
there is a second part after the meal itself, involving the singing of
songs and recounting of stories. Because my grandfather knew we were
all so eager to eat, and the meal took so long, he always dispensed with
the second part.
I loved spending time with my grandparents. I remember taking
showers with my grandfather, playing Casino with him, and sometimes
just watching while he talked to patients on the phone during calling
hour. He was actually one of the first pediatricians in Boston, and
I witnessed the degree to which he was respected in his field. I am sure
that the care with which he treated his patients played an important
role in my decision to become a physician myself.
Meanwhile, my grandmother could not do enough for me.
I remember dragging her to a Dartmouth–Boston College football
game, and we would also go candlepin bowling together. She cut
quite a figure fashion-wise, wearing platform shoes accessorized with
sequined stockings instead of bowling shoes long before the 1960s
craze for them. She also had a long cigarette holder in which were
held, in a vertical position, her Camels. This was an integral part of my
grandmother’s morning constitutional, and she smoked her cigarettes
in the bathroom, as testified to by the many burn stains on the rug and
toilet seat.
Both grandparents also took me to the horse racetrack. Usually,
my grandfather placed six or seven bets for one race. After each race
he went up to the window to collect his winnings. All the bystanders
thought he was a horse-racing wizard, a Guys and Dolls Damon Runyan
character. But going to the races was a source of entertainment to my
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grandparents—just as they themselves were a source of happiness for
me and for all my siblings, who they adored and indulged equally.
My grandmother also loved to gamble. After my grandfather’s
death, she flew down to Nassau to stay with my Aunt Miriam Krock,
my father’s sister, who became a close friend. The prime motivation
for my grandmother’s trips to Nassau, however, was playing craps. She
would dress up in her uniform, abandon her wheelchair, and head
to the casino where she would, inevitably, win—and attract a crowd.
Wherever she went she was always very popular.
My grandmother’s astuteness with money was not limited to casino
gambling. She also played the stock market with great aplomb, and
made a lot of money by, in particular, investing in AT&T stock. She
loved to buy on margin and called her broker ritually every morning to
catch up with the latest market trends. In addition to checking in with
her broker, she also religiously relied upon the Boston Globe horoscope
to guide her decisions on any given day.
For years, my grandmother prepared extravagant holiday dinners
and she made the world’s most delicious gefilte fish. The fish themselves
were nauseating to look at and they smelled awful, but the final result
was sublime, even though my grandmother insisted upon leaving the
skin and the bones in the dumplings because she loved to suck on the
bones. She also made a very unique stuffed veal brisket for the holidays.
Chopped liver was another of her specialties, made using one of those
old-fashioned grinders that clamped to the end of the kitchen table.
When it came to cooking, she was not one for precision, much to Judy’s
frustration, who once pleaded with her —to no avail—for measurements
so that she could repeat the recipes at home.
When my wife and I were married in 1980, my grandmother insisted
on having a party for us. According to kosher Jewish tradition, one
cannot mix meat and dairy dishes together; instead, kosher households
have separate sets of dishware for each—milchik, for dairy, and fleishik,
for meat. By law, Jews cannot eat lobster, which is treif (unkosher), but
my grandmother loved it and insisted on having it on our wedding
menu. She worked around the rules by serving hors d’oeuvres inside
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and then moving everyone outside to dine on the lobster, served on a
third set of treif dishes. We consumed this forbidden feast out in the
backyard to avoid mixing with the other sanctioned food.
Another food-related eccentricity of my grandmother’s was her
habit of serving food on an ingenious hybrid potty wheelchair that my
grandfather had used. After his death, she resurrected the potty chair
as a serving tray and would wheel it into the dining room laden with
heavy-to-carry fare, such as her trademark chicken soup with matzoh
balls. Equally hilarious, and a little creepy, was the time we took our
children to visit her overnight. In the morning, when they demanded
cereal for breakfast, my grandmother poured out the contents of a box
so old that it was writhing with maggots. She was a true character!
They were certainly very different from my paternal grandparents,
Charles (Charlie) and Bessie Alpert, who were not as close. My
grandfather Charlie was a loud, garrulous man in the printing business
and, apparently, a very astute businessman in the vein of first lieutenant
Milo Minderbinder in Catch 22. Aside from his sister, Miriam Krock,
my father—who was the baby in his family—had two older brothers,
Louis and Ferdinand (Ferdy). Together with my grandfather, my uncles
and father were in business together, although my grandfather and
uncles eventually bought out my father.
My grandfather Charlie was a mafioso-like figure. He was the chief
of the family and whatever he said was to be taken as an absolute
commandment. He ruled the roost, and my grandmother, a firstgeneration
American, was a beautiful but very docile Jewish wife. She
played no role whatsoever in my life. Sadly, he died of colon cancer in the
1960s after undergoing botched colon surgery at Massachusetts General.
My grandmother died some years after him from stomach cancer.
On my mother’s side, sadly, I do not know much about my
grandmother’s origins aside from the fact that she was a secondgeneration
American whose family was from Russia. My grandfather,
Eli, was born in Lithuania and came to America with his brother Ben
as a young boy, following an older brother who had immigrated to
Boston, and arrived in Boston, via Montreal.
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Because he was a bright student, Eli’s parents wanted him to be
a rabbi, so, initially, he studied at the Yeshiva, but he did not like it.
He then completed his high school education at Boston English, an
academically select public high school. After high school, he went to
Harvard in 1912, but he decided to become a doctor and transferred
to Tufts Medical School. He completed his medical training in Boston,
where he became interested in pediatrics, a new specialty. Ultimately,
he was one of the first pediatricians in the country, and he later became
the chief of pediatrics at the Beth Israel Medical Center in Boston,
which has since become a Harvard affiliate.
In his autobiography, my grandfather included some fascinating
stories about his medical experiences, such as how to care for patients
prior to the existence of penicillin and how to treat illnesses such as
diphtheria and whooping cough. He had a favorite philosophic quote
that he always cited to patients when treating them: “tincture of time
is important.” It underscored the importance of having the patience to
see if a specific treatment would have an effect. I thought the comment
was so wise that I later ended up adopting and modernizing it, telling
my own patients, “Take two aspirins and call me in the morning.” It is
not that I was dismissing them; I was being patient, waiting to see if a
set of symptoms evolved to help diagnosis and treatment.
Another favorite comment of his was: “Is it post-hoc or propter-hoc?”
(Latin for “after the fact or because of the fact”), by which he was
referring to whether a medical event was independent of or caused by a
specific diagnosis. Ultimately, there are many Eli-isms that have seeped,
consciously or not, into my practice of medicine.
My grandfather’s pathway to medicine represents how immigration
can have a positive effect in giving one the opportunity to succeed.
Grandpa Eli was a role model for me, particularly in the way that he
was so involved with his patients. As a child, I remember how he took
me on house calls around Boston, and I was fortunate to witness the
kinder, gentler aspects of what he did as a physician. Along with his
equipment, he always carried a roll of nickels with him, and at regular
intervals he went to a public phone to call his answering service to
23

check if anybody needed him. I say “he,” but in truth, it was “they,”
because my grandparents were inseparable and my grandmother
always accompanied him. My grandmother was completely enveloped
in my grandfather’s life, and vice versa, giving up a singing career as a
graduate of the New England Conservatory of Music. Their complicity
and union provided a very positive role model for me.
Back then, Eli drove a Cadillac because it represented success and
safety. He had attached a search light to the top of his outside mirror
to read house signs. In the winters, because Boston was so cold, my
grandparents sat beneath a leopard skin blanket. One time, the blanket
got caught up in my grandfather’s feet and instead of braking, he hit the
accelerator, driving right through the plate glass window of a Stop and
Shop grocery store.
While my grandmother often resided in the spotlight, my
grandfather was the éminence grise of the couple. As much as she was
over the top, he was understated, but if he was more reserved than my
grandmother, he had his own idiosyncrasies. I specifically recall him
reading The Jewish Forward, a Yiddish newspaper. He used to say that
his wife’s name was “Edi Come,” because whenever they went out, he
would be anxious to go home, while my grandmother was loathe to
leave a conversation, so he would start pleading with her, “Edi, come!
Edi, come!”
My Aunt Miriam was my father’s older sister, and they were extremely
close. Her husband, Edward Krock, was a very wealthy industrialist and
they lived in an enormous mansion on a sprawling, luxurious estate in
Brookfield, Massachusetts called Rocking Horse Farm.
Miriam and Ed had an adopted son, Richard, who was just a year
younger than I. As youngsters, we were playmates, and I spent a lot of
time at their mansion in Brookfield, Massachusetts. Their home was
lavish, with countless bedrooms, bathrooms, and sitting rooms, as well
as an artificial lake, a swimming pool, and a tennis court where I often
played with Dick. They also had peacock and pheasant coops, and kept
multiple cocker spaniels as pets. The estate resembled a segment from
Lifestyles of the Rich and Famous.
24

In a sense, it was kind of selfish of me to exploit their style of living,
but Aunt Miriam was always very magnanimous. When Dick and
I were young, she would take us to New York, where we went to FAO
Schwarz. My cousin loved some of the toys that were there, particularly
miniature horses from Hopalong Cassidy and Roy Rogers, and Miriam
was very caring of me. If he got a horse, then so did I. Every year, her
family wintered at Boca Raton, Florida, and one Christmas vacation,
they invited me to spend a week at the Boca Raton Hotel and Club,
where I golfed and played tennis.
I love the Red Sox, while Dick rooted for the Yankees. Once, Miriam
obtained tickets to see the 1960 World Series in New York, where the
Pittsburgh Pirates played the Yankees—an irony, since I ended up being
a Pirates (and Red Sox) fan. Another time, she had one of Dick’s high
school teachers take us to New York to see My Fair Lady on Broadway.
We also went to the Automat and the Empire State Building; it was a
really wonderful time. Miriam was not trying to buy me. She was just a
very doting woman, and she and Ed included me because I was Dick’s
playmate and Joe’s son.
Unfortunately, when she was in her 60s, Miriam developed ovarian
cancer and died prematurely. As we got older, Dick and I were less in
touch because he had gone to private school at the Williston Academy,
followed by study at Tufts, where he did not do well. Emulating his
father, he ended up transferring to the Babson Institute, a financial
school in Boston, and pursued a career in business with his father. At
that point, we no longer had any common interests.
As for my Uncle Ed, he had several business partners and together
they became involved in some questionable business deals. As a result,
he was indicted by the government for income tax evasion. In order
to avoid prosecution, he fled the States and sought refuge in Nassau.
Initially, he lived on a houseboat, before moving into a mansion
formerly owned by Sidney Poitier.
After Miriam died, I completely lost track of Dick. The last time I saw
him he had married, and we met him and his Swedish wife on vacation
in Nassau. As far as I know, he now resides on the island of Guernsey.
25

My parents’ wedding picture
26

The New York Times of the day I was born
27

Me and my mother
My father’s announcement of move to Laconia
28

“Lefty”
Jon, Bess, Father, Mother, Jeff, me, Charlie, and Marc
29

Aunt Miriam, Grandfather Eli, Grandmother Edith and Mother
Grandparents, Charles and Bessie Alpert
30

CHAPTER TWO
New Hampshire
I
found growing up in New Hampshire in a town of just 14,000
residents to be a special experience. Because we were surrounded by
lakes and mountains, there were many fun outdoor activities available
to us in the region.
At first, my family lived in a rented house, until my father purchased
a home with a huge yard just outside of town, which we renovated. It
was across the street from a lake where we kept a boat, and we all took
up waterskiing. Our next-door neighbor was a veterinarian who had
a grove of maple trees, so when the sap ran in the spring he hosted a
sugaring off party in which everyone helped to harvest the sap. The sap
was then boiled to transform it into maple syrup. I remember that we
drizzled the thick amber syrup all over fresh snow and ate it—a bona
fide snow cone!
Growing up, I was somewhat of a goody two-shoes who almost never
got into trouble. There were, however, several notable exceptions. In
Grade 5, there was a rebel, Ralph Gable, who talked me into playing
hooky from school one afternoon. Much to my chagrin, only a short
time after we left the school premises we unwittingly ran into somebody
who worked in the principal’s office. When I was subsequently called
in to the principal’s office to account for my crime, I lied and said I had
been going home because I was not feeling well, and that Ralph had
offered to accompany me. Because I had a reputation for being such a
31

good student who stayed out of trouble, the principal believed me, and
I escaped reprimand.
When I was a freshman in high school, I had two friends I used to
spend time with, Mike Tannenbaum and John Trapp, both of whom
were more adventurous than I. We used to play table hockey together
after school. At the time, the legal minimum driving age in New
Hampshire was 16, but I remember that when we were all 15 John
took his father’s car out and the three of us went driving. I had a lot
of trepidation about this jaunt, but I wanted to be part of the group.
Needless to say, I never told my parents. Fortunately, when I turned 16,
I got my driver’s license, which gave me a certain degree of freedom.
Sports were very important in Laconia, and, although I liked
them, I was, apart from skiing and golf, never very good at them.
In elementary school, I was not sure that I was aware of my sports
failings, but in high school it became more of an issue. At that time,
as a younger person, being good at sports provided one with access to
the “in” group.
As a youngster, I played a lot of pick-up touch and tackle football,
but I always got picked last. When I was younger, I also played Little
League baseball, which I enjoyed; however, my only advantage was being
left-handed, which helped with pitching. Otherwise, I was a mediocre
baseball player, and my hitting was terrible. My big mistake was that
my parents played golf and they taught me how to play right-handed,
since left-handed golf clubs were very difficult to come by. This, in
turn, ruined my left-handed batting, and I had more strike-outs than
the walks I would have received if I had been batting lefty.
Choosing an alternative sport, I joined the high school’s golf team,
but I was disappointed that, after four years on the team as second
seed, I did not make captain as a senior. The reason for this was that my
father insisted we take a father–son fishing trip up to Maine in spring
each year. The week he chose always coincided with the first week of
golf season, and I think the golf coach resented my yearly absences. In
the end, I did receive my letter that I could proudly wear on my Laconia
High School jacket, but nothing more.
32

Laconia lived and died with its basketball team. I remember trying
to play basketball with the elementary school team, and this time the
problem was that while I am left-handed, I am right-footed. As a result,
whenever I had the chance to try a lay-up, the wrong leg would go up,
which really made it difficult for me. It became obvious to me, and to
everyone else, that I was not going to be NBA material.
In high school, I attempted a foray into football. In a small town like
Laconia, the high school football team was everything, especially on a
Friday night. Before high school, like all kids, I played touch and tackle
football, but once we got to high school, organized football reigned.
For a time, I actually played Junior Varsity ball, largely because they did
not reject anybody at all at that point. Consequently, I went through all
the training, running up and down hills and vomiting, and keeping my
smelly clothes in the gym. Not surprisingly, since I was small, I was not
very good. I wanted to play tight end and linebacker, but I almost never
got the chance to do so. I think there was one time where I finally did
play at the end of the game. My mother actually came to see me for
that one.
At Laconia High, one’s performance on the field was directly related
to one’s social standing. The most popular boys played on the football
team and went to all the dances with the most popular girls.
While I did not shine on the football field, I had better luck on the
debating team. One of the teachers was well known in the National
Forensic League circles and routinely sent winning teams from
Laconia to the nationals in Montana. I was not the best on the team
by any means because I hated extemporaneous speaking, but I enjoyed
debating because it involved accumulating a set of facts regarding a
given subject, and then creating a paradigm to prove one’s case.
I bonded with a girl named Francie Allen, my partner on the
debating team. Francie and I were together because she was Allen and
I was Alpert, and, in consequence, we sat next to each other in class.
She was a very bright student who was also a good skier, and we became
good friends. Debating was really a lot of fun, and we traveled all over
New Hampshire to debate other teams. We won more than we lost.
33

Regardless, I would come away from each encounter doused in sweat
(I sweat an awful lot) because public speaking makes me very anxious.
To this day, I loathe speaking in front of people, despite having had to
give multiple lectures as an academician.
In pre-PowerPoint days, I used to rely on slides to avoid speaking
extemporaneously. Years later, I am now at the point where if I am asked
to speak, I will decline because of my discomfort at transitioning to
PowerPoint. It is just too much work to create a PowerPoint presentation.
As for Francie, she went to Smith and then married Roger Rosenblatt,
a Jewish boy from my community. He was brighter than I, and his
parents sent him to Exeter on a scholarship. He was accepted into
Harvard a year before me and graduated early because he accumulated
so many APs. Interestingly, he ended up going to Harvard Medical
School and then the University of Washington where he specialized
in internal medicine, before marrying Francie. When I returned
to Laconia for my 25th and 50th high school reunions, I was very
disappointed that Francie did not attend because I would have liked to
reconnect with her. I heard recently that Roger sadly died of cancer, but
otherwise, I do not keep in touch with anybody from my high school
years at all. When I left Laconia, I felt it was just time to move on, and
I guess I have felt that way ever since.
There were several students who were on my level in high school
and that I could talk to or deal with comfortably, and Francie was
one of those people. Others were Sherry Simmons, who later attended
Wellesley, and Jeff Bowen, who went to Williams. They were all in the
outsider group, but unlike me, this seemed never to bother them.
The fact that I was not great in sports was problematic for me
socially. As I grew older, it was not that I was unpopular, but more
that I was kind of an outlier. I had to find my own niche and was
sometimes frustrated by my social issues. My high school was small,
and, in truth, it was an embarrassment socially to be as academically
strong as I was. I actually spent my time in high school downplaying
my academic achievements with classmates so that I could be accepted.
I was always on the outside because of my grades, so I had to work very
34

hard to make friends. In the end, I did finally find a coterie of people
with whom I felt comfortable. This was not, though, at Laconia High
School, but at St. Paul’s, which I will describe later.
There were approximately 180 students in my high school class,
and only three of us were Jewish. Initially, I was friendly with Mike
Tannenbaum, but at some point, however, he became extremely friendly
with John Trapp, and they ostracized me. Ironically, when I returned to
Laconia for my 50th high school reunion, he and I reconnected. The
third person, Richard Brindis, was annoying and disliked by everyone,
and I felt that, because of him, I needed to distance myself, and not
dwell on being Jewish.
In high school, egged on by my mother, I took music and piano
lessons. Initially, I was quite devoted to the piano, even though I did
not play well. My prowess suffered as I grew older and other activities
came along that interfered with my practicing.
I was actually fascinated by the sound of the organ. So, in addition
to piano, I took a summer course in organ performance as part of a
fine arts program. Despite my enthusiasm for the organ, my playing
once again left much to be desired. But because I knew the organ, I was
pressured into playing it at a recital for DeMolay, a service organization
related to the Masons. I was also pressed into service to play the organ
or the piano for the high-school Christmas show. I remember doing
a hatchet job on “Good King Wenceslas.” Following that debacle,
I retired permanently from public playing.
Despite my performance setbacks, by the time I finished high school,
I had developed an appreciation for classical music which has remained
with me to this day. I was never a good musician—I have a poor ear for
music—but I very much enjoy listening. As an adult, I have amassed
an impressive vinyl collection in addition to cassette tapes and DVDs,
and, of course, now I stream. I have been a symphony subscriber for
40 years, and since I retired, I have taken several music online courses.
Bach is my favorite composer.
In the academic realm, my teachers recognized how bright I was,
and I always received straight As. My only B was in typing. I did not
35

