Dr. Wolf Blotzer: It Wasn't How Much He Knew; It was How He Treated the Patients

 

Dr. Blotzer

Dr. J. Wolf Blotzer showed up for his interview on the 25th anniversary of 9/11, on Erev Rosh Hashanah 2026. The next day I watched a sermon by Rabbi Maurice Salth from New York’s Central Synagogue. He told the story of two four-year-old boys, best friends, from the congregation: “When Ben discovered that Michael’s father had died [in the Towers], Ben turned to his friend and said, ‘You can share my daddy.’” 

Choking up softly, Rabbi Salth said this touching story tells of “humanity at its very best.” 

It turns out that Dr. Blotzer was in a meeting in D.C. for internal medicine program directors that clear September morning. It was held in a hotel across from the White House, possibly the Hay-Adams. When the meeting broke around nine o’clock, he heard that “this airplane hit the World Trade Center.”  The attendees returned after the short break and “voted to cancel the meeting.” The third target was struck forty-five minutes after the first. Wolf said, “You could look out of the hotel and see smoke coming from the Pentagon.” Everything shut down; the meeting was canceled, and our world was different.

Collapse of the E Ring of the Pentagon on 9/11/01
 (Credit: Cpl. Jason Ingersoll)

Dr. Blotzer said it was “painful” to meet with me that day “because medicine has changed so much” since then. Before we look at that, it’s useful to see Dr. Blotzer’s family’s background, a bit of his formative childhood,  his path into medicine, and his practice.

After his paternal grandfather finished the eighth grade, he went directly to work in the bituminous coal mines of Clarion County in western Pennsylvania. He labored 12 hours a day, six days a week. The “educated woman” he married at “18 or so” had completed high school.  Together, they bought a small farm in 1929, just before the world’s economy collapsed.  

But “Blotzer’s Folly” (as the farm was called by those who thought it was a mistake) allowed his grandparents to grow enough vegetables to survive the years of the Great Depression. And as he felt certain there was soft coal beneath their plot, Wolf’s grandfather dug into the Earth to extract that as well. 

He sent his son (Wolf’s father, born in 1920) to a one-room schoolhouse, a backbone of rural education at the time.  He was a good student, skipped a grade, and graduated from high school at 16. At that point, he was told he could either have the farm or go to college. Penn State, it would be. 

Sunset School, Marey, West Virginia, 1921, Pocahontas County
(Credit: Lewis Wickes Hine)

Dr. Blotzer’s maternal grandparents were immigrants from Poland. His grandfather (echoing his paternal side) worked in the mines and had a small farm. His mother spoke and could read and write Polish and picked up some Czech and Finnish from her friends. She was one of five children in the family, and she and her sisters all became nurses and enlisted in the Army Nursing Corps during the war. She and Wolf’s father apparently met on a transport ship cautiously carrying fresh troops and critical supplies from the States to England. 

Returning to Dr. Blotzer’s father:  He was in ROTC at Penn State and joined the war effort after graduating. After the Army training center at Fort Meade, Maryland, he was sent to Texas with a tank destroyer battalion. They landed in Normandy on D-Day 28, went through France as part of the liberation, and then into the dark, dense Hürtgen Forest. The fierce and costly battle at the France-Belgium border, the longest US Army engagement, lasted from September 19, 1944, to February 1945. It was, said Wolf, according to historian Stephan Ambrose, a terrible mistake. Dr. Blorzer’s father never talked about it.

Medics tending to a wounded soldier in the Hürtgenwald 11/18/44
(Credit:U.S. Army Signal Corps archive photo)

But one day, when Wolf was 11 or 12, and in Germany (how he was there is coming up), and was supposed to be asleep, he quietly hid behind a chair to eavesdrop on a conversation downstairs between his father and a friend about the war experience. His father told of seeing a mortally wounded soldier pleading for help in shoving his exposed intestines back into his open, gaping abdominal cavity.  Young Wolf had nightmares after hearing this and imagining the horrific scene. 

Wolf’s parents married after the war. His wife had four children, three boys and a girl, and worked for years as a Public Health and School Nurse in Baltimore County. Dr. Blotzer was her first-born. At that time (1946), his father was stationed at Fort Jackson in Columbia, South Carolina.  

Main Street, Columbia, South Carolina, 1940s

From South Carolina, his father was transferred to Monterey, California, to train at the Army Language School. He was to master Chinese, a very difficult task. The plan was for him to be sent to China. But after the 1945-1949 Chinese Civil War, Mao Zedong and the Communist Party prevailed, and Wolf’s father was instead moved to the Japanese colonial island of Hokkaido. 

The Korean War (“The Forgotten War,” resulting in five million deaths) began in 1950. Since Dr. Blotzer’s father spoke Mandarin, he was to go to Korea to infiltrate behind enemy lines. One problem--according to Wolf, "he had red hair and freckles." So he was sent (with his family) to the firebombed city of Kobe, Japan. 

In Kobe, when they were unexpectedly forced out of the nicely appointed officers’ quarters as the General’s son returned to the base, Wolf’s father, a “lowly Captain,” boldly insisted on comparable housing for his family. It was granted, and they lived for a while in a fine mansion belonging to a Japanese banker who helped in the war effort. 

Wolf went to kindergarten in Kobe. He was quite young, but remembers the people being very nice to him. He remembers the sensation of the gardener taking him out on a small boat. And he certainly remembers the birth of his second brother, Mike. But they moved again, and Wolf did parts of first grade in Athens, Ohio, and in Anniston and Birmingham, Alabama. Athens, he noted, was in an economically deprived part of the state (after the collapse of coal mining), and it didn’t occur to Wolf until he was much older that his grandparents, especially on his mother’s side, were desperately poor (but he recalled that his grandmother had a job worked as a “cleaning lady” at the local hospital).

Intersection of Union and Court Street, Athens, Ohio in the 1940s
(Credit: Southeast Ohio History Center)

He fell behind as a result of these quick moves, but more military  were to come. Third and fourth grades were done in East Point, Georgia, outside of Atlanta; he did grade five and half of six in Frankfurt, Germany, and the other half of six and all of seventh in Heidelberg. Following this flurry of dizzying transfers, his father returned to the States and relocated his family to the small urban community of Arbutus in southern Baltimore County.

Wolf fondly recalled that when he and his brother delivered the daily newspaper to their Maryland neighbors, they would get up at three-thirty in the morning to finish their route before school started. He was struck by the irony that, at the end of the week, the little old lady in the housecoat living alone would give him a dollar tip while the real estate agent with a Cadillac parked in front of the house offered him nothing. He learned something about people.

At sixteen, he was working as a lifeguard when someone came around looking for people to work at the Bethlehem Steel Shipyard.  Wolf was interested. He went to welding school for a week to learn to be a tack welder (using small temporary welds to hold plates together for the final fitting into place and permanent welding). 

Sparrows Point Shipyard (Credit: Baltimore Museum of Industry)

He did this during the summers, even as he went to college at Johns Hopkins, where he was headed to a career in chemical engineering. But on the first day of school, his advisor pointed out that his verbal score on the SAT was higher than his math score, and that medicine might be a better fit than engineering. 

But Wolf didn’t decide to switch to the premed major until the summer before his Junior year. A fellow worker in the shipyard had gone to Hopkins as a chemical engineering major and was starting medical school at the University of Maryland. Wolf thought about this for himself, and at the end of the summer, on a lunch break at work, he called his advisor to inform him. 

