Dr. David Gilbert: Cardiologist On His Own

 

Dr. David Gilbert

On an early morning drive to one of our favorite hiking spots, we saw a large roadside billboard announcing Dr. David Gilbert’s private cardiology and vascular practice. My husband knew Dr. Gilbert, but was unaware of this new venture. Would he want to give us his story? Maybe. 

After we passed the smiling image of him again, we contacted him to ask. “Sure,” he quickly said. So we sent him the address of the website containing more than fifty prior doctors’ stories. 

A few weeks later, not having read any of the narratives (he was busy, he said), Dr. Gilbert showed up for the interview. Despite not knowing what to expect, what others had said, and what was written about them, he seemed relaxed and confident.

David said that he was born and raised in a “lower middle class” community in blue-collar Dundalk, Maryland, a planned close suburb of Baltimore. Nearly all the men (and many of the women) worked for giant Bethlehem Steel. The work could be dangerous, but it was steady. 

Worker near blast furnace at Bethlehem Steel,
Sparrows Point, 1951
(Credit: HumansAreMetal)

His Parents and the Family

Dr. Gilbert said that his parents were from “broken homes.”  His dad’s father “ran off” early, and his dad’s mother spent 14 years (yes, years) in a TB sanatorium. So his father was “passed around among family members,” and he was only 16 when he and David’s mother (then 15) were married.

They had six children, three boys and three girls. So, at one point, eight people lived in a house of about 2,000 square feet with one (that’s one, as in uno) bathroom. As his father worked in the steel mill, his mother took a job as a (stern) school crossing guard in the inner city. 

David said that his parents “were great.” His mother was “tough” but good, while his father, his “hero,” was simply “a good, good human being.” Dr. Gilbert told me that he appreciates the many invaluable lessons he picked up from the hard-working individuals of his childhood environment. There could be, he noted, profound wisdom about life without the need for a formal education.  If the family was on the poor side, he didn’t feel that at all.

As a kid, he was, in his words, “preoccupied with sports.” In football, he was one of the best players (as he quarterbacked for bad teams), but baseball was his true “passion,” and he admitted that he was a pretty good all-around ball player. As he was preparing to graduate from Dundalk High School, he didn’t know what he wanted to do, “to avoid getting into trouble.” You see, nobody at his school, including the so-called guidance counsellor, talked to him about college. You might take that route for sports, but never for pure academics. So David was slightly adrift.

Dundalk High interior (Credit: David Robert Crews)

The Navy

Since he enjoyed being challenged physically, six months after graduating, at the age of 18, he joined the Navy.  He wanted to be a special-ops, highly-trained Navy SEAL. In his (adolescent) mind, “knocking off third-world dictators wouldn’t be a bad job.”

(Credit: med.navy.mil)

He heard that one of the best ways to improve your chances of getting into the SEAL program was to start as a Navy Corpsman, where he would learn how to provide medical care for Naval and Marine personnel. The job required academic and physical skills, and he went for it. As a Corpsman, David moved around, and when he was assigned to the Great Lakes Naval Hospital in Illinois, he worked in an ICU.  It was here that he “fell in love with medicine.”  He saw firsthand that you could take somebody who was at the brink of death and return them to a good life. He wanted to be a doctor like that.

(What about his dream of being a SEAL? Well, nobody had bothered to tell David that he needed to have perfect 20/20 vision to qualify for the program; his eyesight was 20/200. Enough said.) 

So, as he fulfilled his Naval obligations around the country (sometimes moonlighting as a respiratory therapist), he took enough college courses to allow him to apply to medical school without having an undergraduate degree. (He had plenty of  credits, just not enough of the ones that York College, where he took his final courses, accepted for a degree.)

Medical School at PCOM and Early Practice

At this point, Dr. Gilbert noted, by the way, that his brother Tom, ten years older than him, and “a tremendous brother” who always tried “to do the right thing,” was an osteopathic ER physician. So when it was David’s turn to go to medical school, he followed his brother’s example and attended the Philadelphia College of Osteopathic Medicine (PCOM) on City Avenue, just off the always-busy Schuylkill Expressway. 

Mid-1990s campus overhaul of PCOM (Credit: PCOM)

Because of his years in the Navy, he entered medical school at 28. As an older, motivated student, he was “incredibly dedicated” to his studies. He had an “overwhelming fear of failure,” but he did well and graduated in 1998 at 32. Dave then did a three-year medical residency at Memorial Osteopathic Hospital in York. 

While in training, he wanted to specialize in cardiology, but by 35, he was “out of gas” and (in his words) “tired of being poor.” So he put aside his lofty ambition and joined a group private practice in York, Internal Medicine Consultants. The practice was busy, and he did inpatient and outpatient work for seven years. During this time, he met his wife, Tiffany (more on her later).

Time for a Heart and Vascular Fellowship

And by age 42, Dr. Gilbert was reenergized enough to look for a cardiology fellowship. By then, he had developed a special interest in peripheral vascular work.  He had taken care of amputees whose legs might have been salvaged with skilled intervention that was not readily available in York. He wanted to change that.

He was offered a position at the Deborah Heart and Lung Center in New Jersey. He was aware that they focused on peripheral vascular disease as well as heart disease, and he liked that, as he could bring back something of value to the region, should he stay. For more than three years, he commuted more than two hours each way daily in order to be with his family. He felt that being an older “non-traditional student“ was a benefit.  (Deborah was founded in 1922 as a small TB sanatorium to allow patients--regardless of their ability to pay--to get away from New York City for the healing fresh air of New Jersey.)

Philanthropist Dora Moness Shapiro founded Deborah in 1922
(Credit: Deborah Heart and Lung Center)

Dr. Gilbert spent about a third of his clinical time doing peripheral vascular work. His world-renowned mentors in this area included Richard Kovach, M.D., and Jon George, M.D., both of whom, according to Dr. Gilbert, are “tremendous critical thinkers.”