eceive any special tutoring at my high school and there were no AP
courses, but I applied for and was admitted to an Advanced Studies
Program at St. Paul’s School in Concord, New Hampshire, which
accepted gifted public high school students for summer enrichment
courses. The program allowed students to take advanced-level highschool
courses in a competitive and stimulating atmosphere. The first
year I was admitted, I took advanced biology, and the following year
I took modern European history, my two competing interests: science
and social science.
I ended up as ranking scholar, first in my class in European history,
for which I received an award. It was gratifying to me to have it
confirmed that I was in a very elite group. I was not so much surprised
as just feeling that I had probably been intellectually muzzled in high
school. What the award meant to me was that I could be competitive
academically at the next level. Just as importantly, I socialized with
peers who valued intellect over sports.
The courses at St. Paul’s were challenging, but what really excited
me was being surrounded, for the first time, by students with my
interests. Finally, I could engage in intellectual conversations and
admit that I read The New York Times on Sundays. The program turned
out to be a very positive, formative experience for me, one that I did
not get at Laconia High, where I completely stood out—and apart—from
my classmates. But there was an added positive. Based on geographic
distribution and diversity, coming from a very small public school in
northern New England contributed to my acceptance at Harvard.
Another plus from St. Paul’s was that I had my first serious relationship.
This was with Linda Frail, a girl from Manchester who was studying
Russian and whom I dated through the fall of my senior year. She
provided a new social dimension, but we drifted apart and did not,
unfortunately, reconnect when she went to Wellesley and I to Harvard.
Ironically, despite my strong academic bent, I did not engage in
much reading as an adolescent. When I was younger, I mostly gravitated
to books such as the Hardy Boys mysteries and, later, biographies.
Perhaps as a result, I was never strong in English; my verbal skills were
36

weaker than my math skills and I never acquired a literary background,
reflecting a significant discrepancy on my college board SAT scores of
650 and 720. (To this day I hate writing, hence my decision to have
help with this book.)
My parents never encouraged me to read, and in fact they did not
strongly encourage me academically at all. When I was younger, I think
they just wanted me to be a child. As a result, I was very self-directed.
I did, however, receive some help from my mother, who showed an
interest in my academic career when I was in high school. As bright
as I was, I struggled with geometry, so she helped me with homework.
She was also my editor and helped me to write and proofread different
papers, even during college.
My mother also encouraged me intellectually. As noted previously,
she invited me to join a Great Books group she belonged to, in which
participants read renowned works of literature, and she also suggested
I join the Council of International Relations to discuss world affairs.
While I believe that, in part, she was trying to stimulate me, I also
believe her goal was to show me off to other people, to flaunt my
intellectual capacities.
Although Laconia was an idyllic place to grow up as a kid, it was,
as a small town, increasingly stultifying for me by the time I finished
high school. When I considered colleges, I wanted to be in an academic
center and go to the best school I possibly could. I also desperately
wanted to get away from a small town and, hopefully, to be in a large
city. With these desires in mind, I applied to Harvard, Yale, Princeton,
Penn, and Tufts.
In truth, I did not want to go to Yale because I did not think New
Haven offered much outside of the Yale campus, but my principal
told me that if I wanted to go there, he could guarantee admission
because of my school’s track record. Even though I was not very much
interested, I did apply. Harvard was my first choice because I was
infatuated with Cambridge and Boston, and I felt it would provide me
with a more expansive college experience. Penn was my back-up school.
I liked Philadelphia, (which would, coincidentally, play a big role in my
37

family’s future, with both my brother Marc and me attending medical
school there, as did my son Craig, while my brother Jon got an MBA
from Wharton, and my son Josh did his undergraduate degree at Penn.
In addition, and just as an aside, my two daughters-in-law also went
to Penn). I applied to Tufts as a back-up, but what I truly desired was
to go to Harvard. Having grown up visiting Boston, I knew the city
well, and that is where I wanted to go, although Philadelphia was an
acceptable alternative, if necessary. Princeton was an afterthought, just
to complete the Big Three.
I was very competitive and never considered not applying to these
top schools. I figured, why should I not apply to the best? I applied
that sense of ambition to everything that I did back then, and I was
certainly qualified. Although I was aware that I might not get accepted,
I was mortified when I received a letter in April of 1963 announcing
that I had been placed on the wait list to Harvard! I was crushed.
Although my mother was very sympathetic to my disappointment,
I got no reaction from my father. I had no understanding of his
attitude; perhaps he was jealous. But from that point on, I never
received any support from him, despite all my academic success—no
sympathy or empathy.
Not too surprisingly, I did not get accepted to Yale or Princeton,
which I never really liked, but I was accepted at Penn.
Fortunately, aware of my despair, Phillip Hugny, the head of the
summer program at St. Paul’s School Advanced Studies Program,
called Harvard admissions. “How could you do this?” he demanded.
“Barry is one of our top students!” He argued very strongly that
I should be admitted, banking on his relationship with Harvard as the
headmaster at St. Paul’s. To my great relief, one month later I received
full acceptance. I quickly suppressed the fact that I had been wait-listed,
convincing myself that, in the end, getting into Harvard, even off the
waiting list, was the most important point.
My grandparents were thrilled to have a grandson who was going
to Harvard, which was a wish come true for every Jewish grandparent.
When I later chose medicine, their pride took on an added dimension.
38

Of my schoolmates who went on to college from high school,
the majority went to places such as Plymouth Teachers College or
University of New Hampshire, but, in truth, probably more of my
former classmates went off to barbershop school and the military than
went to college. Only around 10 of us ended up attending known
schools. Francie went to Smith, Sherry Simmons went to Wellesley, our
football jock went to Dartmouth, Mike Tannenbaum went to McGill.
My competitor for valedictorian went to MIT, and Jeff Bowen, the son
of the school superintendent who, like me, was very smart and socially
ostracized, went to Williams.
It was interesting that I went from Laconia High to Harvard.
After all, academics just were not stressed strongly at my high school.
I still remember that in Grade 8, I had to take a vocational arts class,
vocational arts being prized in a small New Hampshire town. One
of the electives was woodworking and our first project was to make a
breadboard. We had to use a level to make the edges perfectly flat, and
I ended up with the smallest breadboard in the class! I was even worse
when it came to metalworking and print shop. Ultimately, the only
activity in which I did not completely humiliate myself was mechanical
drawing.
Once I was admitted to college, I left Laconia, never to return.
Although I enjoyed high school and ended up being class covaledictorian,
I also found it difficult because of the social pressures
I faced. I was always aware of the fact that people saw me as “different,”
and I don’t think this was because I was Jewish. I never encountered any
overt anti-Semitism, and people were unfazed by the fact that I went to
Hebrew School every Tuesday and Thursday. Friends from school even
attended my bar mitzvah. It could have been because I was so bright,
but ultimately, however, I just felt apart from everybody else and that
fueled a sense that I was in the wrong place, that there was something
more out there, waiting for me.
In terms of my family, I was the oldest of six at the time and had
the urge to be independent. Moreover, there is a self-preservation
gene in my family that verges on self-centeredness. Individualism and
39

taking care of one’s own needs first and foremost were values that were
instilled in all of us by parental example. As such, the moment I left
home for Harvard in 1963, I did not have any regrets. By then, I did not
have a particularly close relationship with my parents or my siblings.
Ironically, my departure coincided with that of my family’s move
from Laconia when my father pursued a change in career. In 1964,
he decided he wanted to reorient his career to a subspecialty, and he
enrolled in a fellowship program in vascular surgery at Montefiore
Hospital in the Bronx, which involved moving to Larchmont, New
York for a year. Subsequently, he was offered a job at Newark Beth
Israel Medical Center in Newark, New Jersey. My parents and younger
siblings moved to temporary housing in Newark and then to Westfield,
New Jersey. After that, I really only saw them when I came home for
vacations and holidays.
Me as a state winner
40

High school yearbook
41

CHAPTER THREE
Harvard
A
seminal moment occurred during my second year at St. Paul’s.
The head of the program, Phillip Hugny—the man who had fought
successfully to get me off the wait list for Harvard—invited me to be one
of two students interviewed on a local radio program. I remember that
the interviewer asked me, “When you arrived at St. Paul’s, did you
discover that you were not as smart as you thought you were?”
My response was: “Absolutely not. Rather, I realized that there were
people smarter than I.”
That realization carried me through college, because at Harvard,
there were students who were extraordinarily bright. I encountered
students who were absolutely brilliant, while I had to work hard for
my grades. I learned to accept the fact that there were people who were
smarter than I was, which was both humbling, and yet comforting to
me. I felt that I belonged there. Looking back, I think my response on
that radio program was both correct and very profound.
Harvard has always been very important to me. I have never been
afraid to let people know that I attended Harvard because it gives
people a favorable initial impression. Given the fact that I never got my
“stroking” from my parents, it made me feel good. I also found that it
might open doors for me in my career.
When I arrived, I felt like a kid in a candy store; there were so
many intellectual activities going on—lectures, clubs, courses—and,
43

most importantly, the intellectual environment from my classmates.
My only regret was that I could not do it all because, regrettably, there
was not enough time to devour all the options so tantalizingly on offer.
Arriving at Harvard as a freshman, I was placed in a room in Strauss
overlooking Harvard Square with two other classmates, Harris Hartz
and Steve Fulling, all of us, presumably, computer matched. They were
physics and advanced math majors who later graduated summa cum
laude, and I had absolutely nothing in common with either of them.
Our dorm consisted of two rooms with bunk beds and a living room.
As soon as I arrived, I lay down on the bottom of one bunk, placing my
belongings on the top, thus staking claim to the entire room for myself.
As a result, the other two shared the second room. Steve had a strange
habit of going to the bathroom and urinating while reading books. He
became a professor of advanced math at Texas A&M. Harris went on
to law school and subsequently became a federal judge in New Mexico.
Our paths never crossed after freshman year.
In the mid 1960s, there were always riots at Harvard for crazy causes
such as “Save the Sycamores” on Memorial Drive. During my freshman
year, a riot broke out, with students tossing water balloons from my
dormitory. Although I was only looking out the window, the authorities
believed that I had been involved and interrogated me. I was afraid that
I would be punished, but fortunately, they believed in my innocence.
When I entered Harvard, I had absolutely no idea what I wanted to
do in terms of a career, and I certainly had not considered medicine.
Despite having taken advanced biology, my academic background had,
up until that time, focused on the social sciences, so I took a Kuder
preference test. Reflecting my math proficiency, the results suggested
a career as a manager of an accounting firm! I, though, thought that
I should explore the social sciences in more detail, and consider
business and law. But I also wanted a liberal education, so during my
first year I took economics, psychology, and calculus courses. Thinking
I needed a French requirement, I also felt compelled to continue my
high school French. I did not care for economics, pointing me away
from a business career.
44

During the summer of my freshman year, my grandparents, through
a patient’s family, got me a job in a meatpacking plant in South Boston,
where I, with Italian immigrants, packed Swiss steak for army contracts.
At the time, my family was moving to New Jersey, so I lived with my
grandparents for the summer, and I enjoyed a vibrant social life with
some friends from Tufts who I had met while skiing.
It was a fun summer, even though the job was boring. The irony was
that I was this Harvard student doing a menial job with all of these
Italian immigrants. Yet, despite our different backgrounds, we really
bonded, and my colleagues really liked me. My grandparents then got
me another job in which I sorted magazines for a magazine distributor.
In retrospect, these jobs were very valuable in terms of teaching me
how to deal with people. I remember asking one of the meatpackers to
help me make a false ID so that I could get served alcohol at 19 instead
of the legal age of 21. That summer I also went to the Newport Folk
Festival with two friends, Mark Orenstein from Tufts, whom I had
met on a ski trip, and my cousin Dick. Since there was no place for us
to stay but there were a lot of empty mansions with no occupants, we
entered one and slept on the floor. It was so unlike me, but great.
Ironically, many years later, my family thought that I had been at
Woodstock, which was, I suppose, a compliment—they did not think
I was so straight after all—but I had to confess that I had not been there.
At the end of my freshman year, with a life in business off the list,
I still did not know what I wanted to do for a career. I decided at
that point that I would move on to the idea that I might become a
lawyer. At the same time though, the thought crossed my mind that
since my father and grandfather had careers in medicine, this might
be a possibility for me. Consequently, as I entered my sophomore year
I decided I might benefit by taking my minimum science course prerequisites
in conjunction with a government major.
To fulfill my bachelor’s degree, I had to have a certain number
of credits in natural sciences, social sciences, and humanities. In my
sophomore year, I opted for biology and chemistry along with a course
in government. I also had to take a literature course, so I enrolled in
45

“Humanities II: Epic and Drama.” The first semester, the professor was
a renowned classicist, and we studied The Iliad, The Odyssey, The Divine
Comedy and Paradise Lost. During the second semester, our professor
was William Alfred, a playwright and an English professor. We started
off with Aeschylus and progressed to Arthur Miller and Waiting for
Godot. I actually enjoyed the course, despite being nervous about the
type of writing assignments involved. I therefore opted for being a
government major, and the As I received in both sciences allowed me
to straddle possible careers.
During sophomore year, we were placed in different houses, the
equivalent of dorms, and we had to choose our own roommates. Each
house had its own dining room and activities, so one got to know
one’s housemates quite well. I was placed in Winthrop House, along
the Charles River. There was a classmate who had lived across the hall
from me in my freshman year with whom I was friendly, but he had
already made a commitment to room with someone else, and I had a
very difficult time finding a roommate for that year. Ultimately, there
was another student, John Rath, also without a roommate, whom I had
known from St. Paul’s. He had taken advanced math there and was a
math major. We connected and ended up being roommates for three
years.
The summer of my sophomore year was unforgettable. I had taken
French during my freshman year, so when I discovered that a classmate,
Barry Goldstein, was going to France for the summer to study, I asked
if I could join him. Since he was 6 foot 4 inches tall, he was “Barry Le
Grand” and I was “Barry Le Petit”. As a result, I spent that summer in
France, auspiciously becoming the first in my family to journey beyond
the United States.
Initially, I spent four weeks in Paris where I had a homestay with
an interesting family who lived near the Eiffel Tower in Paris’s upscale
7th arrondissement. The father, Louis Olivier, ran the Paris office
of Disney productions. Their son, Antoine, was a year younger than
I, and we became close friends. Together we played tennis and went
swimming in the piscine located along the Seine. Antoine and his
46

family also helped me considerably with my French by refusing to let
me speak English. I learned a great deal from watching French TV
without subtitles too—I remember watching dubbed movies, including
Les Intouchables (The Untouchables). I felt encouraged by the fact that
many people mistook me for having a German accent instead of an
American one. Somehow, being mistaken for a European seemed like
a compliment.
My daily routine began with morning classes at the Sorbonne,
where I studied French as a second language with a mixed group,
including Swedes, Scots, and Spanish, two of whom became good
friends. Sometimes we did cultural excursions, visiting the Louvre and
Versailles with our teacher. I had lunch at the Cité Universitaire or at
home, before enjoying free time, often in the company of Antoine, and
actually spent a lot of time just discovering Paris. In the company of my
friend Barry, I also visited Paris’s boîtes (night clubs), sometimes staying
out until 3 a.m., and walking all around the city, since I did not have a
curfew. Barry was somewhat of a womanizer, and I remember that he
met a girl one night, which upset me because I did not have anyone,
so he arranged for his girlfriend to introduce me to her friend, and
I danced with her and walked her home.
After four weeks in Paris, Barry and I rented a car, and on August
1, we battled hordes of French vacationers fleeing the city to make
our way down to the Côte d’Azur. I had never driven a stick shift car
before then. Because the traffic was so bad there was lots of stopping
and starting, and I kept stalling out all the time. We finally made it
and had a fun week in the hills above Cannes before heading to Pau,
a small town in the Pyrenees near the Spanish border, where we took
a three-week French language course at the Université de Bordeaux
et Toulouse.
In our class, there was a set of twins from San Sebastian—beautiful
Spanish girls. Strict Catholics, they had very limited social experiences
in terms of interacting with boys, but we met them after class and
chatted with them, becoming good (platonic) friends. From Pau, we
enjoyed some weekend excursions, including a trip to Biarritz, where
47

I surfed for the first time in my life. Another weekend, we crossed the
border into Spain (at the time still ruled by Franco) to explore San
Sebastian.
At summer’s end, I returned to the U.S. with a very good
understanding of French and the ability to speak it quite well. To this
day, I continue to love Paris, and spending a month in the city is on
my bucket list. I can read French now, although I still have difficulty
understanding and speaking vernacular French. I remain a die-hard
Francophile.
Back in the U.S., Barry and I lost touch as we were in different
houses with different friends. In truth, I am kind of introverted, and
I have never made a lot of friends, in contrast to my son Craig, who
creates a permanent bond once he meets someone. I will usually strike
up a relationship, enjoy it for a short period often prescribed by context
or circumstances, and then move on from it. As a result, I have never
collected a lot of friends, although a second roommate in my senior
year, Ken Roemer, is an exception to that rule.
During my junior year, I split my focus between courses in history,
government, and pre-med sciences. Harvard prided itself on its junioryear
tutorials—weekly sessions during which a student and a faculty
member were paired up to engage in studies on a one-on-one basis. My
weekly tutorial on government with Nadav Safran, an Egyptian Jewish
Middle East scholar, was definitely one of the academic highlights
of my junior year. Together, we explored a new idea that Safran was
developing at the time relating to sociology and political science. Being
part of that formulative process was interesting but, ultimately, foreign
to me, and I felt that my junior tutorial was not as interesting as I would
have liked. That year, I also took physics, as well as courses that delved
into American foreign policy history, the history of U.S. presidential
power, and Chinese and Japanese history. At the time, considering a
career path as a lawyer, I took a history of the U.S. Supreme Court,
which became my favorite undergraduate course and played a part in
my potential choice of future career. I also became secretary of the Pre-
Law Society.
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The summer between junior and senior year offered me a lifechanging
experience. My uncle, Ed Krock, had become a business
associate of Roy Cohn. As a young lawyer, Cohn entered the annals
of history when he acted as chief counsel to the infamous Joseph
McCarthy, the right-wing senator whose interrogations of alleged
communists during the Cold War had a frightening impact on freedom
of speech in 1950s America. Uncle Ed arranged a summer job for me
as a clerk in Cohn’s back office so that I could experience the legal
profession. My duties included delivering papers to law firms, running
errands, picking up legal decisions at court, and serving papers. Setting
aside my personal feelings about Cohn and his controversial past,
I gained significant insight into the law profession, much more than
I had achieved from the intellectual experiences of writing legal briefs,
delving into law review papers, and consulting prior decisions, all of
which had been part of my Supreme Court history course at Harvard.
I spent much of that summer simply shuffling papers and generating pro
forma responses, with surprisingly little person-to-person interaction
or intellectual stimulation, which I craved. By the end of the summer,
it had become clear to me that a law career was not for me.
Coincidentally, during that same summer, while riding the subway
from midtown Manhattan to the courts downtown, I passed the
time in transit reading Intern by Dr. X. Authored by a Johns Hopkins
graduate doing his internship in Phoenix, Arizona, this fascinatingly
detailed account of day-to-day life in a hospital was utterly gripping
to me—so much so that I realized that I wanted to become a doctor.
Thank you, Roy Cohn!
During our senior year, John Rath and I joined together with
Ken Roemer and Geoff Emerson, who were also living in Winthrop
House, to make a quad from our two-bedroom suites. We had a suite
overlooking the Charles River, with each of us having our own room—a
luxury!
Ken’s freshman roommate had been a fellow named Robert
Samuelson. He worked on The Harvard Crimson and later became an
economics reporter, writing for Newsweek and later for The Washington
49

