John Romano

Transcription:

Jack End: Dr. Romano[1] , what were the circumstances which caused you to come to the University of Rochester?[2]

JR: Well, there were multiple reasons. I was professor and chairman of the Department of Psychiatry at the University of Cincinnati . . . at the time I was invited to consider the post here, and at that very same time I was also invited to consider chairmanship posts at the University of Minnesota, the University of Chicago, and shortly before then at McGill in Montreal, Canada. And I believe the reasons that Rochester attracted me more than did the others was the fact that the school was a smaller school in terms of number of students per class, that it had a tradition of being interested in the teaching of students, that it had a very significant reputation as being a very scholarly school in terms of scientific advances and research, and the fact that it was in a city the size of Rochester. And one of my primary interests, then and now, has been in the teaching of undergraduate medical students, and I felt that what I wished to do could be done better in Rochester than in the other schools that I mentioned. The reason I was interested in leaving Cincinnati was that even though we had made very considerable advances during the war years, I didn’t feel that there were going to be sufficient support for the development of the department, which I thought was to be necessary in the ensuing years. Also, Rochester had received a generous gift to help support a new Department of Psychiatry[3]; there had been no department before then, and also I could take some part in the planning of the launching of the department and the building of a new building.

JE: Uh, as you say there was no such thing as a Department of Psychiatry when you came here, so you not only founded the department but also were, more or less, had to supervise the building of a physical plant and subsequently expanding it. Now what were some of the problems involved here?

JR: Well, it was a time I think, at one time we said that they were more strikes than foul balls, and it was a time of repetitive strikes of one group or the other. I remember there was a delay in terms of steel and Dr. Whipple[4] and the others then asked whether we wished to wait for the steel or go ahead with reinforced concrete. And not being much of a builder or businessman, I did feel that it was best to get on with the job, so we went ahead, fortunately, in getting the building started and finished in the next two years[5]. If we had waited, we would have to wait indefinitely for the steel to come. I had had some earlier experience; before I left Cincinnati I was asked by the trustees of the Jewish hospital there to help develop a psychiatric unit in a general hospital. And I had traveled various places in the nation to see new ideas and new developments. And also when I came here, Mr. Leonard Waasdorp[6], the chief architect, and Mr. Raymond Thompson[7], then Vice-President and Treasurer, visited with me various hospitals and clinics in the United States so that we could get some general notion of what some of the developments were. But the interesting thing is, that we got most of our ideas from hotels rather than hospitals. The Statler Hotel in Washington, at that time fairly new[8] served as a model in terms of studio beds, general décor of patient care rooms in a psychiatric unit because hospitals have become more livable than they were in earlier times when they were mostly high-ceilinged and noisy and sepulchral in nature.

JE: During the time that you have been here who were some of the people with whom you worked that impressed you and were particularly helpful?

JR: Well, I came to the University at a at a very interesting time because the Medical School I believe all of the founding chairmen were here, with the exception of Dr. George Corner[9] in anatomy who’d been replaced by Karl Mason[10], and of Nathaniel Faxon[11], the hospital director who had been replaced by Basil MacLean[12], and Stanhope Bayne-Jones[13] in microbiology, who had been replaced by George Berry[14]. So all of the founding fathers, so to speak, were here when I came, with those exceptions. Of course, since then they’ve all changed, sometimes more than one time. And so I came at a midpoint in the history of the Medical School, some almost twenty-six years ago, knowing something of its tradition of the past and of those very outstanding chairmen of departments who helped found the school and then have learned something, of course, of those who have succeeded them. Most intimately involved, I think, were George Whipple, who was of tremendous help to me as well as Basil MacLean the hospital director. And William McCann[15] in medicine and Sam Clausen[16], pediatrics; Karl Wilson[17] in obstetrics; John Morton[18] – all of these persons played a very great part in helping a young man like me come here and build and develop a new department, a new departure for the Medical School. George Berry was then in the Dean’s office as well as professor of microbiology and we became intimate friends, and I was very, very sorry to have him go; he did go to become the Dean of the Harvard Medical School but he was, I thought, a tremendously positive and constructive influence in the affairs of this Medical School in the days that I knew him.

JE: Your good influence has been felt not only in your own department but also in the whole hospital and indeed throughout the entire University. In fact, you were a founding member of the University Senate in 1963. How did the Senate come into being and what are its functions, aims, and goals?