Time for a bit on peripheral vascular medicine, impaired circulation in the legs:  

Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis. Modifiable risk factors, including cigarette smoking, dyslipidemia, diabetes, poor diet quality, obesity, and physical inactivity, (and these), along with underlying genetic factors contribute to lower extremity atherosclerosis. Patients with PAD often have coexistent coronary or cerebrovascular (disease), and (an) increased likelihood of major adverse cardiovascular events, including myocardial infarction, stroke, and cardiovascular death,” (Bonaca, p. 1868).

And:

While LDL-lowering statins are not for everybody, there is underuse of statin therapy in patients with PAD. These medicines have “demonstrated a strong, intensity-dependent effect on amputation and mortality.. (and) cardiologists, primary care physicians, insurers, and other care providers need to do a better job in helping both our colleagues and our patients understand the importance of these medications in preserving both life and limb,” (Aday, p. 1449).

Back to the story:

Dr. Gilbert and his wife considered going south after he would complete his training in the Mid-Atlantic, but as he was a bit into his fourth year at Deborah (the year of interventional work), he received an unexpected call from the small Hanover Hospital, thirty miles west of York. They wanted to develop a cardiac program.

Developing a Cardiac Program

Staying in the area where his wife’s parents lived would foster close extended-family ties, and this appealed to Dr. Gilbert and Tiffany. So he accepted the challenge to build something for the community. Since this was not to be an interventional program, David chose not to finish his fourth year at Deborah. 

Dr. Bridenbaugh

In 2011, about 12-18 months into the new Hanover venture, things were going well, and the administrators changed their minds; they now wanted to offer full interventional services. Obliging, Dr. Gilbert returned to New Jersey to finish the fourth year of his fellowship.  And in 2013 or 2014 (David couldn’t recall the exact date), having racked up lots of miles commuting while listening to cardiology tapes, Dr. Gilbert and local cardiologists Dr. Larry Freer and Dr. Alan Bridenbaugh joined to provide their patients with some of the latest technical advances in heart and vascular care. Acutely ill patients no longer had to wait to be transferred to a large medical center to receive life-saving and heart muscle-preserving stents.

The interventional program quickly became successful, and they expanded from three physicians and a nurse practitioner to a professional staff of 21. They went from doing 100 cases a year to 1600 yearly, all while trying, in David’s words, “to do everything with an ethical and moral perspective.” The aim was to do things “for the right reason and in the right way,” and “not just to do cases and make money.”  

In 2016, Dr. Gilbert, having lost two young patients to acute pulmonary embolism (PE), added another type of procedure to what he had to offer: he learned to remove the deadly, thick blood clots from the lungs that were severely compromised by PE. And, turning to the usual source of the clots, a deep vein thrombosis (DVT) in the legs, he learned to pull them out to prevent the troublesome late complications (swelling, pain, tiredness, and skin changes leading to poorly-healing sores, or ulcers) that were not avoided with use of anticoagulants alone (the standard approach).

When UPMC/Pinnacle took over the Hanover Hospital and Memorial Hospital in York as the Pittsburgh-based health system expanded into the York area, Dr. Gilbert became the Medical Director for both cardiac programs. He was busy. But, after a while, he became, he said, “disenchanted with corporate medicine.”  While he had a lot of responsibility, he had virtually “no say” (when it came to institutional decisions). 

UPMC Memorial (Credit: jeffreytotaro 2019)

Disallusioned 

He was asked to do things (such as to recruit a heart surgeon), but was not invited to the meetings where the final decisions were made (e.g., there would be no surgery). He tried, but could never meet with anybody at all. He saw that the (Pittsburgh) people in charge didn’t understand the nature of the small community they had stepped into. In time, it was too much for Dr. Gilbert to accept. He was paid handsomely, but money was not enough to ease his conscience. He was 58 and could just walk away from medicine altogether, but “it didn’t feel right” to do that. 

(Confirming his suspicions about the administrators and their relationship to the practicing physicians, they made no effort at all to retain him after he told them he was bowing out. You see, he was, he felt, just “a replaceable cog” in a vast impersonal machine.

A scene from Modern Times (1936) (Credit: Roy Export SAS)

So David decided to do the nearly unthinkable in the current climate and start a private practice. He knew how things worked, and he had built a full program before, but this would be his own, and he could adhere to his strong ideals of being, as he said, “a devout Christian.”

He chose to practice medicine in such a way that he would have peace of mind. He realized that he would have a substantial cut in  income at first, but Dr. Gilbert said that he doesn’t lose sleep over money or anything.” He said that money itself is meaningless to him (as long as he doesn’t repeat the time in his twenties when his electricity was shut off).

Return to Private Practice

But building a modern (and viable) medical practice while being hemmed in on all sides by corporate healthcare giants with loads of cash would be a real challenge. After serving the York and Hanover areas for years, people knew of him and his work, but he was aware that word of mouth alone wouldn’t assure success. He had to create a reliable referral base. 

Dr. Green

As he provided the advanced heart and vascular services, he would not be alone. Dr. Gilbert has brought on a respected podiatrist (as peripheral vascular problems usually show up in the feet first), an older but energetic and wise general surgeon, John Green, D.O., to do wound care (as poorly-vascularized tissues heal very slowly), and a seasoned nurse practitioner (filling the somewhat surprising need for additional primary care services).  Dave tried to convince a graduating resident to join him, but the wary resident chose the system instead, the seemingly safer option.

This brings us to a special integral part of his team, his wife Tiffany, who runs the practice. She has a doctorate in Natural Medicine, focusing on traditional herbal and nutritional remedies, manual therapies, and homeopathy. She follows a holistic (i.e., a mind-body-spirit) approach. Dr. David Gilbert, trained in osteopathic as well as allopathic medicine, also believes strongly in the importance of caring for the whole patient, not just their individual parts.  

He said that in his practice, his “security is rooted in doing the right thing.” And he said that  he needs to know that he did what he could, and that he “made a measurable difference in the world.” As noted, Dr. Gilbert was disillusioned as he saw up close that the prime motive of corporate medicine appeared to be financial profit, so the decision to break away from that model wasn’t totally unexpected. 