Post and The New York Times. Currently, he is a commentator. However,
Sammy was so involved with The Crimson that he basically lived in the
newspaper office. In his sophomore year, Ken found a new roommate
in Geoff, and, like John and me, they were assigned to Winthrop
House.
Ken and I have been very, very close since our university days. After
graduating from Harvard, I went to Penn Medical School and he went
to Penn for a PhD in American civilization, where we continued as
roommates the first year, after which he married Micki, his highschool
sweetheart. After graduating, the job market was very tight for
university professors, so Ken was lucky to be hired by the University
of Texas at Arlington. He hoped to move up and then transfer back
to New England, possibly to teach at one of the small schools such as
Middlebury or Bowdoin, but it just never happened. Instead, Ken got
very involved at UT Arlington, where he is now an emeritus professor.
As an undergraduate, inspired by his mother’s philanthropic work
on behalf of Native Peoples, Ken became very interested in Indigenous
issues. During the summers, he often did volunteer work at pueblos
in New Mexico and subsequently became an expert on Indigenous
literature, teaching courses and authoring books on the topic. He
wrote his PhD thesis on utopian literature, another specialty of his.
Additionally, he taught general American Studies. When he married,
I was his best man. Never having been to a Catholic wedding or
attended a Catholic mass, I was led to believe that I, as best man, would
have to participate in the Ave Maria. This created a significant amount
of anxiety, but it was just their joke to their Jewish best man!
Ken and Micki have been terribly kind to me over the years, always
looking out for my well-being, social and otherwise, particularly when
I was in medical school in Philadelphia. When I was in the air force,
I was stationed in San Antonio, Texas, and we were able to see one
another. But even when I was elsewhere, we always stayed in touch.
During our senior year, the four of us discovered that we were very
compatible… or at least, three of us were: Ken, John and I. In truth,
Geoff was a hockey player who did not like to study, and he actually got
50

into Harvard based on his hockey skills and legacy. Geoff kept separate
from us—he had his own life and his own girlfriend. He just took up a
bed when we all lived together in our fourth year.
As for John, he was a math major. After graduating, he was
concerned about the draft and had taken ROTC (Reserve Officers’
Training Corp). He went to Vietnam, but he was in Saigon the whole
time and avoided combat. Upon his return to the U.S., he completed
a PhD in applied mathematics at Stanford and then worked for Bell
Laboratories in central New Jersey as a scientist. He is retired now and
lives in New Jersey. Even though John and I were roommates for four
years, I have been much closer to Ken. I invited them both to Nantucket
for a long weekend a few years ago and we had a wonderful time. John’s
wife, Michele, who is an artist, dubbed us “the Three Amigos,” and
memorialized this relationship in a watercolor, which she sent to Judy
and me. It is now hanging in our Nantucket bedroom.
In terms of academics, John was a very strong student, and he
actually excelled a lot more than I did. He was brighter than I was
in math, but that never interfered in our relationship as roommates.
Ken, however, did not appear to be an intellectual, but he had an
imagination that made literature a good choice for him. Surprisingly,
he had a lot of issues with spelling, and I remember being shocked to
find so many mistakes when I proofread his papers. He just could not
spell, which does not, apparently, correlate with intelligence. He was
and is a wonderful person. He was seriously involved in track and field
in high school, where he threw the shotput, but when he tried out for
Harvard’s track and field team, he was not selected to compete. As
I look back now, I am very impressed by how much he has succeeded as
a tenured professor and author, and what he has achieved academically.
Geoff went on to become an ophthalmologist in Hingham,
Massachusetts, joining his father in practice. As for me, I flourished
intellectually, but work was very hard. If one did not get As or Bs, a C
was almost a failing grade, as everything was weighted. It was easy to
get Bs and B pluses but difficult to get As and A minuses. Ultimately,
I ended up making the Dean’s list, with half As and half Bs.
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The worst grade I received at Harvard was for a government course
I had to take. I did well in the first part of the course, comparative
government, but the second part was political theory, which I hated
and for which I received a B minus. For my major, I chose international
relations as my focus. In my senior year, I took a course given by Henry
Kissinger, which, not surprisingly, was all given in the first person
singular. I was very proud of the A that I received in the class.
In addition to the government courses—which included one on
Freud—I used my senior year to branch out. I took a modern art
course, popularly referred to as “Spots and Dots,” and a comparative
literature course on bildungsroman, which refers to a story that follows
a character through the course of his or her lifetime. As part of my
undergraduate requirements, I also had to take a political theory course,
which I absolutely hated. Of note, the classmate who sat next to me was
Tom Ridge, the now former governor of Pennsylvania and the first
director of the Department of Homeland Security when it was created
in 2003. I also saved my last science course, organic chemistry, for my
senior year. I fulfilled my requirements without a thesis, and I opted to
graduate cum laude in general studies rather than in government.
In the 1960s, the two priority activities at Harvard seemed to be
studying and trying to find a date for the weekend. It was so different
from when Craig attended in the early 2000s. For his generation,
classes seemed to be secondary to extracurricular activities.
Although he did well academically, graduating with honors, he was
involved in so many other activities. He was on the business board
of the Harvard Lampoon, was in charge of the speakers’ program
at the Kennedy School of Government Institute of Politics for
undergraduates, volunteered to serve food to the needy at a church,
and did immunology research at Boston Children’s Hospital. The
Harvard experience was much more than just courses, and one was
encouraged to focus on far more than mere academia. But for me, it
all boiled down to studying and looking for weekend dates. In terms
of the latter, I did not meet with much success. I had better results
with my academics.
52

To my pleasant surprise, my non-dating social life at Harvard was
as important as my academic life. The dinner conversations I had with
my classmates were invigorating and compelling. Socially, I absolutely
flourished with my peers in that atmosphere. I could say what I wanted
to say, and my ability to converse and participate expanded enormously.
I actually listened much more than I talked at the dinners we had,
which frequently lasted several hours.
At Harvard, I learned to smoke a pipe, the preppy affectation of a
Harvard college student! I also learned to drink sherry in my freshman
year. I did not particularly like it, but it was fashionable at the time. At
late afternoon meetings with bow-tie-clad tutors, drinking sherry was
de rigueur. I later switched to more traditional beer and mixed drinks.
What was very memorable from that time was a group of us from
Winthrop House who all sat together at the dinner table. One of my
classmates had a ski house at Wildcat Mountain in New Hampshire, and
during one intersession, we all went on vacation there together. Even
though I was friendly with them, I also sometimes felt uncomfortable
in their presence, like the outsider I had been in high school. Since
I was the only Jewish member of the group, I always wondered whether
this played a role.
During our senior year, we had a 10-day interval between our final
exams and graduation. The parents and grandparents of one of our
classmates, Dave Hodges, had a house in Sconset on Nantucket, and
he invited our group to use it. We all met up on the Woods Hole ferry
and spent a week there together. It was a special time, the pleasures of
which were enhanced by my first experience with pot, Sgt. Pepper’s Lonely
Hearts Club Band, “Lucy in the Sky with Diamonds,” and horrible home
cooking. We just had a fantastic bonding experience at the beach.
I had lost track of these friends over the past 50 years, but I knew
that three of them ended up in the Washington area. One became a
lawyer, one worked as a research physician for NIH, and the third was
a professor at George Mason. They would get together every three or
four months to go out to dinner and discuss a book. When the Covid
pandemic hit, they decided to transform their discussions into a virtual
53

ook club, and in 2021 they invited 12 of us from Winthrop and
Nantucket to join for a virtual book club. Most recently it was Ken’s
turn to choose a book and lead the discussion. He chose an extremely
compelling work by an Indigenous author, and as he led the discussion,
I realized just how excellent he is at what he does. He had really chosen
the perfect career. I was so pleased that, after 50 years, they chose to
include me, and I have enjoyed the experience immensely, both for the
camaraderie and for the fact that each one of us can choose a book and
lead a discussion. As a result, I have read a wide range of books that
I would never have chosen on my own.
It really meant a lot to me to be invited to Nantucket back in my
Harvard days, and then, 50 years later, to the book club. As I’ve noted,
I’ve always been sensitive about being included because that was not
always the case. In fact, I had gone to my Harvard 50th reunion hoping
to reconnect with many of these friends from Winthrop House with
whom I had lost touch, and I ended up feeling excluded because,
unlike me, many of them had been in contact with each other over the
years. Even at the reunion itself, some of them drank, ate, and talked
together without inviting me into the fold. Indeed, the only positive
thing to come out of the 50th reunion was that I reconnected with my
roommate, John, and spent time with Ken and Micki.
I entered my senior year driven by the need to excel at pre-med
science courses. Since I was not a science major, I needed to do extremely
well. Up to that point, I had received straight As in calculus, biology,
chemistry, and physics. However, doing well in organic chemistry—the
most rigorous of pre-med science courses—was key to my admission to
medical school. Fortunately, I not only found the course to be easy and
enjoyable, but I also received a straight A, which made me competitive
for the most prestigious medical schools.
Although I had to take the medical college admission test, there was
not, at that time, the same emphasis on it as now prevails. I remember
simply reviewing my biology notes the night before the exam. There was
no Kaplan course for review. My subsequent scores reflected my overall
competence in the sciences. However, despite my admirable academic
54

performance, my unorthodox non-scientific academic pathway was a
source of concern that was, it seemed, shared by some of the schools to
which I applied. I was rejected by the more traditional schools such as
Harvard and Columbia College of Physicians and Surgeons. Yet NYU
not only accepted me but also offered me a scholarship. The University
of Pennsylvania also accepted me, as Penn administrators were trying
to make medical school more of a humanistic experience. With that
goal in mind, they were more willing to offer admission to candidates
other than traditional science majors. I had also applied to Tufts as a
back-up school. I was drawn to Penn, and to Philadelphia, because it
was the more competitive school. So began my Penn experience, and it
was wonderful. I truly believe that things happen for a reason.
55

Harvard diploma
My Harvard transcript
56

Dean’s List
Me and my parents at my college graduation
57

Graduation picture, college yearbook
John Rath and Ken Roemer, my college roommates
58

CHAPTER FOUR
Medical School
As I have mentioned before, my college roommate, Ken, was
accepted to Penn to do a PhD in American Studies. Consequently,
we decided to rent an apartment together. Together, we also learned to
cook and clean, and attempted to become self-sufficient. At Harvard,
we had been spoiled by dorm life, where perks included housekeeping
and dining halls. At Penn, we suddenly found ourselves left to our own
domestic devices. We would come together at dinner to share daily
experiences, but we had our own separate lunch friends.
Fortunately, I did not have to cook all the time. As a med student,
after anatomy, I would meet up with colleagues for lunch at Houston
Hall, the student hub, where there was a cafeteria. Whether we
wanted to or not, we were forced to sit together owing to the fact that
we all reeked of formaldehyde. No one else wanted to be anywhere
near us.
During that first year, I also bonded with a classmate, named Lew
Yecies, who became my best friend in medical school. He, unfortunately,
died prematurely of pancreatic cancer while in an allergy and
immunology practice in Watertown, New York. It was actually quite a
challenge to make friends at medical school since everybody had very
different schedules after the preclinical years. One rarely saw the same
people for more than one rotation. At the time, there were 120 students
in my program, only four of whom were women, which is markedly
59

different from today, with female students now outnumbering males
in med school.
As part of the medical school’s mission to become more humanistic,
during our first year of basic science the administrators sought to give
students a sense of medicine’s various specialties. Every week, we
embarked on a different “field trip,” having diverse and sometimes
quite unconventional experiences. For instance, I remember visiting
a psychiatric hospital at a time when many patients were being treated
with psychotropics. It was enlightening, and also unsettling, to
encounter people who were schizophrenic. We also visited a children’s
hospital and subspecialties such as ophthalmology. It was a wonderful
opportunity to see the tremendous number of options available to
us as medical professionals. It also made the school a kinder, gentler
place, since we were focused on patients and their plights, as opposed
to merely having our noses in books as we attempted to master the first
two years of the basic science curriculum. Commendably, the school
worked to integrate the science with the clinical. Aside from learning
scientific theory, we also witnessed basic science in clinical action.
This approach benefited me in that I did not really need the
background of physical chemistry or advanced science courses to
succeed. All I needed were the building blocks to correlate what
I learned in basic science and apply them. Consequently, I never felt
that I was ill-prepared for medical school.
Another interesting aspect of medical school was that we began
engaging in physical diagnoses from early on. Initially, making
diagnoses made me anxious because I had very little idea of what I was
doing. I remember performing an ophthalmologic examination on
a volunteer patient during which I found it very difficult to actually
see the back of the retina. It did not help that I had turned the
ophthalmoscope around so that it was pointing at my own eye. When
the patient pointed this out, I responded that, “This is just a different
way of doing the exam.”
While I never mastered the ophthalmoscope, I was fascinated by the
stethoscope. Listening to the sound of a human heartbeat enthralled
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me. At that time, hearing the various sounds and translating them
into physiology comprised a special skill. I remember a renowned
cardiologist, Abe Ravin, who simulated different heart sounds on
records. We would listen to the records and hear mitral stenosis, aortic
stenosis, and other murmurs reproduced. The irony is that nobody uses
a stethoscope anymore—one can obtain more accurate information
from an echocardiogram.
This early fascination with listening to the human heart fanned
the flames of my passion for cardiology. By the end of my first year
in med school, I already knew that I wanted to be a cardiologist. My
grandfather, thrilled at the prospect that I would be following in his
physician footsteps, gave me a subscription to Circulation, the journal
published by the American Heart Association. Obviously, I did not
know much about what I was reading then, but I saved all the issues
for later reference.
With my future career goal clearly in mind and with the help of
my father, I obtained a summer job after my first year at the Beth
Israel Medical Center in Newark, New Jersey, where he practiced.
Along with his partner, Victor Parsonnet, my father was one of the
first physicians to embrace pacemakers in the 1960s. Parsonnet was
a world leader in pacemaker implantations and my father worked
with him (although he did not like performing implants and later
concentrated on vascular surgery). I embraced the opportunity to
do a cardiology externship eagerly and was able to learn much by
shadowing a cardiology fellow. At the same time, I developed a very
superficial research project involving the ways in which routine blood
work changes with pacing.
A highlight of that summer was a visit by an English cardiologist
named Dr. Desmond Julian. A professor at the University of Edinburgh,
Dr. Julian had an avid interest in pacing. I approached him and asked if
there was any possibility that I might be able to do research with him,
and for an externship. He volunteered that if I could provide my own
funding, he would be pleased to have me, something that later became
a reality.
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In my second year, I continued with courses that had more relevance to
practicing medicine, such as pathology and physiology, which I enjoyed.
We also started our first clinicals. I chose pediatrics as my first rotation
because it seemed less threatening with regard to doctor–patient
interaction. As a physician with no skills at the time, I possessed a lot
of anxiety about person-to-person interactions. Unfortunately, working
at the Children’s Hospital of Philadelphia proved to be difficult. I was
in constant contact with children suffering from harrowing conditions
such as spina bifida and leukemia. Ultimately, I found it very depressing
to be a hospital-based pediatrician.
To compensate for this distressing experience, I took an elective
course in outpatient pediatrics in my fourth year. I witnessed more
common benign maladies, such as children with upset stomachs,
suffering from diarrhea, rashes, or upper respiratory tract infections.
On the upside, I got to experience first hand what my grandfather did
as a pediatrician on an outpatient basis. It certainly provided me with
a much better sense of pediatrics, although I never was tempted to
follow in his footsteps, having committed to cardiology. Meanwhile,
I also completed other clinical rotations. Although less daunting
than pediatrics, I found psychiatry to be quite boring. With inpatient
psychiatry, all the patients were constantly medicated. Meanwhile,
outpatient psychiatry struck me at the time as an option for the
very well-to-do. In my second year, I also rotated through obstetricsgynecology.
Although I enjoyed delivering babies, I hated the all-night
hours. Ultimately, all of these clinical experiences merely reinforced
that I wanted to be a cardiologist.
Prior to the summer of my third year, I was thrilled when I was able
to receive funding from the medical school, allowing me to spend the
entire summer working with Dr. Julian in Scotland. In Edinburgh,
I boarded at the house of the head cardiology nurse. Her husband,
Tommy, was a clerk whose two main passions in life were Mozart and
cricket, and he became my close friend and drinking buddy. That
summer was marked by the first landing of a man on the moon, but it
was unforgettable to me in other ways. Aside from Tommy, I bonded
62

with other Scottish medical students and participated in their social
activities.
From a professional perspective, the summer was extremely
rewarding. Dr. Julian was an excellent clinician, and the English way
was to rely on the patient’s history and physical examination, and not
a multitude of tests, like American physicians did. He had also been
kind enough to choose a research topic for me: atropine, PR interval,
and atrial pacing. When one paces the top chamber of the right atrium,
the time from the top to the bottom—or AV interval—gets progressively
longer to the point that if one paces fast enough the signal from the top
chamber never gets through to the bottom chamber, a phenomenon
known as second degree AV block. The question I was trying to resolve
was, what was the physiologic effect of the prolongation of the PR
interval? At the same time, by reversing that PR prolongation with
atropine, one could compare the before and after implications of that
second degree AV block. My research ultimately led to my writing of
a paper, for which I was awarded the Mary Ellis Bell research prize by
the medical school.
Dr. Julian and I developed a strong bond, albeit one that remained
strictly professional. Sadly, his wife had been killed in a tragic
automobile accident, and he had to raise two children on his own. He
was a very private person, and I never saw him outside the hospital
setting; however, at work I had very positive interactions with him and
his entire team. I think that this was, in some ways, owing to the fact
that English and Scottish students tended to be more reticent than
Americans, who could be more aggressive and ambitious. In contrast to
my local peers, I was extremely motivated and that obviously resonated
with the senior staff. Dr. Julian proved to be an éminence grise who
took me under his wing and was, ultimately, instrumental in helping
me obtain a cardiology fellowship. There was also a senior registrar,
the equivalent of a cardiology fellow, named Michael Godman, who
became a personal friend of mine. Another significant contact was a
young Spanish doctor, Valentin Fuster, who was doing research on
lipids. He later trained at the Mayo Clinic and is now Chief of Medicine
63

at Mount Sinai Hospital in New York, as well as the editor of the Journal
of the American College of Cardiology, a distinguished cardiology journal.
My trip home from Great Britain was memorable, albeit not in
an auspicious way. To travel between London and the U.S., I took
advantage of student fare flights, which were inexpensive but often
had haphazard schedules. Since my return flight home from London
was scheduled for 6 a.m., I decided that I would sleep in the airport;
however, since I needed to eat dinner, I traveled into Soho in London
and, for the first time in my life, went to an Indian restaurant. In the
U.S. at that time, eating habits tended toward the bland and pedestrian,
so when, owing to my non-existent exposure to international cuisine,
the waiter asked me if I like my food “hot” I responded, “Of course,”
imagining that he was referring to the temperature. Of course I wanted
my food hot! As a result, I not only unwittingly set my mouth on fire,
but I had a very unpleasant time trying to sleep at the airport before
heading home to New Jersey, where my family was living.
I began my third year of medical school with a rotation in surgery.
Penn tried to teach surgery via books and a syllabus, which was extremely
boring, not to mention unhelpful; after all, the key to being a surgeon
appeared to be having excellent manual dexterity and developing finely
tuned hands. Unfortunately, I was sorely lacking, and during my firstyear
anatomy courses, I was notorious for making horrible messes of
my dissections—I just did not have the required patience. These early
experiences underscored the fact that a career in surgery was definitely
not for me. Interestingly, my brother Marc, who was skilled with his
hands, enjoyed tinkering, and majored in electrical engineering at
MIT, loved performing surgery. As for me, ironically, despite my lack
of prowess, I ended up doing minor surgeries with pacemakers and
defibrillators my whole life, which proves that it can be an acquired
skill. If one does it repetitively, over a long period of time, one can
actually do a fairly good job.
In my third year, I also began a medical externship at the VA hospital
(which meant I was a junior intern). I absolutely loved it. I had a senior
resident, Bill Fox, from Duke, who was so enthusiastic, and he and
64