JR: Well, a number of us for a number of years before it the Senate was was established were interested in having a body of this nature, which I’ve always thought from the very beginning was to be advisory, not legislative. And I think it was Mr. Wallis’s coming[19] which made possible the establishment of this body of the faculty. Uh, the faculty, as you know, is chosen from a the Senate is chosen from a large electorate of the faculty and is, as I said, advisory to the to the President, the Chancellor now, and to other administrative officers concerning the conduct of the University. I always felt that its principal contribution was in terms of the educational conduct of the University. The at one time it was my privilege to have chaired the steering committee of the Senate which was the body which helped to plan the agenda; which appointed the several subcommittees, working committees of the Senate working on various issues. In my day, they related to problems of of multiple disciplines, of interdisciplinary departments and ventures which transcended traditional department barriers. It was concerned with with problems of relationships with the community and community facilities of one type or the other. At one time we discussed the question of honorary degrees construction of new departments in the University as a whole. Uh, I enjoyed my my membership in the in the Senate. At times I was a bit disappointed that there was not sufficient discussion or debate on important issues. Um, but I felt and still feel that the Senate does serve an important purpose in the University in terms of being an advisory body of the faculty and also a body which can be informed directly by the Chancellor and the President. One, a body which has the ear of the Chancellor and President so that communication between these agencies can be effected.

JE: Have the suggestions and recommendations of the Senate been generally listened to? Have you really had the ear of the powers that be?

JR: From my sample, I don’t remember any significant recommendation which emerged from the Senate which was not considered seriously and in most instances acted on favorably by the administration. I know that when I say this that there are others who have different views of the matter, different I speak of other members of the faculty. But from my sample of of membership and participation both in the steering committee and the Senate as a whole, I found the administrative officers attentive, alert, interested in listening to the arguments, the problems, the issues that are presented to them by the by the administration. Now it must be remembered that faculty at times do not recognize the the differentiation of roles between, let’s say, trustees and administration and faculty and students and alumni, for that matter. Uh, and at times many of the faculty I think are less sophisticated and informed than they could be in terms of the role of administration and the what are the responsibilities of administrative officers in a university[20]. Uh, and I think as I remember it, the persons who at times were most intrusive in terms of administrative judgments, were those who were the least sophisticated in administrative experience. For example, many of the teachers and professors in the River Campus who were concerned many times with abstractions and abstruse matters, at times appeared to be the most intrusive, while many of us at the Medical School those of us who have to deal directly with life and death and with human affairs, day in and day out, I think we’re much more content to have the administration assume their responsibilities.

JE: Now to get back to the hospital, what are the differences between a teaching hospital and a non-teaching hospital? Is one more difficult to operate than the other?

JR: I’ve once defined the teaching hospital as one of the consciences of the medical profession. Uh, wherever you have a set in which the questions which are asked must be answered, you have the equivalent of a conscience. And this is the sum and substance of a teaching hospital: that whatever is done, there is a special kind of accountability. One must be accountable. One must be accountable not only to the patient, but also to the student. That if a measure is undertaken or not undertaken, there must be explicit reasons as stated for that action or inaction. So a teaching hospital, different from any other hospital, is a hospital where certain standards are kept high in terms of the the need to explain, to justify the conduct to which has been which has been taken. Now a teaching hospital is always a more complex institution. A hospital in itself, now, any kind of a hospital is a very complex social institution. And at times it seems to be almost a Tower of Babel, because of the many different kinds of persons, particularly today when there’re increasing numbers of persons per patient, for example, involved in patient care. Studies have been undertaken indicating how long a chart was and how many people saw a patient, let’s say a middle-aged woman with heart disease, some forty or fifty years ago compared to today. Today, many, many more people see that same type of patient, many more notes are written, and there are many more paraprofessional persons involved. So today, the hospital is an extremely complex social institution with many persons of very different backgrounds, at times appeared – they appear dissonant to each other, and it requires a degree of courage and tolerance and fortitude to help people understand something of the ventures they have in common in patient care and in teaching the young and in pursuing new knowledge.

JE: Well, why shouldn’t all hospitals be teaching hospitals?