Moral Injury

It has been claimed that physicians leave medicine altogether, or change jobs (looking for something less stressful), because they are “burned out.”  It is said that they are mentally and emotionally exhausted by the workload and that they need to learn how to cope better, that they are just not strong enough, not resilient enough. It has been suggested that the stressed-out doctors should do yoga, or meditate, or splash on some lavender oil to cope better. Maybe what is needed is a Chief Wellness Officer. But brief research told me something else. 

The real problem, according to psychiatrist Wendy Dean and others (writing in 2019, before the Covid-19 pandemic), is that our healthcare system creates moral injury. Accordingly, she notes: 

Moral injury occurs when we perpetrate, bear witness to, or fail to prevent an act that transgresses our deeply held moral beliefs. In the health care context, that deeply held moral belief is the oath each of us took when embarking on our paths as health care providers: Put the needs of patients first. That oath is the lynchpin of our working lives and our guiding principle when searching for the right course of action. But as clinicians, we are increasingly forced to consider the demands of other stakeholders— the electronic medical record (EMR), the insurers, the hospital, the health care system, even our own financial security—before the needs of our patients. Every time we are forced to make a decision that contravenes our patients’ best interests, we feel a sting of moral injustice. Over time, these repetitive insults amass into moral injury. (Dean, p. 400) 

As Dr. Gilbert, I believe, sensed that creeping moral injury, he did something about it. He bemoans the current general societal “lack of empathy for our fellow human beings.”  And he believes strongly that there is “not as much compassion as there used to be.” (Recall that empathy is feeling what others feel, and compassion is that, plus taking action to relieve their suffering.) He reminds his three sons to think of others before they think of themselves, and that they are the least important people in the room. David has “complete disdain for selfishness.”

Back to Family

When he’s not doing for others, how does he spend his free time?  He doesn’t play golf, or fiddle with cars, or play video games, or whatever. He simply said he “hangs out with family.”  David and Tiffany’s first son (Carson, currently a junior at Liberty University) was adopted from Guatemala. His adoption was followed (of course!) by “natural” (fraternal) twin brothers (Grant, an ice-hockey athlete, and Tate, an aspiring actor). Dr. Gilbert revels in watching them mature. Family is very important, and he credits his capable wife for how well the boys have turned out (though I think he has had something to do with it).

And just to remind us that life is short and should be savored, when my husband and I went back to our hiking spot recently, the billboard sign for Dr. Gilbert’s medical practice was replaced by one for a new local family-run funeral home.

References:

1. Aday, Aaron W., MD, and Everett, Brendan M., MD. "Statins in Peripheral Artery Disease: What Are We Waiting For?" Circulation. 2018;137:1447–1449.

2. Bonaca, Marc P., Hamburg, Naomi M., Creager, Mark A. "Contemporary Medical Management of Peripheral Artery Disease." Circulation Research. 2021;128:1868–1884. 

3. Dean, Wendy, MD, Talbot, Simon, MD, and Dean, Austin. "Reframing Clinician Distress: Moral Injury, Not Burnout." Federal Practitioner, September 2019.

4. Trzeciak, Stephen and Mazzarelli, Anthony. Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference.Studer Group. LLC. Pensacola, Florida, 2019.  Exhaustive compendium of scientific and observational studies making a strongly reasoned argument that compassion for others always benefits the giver as well as the receiver. (But awareness of that mystery is ancient knowledge that has to be continually rediscovered.) 

By Anita Cherry 8/17/25

Ballet Class at the Downtown York JCC
(Chalk sketch by Anita, 1986)

(The first collection of these stories is available in book form:  York Doctors: Their Stories Vol. 1)

Dr. Rich Murray: Pulmonary and Critical Care Intensivist

Dr.  Rich Murray

As we sat down and talked, Dr. Richard Murray recalled being at a company picnic as a youngster and seeing children running around with their mouths open and tongues hanging out. They were trying to catch the fluffy white stuff floating down from the sky, excitedly trying to catch the dust spewed from the asbestos factory in Manville, Somerset County, New Jersey, home of Johns-Manville.   

Asbestos exposure is linked to asbestosis (fibrosis), lung cancer, mesothelioma, ovarian cancer, and laryngeal cancer. While it was recognized as a carcinogen in 1943, the use of asbestos in most products wasn’t halted until 1970. But it wasn’t fully banned by the EPA until 2024, after its use was already eliminated in more than 50 other countries. The innocent kids and their parents were clueless.

The sharp, tiny asbestos particles remain embedded in the body forever, and the illnesses they cause can occur thirty years or more after exposure. Dr. Murray said that the peak of asbestos-related mesotheliomas was in the early 1990s, around the time he came to York from the University of Maryland for the practice of pulmonary and critical care medicine. 

Asbestos (Credit: healthgrades.com)

Another one of his childhood memories, maybe his very first clear memory, is of seeing his aunt lying in bed covered by a clear plastic oxygen tent. She was struggling to breathe. He was five or six.   

Did these early experiences influence Dr. Murray’s later choice of a medical specialty? Let us see how the story unfolds.

Geneology

His paternal grandparents (surnamed Bacsó) were born in Hungary and came to the States in the 1920s. They settled in the Northeast Pennsylvania Shenandoah coal mining region. Their first son, whom they named Richard, was joyously paraded through the streets in a “carriage or a Model-T”–as was the ethnic custom. 

Miner testing for flammable gas (Credit: Library of Congress)

Sadly, he developed pneumonia and died a few days later. When Dr. Murray’s grandmother had a second child (Dr. Murray’s father), she also named him Richard. Dr. Murray's grandfather, of course, worked in the remarkably productive and dangerous Pennsylvania mines, digging out (and breathing in) the hard, valuable anthracite coal. He, along with many others, was later recruited to Central New Jersey by the asbestos industry giant Johns-Manville “for a better life.” 

( Dr. Murray was able to find his father’s brother’s gravesite online. He thought about visiting it, but decided not to, since he realized that if the baby had lived, he, himself, wouldn’t be here. Perhaps another day.)

After his paternal grandfather died at a young age, his grandmother remarried and acquired the surname Murray. The town of Manville then had “15 churches and 21 bars,” according to Dr. Murray. One of these latter fine establishments was owned by his grandmother. Her second son, the second Richard, Dr. Murray’s father, survived infancy, thrived, went to Dickinson, and became an attorney.