I formed a close bond. I spent a lot of time with him, taking care of very
ill patients, people with diabetic ketoacidosis, and many with GI bleeds.
At that time, there was a high rate of alcoholism among veterans; many
were not taking care of themselves and were, consequently, bleeding
from excess drinking. At that point in my education, it was not so
much that I needed to learn a wide variety of diagnoses, but rather that
I needed to learn to be comfortable as a doctor in charge. The senior
resident who worked with me gave me the flexibility to help make
decisions. He made the whole process very enjoyable and reinforced
the decision that internal medicine and cardiology was for me.
One of the things I loved most about internal medicine was its
similarity to detective work. Ultimately, one is carefully collecting
information with which one has to try to solve a puzzle. Intellectually,
I found it to be a very satisfying process.
At the VA hospital, I also had a very positive experience with the
chief of medicine, Edward Stemmler, who ultimately became dean of
the medical school. Dr. Stemmler wrote my letter of recommendation,
which played an important role in where I did my training.
Coincidentally, Dr. Stemmler taught my brother Marc, who was five
years behind me in medical school, and also wrote a letter that allowed
him to obtain his residency.
The rest of that year, I had electives, including outpatient pediatrics.
I also did a surgery externship. At a very junior level, one cannot
perform any surgery, and instead, one takes care of patients pre-op and
post-op. But I did the surgery externship for fun. I also did an ob-gyn
rotation at Philadelphia General Hospital where I delivered the baby of
a 14-year-old girl. Other rotations I did included radiology, renal, and
pulmonary critical care. I did not do any cardiology because I knew
I would be doing that for a living.
Meanwhile, after our initial year of living together, Ken had married
his high school sweetheart, Micki, so during my second year, I lived
with another medical student named Jeff Drobis. After a few months,
however, Jeff met a girl and had her move in to our apartment, which
resulted in a very difficult living situation. Fortunately, the apartment
65

had two bedrooms, one at each end of the second floor, so we basically
stayed away from each other. But a very unpleasant atmosphere reigned.
For my third and fourth years, I found a studio apartment of my own at
42nd and Baltimore, although I actually spent very little time at home
since I was always doing rotations and sleeping overnight in hospitals.
Later, when I showed my family where I had lived, I found that it was
now condemned!
With all the focus on work and studies, there was not much time
for socializing. I did date sporadically, but I never met anyone special.
Socializing was not a priority at the time because building a career was
the main focus of my life.
At the end of my third year, I was more than happy to return
to Edinburgh to continue my relationship with Dr. Julian, having
obtained the appropriate funding. This time, I roomed with eight
medical students, all of them ardent soccer fans who got me to watch
the World Cup. Previously, soccer had not even been on my radar, but
I found the game compelling, and I continue to follow it. They also
provided social experiences outside the hospital.
I also had a new project in the summer. When people have heart
attacks, they can develop an abnormality called bundle branch
block. Part of the electric system that connects the top chambers to
the bottom chambers of the heart, the atria to the ventricles, can be
damaged by the heart attack. In some cases, people’s hearts stop, and
they die as a result of this particular complication. Dr. Julian began
investigating the possibility of inserting a temporary pacing lead in
these individuals as a means of preventing sudden fatalities from this
conduction abnormality. He and his team carried out a retrospective
study in their coronary care unit, which was one of the first such units
in the United Kingdom. As a result, they had amassed a great deal
of information concerning patients who suffered from bundle branch
block. The research project sought to explore the potential role for
prophylactic pacing in the bundle branch block in acute myocardial
infarction. When I was not doing an externship and doing rounds and
conferences, I was down in the record room tracking down all the cases,
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eviewing them, and providing my findings to Mike Godman, who
was writing the research paper. When it was finally published in The
Lancet, the English equivalent of The New England Journal of Medicine,
I was credited as a second author. This was a great addition to my
curriculum vitae, not to mention extremely helpful in my application
for medical internship and cardiology fellowship. There is a Yiddish
expression, “Beshert,” which means “good fortune,” or “preordained.”
A lot of things in my life have happened for a reason, and this was one
of them.
Upon my return from Edinburgh, I needed to address internship
and residency. After Christmas of our senior year, my friend Lew
and I took a road trip to look at programs. We went to the Beth
Israel Hospital in Boston, Yale, Georgetown, University of Virginia,
Duke, University of North Carolina, Barnes Hospital, Washington
University in St. Louis, and Presbyterian St. Luke’s in Chicago. Then,
he and I split up because we had different interests. I continued on
and visited University of Colorado, University of California, San
Diego, University of California, San Francisco, as well as Stanford
and University of Washington.
At the time, admittance to internship/residency programs was based
upon a match. In order of preference, one listed the schools in which one
was most interested, and, in turn, the schools listed their preferences
in terms of applicants. Ultimately, one is matched to the program
highest on one’s list that has an available opening. My first choice was
the Beth Israel in Boston. My second choice was the University of
California, San Francisco. My third choice, surprisingly, was Barnes
Hospital in St. Louis, where the program for internal medicine was
highly reputed and very competitive. The chief of medicine at Barnes,
Carl Moore, was a world-famous hematologist. Unfortunately, if one
lives on the East Coast, people are fixated upon Harvard and Yale, but
in reality, there are many other programs that are equally good. To be
honest, I chose Beth Israel, and UCSF for their prestige, but I was also
extremely impressed with Barnes’s program. I was not disappointed
when I matched there. St. Louis was definitely my next career stop.
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Medical school diploma
Note from Dr. Julian
68

My published article in The Lancet
69

Medical school yearbook
70

CHAPTER FIVE
Residency
At Barnes, I had many colleagues from all over the world, including
from South Africa, Jamaica, and Japan. My initial reaction was
a concern that the program was not as competitive as I thought. The
truth was that Dr. Moore lectured internationally and had ties with
medical schools all over the world. He always asked these schools who
their best students were and would then encourage these students to
apply to Barnes. So, there was a mix with very competent international
interns and residents that made for a very interesting experience.
I guess my initial reaction revealed me to be a bit of a social snob.
In addition to excellent training, I had the good fortune to have
a surrogate family there. My mother’s childhood best friend from
Boston, Rae Porter, had just moved there with her family, and they
were a source of non-medical support. Although I had a wonderful
two-year medical experience at Barnes, one of the problems with
the program was that I needed to have the requisite background in
subspecialty training so I could pass my internal medicine boards,
which were very difficult. I wanted to do two years of clinical on
the floor, taking care of patients, but I also wanted to do a year of
subspecialty rotations. The way Barnes operated, however, in that
third year, one only had six months of specialty rotations and not
12 months, a fact that concerned me. As a result, I decided to go
elsewhere for my third year.
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I ended up choosing the Harvard service at Boston City Hospital.
Boston City Hospital, which is now called Boston General, had three
services, a Tufts service, a BU service and a Harvard service. Ironically,
the faculty on the Harvard service did not make enough money to
live on for their Harvard appointments. They all had second jobs
in order to supplement their incomes but wanted the prestige of a
Harvard appointment. Before I got to the program, it was consolidated
and ultimately became a BU program, so even though I was accepted
on the Harvard service, it was a BU program that I had for the year.
Nonetheless, I was able to do all my sub-specialties and study for the
boards, which I passed. I was also able to find a Cambridge apartment
and take advantage of the post-college environment: lectures, adult
education courses, restaurants, movies, and the theater. Being on call
every fifth night instead of every second or third, as I had been before,
certainly facilitated this.
While in Boston, I reconnected socially with Judy Feldman, a doctor
whom I had met while we were at medical school in Philadelphia. Little
did I know that I would meet another Judy Feldman, née Ruben, who
would become my wife.
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CHAPTER SIX
Cardiology Fellowship
While I was in Edinburgh, Dr. Julian asked me in what area
I wanted to specialize. At that particular time, I aspired to be a
general cardiologist and take care of patients with heart conditions, and
I was not planning to do anything specifically involving catheterizations
or research in other areas. When I asked him where he recommended to
further my studies, he told me about a cardiologist named Joseph Perloff
at Georgetown University who had just been hired by the University of
Pennsylvania to be chief. Perloff was known for his skills as a diagnostician
in terms of correlating EKGs, X-rays, and other forms of diagnostic testing
to make a diagnosis, with a special interest in adult congenital heart
disease. Dr. Julian suggested that I apply to his program, and he wrote me
a supportive letter. The program was very clinically oriented at the time,
and I was already comfortable with the University of Pennsylvania.
I had to apply two years in advance for a fellowship. When I was a
second-year resident, an intern named Alan Gradman worked under
me in St. Louis. I knew he was interested in cardiology as well but
wanted to apply a year early, so I asked him if he had completed his
applications for a fellowship. Completely unaware that he needed to
send them out so far in advance, he was thankful for my advice and
proceeded to apply to schools.
I followed Dr. Julian’s advice and applied to Penn; however, as
I was always driven to get the most prestigious program possible, I also
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applied to Massachusetts General Hospital and Brigham and Women’s
Hospital (today affiliated with MGH). I also applied to Stanford, which
had the most important cardiology research program on the West
Coast. We had an acceptance day for our cardiology fellowships, and
when I was accepted to Stanford, Brigham and Women’s, and Penn,
I opted to go to Penn. Meanwhile, Alan was interested in Stanford, but
had not been accepted. I called Stanford to thank them and let them
know I was going somewhere else, and five minutes later, Alan received
a call from Stanford with the good news that there was a slot available
for him after all. Beshert again, for him!
As an aside, after Alan finished his training, he went to Yale and
was a professor at the VA Hospital. By that time, I had gone into private
practice at Western Pennsylvania Hospital in Pittsburgh. At one point,
my hospital was searching for a chief of cardiology for their clinical
program and Alan applied. He concluded that if I was on the staff, it
had to be a good hospital. As fate would have it, Alan’s application was
accepted, and he became my chief of cardiology. What goes around
comes around.
Back in Philadelphia for fellowship, I lived at 12th and Pine, which
is known as Antique Row in Center City. I had a wonderful studio
apartment, which felt very luxurious to me. I also had more of an
opportunity to be sociable because I had rare night calls. Professionally,
there were eight fellows who went through all of our training with
echocardiography, stress testing, cardiology consults, clinics, and
cardiac catheterization (nuclear had just started at that point). In my
program, there was a cardiology fellow by the name of Mark Josephson,
who was a year ahead of me. He had come to Penn because there had
been another cardiologist named Bruce Goldreyer who had trained
at Columbia in the new field of electrophysiology (EP), focused on
arrythmias, and with whom Mark wished to work. Prior to coming to
Penn, Mark had fulfilled his military commitment at a public health
service hospital on Staten Island, where a cardiologist named Anthony
Damato had developed a catheter technique to record signals inside
the heart to determine rhythms—where they came from, and how they
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correlated with the ECG. When Mark arrived at Penn, he brought his
experience with Dr. Damato with him. Soon after his arrival at Penn,
Bruce Goldreyer went into private practice on the West Coast, which
left Mark, who was still essentially a cardiology fellow, running a subsection
in EP.
Obviously, the knowledge that one had to accumulate back then was
far less than it is now, and fellowship was only two years rather than at
least three now. I was fascinated by what Mark was doing. Catheterizations
reflected my experience in anatomy class—still a big klutz, I could not
locate an artery to place the catheter. I was just not a catheterizer.
Electrophysiology was brand new. At the time, cardiac surgeons
were performing bypass surgery and catheterizations were necessary to
direct the surgery; however, I liked the idea of EP as an alternative. By
placing a catheter inside the heart, a technique easier than traditional
catheterization, and recording signals, I could determine what was
happening on the surface of the heart. In any case, I was fascinated
by EP and knew that I wanted to pursue it. At the same time, I felt
that owing to my background at Harvard, Penn, and Barnes, I owed
something to the academic community. As a result, and based on
the two Edinburgh papers I had written, I decided to be an academic
cardiologist. I felt that EP would be my entrée into academic medicine,
which is why I focused on it so much during my two-year fellowship
program’s elective period.
There are two specific experiences that have stuck in my mind from
those fellowship years. To gather information about the condition of
a patient’s heart, one must place a catheter inside the heart via a vein
in the groin called the femoral vein. At one point, we did a study on
a VA patient who was blind. Although I warned him in advance that
I was going to infiltrate a local anesthetic called Lidocaine, he sat bolt
upright when I injected it. Since he was blind, he did not know that
the X-ray image intensifier was directly above him, and he smashed his
head into it, ending up with a concussion.
A young staff cardiologist named John Kastor was hired from
Massachusetts General’s coronary care unit, and he had a clinical interest
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in EP, but he did not have experience with any of the procedures. At
one point, we were doing a study on a patient with left bundle branch
block, but Dr. Josephson was not available, so Dr. Kastor proceeded to
direct me as I placed the catheter.
There are two bundle branches, the left and the right. When one
puts a catheter inside the heart, sometimes one tickles the right bundle
branch. If a patient already has left bundle branch block and one adds
right bundle branch block to it, the impulse from the atrium does not
get to the ventricle. The result is complete heart block, leading to no
heartbeat, which is what occurred with this patient. Since Dr. Kastor
had no clinical experience in EP, he panicked when he realized that the
patient had heart block. Fortunately, I managed to place the catheter
in the appropriate location and paced the patient until he recovered.
Fellowship: I am in the second row, second from the left. My “Art Garfunkel” days
76

Textbook published by my mentor
77

CHAPTER SEVEN
Air Force
As I went through my training, the Vietnam War was still raging and
doctors were being drafted. At the time, there existed a program
called the Berry Plan which allowed physicians to defer obligatory
military service until they had completed their training. My concern
was being stationed in Vietnam as a general medicine physician on the
front lines. I opted for the Berry Plan with the idea that I would be
trained as a general cardiologist, and perhaps as an electrophysiologist
as well, which would obligate me to a large regional hospital away from
the combat zone. I received my deferment, but immediately afterwards,
the war ended. Despite this, I now had a two-year military obligation
with the United States Air Force, from 1976 through 1978.
Originally, I was assigned to Sheppard Air Force Base in Wichita
Falls, Texas. Although I had hoped to do EP, this was a small regional
hospital and it was not very sophisticated, to the point that I asked one
of my fellowship colleagues who had a flair for electronics to create
a stimulator, a piece of equipment crucial to any EP procedure, that
I could bring with me to continue my specialty. As a result, I had a
schematic of a stimulator to bring with me to Sheppard Air Force Base.
As a prelude to Wichita Falls, I received a “Welcome to Wichita Falls”
brochure. It listed major restaurants, including McDonald’s, Pizza Hut
and Long John Silver’s, but otherwise, for cultural activity, there was
nothing substantial for a single Jewish person in Wichita Falls to do.
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It was a tiny place in north Texas and I was very upset about being
assigned there. Professionally, I thought it was detrimental to my career.
Socially, it was a wasteland. Vietnam almost sounded more exciting.
Fortunately, I have a knack for always landing on my feet. Not long
after I arrived, the air force reassigned a cardiologist from the School
of Aerospace Medicine (SAM) Brooks Air Force Base, San Antonio
to Wilford Hall Medical Center, the major air force hospital in San
Antonio. Happily, I was transferred to that now vacant slot.
Here I was, a physician who had suddenly become a major in the
air force, and one who had not a clue about how the military worked.
As part of the military routine, whenever I was on campus, I had to
initiate a salute to a superior officer. Early on, I forgot this protocol
when passing a lieutenant colonel. Indeed, to make matters worse,
realizing my error I also exclaimed, “Oh, shoot!” For this double faux
pas, I received a dressing down, but I quickly became comfortable with
military ways.
The School of Aerospace Medicine was a research school that
also screened pilots for abnormalities in case they had a sudden
incapacitation owing to a heart attack or an arrhythmia while flying
a plane. The role of the School of Aerospace Medicine was to evaluate
pilots and also perform meaningful research related to the flying
experience. The pilots did stress tests as outpatients, and if the results
showed an abnormality, they came to the school so that we could
further evaluate them.
Upon my arrival at SAM, the fact that I had a unique skill provided
me with the opportunity to do whatever I wanted in the field of EP
over the next two years. During my time in the air force, I collaborated
with an electrophysiologist, Robert Schnitzler, who was based at
the University of Texas, San Antonio, Medical School. Like Mark
Josephson, Dr. Schnitzler had EP training with Dr. Damato, and
I relied on him to provide me with some help in setting up an EP lab,
where I did procedures, and to be my mentor.
I was therefore also able to continue the pursuit of my interest
in arrythmias. I did diagnostic testing for conditions such as Wolff-
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Parkinson-White syndrome, which causes rapid heartbeat owing to
an extra electrical connection. Patients with this condition can now
be treated with a procedure called catheter ablation, which was not
available at that time; however, open heart ablation surgery was an
option, and I sent several patients to Duke, where that procedure was
available.
I also evaluated patients who had rhythms called ventricular
tachycardia, irregularities of the bottom of the four chambers. At
the time, it was thought that anybody with ventricular tachycardia
would end up having a life-threatening arrhythmia, but I carried out
a retrospective study at the school to show that patients who had this
with an otherwise healthy heart could enjoy normal longevity. I wrote
a paper based on my research while enabling many pilots to resume
flying their planes.
Altogether, there were five of us working in the cardiology section
at SAM, and during our time together, we bonded and enjoyed each
other’s company. A bonus of the program was that our arrival coincided
with the closing of the school’s dispensary. As a result, there was no
night call—and an enhanced social life! I became close friends with
some of the nurses in my apartment complex, joined a ski club, and
even learned how to scuba dive. Although I had no major relationships,
it was an enjoyable time for me socially, and I even had a dog, a mixed
breed terrier I named Josh. I also became close to Roger Wolthuis, a
scientist at SAM, with whom I carpooled. He, his wife Donna, and
their two daughters became my family away from home.
I found San Antonio to be a wonderful city. It was a unique place in
that, from a socio-cultural perspective, there existed three main groups:
“gringos” (white people), Chicanos, and Afro-Americans. Adhering to
South Texas codes of conduct, I might don my cowboy hat and boots
and head out to a bar to drink Lone Star beers and eat tamales with
friends. Sometimes, my companions and I would go “kicking,” that is,
Western dancing.
Professionally, my time in San Antonio provided me with an
opportunity to develop my subspecialty by myself with limited support.
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I set up a lab, gained some meaningful data, and presented an abstract
at the American College of Cardiology meeting in Anaheim, the
only time in my career that I presented at a national group. All in all,
I came away with a very constructive two-year experience, which also,
presumably, helped me to obtain a faculty job.
I was fortunate in that I was thoroughly engaged in EP during those
two years in Texas. When my time was completed, I was more than ready
for academia and prepared to begin looking for work. Unfortunately,
jobs were hard to find since EP was such a new phenomenon and its
clinical application was unclear to academic centers.
I responded to a call for a job opening at Boston City Hospital,
but, unfortunately, there was no funding for EP. Moreover, because
the chief of cardiology preferred exercise testing, the job was given
to another candidate. I also explored job possibilities at New York
Medical School, University of Rochester, and University of Pittsburgh.
As a curiosity, I also interviewed at private practice jobs in Colorado,
San Diego, Las Vegas, and the Chicago area, but they wanted general
cardiologists or catheterizers, and I had become focused on EP. As a
result, these opportunities were of no interest to me, nor I to them.
Ultimately, I decided that I wanted to do academics. I attended a
meeting of the American Heart Association in Miami where I met Jim
Shaver, who was chief of cardiology at the University of Pittsburgh.
One of Shaver’s faculty members had received clinical tenure instead
of regular tenure and was so angry about it that he transferred to
West Virginia University. Shaver had, therefore, an opening, which he
offered to me. I think he really did not care what I did as long as I filled
the slot and was able to do clinical work, develop EP, and do teaching
rounds. He offered me the job, and for the next four years, I was a
University of Pittsburgh faculty member.
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Major Barry Alpert
83