Working in the shipyard, said Wolf, was formative. When things were “going bad” in his life, he could walk into the facility in the morning and look up at some giant ship and say to himself, "I built part of that!"

He was struck by the (practical) intelligence of his incredibly skilled fellow blue-collar colleagues who were clearly “smarter” (he later discovered) than some of his medical school classmates. Wolf was dismayed that talented laborers often received little credit for their work and were looked down upon by people who had the luxury of being handed the choice of higher education. During his last summer in the shipyard, they affectionately started to call Wolf “Doc.” They strongly encouraged him to continue his education. 

Through his experience, Wolf saw that the way of the world is that “people at their best” are rarely fairly compensated for their work and that deep satisfaction may simply come from the “beauty of the job” and doing it well. 

Dr. Greisman

After he graduated from Hopkins in 1968, he attended medical school at the University of Maryland. Between his second and third years, he did lab work (looking at blood smears from rabbits) with Sheldon (Shelly)  Greisman, a much-beloved teacher and world authority on bacterial endotoxins. Young Dr. Frank Carrozza, just down the hall, taught physical diagnosis. 

One day, Shelly noted that Frank didn’t look right. His blood was immediately drawn, dropped on a slide, and a smear was prepared. Dr. Greisman said, “John, look at this” (“Wolf” was still “John” back then).  The eager student was in “shock and speechless” as he saw “blasts (immature blood cells) everywhere.” Dr. Blotzer said that this moment was his “awakening into medicine, when it became completely different.” 

Upon finishing medical school, he received the prize in surgery. Surgery? He told me that when he was in the ER, he “always liked to do sutures and everything because somebody comes in all lacerated up, you completely sew them up, clean the wound…You’ve got something that’s completely done, and they go.” 

Dr. Woodward

But as he felt he didn’t have “the motor skills to be an excellent surgeon,” he chose to pursue the more cerebral, less tidy, path of internal medicine. So Wolf did a three-year residency in Maryland under the tutelage of the illustrious Dr. Ted Woodward and served an additional year as Chief Resident. 

A clinical anecdote from Wolf: “I had an African-American lady whose hypertension I just couldn't control. And I started to see her more and more often and kept working with her. And then she comes in one time and her blood pressure's controlled. And I said, Hilda, why is it that suddenly it's controlled? She said, ‘Dr. Blotzer, when I finally realized how much it meant to you, I started taking my medicine.’”

After his residency, he did a two-year fellowship (1976 to 19780 in the complex specialty of rheumatology (where there may be nearly 200 different disorders to know about) at the University of Pennsylvania under Dr. H. Ralph Schumacher Jr. and Dr. Allen Richard Myers (the legendary Dr. Hollander had recently left). It was while he was at Penn that “John” (as he was still known then) became “Wolf.” 

A story during the fellowship years: “I can remember when I was doing my rheumatology fellowship, I got called over to the VA, which was right next to Penn. And I had this medical student by the name of... I'm blocking on his name now. He was... He... But, anyway, they wanted us to see a patient because they thought he had arthritis. And so we'd start out by having him walk down the hall. So, I mean, I guess I was doing that [observing gaits] even then. (God only knows why I do these things.) 

But this medical student and I could both look at each other and go, 'He doesn't have arthritis,’ because we could see that he had a spastic gait, and he ended up having a cervical myelopathy even though he's, like, 36 or 38 years old. That medical student, Joe Loscalzo, went on to be the (distinguished) Chief of Cardiology at the Mass General and one of the editors of Harrison's.”

After Philly, Dr. Blotzer returned to the University of Maryland as Assistant Professor of Rheumatology. Dr. Woodward stepped down in 1984, just as Wolf was up for a promotion. This was denied by the new Chairman; they apparently wanted him to stay, but they were unwilling to provide the security of a tenured position. The result? He decided to write a letter of resignation, and he called York.

You see, by that time, York had already shown interest in recruiting him to join their staff.   He had seen a few patients referred to him from York Hospital physicians (including Dr. Miodrag Kurika and Dr. Jack Klein), and he was impressed by their thoughtful workups before seeking help.  

In those days, he said, you could know the quality of a physician, know their thinking, by reading through their notes. It is more difficult (some say nearly impossible) to pull that information from the electronic record as it now stands. Through these few interactions, he saw he could practice quality medicine away from the politics of the university.

York offered him a (partially) funded position, as he ran the Medical Clinic in the hospital while building a rheumatology practice, the first in the area. The expected resistance from the all-volunteer staff did not materialize.

Dr. Blotzer was able to utilize his passion for teaching by, in 1989, becoming the Associate Program Director of the internal medicine residency. He was full Program Director from 1997 to 2004. During that time, he received accolades for his pedagogy. Though he was an early advocate for so-called “evidence-based medicine,” with heavy reliance on the medical literature for decision-making, he feels that “ a lot of the stuff you just teach by example [and] you don’t have to tell them anything after that. It’s very clear what’s going on.” 

Such classic bedside teaching, seeing how to elicit a history and do the physical exam, promoted by Dr. William Osler as essential in the education of competent caring physicians, has been gradually fading away.

Another interesting story from Dr. Blotzer: “One time I saw a man who had a tooth pulled and was put on a penicillin antibiotic, and he developed a rash. And he was seen by one of our residents in the ED who had the guy come into the clinic. The rash had gone away after he was on prednisone, but it had come back again, and he was on a prednisone [regimen] again. Well, we had him biopsied, and all that, and the pathologist calls me and is describing the biopsy to me. And they're talking about macrophages biting on the ends of the small cutaneous nerve endings of the skin. And I interrupt and interject, ‘You know we are considering leprosy.’ And at the other end of the line it was like the sound of a balloon deflating [PffffftttT].” 

Gandhi tending to a man with leprosy (Credit: mkgandhi.org)

You see, Wolf’s patient was from India, where leprosy is felt to have originated, and was still occurring. He was a Hindu priest who most likely ministered to outcasts, including those with the ancient feared disfiguring malady.  A careful and complete history, noted Dr. Blotzer,  (including the patient's social and vocational background) "paints a portrait" and often points the clinician to the disease, or at least a short list of likely possibilities.

While in York, he became interested in faculty and curriculum development. He studied the former at Hopkins. Dr. Blotzer said, “I developed a course on physician-patient communication, and I tried to make that into something that all the residents had to go through. I would videotape them and give them feedback, and it was amazing…They could see themselves.” And they could be changed by what they saw.

Yes, it is hard to see ourselves as we are, as in this surprising comment by Dr. Blotzer about himself: “One of the things is I always thought that I needed to know everything and teach people everything. And when I left the University of Maryland, some of the people that I taught wanted to take me out to lunch and all that. And I always thought it was because I knew the literature, blah blah blah, etcetera. And it had nothing to do with the literature, over and over again, and it was the same thing even up at York. It wasn't how much I knew; it was how I treated the patients. So I'm the stupidest person in the world. I'm the last to get what the real stuff is.”

Certainly, the way we treat each other is vitally important to Dr. Blotzer. He said, “My dad and mother just raised me to treat people right.”  Looking down on others is hateful to him. One of his favorite quotes is from the noted Catholic social activist and pacifist Dorothy Day, who said, “I really only love God as much as I love the person I love the least.”  

Another of his favorite lines (in its current interpretation, not the original sarcastic intent of the shady character who uttered it in A Woman of No Importance by Oscar Wilde): “The only difference between saints and sinners is that every saint has a past, while every sinner has a future."  