JR: Well, many hospitals are teaching hospitals which are not necessarily called “teaching hospitals.” It all depends on who can be taught. I mean, after all, patients can be taught. Patients’ families can be taught. Um, attending physicians can be taught, nurses can be taught, social workers can be taught, technicians can be taught. So you don’t necessarily have to have an undergraduate medical school to have a teaching hospital. So that the term “teaching hospital” is used fairly liberally. At one extremity is the narrowest definition, namely a hospital which is intimately associated with an undergraduate teaching medical school. Uh, however, a teaching hospital can be called that if they teach house officers, nurses, paramedical persons of one kind or the other. But in general, if by your question you mean “should all hospitals have built into them a conscience mechanism whereby there is accountability for what is done,” I would agree that all hospitals should be teaching hospitals.

JE: Are the present state and federal budget cuts affecting mental health services to any great extent, and if so are we at the University of Rochester’s Strong Memorial Hospital better or worse off than other comparable hospitals?

JR: Well we had some scares this past year that incidentally led to a very interesting national response on the part of persons involved directly in mental healthcare, like doctors and nurses and psychologists and others. And also in the families of patients who would suffer from inadequate care, and also from rep – from our government representatives, members of the Congress and the Senate. Uh, in Rochester, a number of us through the medium of local governmental agencies and directly into Washington, to our state Senators and Congressmen, have made quite clear that if the White House and the Bureau of the Budget was were to cut seriously the funds to be allocated for the education – that is training and education – and for research, as well as for patient care, there would be very serious consequences. And I think as a result of this very natural groundswell of national opinion the budget as initially planned was introduced, that is, without a serious cut.

However, there are serious cuts at the state level. Since I have retired from the chairmanship of the department I have begun to make visits, teaching visits, teaching rounds, at the Rochester State Hospital[21]. And here one sees quite clearly the the very devastating effect of cuts in budget, with limits of manpower, limits of recruitment, inability to replace persons who leave, and this is reflecting itself in negligence in terms of day-to-day care, particularly of aged people and of chronically sick people. And I think it’s a function of society; they see in the long run is a society which determines not only the professions it chooses to serve it, but also how it wishes to be served. And it is society in the long run which must determine to what degree it supports those agencies relating to new knowledge, to the education of the young, and to the care of the sick. And any serious cut in this is going to affect the nation as a whole.

In Rochester, we have been quite fortunate. Other than for the state hospital setting. We have had over the years warm and full support of undergraduate teaching programs, graduate teaching programs, investigative programs ever since the inception of the national mental health law, which was passed by the 79^th Congress in 1946 and, however, at the moment, we are anxious in that it is anticipated there will be a cut in training funds and also in research funds. And if there are to be lean years, we’ll have to meet them as best we can. It may mean cutting back on some of our programs, and this of course will be distressing because it means that the physician of tomorrow will be less prepared than was his predecessor in helping those who are mentally sick in their practices in the future, and also reduce the recruitment of people into these important fields.

JE: Do you think this will have these cuts will have long-lasting effects or let’s say that within the year when the cuts were taken back, would this immediately alleviate the situation?

JR: Well, as I mentioned I think we’re all right for this current fiscal year. We’re concerned about plans for the following years because one hears through the grapevine and various kinds of murmurs, that there is to be some reduction in federal support of educational funds, particularly in the field of psychiatry. As I mentioned, if this cut is a serious or significant one, if it is something more than twenty-five percent, for example, of the total amount it will seriously affect the viability of many of the programs throughout the land. Again, we are more fortunate because as a department we have a more sound financial base. The the generosity of the initial endowment and the nature of the hospital hospital design and patient care facilities, make us less vi – less vulnerable and more viable, I mean, as the future, but we will be seriously affected if cuts are if cuts occur at significant levels.

JE: You’ve made many visits outside of the United States to various psychiatric conferences throughout the world. Is there in general a freedom of exchange of professional ideas in these sessions, or are there some areas in which for one reason or another, some of the material which others might have is not given out?

JR: I think in general there is a fairly full and free exchange of data. There are some exceptions. In 1960 on my first visit to the Soviet Union and Moscow and again in 1970 when I visited in Leningrad and in Moscow, I could not get data concerning suicide. Um, since then also I’ve met with Soviet psychiatrists, including Soviet epidemiologists in the field in this country, and here too I’ve asked them the same questions but it is always indicated or inferred that perhaps that someone else would tell me about that. I’ve never been able to get any clear data, although I think their suicide rate is about the same as ours, perhaps a little bit higher. Uh, I did get data and get acknowledgement of high prevalence to stress in the Soviet Union about alcoholism. Alcoholism is a very serious problem, as serious as it is in France. And they spoke about this quite openly, even though when I asked for comparative data from the past they were unable to give it to me.