My abstract presented at ACC

CHAPTER EIGHT
Family: My Wife and Children
In July of 1978, I arrived at the University of Pittsburgh School of
Medicine, Division of Cardiology, where I remained until 1982. In
Pittsburgh, I lived in Shadyside, a younger neighborhood close to the
hospital which is just outside downtown. I rented a townhouse, which
I enjoyed very much, and although my hours were very busy in the
hospital at night, I was able to make some social friends. Professional
considerations aside, one of the reasons I chose Pittsburgh was that
I considered myself to be a very cultured person and it was very
important to me to have access to many cultural pursuits. Pittsburgh
had a world-famous symphony, an acclaimed public theater, and
multiple universities, including Pitt, CMU, and Duquesne, with lecture
events. Unlike New York City, it was just the right size. It is a city that
people do not go out of their way to visit, but it is comfortable enough
that people do not want to leave.
Owing to its steel industry, Pittsburgh had a large Eastern European
community, and much more ethnic diversity than San Antonio. After
spending two years in South Texas, I was thrilled to be able to take
advantage of four distinct seasons. In retrospect, I was obviously very
happy that I ended up here. But more importantly, if I had not moved
to Pittsburgh, I never would have met my wife, Judy.
One of my air force colleagues, Peter Engel, was from the University
of Cincinnati. He had a friend name Norman Levinson who was also
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on the faculty of the University of Pittsburgh. Feeling that I was at
the stage of my life and career that I needed life insurance, I asked
Norman, who had recently married, for a recommendation.
Norman gave me the name of an insurance broker named Tom
Kaplan. After I met him and purchased an insurance policy from him,
I received a phone call from a woman named Ruth Cohen who was a
friend of Kaplan’s wife, Debbie. It seemed that after selling my policy
to me, Kaplan had returned home to his wife, Debbie, and remarked
that he had met a young single cardiologist. Did she know of anyone
available with whom to fix him up? Debbie mentioned a friend of
hers, Judy Feldman, a recent divorcee with two children. Although she
thought Judy and I might possibly be compatible, she refused to call
me to suggest I ask Judy out. However, a much more outgoing friend
of hers, Ruth, had no such reticence. And so it was that I received
a call from Ruth. After an hour-long conversation—during which we
both spoke French to one another—she gave me Judy’s number and
suggested I call her, which is what I did.
Prior to Judy, I had dated primarily in order to share a woman’s
company rather than to be intimately involved. Yet, I was now ready to
look for something more romantic and profound. At 33, I also wanted
to have a family and I feared that I was getting too old to start one.
Our love was something that grew gradually. In fact, it almost did
not grow at all. On our first date, I took Judy to see Handel’s Messiah.
I was unaware that she disliked vocal music, and unbeknownst to me
she hated the performance. She was also furious that I did not invite
her out for coffee afterwards. In reality, I was a little socially backward.
Our second date was not much better. I took her to see a performance
given by an Eastern European dance group called the Tamburitzans,
sponsored by Duquesne University, but Judy later confessed that she
hated that outing too. Another time I took her square dancing, which
she also disliked. Although I had never square danced before, I did
remember doing the Virginia Reel in junior high school gym back in
Laconia, New Hampshire. Really, I am surprised she continued to go
out with me after those outings.
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Some time later, Judy invited me to dinner. Even though there
was a major snowstorm, and Judy lived in a neighborhood on a major
thoroughfare some five miles away, I went. I had joked previously that
she was geographically undesirable, or “GU.” She must have thought
I was desperate for a home-cooked meal to brave the distance and the
weather. Since I had been conditioned not to waste food, I took care to
finish everything on my plate, but Judy’s reading of my thoroughness was
that she had not prepared a sufficient quantity of food. Consequently,
the next time she invited me over, she made a much larger meal—which
I proceeded to finish. The third time, she cooked up a veritable banquet
and I surrendered, obliged to leave leftovers.
Despite this rocky start, we continued dating for a year and a half,
until—please excuse the expression—we had reached the threshold of
“shitting or getting off the pot.” At that point, I realized that Judy was
more than just someone to do something with and that we actually
had a special relationship. I decided that it would be worthwhile to get
married. I proposed to Judy while we were seeing a movie, La Cage Aux
Folles, a comedy about homosexuals in the south of France.
Judy’s mother had died of a cerebral aneurysm at 39, followed by
her maternal grandmother’s death. Her father was remote, not loving
or supportive, and always working in his clothing store. He quickly
remarried a widow without any input from Judy and her sister. She
was sent to multiple schools. He was a horrible father, was verbally
abusive to her, and the new stepmother came out of Cinderella. He sold
their house and its contents without consulting Judy, leaving multiple
important memories behind. Judy found solace in her maternal
grandfather, Harry Silberstein, in Columbus, Ohio, from whom she
later received emotional as well as financial support when she was a
single mother. Throughout her father Sol’s life, there was a hatred and
bitterness that persisted until he died at the age of 102. At the very
least, she received an inheritance, but this did not make up for the rest
of their relationship.
It was her hope that I could provide the support and empathy she
needed to compensate for such a wounded father–daughter interaction
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and a difficult childhood. Unfortunately, I did not have the requisite
skills of support, given my own background, although I tried. At the
same time, she helped me. I became more thoughtful and tried to
be less self-centered. She taught me to care and think of others. She
encouraged me to be a better father. Unfortunately, she has said that
I was a better father than a husband, which hurts. This is true, but, like
her, I try. She is so special, and I never want to lose her.
Judy had married young, at 21, to escape her unpleasant family
situation, and she had two children, Lori and Josh, with her first
husband, Frank, who was, unfortunately, a prescription-drug addict.
After some difficult years, she divorced him, deciding to raise the two
children herself. When I met Lori and Josh, they were eight and five.
I had no second thoughts about dating a divorcee with two children
because by that time, I was 35 and felt it was time to move on with my
life. I really liked children and wanted a family, and I felt that Judy and
her children could be that family. She had the children, and I had the
dog, so it was a perfect match. The only thing we needed was a station
wagon, and to change the dog’s name to Max.
I think that both children were as excited to have a father figure in
their lives as I was to have a family. Things were easier between me and
Josh because his father had not been around for such a long time, and
I could go into the backyard and play baseball or enjoy other sports
with him. Lori was having difficult issues with Judy and gravitated
toward me as a calming influence and a neutral go-between between
herself and her mother.
I embraced Josh and Lori as my own children, but I also felt that
I wanted to participate in the years between pregnancy and childhood.
As such, after our family was settled, we decided to have a third child,
despite Judy’s initial reticence because she was older and a pregnancy
might be risky. After she got pregnant, she had an amniocentesis to
make sure there were no genetic risks involved.
When we got married, Lori was 10 and Josh was 7, and our third
child, Craig, was 12 years younger than Josh. We had a difficult time
getting pregnant, but finally succeeded. At 38, I became a biological
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father. However, blood relation or not, I was adamant that I would
never differentiate among my three children. As a result, I decided that
I would adopt Lori and Josh and officially make us a family of five, with
everything divided equally among the three children. This was easy to
do because Josh and Lori’s father was in drug rehab and had no contact
with his children. Although, initially, he had made attempts to see
them, after a while, he just vanished. Nonetheless, I waited until the
children were 18 to adopt them out of concern that their father might
contest the adoption. At 18, they were no longer considered minors
and could make their own decisions. As an initial step, as soon as Judy
and I got married, Lori and Josh legally changed their names to Alpert.
We moved from Churchill to the city when education choices
became limited in our neighborhood. Lori went to Ellis, a private girls’
school, where, unfortunately, she got pegged at the academic bottom of
the class, despite her intelligence. To prove a point, I wrote an English
essay for her and received the only C I ever had in my whole life! I also
remember how special our father–daughter dance was as we danced to
“Stairway to Heaven” by Led Zeppelin. It represented a special bond
that we carry to the present day.
She was accepted to Boston University, but it was not a good fit
for her, and she transferred to Mount Ida for two years and then to
Drexel Institute of Technology in Philadelphia for a four-year degree,
majoring in interior design. She returned home to a job in a toy store
and later married Ben Smolar, a young neurologist, and they have
three wonderful children: Aaron, Zach and Emma. Aaron is 23 and a
graduate student in architecture at Columbia. Zach is 20 and a junior
majoring in chemistry at Carnegie Mellon University. Emma, 17, is a
senior in high school and will be matriculating at Cornell next year.
I am so proud of them.
After moving back to Pittsburgh after college, she developed a
close relationship with Judy, which has persisted until today. Lori’s
relationship with me has also grown. She acknowledges me as a
moderating influence in her family relationships, and, despite me not
being her biological father, she treats me as her “real” father.
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Since Josh was seven when Judy and I married, he and I were able
to develop a relationship based on sports—baseball in the backyard,
soccer, and skiing. I once took Josh the boy to a softball game with
Josh the dog before Judy and I were married. A spectator asked why
I had a son and a dog by the same name (which we always thought was
funny), which later prompted the renaming of the dog to Max, after
Maxwell Smart from the TV show Get Smart. With Josh, I was initially
concerned about my ability to provide authority. I was particularly
waiting for a time when I might need to discipline him and was afraid
he might say that I was not his father; I worried about that possibility,
but thankfully, it never happened. As Josh grew, he became depressed
from bullying at his private school, Shady Side Academy and transferred
for one year to Falk Experimental School before he found his home at
Taylor Allderdice High School, where he cultivated close friendships.
He was an excellent student and an expert at Trivial Pursuit.
He went to University of Pennsylvania, majoring in philosophy,
adding to the Alpert Penn legacy. After college, he opted to move to
Portland, Oregon with his college girlfriend, and later wife, Katy. It was
this move that led us to discover that he had a major conflict with Judy
and me, possibly resenting her for absenting his natural father, and me
for not being his real father. However, he never shared his real thoughts
with us. In Portland, he went back to law school at Lewis & Clark.
Initially, he worked as a lobbyist and later worked in non-profits—
Americans for Nonsmokers’ Rights, and the Trust for Public Land, as
well as working in a private law practice. He then served as assistant to a
Portland city councilman, Charlie Hales, who later became mayor. Josh
reached his pinnacle as his chief of staff. He now works for a Londonbased
climate non-profit, C40, sponsored by Bloomberg. Along the
way, he divorced Katy immediately after she delivered their daughter,
Lucy, and went on to marry Jill.
Two and a half years ago, he came to Nantucket with Lucy. A terrible
argument about family issues occurred, and he and Lucy left abruptly
the next morning. We have not spoken to him since, waiting for an
explanation.
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Our relationship with Craig is very different. We both participated
in his childbirth. He presented fewer issues growing up. He was
extremely sensitive to other people and was goal-directed. We were
careful to afford him only the same opportunities as the older children
and tried not to single him out as special. He was bright and caring, like
Judy. He rewarded us in each step of his education, with Valedictorian
and special awards. We were so proud. He spent his summers with
a competitive Johns Hopkins astronomy course at Hamilton College,
with Mark Zuckerberg as a classmate in the eighth grade, and then
had exchange experiences in Guadeloupe for French and St. Petersburg
in Russia for Russian language. From high school, he was accepted
at Harvard, although he was embarrassed that his classmates might
consider that he was accepted because of my alumnus status. He had
an amazingly diverse college experience, which included biochemistry
as a major for pre-med, with enough time to do electives in World War
II history, Russian literature, and a music course called “First Nights.”
From an extra-curricular perspective, as noted before, he was on the
business board of The Harvard Lampoon, helped to run the speakers’
program for the Institute of Politics, an undergraduate program for
the Kennedy School of Government, and volunteered for a food bank,
while doing medical research in immunology at Children’s Hospital.
Then, it was on to medical school at University of Pennsylvania,
where he met his future wife, Aviva, followed by an internship and
residency at the Hospital of the University of Pennsylvania, while Aviva
went to Temple School of Medicine. He then went to the University
of Michigan for a three-year cardiology fellowship and stayed for an
additional year to specialise in advanced heart failure, while Aviva
completed a pediatric residency.
It was our good fortune that he accepted a job at Allegheny General
Hospital in Pittsburgh, where he took on additional responsibilities as
the fellowship program director (possibly the youngest in the country),
as a member of the palliative care committee, and director of the
amyloid and hypertrophic cardiomyopathy clinic. Aviva took a job
at a private pediatric practice affiliated with UPMC and Children’s
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Hospital. Craig continues to maintain a close family relationship with
Lori and her family, coming together for family dinners and holidays,
although each focuses on their own families, which now include Noah,
almost five, and Andrew, almost two.
We were pleased to have Lori 0.2 of a mile in one direction and
Craig 0.2 of a mile in the other because this allowed us to be doting
grandparents and for me to experience the growing years of Noah and
Andrew.
Craig continues to be sensitive and caring as he raises his family,
including their golden retriever, Maizey. He also has a wonderful wife
and two fantastic children who bring us so much joy.
We are so fortunate for all of this.
Following our marriage, I suddenly had a wife and an immediate
family, and I loved it. During the years I was in practice at the University
of Pittsburgh, I spent a significant amount of time at the hospital.
I began work at 7:30 a.m. and usually did not return home until 7 p.m.
Even so, I tried as best as I could to get to Josh’s baseball games and to
Lori’s activities, making family as much of a priority as possible within
the constraints of my profession. Weekends were completely devoted to
family, unless I was on call. On Wednesday evenings, Judy and I had a
date night for dinner at a restaurant.
I realize that, over the years, owing to my heavy work schedule, Judy
sometimes paid a price. She says that for 43 years she was “a doctor’s
wife.” Of course, the hours were a burden and she rightfully complained
about them. In compensation, there were some advantages as well.
Although I had not gone into medicine for the financial rewards, I did
make a comfortable living. My position afforded us certain niceties,
and I think Judy also took a certain pride in what I did professionally.
That said, I think, to be honest, she complained about it mostly because
of the hours.
In Pittsburgh, we engaged in many enjoyable activities together.
We went to the symphony and public theater, and Judy organized a
robust social life for us, which included dining out with friends. Our
relationship was a close one and she was a special companion, but in
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etrospect, I regret that I was not more intimate. I am a very private
person. I have a very difficult time opening up and expressing my inner
thoughts. It came from my father’s coldness and my mother’s lack of
boundaries, which affected my personality powerfully.
Over the years, Judy and I have certainly had our ups and downs.
After almost 42 years of marriage, however, it is clear that our
relationship works.
To compensate for my medicine, we traveled a lot. As soon as Judy
and I were married, conscious of the fact that between the children and
my busy work schedule we would need to carve out time for ourselves,
we made a concerted effort to ensure personal time by going on trips
together, accepting the need to have a babysitter for the children.
I have push pins in a map of the world to show where we have
traveled. Over the years, we have traveled two to three times a year and
have probably been to 40 or 50 foreign cities and countries, all recorded
in photos or photo books. Even though we often visited places for only
a week because of work commitments, we did a great deal within that
week. Judy sometimes says that there was never enough time to really
relax and enjoy a place, but, truthfully, if we go to a resort, neither of
us can sit on a beach for more than an hour. I like to walk on the beach
and she likes to enjoy the sun with the hope that, maybe later, there
will be time to do some other activity, possibly walking and shopping.
Her dream of relaxing is just a fantasy. For us, life is a roller coaster, not
a merry-go-round, as Steve Martin said in one of his movies. Because of
this, I do not think that we had much romantic time traveling together.
Yet, this was our way.
Our first major trip was our honeymoon to Amsterdam and
Scandinavia. From then on, we never stopped. We went away on our
own at least twice a year, traveling throughout the world. The only
restriction was that, owing to my professional obligations, the trips
were always limited to a week. I would have to leave on a Friday night
or on a Saturday and return the following Sunday. Later, in the age of
cell phones, I also always had my cell phone with me and always on. Of
course, there were also work-related trips—seminars and conferences
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sponsored by drug and device companies—which Judy enjoyed. She
loved interacting with our peers, and, professionally, we were treated
to wonderful accommodations and dining experiences in places such
as Switzerland, Mexico, France, California and Arizona.
Perhaps the epitome of our special trips was Judy’s 60th birthday trip
to Paris for a curated chocolate tour of the city. This included chocolate
shops, markets, bakeries, luxurious dinners, and a cocktail party on a
houseboat on the Seine, led by an expatriate American chef and author
and an Associated Press journalist who had moved to France. For Judy’s
70th birthday, we did a barge cruise on the Canal du Midi. Other trips
included Dubai, Bali, Singapore, Cuba, Scotland, Colombia, Finland,
a safari in South Africa, Egypt, Vietnam, Thailand, Switzerland, and
Croatia, to name but a few. Aside from our trips as a couple, we also
took vacations with the children, usually during the school vacations,
and over Christmas and Easter we went skiing or enjoyed the beaches
of Mexico. Judy was always arranging family trips.
A very special family experience was a trip to Israel for my 70th
birthday. Originally, Judy suggested it as a nice way to celebrate this
special occasion, but I, with my typical penchant for not wanting to
spend money, despite our comfortable financial situation, demurred.
However, the more I thought about it, the more excited I became, as
Judy continued to push for it. The trip, which took place from June
14 to 24, 2015, was entitled “Barry’s 70th Biblical Bonanza” by Craig.
To celebrate the event, he made special T-shirts, one for each of the 12
family members, with each depicting me and the wearer of the T-shirt.
Later, he had a quilt made of the T-shirts for our family room. Prior to
Israel, we did a pre-trip to Jordan and Petra.
Despite difficulties with canceled flights and lost baggage, we
were all, ultimately, able to rendezvous in Jerusalem. Our guide was
Yahaloma, and we had our own van which, when we boarded it, we
found bore a sign reading “Alpert Bar Mitzvah Tour.” An auspicious
beginning! We did so much on our trip, including spending lots of
time in the Old City, with very meaningful experiences at the Wailing
Wall and Yad Vashem. We also had a scavenger hunt in the Old
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City and camel rides at Genesis Land, where the children learned a
considerable amount about biblical history. From Jerusalem, we drove
south to Masada, and on the way back we all floated on the waters of
the Dead Sea before heading back to Jerusalem. We also participated in
an archaeological dig where we each got ancient pottery souvenirs. We
then headed north to the synagogues and art galleries of Safed. From
Safed, we went to the Golan Heights to view the military outposts and
Syria, followed by a visit to Kibbutz Kfar, with its cherry orchards, and
a rafting trip on the Jordan river. We then went back to Tel Aviv for
the beaches, bike rides, and restaurants, as well as to old Jaffa, before
heading back to the U.S.
The trip was so much a reflection of our family; 15 days of family
interaction gave me a perspective of pride in Judy as the glue that knit
us together, with a bit of my help as well. It allowed me to forge a close
family unit, and it was a realization of the family that I had sought
when Judy and I married.
Skiing was another very special family experience. I had learned
in New Hampshire at the age of seven, and skied several times a week
at the local ski area, Belknap, later known as Gunstock. I continued
skiing throughout my single years, using my vacations to ski out west
and in Europe. When Judy and I married, I wanted her to learn, and
she reluctantly tagged along to a cardiology symposium at Snowmass,
Colorado. Our hotel was on the hill, and she had to ski down without
ever having been on skis, something for which she never forgave me.
She ultimately became a regular on Fanny Hill for the week, and later
improved with lessons, but without progressing significantly. I was,
unfortunately, a poor teacher—impatient and unsympathetic—and
I had also made the mistake of initially teaching Judy and the children
by the method I had learned at a local slope, which was to walk up a
hill sidestep and herringbone before going down, which she felt was
barbaric since there was a Poma lift which would allow her to go uphill
without much effort.
Wanting skiing as a family activity, I taught Lori and Josh, first at
Snowshoe, West Virginia, and later out west at Aspen, Vail, and Park
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City. Fortunately, they enjoyed it, but because they easily surpassed
Judy, she gave it up and would just tag along, walking, shopping, and coordinating
meals and other activities. Nevertheless, it was an important
Alpert experience. Before college, Josh and I were skiing buddies, and
we did special trips to Colorado together. Later, I taught Craig and
he became my partner. When he left college, I then taught Lori’s two
boys, Aaron and Zach, and they became the focus of my skiing. We
had a large family trip to Breckenridge, and recently skied more locally
at Elk Mountain in Pennsylvania, and Holiday Valley in New York. At
Elk Mountain, Zach fell off the lift, and I dropped down to help him,
unfortunately tearing my left calf muscle, which took a few months to
heal. Most recently, Craig got Aviva and Noah on skis. Skiing remains
an Alpert legacy, although, after 69 years, I have now stopped.
More important than skiing was Nantucket. Judy and I spent our
first summer in Nantucket after we were married. Neither of us can
remember why we chose it, but we are so fortunate that we did. We
had both been there independently in 1967, Judy for her honeymoon
with her first husband, and me for a week with my classmates after
exams and before graduation from Harvard. This time, we rented a
cottage on a wharf and arrived in the rain. From the ferry, we used an
A&P shopping cart to transport our luggage to the cottage, including a
television and an Atari game to occupy Josh. For five of the seven days
we had rain, but we loved Nantucket—the history, the food, the beach,
and biking—despite Lori with splinters from grabbing a telephone
pole while biking and Josh with a load of sand in his bathing suit
while biking home from the beach. Subsequent to this, Judy, a newborn
Craig, and I returned, and we have never missed a summer there
since. Again, the history, the beach, biking, fishing from the dock,
and sailing made us fall in love with the island. Initially, we stayed
one week, then two weeks, then three to four weeks, as I commuted
back and forth. In 1991, there was a real estate bubble and we started
looking at houses, despite Judy’s concerns that it was expensive and
impractical. We found a house in a private cul-de-sac, the Stone Barn,
where we had rented before. With some negotiation, we made a final
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decision to buy while leaving on the ferry as Hurricane Bob bore down
on the island.
Buying the house, which we called “The Great Escape,” was the best
decision I ever made (next to marrying Judy), and we have integrated
it into our lives ever since. Every summer, I would drive Judy up at the
beginning of the summer and stay a week, fly back to Pittsburgh, and
then return to Nantucket 10 days later for a long weekend. I did this
until the end of the summer and would then fly up for a week at the
end of the summer and drive us home. As Judy said to her friends, each
summer she was dropped off at summer camp. She had the luxury of
spending three months there since she was a non-working wife and
mother, and I had the flexibility of going back and forth. We would also
go to Nantucket over Thanksgiving, when family schedules allowed. In
the spring, Judy and two girlfriends visited the island for a girls’ trip for
Daffodil Weekend and shopping.
Nantucket provided a marked contrast from Pittsburgh life—a
different set of friends and activities. We had the luxury of getting up
in the morning without an alarm, and of reading the papers in bed
with a cup of coffee. We could walk, go to different beaches, tandem
bike, eat at different restaurants, invite friends and family to visit, and,
most importantly, relax.
Lori never really embraced Nantucket the way we did, but came for a
week with her children. Josh came sporadically because he lived on the
west coast, but Craig has never missed a summer there. After his highschool
summer academic activities, he would come up to work, sorting
the Sunday New York Times in the basement of the Hub newsstand,
working at a kitchen store making sandwiches, and, ultimately, doing
his dream job at Henry’s Sandwiches. He now arranges to bring his
family for a week’s vacation, re-enacting for Noah and Andrew all the
activities he did as a child—biking, fishing, and playing at the beach.
Aviva, who is originally from Lexington, Massachusetts, has become
addicted to the island, and particularly to the Juice Bar’s ice creams,
with at least 10 flavors always in our freezer.
We are so Nantucket!
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Our wedding
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Lori’s wedding, 1995: Mort Gerson, Mother, Judy, Josh, Lori, Ben, me, Craig, Jane Alpert,
and Father
Craig’s wedding, 2013: Josh, Jill, Lucy, me, Zach, Aviva, Emma, Craig, Judy, Ben,
Lori, and Aaron
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Me, Zach, Lori, Emma, Judy, and Aaron in Nantucket
Legacy
100