Anyway, things were going along relatively smoothly for Dr. Blotzer until 2004. As he was preparing to, once again, take part in the 100-mile Labor Day Century bike ride in Hanover, he noted a fluctuating bulge on the inside of his left thigh.  He had it looked at the day after the event by one of his valued trainees, Lakshmi Pasumarthy. He cautiously reviewed the subsequent needle biopsy with the pathologist. It revealed a sarcoma, an extremely rare tumor of muscle with a frightfully dismal prognosis. He thought he might live only a year. He had to have a plan. 

Wolf: “So I always thought that if I ever had a bad diagnosis that I would be so scared and emotionally involved, I would just put myself in the hands of the best person I could, the best doctor that I could find, and that was that. It was exactly the opposite [of what] happened. It was like any consult I would do.”

So he went into action. He reviewed the scanty literature, talked with a wise oncologist, and found the appropriate surgeon (someone he knew well and trusted at Sinai in Baltimore). Radiation preceded the surgery. 

Avoiding an amputation (a common approach when he first learned about these tumors in medical school), the nasty growth was removed, but several thigh muscles had to be sacrificed. Wolf developed a post-op MRSA infection and needed a prolonged course of antibiotics and “four or five months with a [cumbersome] Wound VAC.”  

But he focused on making the next scenic Century ride, and this simple, well-defined goal off in the distance kept Wolf going.  The wound finally healed in August 2005 and, despite the absence of a few leg muscles, he completed the exhausting ride in September of that very harrowing year after the day he suddenly became a cancer patient. The day, he noted, “when your identity immediately changes.”

Dr. Blotzer kept working, but stepped down as Program Director in 2007 to do rheumatology, palliative care, and hospitalist work before serving as a full-time academic hospitalist until retirement in 2014. But he has stayed active in teaching through Dr. Andre Lijoi’s narrative medicine program and told me he was planning to present something in September 2026.  

Though he is no longer practicing medicine, he (of course!) continues to read (and digest) the journals (NEJM, The Lancet, BMJ, JAMA, etc.), and he has grave worries about where things seem to be headed for his beloved profession. He sent me (of course!) several articles regarding reliance on artificial intelligence in healthcare, especially in documenting visits.

The first article was “The art of fidelity: clinical documentation and ambient AI”  in The Lancet. The authors note: 

The art of documentation has traditionally involved judgement about what to compress and what to preserve. Clinicians learned when to include a patient’s own words, how to signal uncertainty, how to respect confidentiality, and how much context to provide. This was tacit knowledge, absorbed through apprenticeship rather than taught in any curriculum.” They argued that clinical notes as currently generated by ambient AI may produce a coherent story that is accurate, but without the fidelity of representing the actual lived experience of the encounter.  The authors say that mismatch can be fixed if there is a will to do so. (Italics added.)

The second article was “The iPatient Meets the iDoctor” in JAMA.  David Rosenthal and Abraham Verghese write:

A decade ago, we suggested that a major purpose of the physician’s work is to bear witness to the suffering of others and in that context provide comfort and care. The EHR, for all its advantages, seemed to distract from that work. The advent of AI and the emergence of the iDoctor will enhance efficiency [and should free us]  to spend time in the face-to-face interactions that patients want and that satisfy and define us as healers. The hand on the pulse, the chair pulled to the bedside, the witnessing of suffering may seem trivial, except when one is on the receiving end. The iDoctor knows all there is to know about the flickering shadow cast by the patient on the cave wall, but it cannot be present with the embodied human at the bedside. That remains our work.” (Ilalics added.)

Outside of medicine and reading, Wolf is strongly drawn to the outdoors as he gardens (and can recite the full Latin names of his plants) and practices the delicate art of fly-fishing weekly. He has a collection of cacti and finicky less-is-more succulents, the latter mainly from Madagascar (he told me it’s time, the end of summer, to take these indoors to the basement under lights). 

Reflecting on his career, Dr. Blotzer said: “Well, first of all, and it took me until I retired to realize this--I couldn't have done any of it without my wife. I get the credit, sure, but it should go to her halfway, I mean. And all the people that taught me in medical school and residency and all that. All the patients that taught me. That's what I'm getting at. It's not about me.” 

And as I look back on his story, it seems that his deep compassion for others, the awareness of their suffering and a desire to relieve it, that Dr. Blotzer demonstrated again and again with his patients during his years in medicine, was already evident in him as a youngster seeing the world. Just as an innocent four-year-old boy unhesitatingly showed compassion as he generously shared his own father with a friend in need of healing on 9/11.

References and Recommended Reading:

1. Ekstrom, Victoria, and John Laune, "The art of fidelity: clinical documentation and ambient AI.”  The Lancet, Vol 408, July 18, 2026, p. 209.

2. Rosenthal, David M.D., and Abraham Verghese, M.D.,"The iPatient Meets the iDoctor.” JAMA, Vol. 336, Number 8, August 25,  2026, p. 336.

3. Tumulty, Philip A., M.D. The Effective Clinician: His Methods and Approach to Diagnosis and Care. Philadelphia, PA. W. B. Saunders, 1973. (A master Hopkins clinician shares his wisdom, especially regarding the importance of obtaining a full history and of carefully observing the patient and performing a meticulous physical exam. And early on, he states: "...what many patients miss and resent today is their inability to communicate with their physician in a meaningful manner" p. 5). 

4. Vanderveer, Joseph B., M.D., and Bryan, Charles S., M.D. Osler for White Coat Pockets. Morgantown, PA, American Osler Society, 2017. (Well worth perusing. Osler, speaking to students at Oxford, said "In my behavior to my patients I make no difference whatever between the high and the low, between a duchess and a cook," p. 100).

By Anita Cherry 10/18/26

Portrait of Grief (by Anita Cherry, undated)

Bruce Williams, M.D., M.B.A., Ph.D. : Tending to the Body and the Spirit

Dr. Williams

My husband and I sat close together on the sofa. To get the camera at the right angle, the laptop on the coffee table in front of us was perched precariously on his copy of “The Heart.”  And we waited for Dr. R. Bruce Williams (who lives in Chattanooga) to join us on Google Meet.  

This was the first interview conducted this way, the first that was not face-to-face in person. I didn’t know what to expect. When the doctor came online, it was difficult for me to see him clearly–I was unsure if I was accurately picking up significant facial expressions. I was disappointed. 

This reminded me of COVID-19, when our facial movements were hidden by masks. It reminded me that we had to rely on the appearance of the eyes to detect the emotions of the person in front of us. It reminded me that technology designed to connect people may deprive them of critical social signals. 

Anyway, after a few pleasantries, Dr. Williams quickly noted that three things shaped his career: 

The first was that six months before he graduated from medical school in 1973 in Melbourne, Australia, he developed a “pretty aggressive” case of rheumatoid arthritis (RA) complicated by acute serum sickness, a serious, life-threatening immune system reaction. 

Dr. Williams is fourth from the left in the top row (Credit: Royal Melbourne Hospital)

The second was that “around that time,” and with a “cultural background” in Christianity, he “became a Christian.”  

The third was that he “felt” the need to leave Australia for North America, to leave his homeland for a place unknown. (Reminding one of Abraham’s Lekh Lekha in Genesis 12:1.)

Leaving home and coping with, living with,  the active autoimmune disease, he started a three-year internal medical residency in Toronto, Canada.  During the second year of training, he was on high-dose aspirin therapy (4.8 grams per day) for the RA, and he felt “sedated.”  By the third year, as he struggled even more, he couldn’t deal with continuing.  Because he didn’t have the energy for a demanding specialty fellowship, he decided to try research. 