Manville movie theater circa 1954 (Credit: Neal Ranauro)

Dr. Murray’s maternal grandmother worked as a dancer in Atlantic City. When the family moved from South Jersey to the central part of the state, her daughter (Dr. Murray’s mother) met Mrs. Murray’s son when they attended high school together. She chose a medical career and would eventually become a respected orthopedic head nurse. Her son (our protagonist) would later visit her at work in the hospital.  

(First-born Rich has four younger sisters, so he was in a very enviable position within the family.)

Middle School and High School

Dr. Murray’s middle school and high school experience was, shall we say, a bit unusual. He went to Delbarton in Morristown, a monastery associated with St. Mary’s Abbey. According to their website: 

Delbarton is one of the finest all-boys Catholic college preparatory schools in the United States because our Benedictine Catholic character and values undergird all we do. All who form this learning community believe God calls them to develop young men to their highest potential and purpose, intellectually, physically, spiritually and morally-and they do just that, with earnestness, humility and true welcome for all.

Dr. Murray told me that you went there either because you were ”kicked out” of two other schools, or for sports. (I will assume Rich went there for the athletics, not discipline.) There were seventy black-robed monks in residence at the time. The students interacted with them outside of the classroom regularly, and the experience was “great,” said Rich. 

Kountze Mansion/Old Main (Credit: delbarton.think-12.com)

He has good memories of attending plays in New York with the monks, and playing bridge with them on the weekends (even though all “knew” that the monks cheated).

Rich said that “the monks kind of told you where you were supposed to go for college.”  He was steered to Yale and was advised to apply as a French major. But Rich claimed that he was not good at French and didn’t even like studying it. However, he listened, worked hard, and got an A.  This was, it turned out, the ticket to getting accepted. (After he arrived in New Haven, he didn’t take a single French course. The wise monks knew the system, and they seemed to be able to get everyone where they were meant to go.)

Not too long ago, Dr. Murray went back to Delbarton for a funeral. There were only 12 monks left. 

Yale

As he entered college, the tumult of the Vietnam conflict was over, and everyone, he said, “just wanted to be a doctor, lawyer,  or businessman.” The women’s movement was growing, and formerly all-male Yale had become co-ed in 1969. This relatively new change in the composition of the student body was such that (even by 1976) the (very successful) women’s crew (including two Olympic rowers) still didn’t have their own showers; they had to wait and wait (often in the bitter cold) for the men’s team to finish before they could use the facilities. 

This was unacceptable. So nineteen women (Rich was friends with one of them) took a stand. They calmly presented their demands to the Director of Physical Education, Joni Barnett, while standing before her in a state of complete undress and with “Title IX” painted (in Yale blue) on their bodies. This peaceful, but effective, demonstration of inequity made the New York Times and helped shape the future of women’s college sports.

The Yale Women's Eight (Credit: The Boston Globe)

Speaking of sports, at Yale, Rich played on the football team for six weeks.  He gave up after he suffered a concussion, didn't remember the game at all, and was allowed to resume playing in a few weeks. He decided to stick with intramural sports after that. Dr. Murray didn’t say much about his studies at Yale, where he switched from French to the sciences to prepare for medical school.

Medical School and Residency

After urban-situated Yale, Rich longed for a more bucolic setting for medical school. He visited his sister at UVA in Charlottesville and liked the feel. So he was pleased when he was accepted to Thomas Jefferson’s beautiful University of Virginia Medical School in the Shenandoah Valley of Virginia.

As a student, he especially enjoyed the course in pulmonary physiology. For his OB experience, he spent a month in southern Virginia. With the help of the skilled nurses, he delivered 29 babies. He liked this so much that he thought he would do obstetrics and gynecology. 

When his sister heard this, she tried to dissuade him from following that path since, according to her, “there are a lot of women who don’t want to go to a male doctor.”  Rich said he would think about it.

Dr. Castle

Later on, Rich did an intense pulmonary elective in Roanoke with Dr. Kirk Hippensteel and Dr. James "Rick" Castle as they took care of very sick patients. This influenced him strongly, and Dr. Murray said that during his interviews for a residency, he switched from OB/GYN to internal medicine, “at the last minute.”   

So Dr. Murray did a three-year residency in internal medicine at the Medical College of Pennsylvania (formerly Women’s Medical College and now Drexel University College/Hahnemann University Hospital) from 1981 to 1984. He spent about half of his time at the Philadelphia VA Hospital. 

Back then, he recalled, there was still no CT scanner at the VA, and the residents had to ride along in the ambulance that shuttled patients needing a scan to Penn.  Rich fondly noted that the daily lab results at the VA were printed on small slips of paper that were unceremoniously dumped on a table for the eager residents to sort out!

HIV  

He told me that he “almost got fired” four or five months into his internship. Patients who had what would later be known as AIDS were first reported in early 1981. They had an unusual fungal pneumonia (now called Pneumocystis jiroveci)  and rare skin cancers (Kaposi’s sarcoma) that were only seen in immunocompromised people. The patients were all previously healthy gay or bisexual men. 

As a green intern, Rich helped care for a woman who fit the picture of the five men reported in the Morbidity and Mortality Weekly Report of June 5, 1981. After the woman died (AIDS was devastating and uniformly fatal then), Rich made the “mistake” of not pushing hard enough for an autopsy. She would have been the first reported woman with the mysterious disease that attacks the T cells of the immune system. The infectious disease attending was livid when he found out there would be no post-mortem exam, hence the "almost got fired" scare. (The initial report of a woman with AIDS in the US wasn’t published until the following year.) 

The term “AIDS” (acquired immune deficiency syndrome) was coined in September 1982. In 1983, Barré-Sinoussi and Luc Montagnier identified the retrovirus causing the disease. A blood test to detect this was quickly developed, and it became available commercially in 1985. The first medication to treat the deadly disease itself, rather than the complicating infections, AZT, had to wait until 1987; it wasn’t very effective,  but it was a start. 