Noah, Craig, Maizey, Aviva, and Andrew
Our travels
101

Judy and me on the Blue Trail in Cinque Terre, Italy
102

Some of the picture books I created
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The Alperts at Masada in our special T-shirts
In Vail
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Nantucket Harbor
The Great Escape
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CHAPTER NINE
University
My official appointment at University of Pittsburgh was Assistant
Chief of the ECG department. As a junior person, I read ECGs
and 24-hour monitors. More importantly, the administrators bought
the equipment I needed for EP, giving me carte blanche to do what
I wanted to establish an EP specialty.
Meanwhile, professionally, I was involved in many activities. I was
also teaching physical diagnosis to first-year medical students and
doing rounds with internal medicine interns and residents, and was
also responsible for reading the ECGs and monitor strips daily with Ed
Curtiss, my senior faculty member in the heart station. While doing
this, I also performed EP studies and did clinical research.
Electrophysiology is very complicated, involving placing catheters
inside the heart and recording the heart’s electric signals on a
recorder. From the recording, I would then print out the relevant data
to analyze. I could then diagnose arrhythmic disturbances, often then
also gaining insight to mechanisms and therapy. An EP study could
take many hours to complete as data is obtained and then analyzed.
Because it took so long and no one had an understanding of what
I was doing (my colleagues were much more interested in cardiac
catheterization and the hemodynamics of heart valve problems), I was
given a time slot at the end of the day. As a consequence, my workdays
were very long.
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Since EP was a subspecialty in search of an application, I had to
explain to people what I actually did as an electrophysiologist and how
it was relevant to clinical practice. I spent a lot of time traveling around
the tri-state area, giving many lectures at luncheons and dinners, not
to mention consuming many bologna sandwiches and pizzas, in order
to attract referrals.
Once, one of the former fellows from my program at the University
of Pittsburgh, who had gone into practice in Youngstown, Ohio,
invited me to give a grand rounds there, which involved giving a formal
lecture followed by seeing patients at bedside visits with house staff.
He suggested that Judy and I come the night before so that we could
participate in a formal dinner and then stay overnight in a nice hotel.
Judy was excited about the excursion. Unfortunately, as soon as
we arrived in Youngstown, which was about an hour and a half away,
I realized that I had forgotten my slide carousel for the presentation.
We went to dinner and then, at 9 p.m., we turned around and drove
back to Pittsburgh for the forgotten carousel. By the time we returned
to the hotel it was 1 a.m., which ruined a romantic night.
From the beginning, I was always very anxious when confronted
with public speaking. My initial grand rounds would leave me drenched
in sweat. After the first few words, I would settle in with a glass of
water and plow ahead. An important aid I relied on sometimes was
to take a beta blocker, propranolol, a drug which blocks adrenaline.
Interestingly, there was an article in The Lancet that discussed how
professional violinists took beta blockers to combat stage fright, which
produced improvements in their performances. For me, it was a useful
solution until, over time, I gained more comfort with public speaking.
The first time I did grand rounds at the university was memorable
in more ways than one. My first patient was a young woman named
Marie McKinnon, who was pregnant and had an arrhythmia called
supraventricular tachycardia. Owing to her pregnancy, I could not
treat her with medication or with surgical ablation, the standard
treatments, but I controlled her arrythmia with older, less dangerous
medications. I was then asked to discuss her case and treatment in
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front of the medical school. So, I used her as an example to explain the
different types of supraventricular arrhythmias, and how the different
mechanisms could be utilized to differentiate them and, subsequently,
treat the patient.
As an aside, following her delivery, Marie went through open heart
ablation surgery. Amazingly, she remained my patient until I retired on
April 1, 2021—43 years later!
The first month I was in practice, I only had two procedures, but
my role with these and many subsequent patients was longstanding as
the arrhythmias might recur or change, warranting a shift in therapy. It
also reflected the fact that since arrhythmias were frequently chronic, it
afforded me the opportunity to take care of patients over a long period
of time.
In general, I initially treated patients in two ways. There are
arrhythmias that one can provoke by putting a catheter inside the heart
and stimulating it. Having had the ability to initiate an arrhythmia,
I would then try different anti-arrhythmic medications to prevent my
ability to stimulate the arrhythmia, suggesting a favorable response.
This method was known as serial drug testing, and it allowed one to
predict the effectiveness of a medication for rhythms for the top, but
also more importantly for the bottom chambers, called ventricular
tachycardia, and which were life threatening. For rhythms that could not
be reproduced, I would need to try different medications empirically.
In addition to standard and investigational anti-arrhythmics, a drug
from France, amiodarone, manufactured by Sanofi, was shown to be
very effective. Unfortunately, the requisite studies had not been done
in the United States and it was not therefore approved for use here.
However, at an NIH symposium on the drug to which I was invited,
I learned that a compassionate use exception could be used. The only
way I could obtain it was to import it personally, and I had to make
arrangements for it to clear customs at the Pittsburgh airport for each
shipment. This became my “French Connection.” As an aside, the
FDA later approved the drug for use in the U.S., and it is now the most
effective and most commonly used medication in rhythm management.
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I also later implanted devices, with pacemakers and defibrillators
providing another method of treating arrythmias. In this regard,
I became involved with what was, at the time, the world’s third
defibrillator implantation. It was believed that this device could shock
someone out of a life-threatening arrhythmia. A doctor at Johns
Hopkins, Michel Mirowski, developed the implanted defibrillator. He
went to Medtronic, the world’s largest pacemaker company, and showed
them a video in which he had implanted a defibrillator into a dog.
Mirowski stimulated the defibrillator to cause a cardiac arrest. The video
then revealed the dog passing out, defecating, and shortly afterwards,
regaining consciousness after a shock, jumping up, and behaving with
great vitality. It was quite amazing to behold, but Medtronic was not
interested in the device. A biomedical engineer named Steve Heilman
had a company called Medrad in Pittsburgh where he had developed
a dye injector for cardiac catheterizations. This injector was later sold
to Siemens, earning Heilman a great deal of money. When Mirowski
showed him his device, Heilman was enthusiastic enough to invest
in it. As a result, the implantable defibrillator was developed and
manufactured in Pittsburgh by a company called Intec, in Blawnox.
(As an aside, Intec was later bought by a company called Cardiac
Pacemakers Incorporated, which later became Guidant, and is now
Boston Scientific.)
At that point, much of the medical research performed on animals
was carried out at the University of Pittsburgh School of Medicine
because of its proximity to Intec. The first implant was performed at
Johns Hopkins by Mirowski and his clinical EP counterpart, Phil Reid.
The second was performed by Roger Winkle at Stanford. Mirowski
wanted to continue research in the Pittsburgh area and utilize me as
the Pittsburgh electrophysiologist for implants.
As a result, I was invited to Johns Hopkins to watch an implant
before overseeing my own. Unfortunately, the procedure was delayed
and was only concluded at 10 p.m. in the evening. Since it was too late
for me to return home to Pittsburgh, Phil Reid invited me to sleep
on a couch in his basement. He was used to working late into the
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night himself. I remember meeting his daughters at breakfast, and they
laughingly joked that the only way they ever knew that Dad had slept at
home on any given night was if the toilet seat was up in the morning.
Ultimately, I performed the world’s third implant in 1981. The
patient was a young insurance executive named Lou Arturo, who
subsequently lived for many years before dying of congestive heart
failure, or weakened heart. Unfortunately, I never received any academic
credit for my accomplishments. While the first two implants had taken
place at major academic centers, I performed mine at the University of
Pittsburgh as a matter of convenience, because of the proximity to the
manufacturing site.
At that time, I saw my career possibilities in a realistic light. I was
a young faculty member who had not written many papers. The EPs
who received plaudits were internationally famous cardiologists who
published in the major journals such as Circulation and The New
England Journal of Medicine. It was enough for me to rub elbows with
these people and earn their respect, which was satisfying for me. (As
a comment, now that I am retired, I lament that younger EPs were
unaware of the contributions I made to the early days of clinical EP.
In that regard, I have many additional stories I could have shared
with them.)
Regardless, performing this implant was one of the highlights of my
four-year experience at the University of Pittsburgh, one that I would
not have received had I initially opted to enter private practice.
Another special patient of mine at the university was Louis Wolititch.
When he was in his 50s, Lou had a heart attack and also suffered from
recurrent ventricular tachycardia. Between 1978 and 1982, I took care
of him at the university. After serial drug testing, I found a medicine
that initially worked for him.
Like Marie, Lou became a patient who followed me throughout
my professional career. As I continued in EP, the therapy evolved to
include not only the serial drug testing, but also investigational antiarrhythmic
medications. Later, in addition to defibrillators, I learned
how to use pacemakers and to perform ablative surgery for the
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ventricular tachycardia, the arrhythmia from which he suffered. As EP
evolved, so did the therapies for Lou. During all the time he was my
patient, a period spanning 30 years, he received each new treatment
modality as necessary. His most noteworthy therapy was a patientactivated
radiofrequency anti-tachycardia pacemaker. When he had
his arrhythmia, he would present to the emergency room where he
would activate his device and terminate his arrhythmia while being
monitored. Ultimately, Lou died of his underlying heart disease.
Following two patients over such a vast period of time afforded me
valuable insights and provided a history of the evolution of EP. It also
reinforced my preference for treating a patient as a person and not as a
disease or a procedure.
When I was a cardiology fellow, the University of Pennsylvania
developed a highly significant surgical technique for arrhythmias.
Much ventricular tachycardia occurs at the border of a heart attack
scar. A heart attack is a blockage of blood supply which causes the
tissue to die. However, on the periphery, there are outpouchings of
the scar with normal tissue, an area known as the border zone. This
is where ventricular tachycardia may develop. At Penn, researchers
developed a technique whereby they would cut out the scar, called an
aneurysm. They would then scrape the area on the outer portion of the
aneurysm in order to destroy the healthy outpouching of tissue among
the dead tissue. This groundbreaking technique became known as the
“Pennsylvania Peel,” as it was described by Newsweek. I pushed surgeons
to perform a Pennsylvania Peel procedure at Pitt that saved a patient’s
life. Judy remembers that moment well because I had I invited her to the
grand rounds at which I explained the procedure, and she developed a
horrible migraine from the anxiety of watching me give the lecture to
the medical audience.
Although my position at the University of Pittsburgh was very
enjoyable, I became disenchanted with academics. Teaching the same
courses year after year gradually grew tedious, and even the research
projects I was engaged in were not stimulating. Ultimately, in 1982,
I decided that I really no longer cared for university life and that I would
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e more fulfilled in a clinical practice. My ultimate satisfaction came
from caring for patients, rather than achieving academic success. As a
result, I made the decision to leave the university for private practice.
After I married, my salary was only $38,500, and I was also secondarily
concerned about my ability to support my new family.
Memorobilia of an electrophysiologist
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Published article
114