Dr. Ed Sellers

So Dr. Williams studied clinical pharmacology at the University of Toronto for a year, mostly working in infectious diseases as the first research fellow of Edward M. Sellers, M.D., Ph.D., who had just returned from Mass General after his stint as Chief Resident. (By the way, Dr. Sellers, now a world-recognized authority in psychopharmacology and drugs of abuse, is the son of Dr. A. Sellers, who had trained in Canada with Dr. Charles Best, one of the co-discoverers of insulin in 1921.)

When Naprosyn (approved in 1976) was substituted for the high-dose aspirin, the sedation lifted, and Dr. Williams could return to clinical medicine. He started a fellowship in infectious diseases. Six months into that, there was an unexpected opening in an endocrinology residency. Since he had greatly enjoyed that relatively new specialty as an intern, he decided to apply for the spot–he was accepted. 

Following the rigorous two-year fellowship in Canada, Dr. Williams moved to the States for a position in Chattanooga, Tennessee, where he practiced general internal medicine and endocrinology. Since he was only the second endocrine specialist in the scenic riverside city, he was very busy. For example, when sharing weekend coverage with two other internists, he might need to make rounds on as many as seventy patients. 

When he eventually transitioned to doing only endocrinology, only seeing patients with hormonal disorders, he made himself available to his referring doctors and was in demand at “ten or eleven hospitals.” He often traveled 500 miles a week, and as he made his way around the different facilities, he soon found that the unforgiving concrete floors “were not user-friendly” to someone with painful feet of RA. 

View of Chattanooga (Credit: National Geographic)

This was the early 1980s, as Dr. Williams (an outsider, an immigrant, an observer) was beginning to develop an interest in “what was happening to healthcare in the U.S.”  One notable part of this change, he said, was the federal government’s 1983 implementation of the so-called DRG (Diagnosis-Related Group) system. Under this plan, hospitals were paid prospectively as they were given a lump sum of money based on the patient’s reported diagnosis. This was an attempt to control soaring Medicare costs under the then-prevailing fee-for-service retrospective-payment model. It didn’t work as expected.

Rising Medicare Costs since 1975 and Future Estimates
(Credit: Medicare Trustees Report 2023)

Dr. Williams wistfully said that in the  “cottage industry” medical practices in Tennessee at the time, you could ask a colleague, a friend, to see a patient urgently, even somebody without insurance, and there was no hesitation at all. He said the “people were well-served” by this (informal) way of doing things that was under economic pressure to adapt to the new rules. 

But substantial changes in healthcare were happening long before then.  Even in the 1950s and 1960s, the close relationship between patients and their doctors was being slowly eroded as thousands of hospitals were built after the war (a result of the Hill-Burton Act of 1946, noted Dr. Williams ) and people (often without having a personal physician) began to routinely use the new emergency rooms for non-emergency ailments. 

Dr. Kissick

To delve more into this process, Dr. Williams took a few business courses at the University of Chattanooga. This sharpened his interest in the complex economics of healthcare and led to him earning an Executive M.B.A. at The Wharton School of the University of Pennsylvania. While in West Philadelphia, he studied under legendary Dr. Bill Kissick, one of the architects of Lyndon Johnson’s Medicare Act of 1965. Dr. Kissick later noted that the Act “had created a monster” after only a few years of it being in place, as all seniors now had health insurance, and the total cost of U.S. healthcare escalated rapidly. 

With his new social and economic understanding of the evolving pluralistic and individualistic American system of healthcare, Dr. Williams decided to forego the physical demands of clinical practice and to focus, instead, on the more sedentary administrative aspects of medicine. He did this for a good while: he was Chief of Staff at a VA Hospital, served as Medical Director at a hospital in the Boston suburbs, and later took a position with a hospital in Iowa. 

But he eventually realized he was not temperamentally suited for these bureaucratic roles. He decided to return to clinical practice, to return to taking care of one patient at a time. Where to go?

Gayle

His stepbrother was living in Lancaster, Pennsylvania, and his stepbrother's grandmother-in-law was finding it difficult to get an appointment with an endocrinologist. Dr. Williams showed an interest in helping out Dr. Charles Rost (no relation to psychologist Dr. Polly Rost in a previous story in this series). However, the proposed arrangement through Lancaster General Hospital wasn’t sufficient, and he moved across the river to York to work with Dr. Rita El-Hajj and Dr. Gayle Andrews-Murray, who were busy and in need of help. 

Dr. Williams started there as a locum tenens and was soon asked to join the practice. The work was “enjoyable” as he got to know Gayle and her husband Rich (both subjects of prior stories), their sons, and Rita. He stayed in York for ten years doing general adult endocrinology, sometimes helping out with paediatric patients.  

While the practice was heavily weighted to diabetes, thyroid diseases, and adrenal and pituitary disorders, he was surprised to find a good number of relatively uncommon conditions (including pheochromocytomas and patients with the syndromes of genetic multiple endocrine neoplasms)  in the small semi-rural community. But his deforming, painful rheumatoid arthritis made it difficult to manage a full-time schedule, and he eventually had to cut back. 

(He noted that in the practice he found that he could spend sufficient time with his patients, as the newly introduced electronic health record allowed him to finish his detailed clinical notes at home.)

Turning to the third thing that shaped his career, Dr. Williams told me that while he had felt a calling to be led by the Spirit in the mid-1970s, it wasn’t until the 1990s that he decided to read “all 66 books” of the Bible seriously. And in his careful reading, he chose to employ a scientific (i.e., medical) rather than theological methodology of analysis. 

How to be Led..

He was helped in this weighty task by his wife, Alta Ada Williams (whom he had met and married while living in Tennessee). She was an Oxford-trained classicist with a Ph.D., and knew Greek “and a bit of Hebrew.” Working together, they eventually finished a 520-page book titled How to be Led by the Spirit of God: Maturing in the Spirit” (published in 2008). 

Dr. Williams said that, in his studies, he was especially inspired by the work of the noted Chinese evangelist Watchman Nee (Nee Shu-tsu). In the early part of the last century, Nee taught that we are comprised of three components: the body, the soul, and the spirit. (After the 1949 Communist Revolution, Nee was imprisoned for 20 years for spreading his ideas; he died in a labor camp at 68 in 1972.)

In the book by Dr. Williams and his wife, human “anatomy,” as revealed in Scripture, was divided further into the physical body, mind, soul, spirit, conscience, and will.  

Following the mention of his wife, I wondered if Dr. Williams had children. He said that while he had none of his own, Alta Ada came with three teenagers (and that was more than enough!).  He told me that two of his father’s sisters had Huntington’s disease. While his father (who died in his 80s) was not obviously affected by this fatal hereditary neurodegenerative condition, there was still the possibility, in the back of his mind, that he, Dr. Williams, might have inherited the faulty gene and could pass it on. 

However, he said he really didn’t believe that would happen, and that the family history did not affect his having or not having a child. (Testing for the gene mutation wasn't available until 1993–but 90% of people at risk still refuse to be tested for a devastating untreatable disease.)

Anyway, Dr. Williams left the gratifying and congenial WellSpan group practice in 2009. After this, he took a variety of locum tenens positions that allowed him to continue writing with his wife. For instance, he saw patients at a small hospital on Washington’s Olympic Peninsula every other month for three years, worked for a while on the eastern side of Lake Michigan, and filled in for a Yale practice in Connecticut. 