When Rich was a third-year resident, he was often on call with an intern from Texas. He liked her instantly, played favorites, and saved the “best” admissions for her. And if he thought she might be having a difficult night, he worked up the patient himself as he willingly “did the intern’s work.” It was a little awkward, but it paid off as the intern, Gayle Andrews, later became his wife. 

Fellowship

Following his residency, Rich pursued his interest in chest medicine that was ignited by his experience in Roanoke, with a fellowship in pulmonary disease and critical care at the University of Maryland. This training experience under a new chief from Duke lasted from 1985 to 1988. When Gayle finished her residency in Philadelphia, she joined Rich in Baltimore for an endocrinology fellowship under Dr. Thomas Connor. 

University of Maryland Medical Center (Credit: UMMC) 

In time, they decided to get married, but during the planning of the wedding, Gayle’s mother became ill with an ulcer. The couple chose to elope. They said their vows at the Baltimore Courthouse on Valentine’s Day in a “one-minute ceremony,” said Rich. 

(Dr. Murray's father was the only one who was upset; he had paid for the weddings of two of Rich’s sisters and was looking forward to a celebration where someone else received the bills.)   

Dr. Criner 

Dr. Murray’s mentor during the fellowship years was noted pulmonologist Dr. Gerard Criner (Rich was his first fellow). The field of critical care was “becoming a big deal” at the time, noted Rich, and Maryland went from a simple five-bed open ICU to a full “state of the art” unit a year later.  Patients with serious (and sometimes atypical) infectious complications of HIV often filled the critical care beds in downtown Baltimore. While there, Rich reported on five HIV patients with an unusual pattern of tuberculosis on X-ray--"weird" diffuse infiltrates.  He also wrote up and reported the first case of a woman with pulmonary hemorrhage from free-basing crack cocaine. (Back then, "it was like ‘The Wire,’” said Dr. Murray.)

After completing his fellowship, Dr. Murray stayed in Baltimore for two years as an attending. He and Gayle moved from their Bonnie Ridge apartment outside the beltway to a row home near the old Memorial Stadium and started a family (with boys born in 1988 and 1990). 

Gayle had worked closely with endocrinologist Dr. Francine Camitta at the University, and after Frannie opened her practice in York (forty miles north), she offered Gayle a job there. So Gayle commuted for a while. But traveling while raising two young sons was very tiring. Gayle thought they should move to York. 

The Move to York

She told Rich that there was a possible position for him in York. When he visited the York Hospital, he saw that they had a full trauma team (led by Dr. Nik Agarwal) but no dedicated “medical” critical care physicians. He was reluctant to start a new program from scratch, and at that point, was content to stay in Baltimore.

But the neighborhood around the outdated stadium was in decline as the Orioles were moving to Camden Yards. And one night, after a police helicopter's glaring spotlight lit up their backyard during a chase, Gayle said they had to move. 

Police helicopter searchlight (Credit: Getty images)

So in 1991, Dr. Murray came to the York Hospital to start a critical care service. The two pulmonologists in practice, Dr. William Rexrode and Dr. Richard Keeports, were skilled at using mechanical ventilators but were not specifically trained in other aspects of critical care.  So Rich had to practice the new specialty by himself for two years. The ICU was “open” (to other attending physicians), and the beds, at first, were simply separated by flimsy curtains that were often pulled back (there was a feeble attempt at privacy).

Accidental Needle Stick

The existential crisis came when he was inserting a femoral line in a drug-addicted patient who had HIV and hepatitis C (neither of which was treatable). Rich pricked his finger right through his glove. He went to Employee Health, where he saw infectious disease specialist Dr. John Manzella. He would need to use AZT for a month, as this was the suggested protocol for healthcare workers who were accidentally exposed to HIV (though there was no evidence at all that it helped). And, for six months, after seeing patients in the hospital, he had to quarantine himself when he got home.  

This time was, of course, remarkably stressful and anxiety-provoking. Gayle was pregnant with their third child, and Rich had to sweat through testing for HIV and hepatitis C every two weeks for six long months.  

The ordeal was tiring, and he had had enough. He went to the department chairman, Dr. John McConville, and told him he was “done.” That he needed help. While initially unwilling to bring in another pulmonologist, they eventually reneged and did (in Rich’s third year). 

Critical Care Team

Lew Williams

So, with intensivist-pulmonologist George Robinson and nephrologist Paul Schendel (who had done a year of critical care training), Rich was “finally able to get a medical critical care team started.” He said that “the nurses were great” (there was almost no turnover) and that there was plenty of help as residents from the ER, Family Medicine, Internal Medicine, and OB/GYN rotated through. (Cardiologist Dr. Thomas Schryver, “with great hands,” was always available when they couldn’t insert a line.)  There was quick and enduring support from pharmacologist Lew Williams (“the father of clinical pharmacology at York”), and the students from the fine respiratory therapy school connected with nearby York College (just across the street).

However, the medical staff was initially slow to relinquish control of their ICU patients to the team. With time, they eventually came to see it as necessary, as the technology and bioscience of keeping very sick people alive, bringing them back from the brink of death, became much more complex and specialized.

The six units remained "open” until 2005, after which two were changed to being "closed." Other units followed. The Leapfrog Group of “healthcare purchasers” looked at patient safety in the ICU. According to their 4/01/2024 revision: 

“The Leapfrog Group's Intensive Care Unit (ICU) Physician Staffing (IPS) standard aims to improve the quality of care for critically ill patients by requiring hospitals to have board-certified intensivists primarily responsible for managing or co-managing all ICU patients. This involves having intensivists present during daytime hours for at least 8 hours a day, 7 days a week, and ensuring they are readily available by phone with a response time of within 5 minutes, 95% of the time.”

Over time, other physicians joined the pulmonary group. And Rich said that his colleagues, Dr. Lee Maddox and Dr. Marina Dolina, led the drive to bring York Hospital into compliance with the new critical care standards.  