I remember a rather amusing incident in which I visited one of the academicians, together with a young lady who was acting as an interpreter, and even though I knew that this man spoke and understood English, yet I had to speak to the girl who in turn spoke to spoke to the academician and I asked, “Why is it you have such a great problem with alcoholism?” And he spoke to her and she said to me, “He told me to tell you that it’s much less than before the Revolution.” Whereupon I said, “Well could you tell me more specifically why, because I don’t know how accurate are your data; I can tell you that our data, our prevalence and incidents data in America are dreadfully poor. They’re very bad, except for hospital admission figures. And so why do you have as much as you have?” Whereupon this time, he was smiling as he spoke to the girl and the girl smiled a bit as she said to me, “He told me,” she said, “to tell you again that it is much less than before the Revolution.” Whereupon I pursued the point further and asked, “Well, why do you have as much as you have?” This time he was smiling very broadly; he spoke to her rather quickly, and she giggled as she said to me, “He said that it is probably a residue of the capitalist regime.”

JE: [laughs] Um, there seem to be some trends towards shortening and otherwise changing the training period for physicians. Do you think this is a good thing?

JR: Well, I believe that it is important always to examine the curriculum. As a matter of fact, the initial meaning of the word “curriculum” meant a diminutive race course where it’s difficult to know at times who is the victor and who are the vanquished. I believe that concern about the curriculum should be a constant and should always be before us because what we teach and how we teach it and how long we teach it is a function of the day. That is, what kind of information we have, what kind of technical knowledge we have, and what society, economically and socially, is ready to support. Therefore I am all for a constant vigilance about curricular matters.

On the other hand, I am seriously concerned about the truncating of the medical professional period. Uh, there are talks about truncating and reducing the collegiate preparation. There are talks about reducing the period of the undergraduate medical school and there are also talk about abandonment of the free-standing internship, which means that there would be a reduction in the collegiate period, reduction in the undergraduate medical period, and a further reduction in the post-graduate period of the young physician. I believe that as Thoreau did, that it takes a little time for a man to fit his clothes. And I believe that certain years are necessary to acquire the phase-specific task of becoming a physician, of disciplining one’s capacity for human intimacy in the role of the physician. And I believe this is done when the person, that is a young man or woman, has sufficient responsibility in assuming certain tasks. I don’t think this can be done at times in student roles. And I think that it takes time to learn this. To learn it, for example, as an intern, when one is responsible, whether one is sick or not, or tired or not, to stay with the patient, care for the patient, let’s say, through the night and through whatever period is necessary as the patient may need you. The whole questions of reliability, dependability, and accountability, in addition to the matters of information, I think negate any truncating or reducing in time.

Furthermore, medicine is such a rich menu. There are so many things that to seduce the student early in his career to choose a track – whether it be in molecular biology or psychobiology or social science or administration or surgical specialty – for him to do this early, I think, is to do a man injustice. He makes a choice at that time  – which is not informed. I believe he should have free choice of what he wishes to do and the field is very broad indeed. But I think it should be an intelligent and informed choice from having a broad repertoire of experience in the various fields. And for these reasons, I am of the view that at the moment, there is a kind of a priori evangelism. I think, principally for economic reasons, to cut down and to make – to cut short the maturation – in general, then, I am a protagonist of the liberal tradition. I believe the the liberal tradition should be extended into professional education. I believe the best informed physician is the broadly civilized physician. So that he can be best prepared to look critically at his data and to meet the tasks of his day.

JE: Are physicians other than those who are in the field of psychiatry becoming more involved in mental health service to their patients?

JR: Well, I think in the middle third of this century, a number of us have tried to point in this direction the education of all medical students towards these ends, to have them learn something of the nature of medicine in human and social terms, as well as in mammalian terms. And the various types of teaching relationships at intern and resident levels in various clinical disciplines – our work here perhaps in medicine and obstetrics and pediatrics have enabled us, let’s say, to share many of our ideas and to learn from them – from others of their ideas, so that today much of these matters concerning psychosocial matters in obstetrics and gynecology, for example, are taught by the obstetricians and gynecologists, not by us. Because they have become informed as to what are the matters relating to post-partum blues, for example, or some of the problems of sexuality or the problems relating to abortion or sterilization or other critical moments in the life of a woman.