Scenic Olympic National Park on the Peninsula (Credit: earthtrekkers)

When Alta Ada became ill, Dr. Williams stayed home with her for a year. She died in late 2018 at age 76. Following her passing, Dr. Williams left clinical medicine again and dedicated himself more fully to theological pursuits. Upon the urging of his pastor in Lititz, Pennsylvania (near Lancaster), he did some teaching. And in 2020, he “clearly heard the voice of the Lord” telling him to obtain a Ph.D. in research psychology. 

And in 2025, through a program with Dr. Jichan Kim at Liberty University, he was granted his second doctorate degree. He was surprised and pleased to find out that his dissertation on charting spiritual development and communication with God (as of September 18, 2026) has been downloaded more than 480 times, placing it in the top 90% of such academic works.  

According to the study’s abstract: “The human experience of Christian sanctification and communicating with the God of the Bible was studied using a Constructivist Grounded Theory. The setting was the United States, a post-truth society with concurrent falling church attendance, diminished Bible reading, and deteriorating social discourse.” 

He found that the 15 reborn participants he interviewed “were not fully obedient to Him, did not focus on His kingdom, maintained worldly cognitive patterns, and used less than full truth in their communications and behaviors.”  Tellingly, the subjects didn’t know what they didn’t know. (Dr. Williams is currently working on a book based on the 342-page dissertation.)

He is quite concerned about the spiritual effects of “the ground shifting” underneath the feet of people who don’t know why it’s happening. In his solitude, as he contemplates in silent prayer,  he sees the widespread loneliness, broken families, deep anger, and social problems that underlie many thorny issues in our exceedingly complex, uneven healthcare systems. 

He sees that the Church and U.S. Healthcare are both failing the people and are in sore need of repair. He sees that these failures are invariably tied to an array of impersonal systemic factors. He continues to search for ways to understand and to heal deep bodily and spiritual wounds. And, finally, he laments that “people are losing touch with themselves, with who they are.”   

So, after listening to kindly Dr. Bruce Williams for more than two hours, I can now see him more clearly.

Recommended Readings:

1. Kissick, William, L. M.D., Dr. P.H. Medicine's Dilemmas: Infinite Needs versus Finite Resources. New Haven and London, Yale University Press, 1994. (Though somewhat dated, this is a carefully reasoned, detailed analysis of the problems we face and the many barriers to easy solutions. Concluding, Kissick mentions the University of Pennsylvania's motto: Leges sine moribus venae-"Laws without values are meaningless."  And he states that "the search for health security must reflect society's values and its emerging conviction that health care is a right for all Americans" p. 160.)

2. Vaillant, George E., M.D. Spiritual Evolution: A Scientific Defense of Faith. New York, Broadway Books, 2008. (Psychiatrist Dr. Vaillant directed Harvard's famous "Study of Adult Development" for 35 years. In this accessible, enjoyable book, he states that, as it is rooted in the mammalian limbic system, spirituality "comprises positive emotions and social connection."  He believes that "love is the shortest definition of spirituality" p. 16).  

2.  Williams, Bruce, with Alta Ada Williams. The Church in Crisis. Lititz, PA. Lititz Institute Publishing Division, 2019. (Noted in the description of the book on Amazon: "The Church has lost its saltiness" due to "progressive and marked secularization of the Church over the past 400 years. "The Church no longer operates in the spiritual realm." Why "saltiness"?  Salt was used to purify, to preserve, and to enhance flavor--goodness.)

By Anita Cherry 9/20/26

Jennifer Gross, CRNP: Bringing the Skills of a Nurse to Primary Care Medicine

Jennifer Gross CRNP

The borough of Columbia in Lancaster County sits just across the shallow Susquehanna River from Wrightsville, York County. Jennifer Gross, CRNP,  was born in the 62-bed Columbia Hospital. Her parents, together since they were in high school and married at 18, started their lives in the same small facility. Where were her grandparents born? Why, of course, in the very same place (the hospital was founded in 1895 and closed in 2003). Jenny’s father went to Franklin & Marshall College in Lancaster and became a CPA. Her mother worked as a medical technician and went back to school at 40 to become an LPN. 

For a few summers while in high school, Jenny volunteered at York Hospital as a Candy Striper, assisting the nurses with small non-medical tasks. She, with her friend,  proudly wore the classic red-and-white pinafores. But after she graduated, she decided to study business (like her father) instead of medicine (like her mother). So she went to Elizabethtown College in Lancaster County for a business degree. She didn’t like it, and quit after a year and a half. And, as she said,  she “wanted a career” and “loved being around people,” and she turned to nursing. 

Becoming and Working as an RN

Jenny decided to study for her RN degree at York College of Pennsylvania. On weekends, she worked as a Nursing Assistant at nearby York Hospital (caddy-corner to the current boundary of the college campus).  She signed up for her shifts on different floors to see what she liked, what suited her personality. She spent time in the various ICUs, medical and surgical floors, the nursery (where she rocked the babies), and the OR (where she stood around watching–not her cup of tea). 

York College of Pennsylvania Campus (Credit: York College)

After graduating from the program, she worked on 6-Main, the oncology floor, with Drs. Miodrag Kukrika and Eamonn Boyle.  She carefully administered chemotherapy drugs that often made patients violently sick and, as their white blood cell counts dropped precipitously, terribly vulnerable to life-threatening infections. Jenny said she did this emotionally demanding nursing “for nine or ten years” before she “wanted something different.”

She then rotated monthly through four different intensive care units for a year and a half. But it was “too depressing” taking care of patients with devastating strokes or traumas that precluded meaningful recoveries. This type of nursing was not for her, and she moved on. 

Returning to cancer medicine, Jenny then worked in outpatient Radiation Oncology for the next nine years. She helped people cope with the side effects of the treatments. And, for example, she assisted with so-called conscious sedation when patients had to be mechanically immobilized for precise radiation of localized brain tumors. As she did “all kinds of things” and worked closely with patients one-on-one, she began to feel the pull to be “more autonomous” and to make her own decisions about how to take care of people.

Transition to Nurse Practitioner

So she decided to further her training by becoming a Nurse Practitioner, a defined medical role created in 1965 to address the shortage of primary care physicians as Medicare and Medicaid were created to provide health insurance for low-income women, children, the elderly, and those with disabilities. Jenny enrolled in the NP program at Millersville in Lancaster County. 

Old Library at Millersville University (Credit: universityicons.com)

Because she continued to work full-time (ensuring that 75% of the tuition was covered by her employer–WellSpan), it took her five years to complete what was designed as a three-year program. Jenny said she didn’t see much of her husband during that busy time as work and study kept her occupied, and Dodd (an icon in the adult sport kite world) was spending four or five weeks at a time in China (where kite-flying was invented around 500 BCE) overseeing the manufacturing of beautiful dual-line stunt kites. 

As a nurse practitioner, Jenny needed to pick a specific field in which she could practice. Like the vast majority (nearly 90%), she chose primary care family medicine. Most of the program was spent doing academic work, including writing papers that had to (for some reason she couldn’t quite get) adhere to a precise format. There were three hands-on “clinicals” (she saw low-income patients in Lancaster and York, and spent time with Dr. Ben Hoover), totaling just 700 hours (less than 20 weeks) during the five years. Looking back, Jenny said she would have liked to have had a lot more than that; she thought there should be much more attention to practical matters.