Board certification in electrophysiology
115

My first defibrillator implant

CHAPTER TEN
Private Practice
In 1982, my decision to move into private practice was actually a
pioneering move in the subspeciality of EP. At the time, there were
only 50 EPs in the United States, all of whom were academics and
part of a national group known as the North American Society of
Pacing and Electrophysiology, which I had joined. Although many
young EPs like myself were toying with the idea of going into private
practice, there was serious concern about how an esoteric subspecialty
could be successful in the private realm, and I was only the second
electrophysiologist to make such a move. In the aftermath, I received
calls from several of the stellar academic people in the field, wanting
to know what it was like to go into private practice. My response was
that nothing really changed in my EP activities, aside from the fact that
I had fewer constraints and could focus completely on EP, while also
earning a living.
At the time, what bound our small, select group together was that
our livelihoods all depended upon clinical research, particularly for
new medications, new devices, and new techniques. Manufacturers
of these devices viewed us as specialists, regardless of our academic
status. My academic peers and industry did not discriminate against
the private practitioners. We remained “in the club.” Among the
private practice forerunners were John Gallagher from Duke, who
invented a surgery for Wolff-Parkinson-White Syndrome, a special
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arrhythmia problem; Eric Prystowsky from the University of Indiana,
an exceptional teacher; and Roger Winkle from Stanford, who had
implanted the second defibrillator. All three of these men initially
called me to get a sense of the pros and cons of private practice before
launching their own practices. Even though few young physicians today
are aware of my legacy, the forging of my own non-academic path in
1982 was groundbreaking.
As a result of the four years I spent developing my specialty at
the University of Pittsburgh, I had, by 1982, become known as the
electrophysiologist in Pittsburgh. My reputation extended beyond the
city itself, and I had patients from the tri-state area of West Virginia,
Ohio, and western Pennsylvania being referred to me.
In 1982, I joined West Penn Cardiology Associates at West Penn
Hospital. In order to be sure of my decision, I had also explored jobs
in Florida, California, and Colorado, but none of them provided me
with assurances of practicing EP. Because of competition with the
University of Pittsburgh Medical Center, local hospital systems were
looking for an advantage. West Penn Hospital was willing to set up an
EP lab for me, and Dr. Richard Heppner, a private cardiologist on staff,
was willing to incorporate me in his practice.
Dr. Heppner had a partner, Dr. Fred Porkolab, and I became the
third partner. I was so busy that I thought it would be to my advantage
to teach Dr. Porkolab EP to help me. My thinking was that he could
operate as my backup while also building up his own practice. In reality,
there was a lot of friction between us during the 19 years we worked
together. I think he resented my success. At the same time, I did not
always give him a lot of my cases because I wanted him to generate his
own. The practice was structured so that each person was renumerated
on the basis of collections. Because there was no equal splitting of
fees, a competitive atmosphere reigned, which only increased as more
physicians joined, ultimately, up to nine.
My practice continued to grow and was successful both academically
and financially; nevertheless, I never lost my overriding interest in
fostering doctor–patient relationships.
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In 1984, a patient named George Derrick was referred to me from
Jefferson Hospital. He suffered from ventricular tachycardia with the
bottom chamber of his heart racing too fast, like Mr. Wolititch, but
more incessantly. It was necessary to shock him out of that rhythm
multiple times during attempts to find a medication to suppress it.
As EPs developed pacing techniques for dealing with ventricular
tachycardia, we discovered that we could pace the heart at a rate
faster than the ventricular tachycardia to terminate the rhythm, a
technique called burst pacing, which was similar to what was done
with Mr. Wolititch’s radiofrequency pacemaker. If the heart rate was at
150 in the dangerous rhythm and we paced temporarily at 160 or 170
per minute, we could stop the tachycardia. What I opted to do was to
put a temporary catheter in Mr. Derrick’s shoulder vein to pace him so
as to avoid giving him shocks while searching for a solution.
After two days, the rhythm could not be controlled, so Dr. Heppner
did a catheterization on the patient to find out what his anatomy
was. He had what was called single vessel disease—one of the three
coronary blood vessels had blocked off and he had a large aneurysm or
outpouching of dead tissue. Urgently, we performed the Pennsylvania
Peel procedure on him that Monday night, which cured his arrhythmia
and led to his recovery. Over the weekend, Mr. Derrick had received
over 400 episodes that were burst. Most of them were stopped by
pacing, although he did occasionally receive shocks.
We found the experience so interesting that we released it to the
local newspaper, which then had it picked up by the Associated Press,
which in turn passed the story on to news outlets throughout the world.
Amazingly, I was receiving newspaper clips from people as far away as
Japan. There was even a headline in the tabloid, Star Magazine, which
is similar to the National Enquirer: “Man dies 400 times and lives to tell
about it.” As a result of all this media coverage, I became an international
celebrity. My sudden Andy Warhol fame led to an invitation to appear
on The Jack Bogut Show, the local Pittsburgh equivalent of The Today
Show. I roused my family early in the morning so that they could fill a
row of audience seats during my televised interview.
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Like the other two patients I have mentioned, George Derrick
became a longstanding patient of mine. After we cut out his aneurysm,
his heart was weakened, and although he lived for another 20 years, he
eventually succumbed to heart failure as well. Later, I inherited his son
as a patient. He had a different heart condition causing his ventricular
tachycardia, known as cardiomyopathy, or a weak heart muscle, and he
received a defibrillator and medication to correct his rhythm, as well
as heart-strengthening medication. I took care of him until I retired on
April 1, 2021.
West Penn put out a booklet for marketing purposes in which it was
recorded that we had performed 1,300 procedures on over 1,000 patients
in a single year. I do not think these were all EP procedures, but it is,
nonetheless, an impressive number. This explains why I got home so late!
I also had a number of patients from West Virginia. Among them
was a 14-year-old girl named Denise Sadowski who had hypertrophic
cardiomyopathy, a congenital thickening of the heart. Such patients
are prone to cardiac arrest and sudden death. Denise suffered a cardiac
arrest and was resuscitated before being referred to me. At 14, she was
the youngest person into whom I placed a defibrillator, and I replaced
it four times as she grew older. Consequently, I became very close to
Denise and her family. She later married, had children, and moved to
Ohio where she was referred to another cardiologist. Unfortunately,
her hypertrophic cardiomyopathy worsened and she developed heart
failure, as well as an infected defibrillator. The Cleveland Clinic had
to replace the device, and later performed a cardiac transplant because
her heart condition had worsened considerably. Happily, today, she is
alive and well in Ohio.
Even in private practice, drug and device companies sought me
out to do research and help advance the field. Because of my interest
in anti-arrhythmic medication, I became involved in a rhythm pill
developed in Russia called ethmozine. It was co-owned by DuPont
Pharmaceutical at the time.
There were two ways of using anti-arrhythmic drugs at that time.
One was to do formal research, in which one would have randomized
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controlled trials to make a decision about whether a drug was effective,
but DuPont also wanted to know about the drug’s side effects and
efficacy. There was an approach called compassionate clearance to be
able to use the drug before FDA approval. I applied for compassionate
clearance and then used the drug significantly over a period of time,
as I did with many other drugs. That was how I acquired access to
research drugs to take care of dangerous arrhythmias in a private
practice setting.
At a certain point, DuPont decided it would be helpful to have
a symposium to review knowledge about the drug. However, there
was a problem in that the drug was developed by Russian scientists.
Because of Cold War concerns, a neutral site had to be found where
investigators could gather. Consequently, the symposium was arranged
in Montreux, Switzerland. I was allowed to take Judy with me. Not only
did I have a wonderful academic experience, but we flew business class
with Swiss Air, and enjoyed stellar accommodation on Lake Geneva,
and this was just the starting point for a subsequent Swiss vacation,
which included visits to Lucerne, Bern, Lugano and Zurich.
At that time, there was not yet much concern that drug companies
were influencing doctors. As a result, I was invited to countless
symposia all over the world. Judy and I traveled frequently to France,
Switzerland, Mexico, and the southwest U.S., often housed in luxurious
hotels and resorts and able to add on a few days for leisure travel. Judy
still remembers—not too fondly—our stay in a high-end resort in San
Diego where she choked on a hot dog and I performed a Heimlich
procedure, saving her life.
A group of rising young EPs such as myself attended these meetings,
and over time we became quite friendly. Seeing each other in these
different locales was always a pleasant experience.
I had been involved with pacemakers ever since I was a first-year
medical student and had joined the project being undertaken at my
father’s hospital. I had subsequently written the paper about pacing
when I was in Edinburgh as a medical student. By the time I got to
West Penn Hospital, I had developed a major interest in pacemakers.
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Up until that time, surgeons were implanting pacemakers but without
truly understanding how to manage them after surgery. Over time,
there had been an evolution from single chamber pacemakers with a
lead in one chamber to dual chamber pacemakers. The latter possessed
a lead electrode in the top chamber synchronized to a lead in the
bottom chamber to allow the heart to beat in a normal fashion (top to
bottom). These were known as physiologic pacemakers. It was a feat of
engineering to create those devices. Surgeons who wanted to implant
the devices had no concept of how they worked, how to follow them, or
what to do with complications. Conscious of this shortcoming, I chose
to become actively involved in pacing.
In 1984, one or two of my colleagues in the U.S. who were EPs
decided that they were going to implant pacemakers, instead of
surgeons doing them. Since this was a minor surgery procedure, they
were having political battles with surgeons over who would implant
the devices. These battles further reinforced my desire to be involved
in pacing, and I resolved to pursue this goal aggressively. I realized
that no cardiothoracic surgeon was going to teach me how to implant.
With this in mind, I sought out a friend, Harvey Slater, who was a
general surgeon and who did pockets in the chest for chemotherapy,
making a simple incision just under the skin on top of the muscle and
underneath the clavicle—the same surgery involved with pacemakers.
Moreover, he shared my antipathy for cardiothoracic surgeons. United,
we decided to join forces to perform a procedure together—without
permission. Working together in the outpatient operating room, my
friend created the pocket while I put the leads into a patient. Although
I had never before implanted a permanent pacing lead into a patient’s
heart, I had successfully placed other leads under the collarbone in the
subclavian vein and was comfortable with the procedure.
Together, he and I performed the first non-cardiothoracic surgery
pacemaker in the city of Pittsburgh. Our triumph was short-lived,
for our subversive feat caused an immediate uproar. The chief of
cardiothoracic surgery claimed that we did not have credentials to do
what we had done and banned us from the operating room. Moreover,
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we created tremendous animosity between us and the heart surgeons,
who complained that we were stealing procedures from them.
Ultimately, the hospital determined that I had the interest and the
potential skill level to be able to implant pacemakers. However, the
problem that then emerged was that I could not learn how to do them
if I could not gain access to the operating room.
Fortunately, a young cardiologist on staff at West Penn, Mark Geller,
had trained to do pacemakers at Tufts University as a fellow. He was
really obnoxious and universally disliked, but I saw that I could use
him to help me. He was willing to teach me how to do pacemakers if
I would let him do pacemakers in the EP lab where I worked. It was a
win-win situation for both of us. As a result, I did 10 pacemakers with
him and became quite proficient at the procedure, receiving credentials
from the hospital to implant.
This was in 1986. With my newly acquired skill, I made the rounds of
all the pacemaker companies to let them know that I would be happy to
carry out clinical research for them. Such research entailed implanting
a certain number of new pacemakers in patients and then presenting
the results to the FDA for approval. Although the manufacturers were
fairly indifferent to where the pacemakers were implanted, I was at
a disadvantage compared to major institutions such as the Cleveland
Clinic that routinely installed large numbers of pacemakers. Owing to
the large volumes they dealt with, the pacemaker companies routinely
sought out these major institutions to carry out their research, rather
than those with smaller volumes.
Although I was facing an uphill battle, my determination finally
paid off. Medtronic, the largest pacemaker company in the world,
had a deadline to approve a pacemaker called the Medtronic Symbios
bipolar dual chamber pacemaker. Fortuitously, I was able to perform
six implants within the space of two weeks, which helped Medtronic
achieve success with its FDA filing. Because I provided a large
volume with this device, Medtronic took me on as an investigator,
which expanded my reputation and gave me access to additional
investigational devices.
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From that point onward, I spent a lot of time with the Institutional
Review Board, getting permission for doing research on these new
pacemakers, as well as anti-arrhythmic medications. Before long,
I had a major pacemaker practice, with state-of-the-art pacemakers
and, eventually, state-of-the-art defibrillators as well. In addition to
being known as an electrophysiologist, I quickly gained renown as a
pacemaker/defibrillator device specialist.
In 1982, a paper was published in The New England Journal of Medicine
describing destruction of underlying cardiac conduction tissue with an
electrical impulse. Wanting to learn this new technique, I contacted
a friend, John Fisher at Montefiore Hospital in the Bronx, to obtain
additional information. He described the procedure and encouraged
me to observe the effect in vitro by placing a bipolar catheter in a
container of saline, emphasizing plastic and not glass for reasons not
apparent to me. I attached the catheter to a defibrillator, turned off the
lights, and delivered a 200-joule shock. There was a bright flash, the
catheter shredded apart, and the container went flying. He had failed
to tell me to attach only one of the electrodes to the defibrillator and
the other to ground.
At this point, ablation therapy became an integral part of therapies
that I could offer patients. As the procedure evolved, I made pilgrimages
to friends at University of Oklahoma and Bordeaux to acquire these
new skills in order to provide the most advanced treatments. At the
same time, I prevailed on West Penn to obtain the requisite 3-D
mapping equipment and energy sources to facilitate the procedure.
Over time, the technology has evolved considerably. Today’s devices
are very complicated and have their own special needs for follow up
management. Similarly, EP has taken a different path. The mapping
procedures—by which a specialist detects the origin of an arrhythmia
in conjunction with new energies for ablation—have transformed
ablation into the key aspect of EP. Ironically, the area has come full
circle to the way it was at the outset. When an EP fellow finishes his
training now, he either becomes a specialist in pacing or in invasive
ablation. The North American Society of Pacing and Electrophysiology
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enamed itself the Heart Rhythm Society to reflect the evolution of
the field.
What ultimately happened to me at the end of my career was that,
as I grew older, I did not keep up with the ablation technology, which
was increasingly sophisticated and technically demanding. Moreover,
all the young physicians emerging out of fellowships were trained to
perform ablations every day. Not surprisingly, all they wanted to do
was procedures. As such, a young electrophysiologist with three years
of training would have already completed a multitude of ablations
that were, technically, far more complex than the ones I carried out.
Indeed, I did not do my first complex ablation until 1991. From then
on, I only did an average of four to five a month. When an ablation
technique, for atrial fibrillation, a different arrhythmia, was developed,
I was the first physician in the city to perform it; however, afterwards
I only performed one or two a month since they were so complicated.
Now, younger colleagues easily do two or three a day. Obviously, the
more one does, the better one gets. In that regard, I fell by the wayside.
Instead, more recently, I focused on what I was comfortable with:
pacemakers and defibrillators. By the time I retired, I had implanted
more devices than anyone else in Pittsburgh. I could do a pacemaker
in my sleep.
I never followed anyone’s path; I created my own. I always wanted to
be on the leading edge of technology, and for a long time that’s where
I was. What I always wanted was for people in the local EP community
to ask the question, “What is Alpert doing?” And even up until three
or four years ago, that was the way it was. When I first started out,
I was one of 50 electrophysiologists in the world. Today, there are 50
electrophysiologists in Pittsburgh alone.
I absolutely loved being in private practice. I loved taking care of
patients and enjoyed continuing to do so over 44 years. I was very
busy in my practice. Being in private practice was also very financially
rewarding; however, that was not a motivating factor for me. To me,
medicine was always a profession and not a business, but I was very
fortunate in terms of my specialty. Currently, there is a popular belief
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that radiology, ophthalmology, anesthesia, and dermatology are the
“road” to success, but all of these specialties are relatively easy compared
to what I did in terms of hours spent, and they are extremely lucrative.
Money, though, was not my driving force.
At one point, Dr. Heppner suffered a heart attack and had to have
stents and later, bypass surgery. By then, he had been heading the
practice for 15 years and he confessed that he could no longer deal
with the stress of trying to mediate among the competing interests of
nine physicians. His solution was to retire, and in the aftermath the
practice slowly disintegrated. I made life even more difficult for the
other partners by leaving the practice in 2001, after 19 years.
At that time, I had a falling out with my partners based on how
to split overhead and my ongoing chafing with Dr. Porkolab. It was
a very difficult moment for me. My partners actually had a choice
between modifying finances and firing Dr. Porkolab or letting me go.
To my initial great disappointment, they chose to let me go. I was very
anxious as to where I would acquire new patients, but we agreed that
I would take my own patients with me. However, the deal was that
my (former) partners would split revenues with me for every patient
from the practice that I treated. The agreement was probably illegal,
but I signed a contract whereby they did the billing and I received the
payments. Not surprisingly, they made my leave-taking very unpleasant.
In order to treat my pre-existing patients, I needed access to my charts.
My now former partners insisted I return to the office with two of my
employees to copy necessary records at 5 cents a page. It was very petty.
The irony was that Dick Heppner had retired owing to coronary
artery disease, his specialty. The person who took his place, Larry
Hurwitz, was a general cardiologist without a place to practice and
I had been the one who had recommended he join our practice. This
obviously had no effect on the decision to let me go. Once I left,
I severed my relationship with him and everyone else in the group.
I suppose a practice is similar to a marriage in some respects. My
father was part of a practice where all the partners split profits evenly,
based on the belief that each physician brought something different
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to the practice and that he should be rewarded equally. In retrospect,
I wonder if this solution would have made the relationships in my
practice healthier and happier. On the other hand, some of the partners
were very financially oriented and had a particular skill and work ethic,
making individual salaries appropriate.
I remember that when I signed my first contract with West Penn
Cardiology, I had the option of accepting a guaranteed salary with a
limited bonus, or taking a smaller salary with a larger incentive bonus
based on my patient volume. I ended up opting for the more secure
choice, which was a financial error on my part, considering how
successful I became. Moreover, when we were splitting up the practice,
there was a division plan that strongly favored Dr. Heppner in terms of
the percentage of the practice he would receive.
In the end, I was not a very good businessman. Throughout my
career, my prime motivation was to practice medicine and help my
patients, and as Judy will remind me, I made poor business decisions.
I really did not want to be involved in any type of management. I had
office managers to take care of such details. Because I did not oversee
them as well as I should have, they presumably made decisions that
might have been financially detrimental.
Fortunately, after the split, West Penn Hospital was not going to
get rid of me; I was far too successful. At that point, I had the biggest
reputation in my hospital, and my name was important for advertising.
Consequently, even though Dr. Heppner’s practice was the most well
known at the hospital, the administration was very supportive of me,
and they set me up as a single practitioner.
I had to organize a private practice and had the good fortune to
have Tammy Rock as office manager. Judy worked the front desk, and
Merri Lee was our billing specialist. Connie Glagola was my trusted
nurse practitioner and colleague. Throughout my private practice years,
I never wanted to embrace the management of the office, leaving it to
a long list of incompetent office managers and billing specialists after
Tammy retired to raise a family in 2004, until I hired Mary Grover in
2014. With her, and with Kristi Siters as my medical assistant, we formed
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a cohesive group. I signed paperwork and helped with decisions, and
they took care of daily office responsibilities. I was free to be a doctor.
However, after I went solo I became so busy that I urgently needed
a partner. I also wanted a younger person who was comfortable with
the newer procedures, particularly the new ablation technique of atrial
fibrillation, a complicated rhythm in the upper chambers, which I had
not been trained to do. This would allow me to focus more on my love
for implantable devices. For four years, I searched for a partner, but to
no avail. The candidates were of poor quality and the salaries they were
commanding were exorbitant.
I made an unfortunate error in terms of the person I ultimately chose.