JE: I know that you have written well over a hundred publications related to your field in addition you’ve taught, been an extremely capable administrator, done research, and still found time to treat patients. How have you managed to do all this? Do you ever sleep?

JR: Well, I sleep and I sleep well. Um, I I’ve had this I feel I’ve been very fortunate in in having come to Rochester and having the associates I’ve had over the years, and I’ve ta – I’ve had tremendous pleasure and pride in taking part in the development of many things here in Rochester. The the opportunity to to chair a department, to help direct some of its its interests and energies, the recruitment of young persons, young men and women, who’ve come and have taught us a great deal, and who have gone beyond us to many other departments in the world. We have many persons whom we’ve helped to groom for posts in New Zealand and Australia, in Colombia, South America, in Lebanon, in Israel. Uh, a young man has been with us now will be returning to Iceland. He’s been with us for three or four years and he also probably will be helped be groomed to assume a provisorial [sic] post in his in his homeland.

But all these have been very exciting things to be a part of. And to be nourished by the young in terms of their interest and their energy. And of course the other has been the care of patients and the teaching of students, day in and day out. Because this is how one learns. And what one learns from the patient, how little we know and how much more there is to know. And it’s in working with the patient and working with the student that I think that one, at least in my experiences, remains young at heart and in interest in his work. It’s an exciting thing, to be a psychiatrist at this time. Uh, the field the field is very broad. It touches mathematics, and now this uncanny development of mechanized intelligence with the computer. It touches the physical sciences. It there are new emerging notions concerning biochemical and biophysical phenomenon. It touches all of biology and it touches all of clinical medicine and several disciplines. It touches psychology and the social sciences and the humanities. And as Terence the Roman poet said, “Nothing truly is alien to it. It all relates to the human.” [22] To the human equation. And so it is an – I’ve always found it a very rich and interesting experience to be a psychiatrist and to be enriched by these many sources of information and new knowledge which come to one through these mediums.

JE: Finally, Dr. Romano I’m sure that, you know, psychiatry and everything that you do in this field is not all serious; I bet there is various humorous things that have happened in these past twenty-five or twenty-six years.

JR: Well, I can tell you about two. Both happened very early. There have been others but I’ll choose these two. One has to do with with the naming of the building. Um, initially, the the was to have been called after its very generous benefactor, Mrs. Helen Woodward Rivas. And there was to be a – inscribed in stone, beautiful Indiana limestone across the entablature of the front of the building, above the pillars: “The Helen W. Rivas Clinic.” And then the lady, as ladies are apt to, changed her mind and it was to have been the Helen Woodward Clinic, and then I think there were two or three other modifications. Well finally a decision was made, and it was the Helen W. Rivas Clinic. All of this was done with beautifully, beautifully inscribed Roman letters more than two feet high in an entablature extending over the entire front of the limestone façade of the building above the pillars. After this was done the lady changed her mind again and did not wish her name to be on the building. And there was a great deal of discussion; I remember Dr. Whipple, who was always a thrifty and frugal man, was quite pleased with my initial suggestion that we put a sign up on the left saying, “This is not the Helen W. Rivas Clinic but others, more practical minds, thought that this wouldn’t do.” Well, actually, what happened was the lady agreed to pay for taking the stones down and replacing them with plain stones, and so men were brought, stonemasons were brought, to take down the beautiful Indiana lime stones and when they had done this, one of the men called me over and said, “Doc, we want you to have this.” It was a beautiful Roman letter R. And they said, “We thought you earned your letter.” And this is actually the only letter I have ever earned in a collegiate setting.

JE: [laughs] Very good.

JR: The other had to do with the name Wing R at that time is what Wing Q[23] is at the present time. And they wanted me to have Wing Q. They wanted us to have Wing Q. But I thought that Wing R would be better because R would stand for “Rochester” and R would stand for “Rivas.” And so I recommended and really persuaded Dr. Whipple and Dr. McCann to yield R to me and for them to take Q. The other reason was, I told them quite frankly, that I thought I’d had enough difficulty in Rochester launching a Department of Psychiatry without having to call it Wing Q.

JE: [laughs] Thank you, Dr. Romano.

[recording ends]

- Transcribed by Eileen L. Fay (February 2014)