She Joins a Medical Mission to Ghana

(Such “practical”l matters surely arose when Jenny joined a medical mission to the small fishing village of Apam, Ghana in 2006. She worked as a nurse practitioner, seeing grateful patients in the local clinic while the surgeons on the trip did long-awaited procedures and others on the team were busy digging wells, hoping to find water. Jenny said the trip was an “amazing experience.”  Though our system has flaws, the high-tech things we mindlessly enjoy and take for granted are often intensely sought after by people in less privileged parts of the world.) 

Women selling fish in Apam, Ghana (Credit: Jean-Bernard Cabana)

Working with Dr. Beekey as a Nurse Practitioner

Anyway, when she finished her NP studies 20 years ago (as of this writing in 2026), there was “not a lot of opportunity” for her primary care skills in York. Jenny feels that she was fortunate to have found a position with Dr. Cyrus Beekey, as her (required) “collaborating physician.” Dr Beekey is a nephrologist who had recently decided to practice general internal medicine in addition to his specialty. He was, said Jenny,  “wonderful” and “an excellent mentor.” 

But there was one problem: oddly, as a graduate nurse practitioner, there was no “eight to twelve week preceptorship” to ease into her new role of seeing patients on her own, as there is for medical assistants, LPNs, or RNs. Thus. after she spent just a week following Dr. Beekey around from patient to patient, she was on her own. 

Though Jenny met with Cy “every Tuesday to go over things,” the first few years (yes, years) “were really hard” and she “felt like an impostor.” Aware of her limitations, she was “scared.” She said it would have been helpful to have had at least a month or two of a closely supervised preceptorship to gain the confidence she lacked. As it was, it took several years, but the self-assurance gradually came as she took care of her patients in the office alongside Dr. Beekey, who saw his. 

And they practiced together for six years until he retired. “He took mentoring seriously,” said Jenny. She recalled, for example, that he carefully advised her to pay attention to her gut, to see “the gestalt,” when there was nothing definite, but things just didn’t seem right with a patient. 

Joining Dr. Harootunian

Dr. Harootunian

The next transition was to join Dr. Richard Harootunian at Pine Grove Internal Medicine. The private practice was eventually folded into WellSpan at Freedom Way, and Jenny has stayed with him for the past eleven years. She is quite confident in her abilities, but when she has a question about a patient, she relies on his vast medical knowledge and accumulated wisdom (he graduated from Penn Medical School in 1968, and as of this writing in 2026, he still works three days a week and has no plans to stop).

Jenny freely admits that as a nurse who “didn’t go to medical school,” there are things that she doesn’t know. She feels that it is critical to be aware of this gap and to “not be afraid to ask questions.” She is humble enough to not let her ego get in the way of doing what is best for her patient. 

Over the years, she has served as a preceptor for an NP student “nine or ten times.” She noted that when she started her program twenty years ago, you had to have had at least three years of nursing experience (she had 16). The current requirement is only a single year. She’s not sure that’s enough time to know how to be “a nurse first.”

Nursing is holistic, and one of the foundational and essential tasks of a nurse is teaching. Explaining complex health issues to anxious patients and concerned family members requires experience and, of course, time. She used to be allowed 60 minutes for a new patient, but that has been reduced to forty (it is twenty for an old patient, down from thirty), and that isn’t always enough. So Jenny “often runs late” as she tries to give her patients as much of her time as they need. And that effort is greatly appreciated, as judged by the online comments she has received. 

Using AI in the Exam Room

Fortunately, Jenny has been helped in this regard by the recent evolution in large language models of machine learning. She is happy to make use of a so-called ambient AI medical scribe developed jointly by Microsoft and Nuance (of Dragon NaturallySpeaking fame). 

This proprietary program listens to the conversation in the exam room, is able to “filter out chitchat,” and generates a polished medical report of the encounter (suitable for submission to the insurance company, if needed, to justify the charges) in seconds. There is no requirement for the clinician to be busily entering data; often with their back to the patient. (This will almost certainly turn out to be an unexpected solution to some of the annoying EHR-created problems noted in earlier stories in this series.)

As nursing has always focused on the whole patient, including the context of the family, the diligent nurse practitioner follows in this tradition. This is especially important as many medical specialists have progressively narrowed their practices to very specific problems within their fields (for example, one cardiologist might only see patients with rhythm disturbances while their colleague may only see those with coronary disease). The primary care provider is then responsible for putting things together, especially as the visit with the desired specialist may be (inexplicably) many months off. 

But there is even more, as AI programs to answer phone calls from patients who need to make appointments or reschedule or pay a bill or ask a medical question are starting to be deployed. These systems can easily manage the non-medical issues and will route other types of calls to a real person.  Jenny said she currently has to answer as many as twenty messages a day; there could be much less for her to do as these new programs are more widely used. But will we be okay with the progressive loss of simple human contact? Will we be okay talking to an emotionless robot who never tires? 

And when Jenny needs to quickly learn about something she’s not familiar with, she doesn’t need to search out Dr. Beekey or Dr. Harootunian as she simply turns to the comprehensive “Open Evidence” app on the computer and gets an answer in seconds. She can even peruse the relevant clinical and scientific articles online; the York Hospital’s physical library with neatly organized shelves of printed texts and bound journals, you see, only exists as a quaint and rapidly fading memory. 

After Work

Outside of her practice? Jenny said she enjoys reading. She has always liked mysteries, but has recently been getting into historical fiction. She just started The Calamity Club by Kathryn Stockett (author of The Help), an epic 656-page novel about two strong women in male-dominated Oxford, Mississippi in the 1930s. 

And Jenny has always loved animals. So, in her free moments away from the medical office, where she takes care of appreciative patients and their families, she takes care of chicks and geese, her dog, and the few itinerant ducks who stop by every so often. And at this time of year (it’s a steamy mid-July, as this is being written), she and her husband spend time together at their “summer home,” a small camper that they park by the creek that runs through their property, one county over from where she was born. If the wind is just right, they might decide to fly a colorful dual-line kite.

A "New Tech" Dodd Gross Diode Stunt Kite (Credit: kitestop.com)

Suggested Reading:

Topol, Eric. Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again. New York, Basic Books, 2019. (A detailed, but already somewhat dated, discussion of what AI is and is not, and how it might or might not improve healthcare. The final chapter is titled "Deep Empathy." In it, Dr. Topol argues, for example, that no machine will alleviate suffering; this essential task "relies on human-to-human bonding: it requires time, and its basis is trust" p. 292). 

By Anita Cherry 7/18/26

Two volumes of these collected stories are now available in print form:

Dr. Tim McGuinness: Gynecologic Oncologist

Dr. McGuinness

“Thanks for coming,” I say as we sit down together.

“Thanks for asking me,” he answered.

“Thanks for saying yes. This is not easy to do.”

“Which part? You or me?”

“Both,“ I say, as we laugh.

Dr. Tim McGuinness said that he has never been one to talk about himself--that is not his style. I told him that this has been my experience with almost all of the doctors interviewed for these stories. But once they begin talking, and I can keep myself from interrupting the flow, they can open up and go on for two hours. 

So Tim asked where he should start, and I suggested with his family. And so he did.

[Click the box below to hear the story read by an AI-generated voice.]

Family and Before Medical School

His father, born in the Lehigh Valley of Eastern Pennsylvania, was a Border Patrol officer in Texas in the early 1950s. It was a very humanitarian service then. While there were some people who had to apprehend and deport, they often took care of people “walking in the hinterlands of South Texas” who needed water, a meal, and medical care. Tim’s mother (also from the Lehigh Valley) was a nurse.