Dr. Leonard Ganz was chief of EP at the University of Pittsburgh, having
been Harvard-trained, and had been the prior chief of EP at Allegheny
General Hospital, UPMC’s competitor. For professional and financial
reasons, he approached me to see if he might join me in practice. I made
the assumption that we would have a regional monopoly by merging
our two practices. I thought that, like my personal experience, he
would carry his patient population with him, making it a true merger.
As a result, I offered him a very lucrative employment contract, since
he was, presumably, self-sufficient. Unfortunately, he never generated
his own cases and I had to support him. We began together in 2005.
My resentment grew as he continued to feed off me, and I found that
his EP skill set was no different than mine. In short, my assumptions
about him were not correct. He did not add a new dimension to the
practice. Nevertheless, our practice, now named Arrythmia Associates
P.C., flourished.
After some time, Len suggested adding a third and younger person
who did have newer skills and who would provide us with the ability to
expand our hospital affiliation to outlying hospitals, including Forbes
to the east and Jefferson to the south. Although I was fearful of having
to support another person, I reluctantly agreed, and Jonas Cooper
joined us.
He had an academic background from Washington University in
St. Louis and could provide a more contemporary approach to EP.
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Very naive about money, he just wanted to do what was good for the
patients. He had acquired more recent skills and knowledge that I did
not have. Over time, we forged a very close professional relationship
that I enjoyed very much. He ultimately left in 2013, not because of
me, but because he had issues with Len stealing his cases. His wife,
who was from St. Louis, also disliked Pittsburgh and missed St. Louis.
In 2008, West Penn Hospital, which had rescued a bankrupt
Allegheny General Hospital and formed Allegheny Health Network,
became involved in a board coup and lost its primacy, suffering
financial setbacks that left it almost bankrupt. As a result, it could not
afford physicians, and its reputation plunged. Our group was offered
a financial incentive to move our practice to Shadyside hospital, a
UPMC affiliate. We were successful there for five years, competing
with the full-time university EPs. In 2013, I alone was offered an
opportunity to return to a resurrected West Penn hospital, thereby
breaking up Arrhythmia Associates, with Jonas moving to Butler, and
then St. Louis, and Len to Heritage Valley Health System in Beaver,
Pennsylvania. In the final stage of negotiating a lucrative contract,
West Penn pulled my deal. I was then left with a practice, but without a
location. Fortunately, my lawyer negotiated a settlement that provided
me with office space at West Penn and money for moving expenses.
At this point, I had to give up Connie, my trusted nurse practitioner,
and a medical assistant because of overhead issues as a solo practitioner.
I serviced West Penn, Shadyside, Forbes, UPMC East, and Jefferson
until 2019, as a solo physician. When it became apparent that my focus
was Forbes and UPMC East in Monroeville and I was being squeezed
as a private practitioner for office space at West Penn, I moved my
office to Monroeville, thanks to Dr. Athan Georgiades, who provided
me with leased office space.
My final two years of practice were complicated by health issues
and hospital politics. In the past, I had had a radical prostatectomy
for prostate cancer and then later chemotherapy for in situ bladder
cancer, neither of which impacted my practice. In January of 2020,
I developed a loculated pleural empyema from a post-viral pneumonia,
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which required a thoracic surgical decortication procedure in January
of 2020 and incapacitated me for two months. This was followed by a
two-month practice closure at the onset of Covid between March and
May of 2020, when I was able to start telehealth before returning to the
office in July. More importantly, I came under strong political pressure
from Allegheny Health Network to retire and turn my practice over to
a new full time AHN EP, Mati Friehling. My volume and complication
rates were unfairly scrutinized, and my ablation privileges were severely
limited by Dr. Srinivas Murali, the chief of cardiology at AHN. I had
had coverage from another private EP, Dr. Vijaykumar, but his privileges
were later rescinded because of a high complication rate. At this point,
the full-time AHN EPs refused to cover me. As a result, without any
backup coverage, I lost my EP privileges. In my last months of practice,
I was relegated to UPMC East and Shadyside hospitals, implanting
devices until I retired on April 1, 2021. At the same time, my private
practice was winding down. My patients were dying or moving to the
two dominant health care systems. I was also no longer receiving new
consults or office patients as 90 percent of the physicians in Allegheny
County were owned by the two systems. I was left with no choice but
to consider retirement.
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Private practice brochure
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My “15 minutes of fame”
My patient
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Newspaper article on ablation
Solo practice
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CHAPTER ELEVEN
Retirement
In addition to the political pressures upon me, there were other
factors that contributed to my decision to retire. For some time, the
diminished scope of my activities—which had largely been reduced to
pacemaker/defibrillator follow-ups and limited procedures—had made
practicing medicine much less satisfying to me on both a professional
and personal level. There was also the fact that my decreasing number
of patients made it increasingly difficult to cover expenses as a solo
physician. However, the final straw was the arrival of the Covid
pandemic in early 2020, which created enormous disruption and
complications. As such, in February 2021, after careful deliberation,
I informed my staff that we would be closing the practice for good on
April 1. By giving this advance notice, I wanted them to have sufficient
time to inform patients of the news and transfer records. Fortuitously,
I was able to sell my patient records to UPMC; I used the payments
I received to help defray the substantial costs of closing a practice
(unfortunately, there was no one to inherit it).
One afternoon, shortly before we shuttered our doors, Judy, Craig,
Lori and my staff threw a retirement party for me. I was very moved
that they were able to track down so many of the people I had worked
with during the entire length of my career. Among those who attended
were my former nurse practitioner, Connie, as well as vendors, doctors,
nurses, and some special patients. Craig and Judy also compiled a
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scrapbook filled with newspaper clippings, magazine articles, and
“thank you” notes from grateful patients that Craig had solicited. As a
way of summing up and capping off my 43 years of practicing medicine,
the party was quite momentous. Although it provided me with closure,
in truth, as I left my office for the last time, the sensations that washed
over me were bittersweet.
Prior to retiring, I had spent a year contemplating making such a
drastic change, trying to gauge the possible ramifications on my life.
What concerned me most was what I would do to occupy all that
sudden free time after decades of 12-hour workdays. Seeking insight,
I consulted with various people who had already taken the plunge. A
close friend, Joel Harris, a former neighbor of Judy’s, warned me that
it would likely take a year for me to define what my retirement would
look like.
Joel’s warning turned out to be stunningly wrong. My life as a
retiree came into crystal clear focus on April 2, the day I officially
turned my back on medicine. Purging myself of my past, I canceled
my electrophysiology journals and quit my medical societies. The only
remnants of my former life I allowed myself were my subscription to
The New England Journal of Medicine and Journal of the American College of
Cardiology, as well as continued membership in the American College,
which was free upon my retirement.
With great enthusiasm, I embraced activities that I had forsaken
during my career. I also took enormous pleasure in making up for lost
time with Judy and my family. Seeking intellectual stimulation, I went
hunting for online courses. These had the advantage of being free, with
no papers or exams, and I could enroll at any time I desired. One of the
first courses I selected was “First Nights,” a music course archived from
Harvard and taught by Thomas Kelly, which, coincidentally, Craig had
taken 15 years earlier at college. I also took a course in the history
of finance. Eager for knowledge, I downloaded courses about jazz,
meteorology, particle physics, the Internet, European history, Russian
history, world literature, Bach, and photography—all of which I still
look forward to taking.
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I also began reading, another pursuit for which I had never found
time, except for during long airplane flights. I developed a proclivity
for non-fiction, particularly biographies, as well as popular fiction,
and classical mysteries such as David Silva’s Gabriel Allon series,
John Grisham, Sherlock Holmes, Agatha Christie and Dorothy
Sayers. Also, becoming involved in a book club with 12 of my college
roommates led me to discover books I might not have found on my
own or chosen myself.
Apart from tending to my intellectual side, I also dove into physical
pursuits. My friend Joel invited me to take part in a senior doubles
tennis group. I also joined a country club, where I spent hours trying to
improve my golf game, which had lain dormant since college.
Most important, however, was taking up my role as a grandfather.
All the hours that I had devoted to work left me unable to experience
the growing years of my children and grandchildren. When I married
Judy, Lori and Josh were 10 and 7. Later, since I was available only at
nights and on weekends, Craig’s early childhood was mostly overseen
by Judy. When Craig was older, I spent more time with him, engaging
in sporting activities such as baseball, hockey and soccer. However,
I then missed out on spending time with Lori’s three children because
her primary focus was her children, and our services were not needed.
As they grew up, there was little room for me in their lives, except for
the rare game of hallway hockey on the Wednesday nights when Lori
and Ben went to dinner, leaving me and Judy to babysit.
With retirement, I was free to participate in the lives of Craig’s
young children, Noah and Andrew, who at the time of this writing are
five and two, respectively. Embracing the concept of grandfather has
been very important to me. It has felt so good to be “Grampy” to Judy’s
“Grammy,” to play Legos and Hidden Pictures, to toss a ball with Noah
while chasing Andrew around to keep him out of mischief. Sleepovers
with Noah, giving him a bath and reading him bedtime stories were so
special—until Covid intervened.
During the summer of 2021, Judy and I escaped to Nantucket
for three months, which was the longest time I had ever spent there.
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Armed with the luxury of time, I fully embraced this beautiful place
and its many attributes. I spent precious hours with Judy, walking
and beaching, tandem biking and dining out. We also entertained,
hosting our families, as well as two couples who are close friends of
ours. I joined a twice-weekly cardio-tennis clinic, where I was the oldest
member. With 45 miles of bike trails available, I rode my bike daily,
usually for 10 or 15 miles, while listening to audio tapes of my favorite
detective stories and classical music. I would also bike to the golf course
to practice, even though a shank crept into my game, causing significant
frustration and preventing me from wanting to play on the course.
All in all, it was a very special summer for us. At the end of September,
we attended Rosh Hashanah services at Temple Shirat Hayam, which
we had embraced over Pittsburgh’s Tree of Life synagogue after the
shootings in October of 2018. We felt the synagogue had ignored the
needs of the congregation. Then, at the beginning of autumn, Judy and
I returned home and settled back into our Pittsburgh routine.
On October 6, I went for my yearly appointment with my internist,
Alan Steckel. When he read me the results of my blood test, I felt as if
I had fallen off a cliff. My blood work was markedly abnormal. It was
consistent with a transformation of previous monoclonal gammopathy
of undetermined significance (MGUS)—which I had known about for
11 years—into full-blown multiple myeloma, a plasma cell blood cancer.
Ironically, this transformation occurs about one percent per year, or
11 percent over the period. How unlucky I was! Perhaps my illness was
influenced by the fact that, in his 80s, my father had apparently suffered
from smoldering myeloma (a type of myeloma without symptoms,
which requires no treatment).
Having received this shocking diagnosis, I was referred to Dr. James
Rossetti, a hematologist oncologist at UPMC Hillman Cancer
Center whom I had known when he was at West Penn Hospital as a
fellow and staff member specializing in bone marrow transplants for
blood cancers. In the meantime, in early October, I also developed
excruciating back pain and a shortness of breath from anemia. Lab
exams revealed that between March and October there had been a
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jump in my M-spike measurement, a reflection of myeloma activity,
from 2.1 to 4.5, necessitating that I receive immediate treatment. In
addition, a bone marrow biopsy revealed a cytogenetic pattern that
carried a high-risk prognosis.
I immediately began a four-drug regimen consisting of Velcade
(Bortezomib), a proteasome inhibitor; Revlimid (lenalidomide), an
immunomodulatory drug; Dexamethasone, a high dose steroid; and
Daratumumab, an anti-cancer monoclonal antibody. The possibility
was left open for an autologous bone marrow transplant in the future, if
and when the M-spike decreased enough to allow harvesting of my stem
cells. Fortunately, my lab tests have improved, and I am contemplating
a stem cell harvesting for a transplant, hopefully after I return from
Nantucket in the fall.
Given my present condition, I take comfort from the fact that, on
most days, I am able to embrace my philosophy of living life to the
fullest. I will continue to do so as long as I am physically capable. As
I reflect back, I am confident that I gave my utmost to my family and
my work. As I have said before, my life has definitely been more of a
roller coaster than a merry-go-round.
As I write this, I am seven months into therapy. Up until my
diagnosis, I had felt that I was younger than my chronological age.
I thought that the fact that my two parents passed away in their 90s
would have allowed me to reach at least my mid 80s. Now, I will feel
fortunate if I reach 80. It is difficult to accept a potentially decreased
lifespan, and I frequently contemplate my limited future with sadness.
Nevertheless, I also embrace cautious optimism. My mantra going
forward has been “fingers crossed.” And as Craig says, “Enjoy the good
days and weather the bad.”
I have a tendency to be optimistic about outcomes, but I can also
accept when they do not come to fruition. I am able to rationalize failure
and move on. I would hope that my sense of optimism, even if tempered
with realism, is a perspective that Judy and my family can adopt.
I cannot fully express how much Judy has meant to me—now and
always. Although she and I are opposites in so many ways, we are also
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strikingly complementary. While I veer toward the positive, she can be
negative. I tend to be very reserved, private and sometimes stiff, while
she is warm, open and social. While I am self-focused, she thinks of
others first. My bent is intellectual, while hers is practical. On paper,
our polarities may seem irreconcilable. In practice, our very differences
bind us together.
I am certain that Judy has made me a better person. At the same
time, I hope that I have been a positive force in her life. She has taught
me how to open up, to become more giving—and romantic. She is my
life, my love and my closest companion.
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From my retirement scrapbook
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From my retirement scrapbook
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From my retirement scrapbook
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From my retirement scrapbook
Grandparenting is special
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From when I first got sick
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My special person
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CHAPTER TWELVE
Me
On our trip to Israel, we did a scavenger hunt around Jerusalem.
Craig added bonus points for objects specifically related to
me. Over the years, my family has playfully brought up various
characteristics, habits, and idiosyncrasies that define me. Since this
book is about me, I thought it appropriate to share some of these.
I never throw things out and am a terrible hoarder—of which clothes
and food are the most blatant example. I am an adventurous eater,
seeking out exotic cuisines and street food. Every night, I have a glass
of red wine—for “medicinal purposes.” I love spicy foods, particularly
Szechuan, and choose 7 out of 10 with Thai food. I always have loved
cookies and prefer chocolate chip cookies without the chips. I am
known as the “cookie monster.” I like potato knishes and pierogis. In
Nantucket, I love to eat clam chowder, fried clams, and bluefish, and
am lukewarm about lobster. I never leave anything on my plate and will
contrive to taste or finish whatever is on Judy’s.
Despite being conservative, I have always driven a sporty car with
a stick shift, starting with a red Volvo P1800 coupe when I came to
Pittsburgh, and most recently, a BMW 430 Xi coupe. I have always enjoyed
the challenge of shifting gears, adjusting the radio while answering my
cell phone, and drinking a cup of coffee all at once on the way to work.
From a sartorial standpoint, my uniform is a button-down shirt
from Brooks Brothers, khaki trousers, loafers, and one of the more
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than 200 ties I have collected, many with motifs from stethoscopes to
wine bottles and Bugs Bunny. I love crew-neck sweaters. When I was a
medical student in Edinburgh, I bought my first university scarf with
vertical stripes. Subsequently, whenever I traveled to England or went
to J. Press clothiers in Cambridge or New York, I would buy one and
now have over 40. As I do with aftershave lotion, I rotate them on a
regular basis to wear with my toggle coat.
One of my loves is the Boston Red Sox, who I have followed since
I was growing up in New Hampshire. I cherish my 60th birthday
present of a Red Sox–Yankees game on the Green Monster with Craig.
I read the sports page every day. Other loves include biking, classical
music, particularly Bach, classic rock, Bob Marley and U2 (influenced
by my kids), and The New York Times.
I refuse to be limited by physical ailments and rarely complain of
pain or discomfort. I was hit by a car crossing the street in a crosswalk
and was thrown 15 feet. Since I could get up and had no pain, I then
proceeded to the hospital to do a procedure after a stat X-ray showed
no fractures. After my prostatectomy, with a Foley catheter in place,
I saw office patients dressed in baggy pants with a urine bag strapped
around my leg. I let little interfere with work.
I was always available to patients and doctors 24–7, and I never
turned my phone off, which led to calls at inopportune times. I was
interrupted during Noah’s bris, have received calls on the chairlift and
airplane, and have gotten calls from doctors at 12 midnight in Vietnam
and 4 a.m. on safari in South Africa.
At work, in the afternoon, I would become sleepy interviewing a
patient. I would then disappear into my office to close my eyes at my
desk for a few minutes, awakening refreshed and ready for the next
patient—my power nap.
I am well known for my pratfalls. On our first trip to Israel, Craig
tipped a glass of coke over and I fell over backwards trying to move out
of the way, my back chair legs caught on a ceramic tile floor. I have also
missed steps in the plaza of Milan’s cathedral and Mont-Saint-Michel,
and I have been “gummed” by a toothless chimpanzee belonging to a
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street vendor in Acapulco while trying to retrieve a wallet that he had
pilfered from Craig’s hand.
I always read instructions first and try to complete tasks. I am
terribly stubborn and need to provide my own answer without hearing
the answer already given to me. I try to multitask but have seen this
deteriorate as I have aged. I hear but I don’t listen. I become so involved
in doing something that I am oblivious to anything around me,
particularly to what Judy is saying. Verbally, I have no shut-off valve,
and “hoof in mouth disease,” invariably saying the wrong thing at the
wrong time and creating trouble.
Finally, I have several stock quotes or “Barryisms,” as Judy calls
them. “If you are not standing on the edge, you are taking up too much
space.” “The glass is always half full,” (and half empty for Judy). When
Judy gets nervous, “Relax Max,” and “Whatever.” When asked to weigh
in on a decision when I don’t know or don’t care, “It’s a 50-50 chance.”
Our toast with each evening’s wine is “Health and happiness.”
In short, I am me.
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Israel trip scavenger hunt list of objects related to me
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CONCLUSION
Looking back over my life, I am conscious that my medical career
has always taken a front seat. Medicine offered me a profession
in which I could feel confident about myself. It allowed me to strive
in order to excel and succeed using my intellectual gifts. At the same
time, the relationships I was able to forge with patients allowed me
to overcome the shortcomings I usually experienced with people in
wider social settings. Armed with knowledge, I was buoyed, capable of
sharing my expertise and compassion with my fellow human beings.
In my role as a physician, I connected with many wonderful patients,
some of whom became long-lasting friends. I was also gratified that
I provided a legacy for Craig, impacting on his decision to become a
physician.
Unfortunately, the political battles into which I was thrust, primarily
with AHN, and the discrimination I suffered as an independent
physician, soured me on the current state of medicine in the United
States. The focus of insurance companies on bureaucratic paperwork,
numerous government regulations, and the institution of electronic
health records also contributed to my disenchantment with the current
state of the profession. Medicine has become a business and is no longer
the altruistic, community-based practice that my grandfather exercised
and passed along to me. I regret that my career interfered with my
family life to the extent that it did, with long hours and incessant
phone calls causing Judy, and to a lesser extent my children, to be
denied the fruits of personal and family life. I so appreciate Judy being
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the consummate doctor’s wife and my children never complaining. It
was always a challenge for me to balance my work life and my home
life, but I tried. Now that I am in retirement, I hope to make amends.
As I write these words, my body is responding to treatment and my
condition is improving. But none of us know what the future portends.
At the moment, I am getting better. The question is, what will I be like
when this is all over and done with? I would love for my back pain to
vanish and to regain my physical strength and stamina.
I hope that I can get back to biking and at least swing a golf club.
Maybe I will even be able to play old fogey tennis in some fashion.
I dream of returning with Judy to Nantucket, to walk along the beach,
hand in hand, and to be able to travel again, but without the constraints
my practice imposed. I would love to be able to do all these things. But
if I cannot, I cannot. I am thankful for where I am now.
As a final word to my children and grandchildren and greatgrandchildren,
I would tell you to make your family your first and most
important priority. I would encourage you to do what you like and
like what you do. Be open and loving. Live your life to the fullest and
be happy.
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