As Dr. Murray applauded the improvements brought about by the initiatives, he spent 30 years in York refining his practice of critical care medicine. During this time, there were many remarkable technical advances. These included advanced life support techniques such as (the remarkable) ECMO (extracorporeal membrane oxygenation) when the lungs fail completely, better ventilation strategies (e.g., ventilating in the prone position), and “precision” medicine (with AI input).  

Working with ECMO (Credit: Children's of Alabama)

These advances allowed more patients requiring the skills of the intensivist to survive catastrophic illnesses.  For example, in one large study, the hospital survival rate for people with sepsis in 1979-1985 was  27.8% whereas the mortality rate from 1995-2000 was 17.5%. The statistics have improved since then.  One report noted that mortality in the acute respiratory distress syndrome declined from 35.4% to 28.3% from 1996 to 2013.

Post-ICU Syndrome

But, in my reading for this story, I found that many who survive the acute ICU event, having been on a ventilator and heavily sedated, treated for delirium, and essentially immobilized for days, have suffered serious long-term (often permanent) consequences. There may be lo. long-lasting cognitive impairment (with frontal and hippocampal brain atrophy), and there is often a striking, widespread loss of muscle resulting in severe weakness. Depression, anxiety, chronic pain, and fatigue are common. And the quality of life is poor. This is termed the post-intensive care syndrome, and it is often debilitating. 

Intensivist Dr. Wes Ely was saddened when he decided to follow up patients after they left the ICU (something rarely done) and discovered this formerly hidden tragedy. He sought a remedy. He and his colleagues found that by severely limiting the use of benzodiazepines and weaning the patients from the ventilator as soon as possible, and quickly addressing dangerous delirium, there were much better long-term outcomes. He advocated for a “patient-centered” model, getting to know patients and their family circumstances more intimately. This innovative approach was slow to be accepted, but has been endorsed by the York ICU staff. 

His "Side" Interest

As a break from the high-pressure demands of the ICU, Dr. Murray said he had a “side gig.” In the early 1990s, he helped form the York Hospital sleep lab. Obstructive sleep apnea (OSA) was becoming increasingly recognized as a serious health problem. He did some training in Atlanta and learned to interpret the squiggles on an EEG (displayed on reams of paper!) and was able to take the sleep medicine boards.  

EEG stages of sleep (Credit: Britannica)

Rich said that it was Dr. Keeports who recruited Donna Vesnaver, a registered sleep technician, to start the sleep lab. Dr. Murray and (a bit later on) Dr. George Robinson developed the program further, but it was Donna who did most of the hard work.  

The first treatment (and still the mainstay) for OSA was the well-known CPAP face mask. Improvements in the idea of keeping the airway open followed, and included oral and jaw surgeries, oral appliances, electrical stimulation of the tongue through the hypoglossal nerve, and bariatric surgery.  There is emerging evidence that the GLP-1 and GIP agonist terzepatide (iMounjaro) significantly reduces the number of obstructive events. 

"Too Old" for Demanding Inpatient Work 

By Christmas 2016 (three years before COVID-19 would severely test the critical care staff again), at the age of 61, Dr. Murray took his last night of ICU call. He felt that he was “too old” for the demands of inpatient work. He then served as the pulmonary outpatient site director for the next four and a half years. At that point, the treatment of chest disease (as with many other disorders) had become exceedingly complex, mostly due to increasingly sophisticated immunologic therapies for lung cancers, COPD, and asthma. Dr. Murray thought that "it was great."

Dr. Murray has been active in retirement for the past four years. As mentioned, Gayle had a third son, and all three boys (despite a lack of direct encouragement) are physicians. Mike (the middle son) completed a pulmonary fellowship in Boston last year.  Matt is completing an Internal Medicine residency in York to become a hospitalist, and Andrew has just started a Family Medicine residency here.  So Rich and Gayle spend time with the kids, and Gayle arranges “play dates” with former colleagues for her husband.

They enjoy hiking and often visit Gayle’s 96-year-old father, who is still living independently in Las Cruces, New Mexico, where they hike the trails and canyons. The Southwest sky can be deceptively blue at times. But while there are none of the fluffy, slowly drifting carcinogens of Rich’s childhood, the local air still contains high levels of lung-damaging ozone.

Looking back at his work in the critical care units, Dr. Murray saw that while “things go wrong all the time…you just have to learn from it and try something different.”   And to develop "good judgments based on bad experiences.” 

References and Suggested Readings:

1. Cleveland Clinic. "Treatments for Obstructive Sleep Apnea: CPAP and Beyond." Cleveland Clinic Journal of Medicine, July 7, 2025.

2. Ely, Wes, MD. Every Deep-Drawn Breath: A Critical Care Doctor on Healing, Recovery, and Transforming Medicine in the ICU. Scribner, New York, 2021. 

3. leapfroggroup.org/hospital. "Factsheet: ICU Physician Staffing." Revision: 04/01/2024.

4. Murray, Richard, MD, Albin, Robert, MD, Mergner, Wolfgang, MD, and Criner, Gerard, MD. "Diffuse Alveolar Hemorrhage Temporally Related to Cocaine Smokng." Chest, 93 (2), p. 427, 1988.

5. Shigeaki, Inoue, Nakanishi, Nobuto et. al."Prevalence and Long-Term Prognosis of Post-Intensive Care Syndrome after Sepsis: A Single-Center Prospective Observational Study." J. Clin. Med. 2022, 11 (18), 5257.

6. Shigeaki, Inoue, Nakanishi, Nobuto et. al. "Post-intensive care syndrome: Recent advances and future directions." Acute Medicine and Surgery, February 2, 2024.

7. Wulf, Steve. "Title Waves." ESPN 5/29/12. (The story of the Yale Women's Crew team.) 

By Anita Cherry 7/27/25

 (The first collection of these stories is available in book form:  York Doctors: Their Stories Vol. 1)

"Untitled" by Anita

Dr. Vatsala Parchuri: It's All About the Breath

Dr. Parchuri

 At the end of the long flight, Vatsala’s plane finally landed in India. She was tired as she rushed to the hospital to see her 78-year-old aunt before a scheduled knee replacement. She arrived as the gurney was being wheeled into the operating room and only had enough time to wish her aunt good luck. 

Her aunt and her aunt's 82-year-old husband lived by themselves; their children were in the States, and there was not a lot of support. Though she lived and worked in the U.S. in her forties, she and her husband returned home in retirement, and she did not want to leave for a routine medical procedure. Vatsala's aunt felt that breathing the Indian air gave her life.

Dr. Vatsala Parchuri was in her twenties when she came to the U.S. in 1997 to join her husband and for training in internal medicine. While India remains a great comfort, she has lived here long enough to feel that York is now home. And a place of healing, hope, love, and belonging. But she told me that she experienced terrible sadness while in her residency at the York Hospital. 

Attached to her Father

Though she has a younger brother, Vatsala said she was “raised as an only child” in Korukonda, a small enclosed schooling community in the district of Vizianagaram, Andhra Pradesh state, on the east coast of southern India. She said that she was very “attached” to her parents. Her father was a teacher. After he “retired,” he was recruited to be the principal of a boarding college. He was, Vatsala said, “a very active person” mentally, physically, and spiritually. He had a minor heart attack when his daughter was in medical school in India, but this didn’t slow him down, and he continued to work as the school principal. 

Young Vatsala with her father

But later, when Vatsala was in the second year of her residency in York, he had trouble breathing and began to wheeze. The local doctors saw that he had an enlarged thyroid gland, a goiter, and blamed the noisy breathing on that. Vatsala wanted her father to come to the States for the planned procedure, but he wanted to have the surgery in India; Vatsala relented.

When her beloved father was slow to awaken after surgery, and Vatsala was informed of this, she collected her three-year-old daughter and quickly booked flights to India to be with him.  She prayed intently throughout the long journey. When she arrived at the hospital, her father was awake and seemed okay. In time, he was eating and drinking. But he began to wheeze again two days later. Dr. Parchuri was by his side, and she was concerned as the upper airway was being blocked. 

The ENT doctor determined that he had vocal cord paralysis. So he was put back on the ventilator. Temporarily relieved, Vatsala went home for lunch. But her father had developed pneumonia, and he died after she left (and planned last words and final requests were left hanging). This was in 2003; her father was 75. Dr. Parchuri told me she has not fully recovered from that loss, even more than 20 years later. She said that “the brain blocks all unhappy, unpleasant things.”

She was tightly bonded to her father; Vatsala had a deep emotional need and intensity that she senses may be less common now (but she admits that she might be wrong).  She accepts that not everyone can feel attached to their parents in the way she did. After her father died, Dr. Parchuri and her mother were in deep grief, and Vatsala cried every day for a good while. 

To India to have her Green Card Stamped

When she took a brief time off work to return to India (with Raj) to have her Green Card stamped, Vatsala felt sick and nauseated the entire flight. She went to Chennai (formerly, Madras) to get the required chest X-ray to rule out tuberculosis for the immigration process. But “something” told her, she said, not to expose herself to radiation without a pregnancy test. Of course, the test was positive; she was carrying her second daughter.  

Parry's Corner in Chennai (Credit: moxon.net)

Pregnant, Dr. Parchuri returned to the States and brought her mother with her. The gestation went well, and she delivered her second child.

One-Year Anniversary

Two months later, it was time for the important Hindu rituals marking the one-year anniversary of her father’s death. This first-year Shraddha helps his soul make the transition to the ancestral realm.` Vatsala was happy; her mother was with her, and her baby was healthy.

Dr. Parchuri was considering doing a cardiac fellowship, and she went to Ohio to give a cardiology presentation at the prestigious Cleveland Clinic. By the time she drove home, the ceremony in India for her father had been done. She and her mother sat and cried for a short while. Dr. Parchuri was tired, and after she made sure that the kids were fine, she told her mother that she was going to bed. 

She slept in until around 9:30 and did her Sunday morning chores before realizing that her mother wasn’t up yet. Vatsala went into her mother's bedroom to check on her. Everything looked normal and peaceful, but her mother was absolutely still; her chest “didn’t rise and fall,” said Dr. Parchuri. Her mother had died in her sleep. 

No post-mortem was done, and the cause of her mother’s sudden death was never determined. (I wonder if it was due to the Takotsubo “broken heart” syndrome seen in post-menopausal women after acute emotional stress, as was told to me by Dr. Jay Nicholson when he sat for his interview a few years back.) 

Ballooned left ventricle resembling a Japanese octopus trap (Credit: Bri J Card)

Losing both parents in a year, the last year of her residency, was very difficult for Dr. Parchuri. She feels guilty for being so busy with her own life that she didn’t give enough support to her grieving mother. Both of her parents were special. She had no siblings at home, and as there was “nobody to play with,” said Vatsala, all she had was her mom and dad. She learned to be “happy and content” with “nobody around.”

Her parents were “peaceful and happy” in their “middle-class life,” noted Dr. Parchuri, and she said that she had “such a peaceful childhood.” She never saw her parents unhappy or complaining. They led a spiritual life in practice. (She remarked that while she was fearful of displeasing her mother, there were no such concerns regarding her doting father.)

The boarding school students, being away from home, treated her mother and father like second parents. Many of these former students have come to the States, and they “swarm around” Vatsala when they meet her, and her parents’ names come up. She knows now that her loving parents “touched people’s hearts.” She did not see this when she was a child. She believes that she receives help from others “every step of the way” because of how her parents were to others. (Transgenerational karma?)

“He loved me. She loved me. I loved them.”

Military School

Speaking of the highly competitive boys' military boarding school (the Sainik School Korukonda under the Ministry of Defence), young Vatsala passed the entrance exam with the top score. She was permitted to attend as the only girl in her class of 80 (and one of, at most, five girls in the entire school) because her father taught in the school. She went there from the 6th through the 12th grades. She (of course) liked math and biology. The always-courteous boys in the class saved the front seat for her, and she sat by herself.   Her parents lived in a home on campus. (By the way, girls were only officially admitted to the school in 2021.)

Sainik School Korukonda (Credit: Times of India)

Her strict, but progressive, home-schooled mother didn’t have the opportunity to go to college; she wanted more for her daughter. She wanted her to be an officer in the IAS, the Indian Administrative Service. She wanted her to be a leader. She wanted her to, said Vatsala, “have the knowledge to do good in all realms.” So Vatsala studied dance, classical Indian music, and knitting in addition to academics. But there were subtle (overheard) hints that being in medicine would be a good way to help others.

Medical School

So, following the military-style high school, she took the challenging Medical College Admission Test (MCAT). She did okay, but not well enough for admission. Not inclined to give up, she took the test again and did better. She attended the Guntur Medical College.

Entrance to Guntur Medical College (Credit: HandIndia)

While in medical school, she met her husband, Dr. Rajesh Nallapati, she said, through an intermediary, “a middle person.” The parents then got together and offered their approval. Vatsala said that she and Raj  “went out a little,” and since he was already here doing his residency, they “spoke on the phone for six months.” They were married in India in 1997. And Dr. Parchuri came here two months later with a degree, but without a job lined up. 

Dr. Landis

She wanted to study internal medicine before her planned fellowship in cardiology. She was permitted to “shadow” with the first-year interns at the York Hospital, where her husband trained. When she applied for a formal residency position, several influential attendings (especially Dr. Tex Landis) stood up for her, citing her obvious competence and knowledge of medicine (gained through the Indian educational system)

She enjoyed her training in York and is particularly grateful for having been taught and mentored by, among others, program director Dr. Wolf Blotzer, general internist Dr. Tex Landis, gastroenterologist Dr. Jim Srour, and rheumatologist Dr. David Francois.  She said that Dr. Blotzer was almost a father figure; she looked up to him.

After Residency

Dr. Parchuri started the three-year residency “off cycle” in January, so she finished up in December, two months after her mother passed away. Already grief-stricken before that, she had shelved her plans for a cardiology fellowship. Raj had stopped working briefly to focus on research and fellowship applications and to take care of the girls, so she needed to find a job. 

Vatsala found that her best opportunity was to take a position across the river at Lancaster General Hospital. So, after a few months off, she started working there. She stayed for four years before the forty-minute commute took a toll. She returned to York to do outpatient work with WellSpan while managing inpatients at the local orthopedic hospital (Orthopaedic and Spine Specialists or OSS). She enjoys the work.

Lancaster General Hospital (Credit: Blaine Shahan)

Negotiating a medical marriage and raising two daughters while working two jobs with her only family “on the other side of the globe” has been challenging, said Dr. Parchuri.

Her older daughter (24) is in her third year at the highly competitive Touro College of Osteopathic Medicine in New York. The focus of the innovative “holistic” school is on the training of minority students to serve in underserved rural and urban communities. Women make up the majority of the enrolled students. Vatsala’s younger daughter (now 20) is in Boston as a Chemistry major who has, as yet, shown no interest in medicine.  

Dr. Parchuri wants her children to do what makes them happy and to realize that “time is precious” and “you don’t know your exit date.” 

Spirituality

This awareness of the fragility and unpredictability of life raised the topic of spirituality. Vatsala said that she has always felt connected to Hinduism, but she is more concerned now with connecting with her inner self. Along this quest, she has tried several types of meditation and methods of using the breath. She has done online work and has gone on short retreats in Atlanta and at the Boone Center in rural North Carolina. She said experiences the “physicality” of the practices more readily than the mental effects per se.

A colleague and friend, Dr. Jayram Thimmipuran, practices and studies “Hearfulness” meditation. She had a few one-on-one meditation sessions with his father, who was here from India visiting his son.  When she went to India in 2024 (“for some reason”), Vatsala met Jay’s father and spent three days in group heartfulness meditation at Kanha Shanti Vanam outside of Hyderabad. The large ashram is (according to their website) “an ecological paradise, a place for spiritual retreat, where you can experience simple living in-tune with inner and outer nature."

Kanha Shanti Vanam (World headquarters for the Heartfulness Institute)
(Credit: telanganatoday.com)

Indeed, Vatsala so enjoyed the (massive), remarkably quiet group sessions that she later rented an apartment on the grounds (with the help of an old classmate who works at the center and lives there now). She stayed there by herself for a blissful week. She meditated, read a book, had pleasant, simple meals at the canteen, and was thrilled by the beauty of nature as she walked quietly throughout the large, serene plantation that reminded her of home.

Dr. Parchuri observed that some people seem to age more slowly than others and believes that negativity hastens the ageing process. So she strives to avoid negative thoughts as she navigates the challenges of life and solves problems of being a wife, a mother, and a busy physician. Being content, she believes, slows ageing.

She witnessed this calm tranquility in how her parents faced problems, and would like to emulate that. Vatsala is a perfectionist, and she wants to get it right, especially when it affects her family. But she feels that we know nothing, while we think we know a lot. And she feels that being alive, just waking up each day and taking a breath, may be a wonderful thing.

Suggested Readings:

1. Diaz-Navarro, Rienzi. "Takotsubo syndrome: the broken-heart syndrome." British Journal of Cardiology, 2021 28; 30-34. (This usually follows a benign course, but fatal arrhythmias may occur.) 

2. O'Connor, Mary-Frances O’Connor. The Grieving Brain: The surprising science of how we learn from love and loss. Harper One, New York, 2022. 

The brain devotes lots of effort to mapping where our loved ones are while they are alive, so that we can find them when we need them. And the brain often prefers habits and predictions over new information. But it struggles to learn new information that cannot be ignored, like the absence of our loved one. Grieving requires the difficult task of throwing out the map we have used to navigate our lives together and transforming our relationship with this person who has died. Grieving, or learning to live a meaningful life without our loved one, is ultimately a type of learning. (p. xiv)

3. Patel, Kamlesh, and Pollock, Joshua. The Heartfulness Way: Heart-based Meditations for Spiritual Transformation. New Harbinger Publications, Inc., Oakland, California, 2018.

Heartfulness is based on the ancient Indian spiritual practice of raja yoga, which recognizes that as sentient beings, our nature is inherently divine, and that the path to self-realization is inward, internal, and introspective. (p. vi)

 

By Anita Cherry 5/4/25

At a Flower Show (painting by AC)