Because of his father’s job in immigration, Dr. McGuinness and his younger brother had the opportunity to experience life in several quite different places. While he spent most of his childhood in Laredo, Texas, he also lived for a while at the Canadian border, and (as a high school sophomore and junior) in “idyllic” Hawaii (toward the end of the Vietnam War, during which refugees came through the islands ).

He finished high school in 1971 in Corpus Christi, Texas, sitting on the Gulf of Mexico, and went to Texas A&I University (now, since 1993, Texas A&M) in Kingsville, South Texas (where he was born).  Tim said that he “always wanted to be a doctor” (reportedly since he was only three or four years old), but as he was a B student in college, and admission to medical school in the U.S. was very competitive, he decided to do a Master’s in microbiology (also at A&M). 

College Hall at Texas A&M Kingsville (Credit: A&M)

In the infamous compulsory 1972 military draft lottery, he was assigned the ignominious number 4. He knew that when the time came, when his very unlucky number was called, he would be drafted into the Army.  He was not going to flee to Mexico or Canada to avoid military service, but he did not want to find himself in the infantry in the hot jungles of Vietnam. Tim decided to join the Coast Guard Reserve. The part-time commitment was for six years.

Medical School, Internship, and Public Health Service

He applied to medical school as a graduate student and was accepted to the Texas College of Osteopathic Medicine (TCOM) in Fort Worth. Tim attended by way of the generous Public Health Service program. This covered school tuition and fees, and provided a stipend for living in exchange for a promise to practice in an underserved area for as many years as the scholarship covered.

One day, as an eager second-year student learning about disease, he felt a lump in his neck and had someone look at it (more about this later). 

After he finished medical school and took a rotating internship (doing surgery, internal medicine, ER, OB/GYN, etc.), Dr. McGuinness decided to fulfill his Health Service obligation as a solo practitioner in Del Rio, Texas, a medically underserved area sitting directly on the border. Why solo, and not in a clinic? He told me that he didn’t like the idea of “being told how to take care of patients by non-medical administrators.”

International Bridge spanning the Rio Grande and connecting
Del Rio, Texas, with Ciudad Acuna, Mexico (Credit: Ronald Castle)

While there, as he said, he took care of everything that “walked, crawled, or got dragged in through the door.”  He did one hundred deliveries a year and spent one half day a week at a Title IX health clinic for women. He recalled the sadness of finding a young woman’s advanced cervical cancer that had been misdiagnosed by several physicians in town. 

The experiences in this fragile community affected him deeply, and as he looked at the texts he collected in his bookshelf, he realized that he had developed an interest in Women’s Health, and especially in gynecologic cancer.

What to do next? As part of his four years of government obligation, Dr. McGuinness spent a month at an Indian Health Service clinic in Oklahoma. While there, he met a fellow physician who had trained at York Hospital. Tim was intrigued by his colleague’s glowing description of the place and the program, and he said to himself, ”That’s where I’ve got to go!"

Residency, Fellowship, and Initial Practice

And as Dr.McGuinness did his “great” OB/GYN residency at York Hospital, he couldn’t wait to get to work every day. What he had been previously told about the staff (including Drs. George Johnson, Hank Carter, Brad Myers, and Jay Jackson) was true. They were, he said, “superb teachers and surgical beasts.” He was also taught by experts who came up to York from Hopkins (including the renowned GYN cancer specialist Dr. Neil Rosenshein–"A prince of a man,” according to Tim). All in all, Tim had a wonderful time as a resident. 

Dr. Mangan

After this, he continued his training with a fellowship in gynecologic oncology at Pennsylvania Hospital (the nation's first hospital) in Center City Philadelphia. The director of the program, Dr. Charlie Mangan, was an “amazing teacher,” and a perennial Philadelphia Magazine “Top Doc.” Dr. Mangan became Tim’s mentor. As they worked together closely, Dr. Mangan recognized his protege’s talents and asked him to join him as a partner.

The next six years in Philly were quite active as local residents and women from the distant suburbs sought knowledgeable specialty care for gynecologic cancers. In fact, the program was busier than the same services at Penn, Temple, and Fox Chase. 

But the big insurance companies (including US Healthcare) were in a race to be “the lowest paying people in town.” As the increasingly inadequate reimbursements could no longer cover the costs of the practice, the well-regarded group was pushed to near bankruptcy. Dr. McGuinness had two kids in high school, and he needed a secure way to provide for them.

Return to York

Dr. Nicolas Simon, hoping to recruit a fellowship-trained gyn-oncologist to York, called Dr. McGuinness to ask if he knew of anyone who might be interested. Tim’s response? “Yeah, you’re talking to him.”

So Dr. McGuinness returned to York in 2000 to develop the Division of Gynecologic Oncology. He was essentially by himself for a grueling six or seven years as the service grew. He was greatly helped out by his first nurse practitioner, Michelle Thompson, who made his life “a heck of a lot better.”

Michelle

His wife Janet (an OR nurse) planted the idea of having him start a fellowship program in York. He listened to her and, over time, he trained ten fellows (“good people”) who, in turn, helped lighten his day-to-day workload. In subsequent years, they were able to add attending staff from the graduates. Dr. McGuinness practiced the demanding art of gynecologic oncology in York for 16 years before retiring at age 62. 

Advancements and Other Changes

He saw many improvements in his chosen field over the decades. Though he was initially trained as a “big hole” surgeon, he learned to do the tricky laparoscopic procedures, and he was happier when robot-assisted surgery made complex cases easier and much more precise. 

He was also a witness to dramatic changes in the non-surgical aspects of caring for women with cancer. He was glad when Zofran, “a miracle drug,” virtually eliminated the “almost unconscionable” misery of intense chemotherapy-associated nausea (that sometimes started even before the chemo infusions, in a Pavlovian manner, he noted). Unlike older, much less effective, treatments for nausea, Zofran directly blocks the effects of the surge of serotonin released by the gut at the brainstem chemoreceptor trigger zone and the vomiting center. It may also dampen general awareness of internal body signals. It made the dreaded chemo sessions tolerable.

When Dr. McGuinness was in Philadelphia, he had “the extreme displeasure” of watching three young girls die with cancer of the uterine cervix. He is glad that this might be a thing of the past. Virtually all cervical cancers are caused by persistent infection with one of the HPV viruses. Vaccination against HPV with Gardasil (approved in 2006) by age 11 or 12 (before sexual activity) may prevent up to 90% of invasive cervical cancers. 

And since HPV may also cause oral and anal cancers, all adolescents (including boys) should consider early vaccination to defend against infection (only about 70% of U.S. teens are currently fully vaccinated). 

Ovarian cancer that has spread beyond the ovary (the vast majority of cases, sadly) is “very difficult to eradicate,” said Dr. McGuinness. Localized tumors, those few that are curable, are usually picked up incidentally when looking for something else. But the most recent “biologic” and immune and targeted therapies for ovarian (or fallopian or primary peritoneal) cancer can sometimes result in a manageable “chronic disease” with long-term survival. The complex science behind these new (and emerging) therapies is truly remarkable.

Importantly, women with BRCA gene mutations are at extreme risk of developing ovarian cancer (maybe up to 60% with BRCA-1 defects, considerably less with BRCA-2), and may be candidates for prophylactic ovariectomy when they are beyond their childbearing years. Intensive screening to identify small tumors early on, when they can be fully removed, hasn't worked out yet. 

Risk of breast and ovarian cancer and BRCA mutations
(Credit: Myriad Genetics)

And Dr. McGuinness has seen how the electronic health record has altered the doctor-patient relationship. He said that he is a “firm believer of looking people in the eye, touching them, and talking to them.” He is not a “data entry clerk” and refused to give in to that misguided demand when it surfaced, and preferred to continue to dictate his clinical notes. He believes that “patients need to feel connected to their physicians” as caring doctors, not “just as technicians.”   

He has seen, and is pleased, that there is now more attention to alleviating the heavy psychological aspects of receiving a diagnosis of cancer and living with it, including the ever-present fear of recurrence. 

He Retires from Practice to Live Near the Beach 

So, sixteen years after starting the division of gynecologic oncology in York, and at 62, Dr. McGuinness chose to leave practice behind. He and his wife, he said, wanted to “live near the beach.” (Wouldn’t most of us like a permanent beach vacation?) Well, as they looked around, they saw that there were no easily affordable sunny spots along the East Coast. 

The Caribbean was an option, but was crossed out due to the risk of hurricanes. So they turned further south. Tim speaks passable Spanish, and they considered Mexico, but thought it was too dangerous. After months of online study about where to settle as expats, they decided to try Ecuador. 

They visited and stayed with an American couple. They (meaning his wife) had been looking at a place in Manglaralto, a quiet, tranquil village three hours by car from Guayaquil, the cultural and financial center of Ecuador. They were not sure where it sat, but the two-story wooden house that Janet found online turned out to be a baseball's throw from the beach. It was perfect. And they fell in love with it. So they did what you were not supposed to do in these situations–they immediately bought it (for cash, the only option). 

Beach at Manglaralto (Credit: Expedia)

The weather was idyllic for four and a half months of the year–every day was sunny and in the 80s; Southern California-like. For the rest of the year, though it was still warm (never lower than 68 or 69), it often drizzled, and the sky was cloudy and uniformly, depressingly, gray. But even when the sun wasn’t out, “amazing” fresh vegetables and fruits ("amazing" except for the puny peaches) and “amazing” seafood (including giant shrimp) were always available, and Tim and his wife were okay. 

The Pandemic and an Unexpected Tragedy

They were friendly with the locals, as well as with expats from Romania and Venezuela (and less so with displaced Americans). But things began to change when the pandemic hit. There was great fear of contagion, serious illness, and death. 

To limit the spread of the virus, you could not leave your house after five in the evening, and you could only drive every other day. For nearly two years, they left home to shop or to go to the pharmacy. When vaccines became available, the only one used in Ecuador was the inactivated virus from China. It was not nearly as effective as the novel Pfizer and Moderna mRNA vaccines. Dr. McGuinness admitted that healthcare in Ecuador wasn’t “all that great.” So as soon as he and his wife were permitted to travel, they came back home to be immunized. 

But their six-year stay by the Pacific Ocean was “tainted” further by a family tragedy when Tim’s brother-in-law and sister-in-law were staying with them. His sister-in-law was tired, went to the bathroom, fell off the commode, bumped her head, and began acting “kind of weird.” She was reluctant to get things checked out, but she finally agreed to go to the small local hospital. 

The 2-story Dr. Liborio Panchana Sotomayor Hospital
(a typical rudimentary healthcare facility not too far from Manglaralto)

She had a head CT. There was no bleed, and the neurosurgeon sent her home. The next morning, she was up briefly, then went back to bed. Her husband found her unresponsive and quickly alerted Tim. Dr. McGuinness tried to resuscitate her; she wasn’t cold, but he knew that she was already gone. 

That sad experience, the stifling pandemic restrictions, and the awareness that healthcare in Ecuador was somewhat lacking and that they were three hours from the nearest major hospital led to the decision to return home.

Return to York, and We Share Stories

He and Janet came back to York four years ago. He planned to pass the time by reading (he especially enjoys David Baldacci novels), playing (very basic) blues guitar, or traveling (their dogs currently hold them back). But he was coaxed into seeing patients in the office again to help out Dr. Eav Lim until they are able to recruit a second full-time gynecologic oncologist. But he doesn’t do surgery anymore. 

Deep into the interview, after hearing Dr. McGuinness talk about his extensive career taking care of women with gynecologic cancers, I quietly told him that I was an ovarian cancer survivor. I told him that I was 27 in 1981 and living in Syracuse when the stage IV disease was found. I took Alkeran tablets daily; they made me sick. 

After we moved to Baltimore and had the “second-look” surgery a year after diagnosis, there was residual tumor, and I was flatly told that “there are things we can do.” Shaken, I sought a second opinion. I saw Dr. Rosenshein. He phoned me early one morning after the visit (I was still in bed). He had just come back from a conference and had cutting-edge information. Stay with what you are doing, no more chemotherapy, he said. I was overjoyed. As he predicted, my unusual cancer disappeared. I was lucky. But the damage to my psyche through the ordeal was real and long-lasting. And I felt alone. Having never met a woman who survived ovarian cancer, even 40 years later, has added to this heavy emotional isolation.  

As I spoke, Dr. McGuinness looked at me and listened intently and with obvious compassion. After a brief pause, he gently told me that he was a survivor too. You see, the lump that had popped up high on his neck when he was a second-year medical student in Texas was a Hodgkin’s lymphoma. When the surgeon who operated on him relayed the diagnosis, he was painfully blunt: “You’ve got it, chief.” 

The young, optimistic medical student instantly imagined the worst–the only person he had met with Hodgkin’s, a colleague in graduate school whom he had known only briefly, had died within two months of diagnosis. What was Tim to think? Would he live to see another spring, his favorite season? But the stage IA presentation of Hodgkin’s was often curable even then, and the lymphoma shriveled away with radiation therapy. 

We are both survivors, yes, but the emotional impact, the shock, of facing our mortality at such a young age can last forever. And it molds who we are and how we respond to the world. Among other things (and Dr. McGuinness quickly agreed), it fosters a positive sense of gratitude for being alive. Each new day is a gift. 

And, by the way, as my husband often reminds me, “everything is practice for later.”  

Suggested Readings:

1. Anonymous. Cervical Cancer Causes, Risk Factors, and Prevention. National Cancer Institute at The National Institutes of Health. Accessed at https://www.concer.gov/types/cervical/causes-risk-prevention. Updated 8/2/2024. ("Nearly all cervical cancers could be prevented by HPV vaccination, routine cervical cancer screening, and appropriate follow-up treatment when needed.")

2. Hillmann, J., Maass, N., Bauerschlag, D.O. et al. Promising new drugs and therapeutic approaches for treatment of ovarian cancer-- targeting the hallmarks of cancer. BMC Med 23, 10 (2025). (They conclude: Ovarian cancer "remains the most lethal gynecologic cancer...but many new strategies to improve [a] patient's outcome appear upon the horizon...[including] targeted therapy, immunotherapy, gene therapy, and drug-conjugates.") 

3. Hodgkinson, Katherine, Butow, Phyllis, et. al. Long-term survival from gynecologic cancer: Psychosocial outcomes, supportive care needs and positive outcomes. Gynecologic Oncology, 104 (2), 381-389, 2007. (An Australian single-institution self-report study of disease-free women up to 8 years following successful treatment revealed that while 68% had positive outcomes emotionally, 19% had post-traumatic stress disorder, and 29% had clinical anxiety, often regarding fear of recurrence. Many women reported unmet existential needs.)

By Anita Cherry, 6/17/26

Anita Cherry, Self-portrait, 1981, Watercolor on paper, 10 x 12 inches

Two volumes of these collected stories are now available in print form: