Bruce Williams, M.D., 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.  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.")

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:

Dr. Vince Butera: Orthopaedic Physician/Lifelong Learner

Dr. Butera

Dr.Vincent Butera's father, Liborio, left the island of Sicily with his own father for the U.S. in 1928 when he was fourteen. Many poor peasant farmers had already immigrated to America with the goal of finding a better life, and his uncle was here.

Italy was in turmoil after World War I. The extreme nationalist leader Benito Mussolini, after several years spent systematically eroding democratic ideals and the left, announced his right to assume dictatorial power on January 3rd 1925. Widespread brutality and suffocating oppression followed.

Liborio was safe in the US. And at eighteen, after training in the ancient craft of the cobbler, he opened his own business in York, Pennsylvania.  Dr. Butera said his father embodied the “proud Italian work ethic.” This left a deep impression on him.  Much of his father’s work involved fashioning and repairing so-called orthopaedic shoes.  So the word “orthopaedic” (meaning straight child) was part of Vince’s world from a young age.

Dr. Butera told me that his immigrant family story was typical. After working here for a while, his paternal grandfather would return to Italy “to make another child.” He then came back to the States to work and send money back home. When his grandfather was away, Vince’s father would stay with an uncle.

Eventually, the Butera family settled in York. Vince went to York Catholic High. He was (of course) a good student, and as he “enjoyed science” and wanted to be “in a service type of profession,” he turned to medicine. After graduating from high school in 1963, he attended Catholic all-male La Salle College in North Philadelphia (he had received a scholarship to the school). He felt that the rigorous pre-med program (the vast majority of physician-hopefuls were gradually weeded out) was “the most difficult part” of his education. Medical school was, he said, “focused and supportive.”

La Salle University in Northwest Philadelphia (Credit: La Salle)

(Incidentally, as a team physician and in recognition of what was deemed to be his “service to God and country,” Dr. Butera was inducted into the York Catholic Athletic Hall of Fame in 2005.)

So when he went to Temple for medical school, “it was easy.”  After his first year, he married his high school sweetheart, Kathy. And she supported them for the next three years by working as a dress buyer for John Wanamaker’s innovative and famous block-long, 12-story department store in Center City Philadelphia.

At Temple, he enjoyed and was drawn to the “hands-on” approach to doctoring that surgery offered. During his orthopaedic rotation with taskmaster Dr. John Lachman (a clinical test that bears his name is still used to diagnose a torn ACL in the knee), he saw that this was a “happy specialty.”  He saw that most patients came with a specific problem that could be fixed. And he saw they could “return to the mainstream of life.” Vince thought that this would be “a very positive way to practice medicine.”

Temple's Lewis Katz School of Medicine
on North Broad Street in Philly (Credit: Temple University)

And he liked the variety of tasks in orthopaedics, as you could, he noted, fix a newborn’s club foot or replace a hip in a 95-year-old. The specialty was, he said, “applied anatomy.”

During summer breaks from college, Vince had worked as an orderly at York Hospital. When he rotated through the ER, he had fun driving the ambulance. And he enjoyed being in the cast room with orthopaedists Dr. John Kruper and Dr. Joseph Danyo--he saw that they seemed to really enjoy what they were doing for patients.

And in 1971, he left Temple and returned to York for his internship. But this was the time of the Vietnam War (1955 -1975). Since Vince was no longer in college or medical school, he no longer had a 2-S student deferment. So he was vulnerable to being drafted into the Army and being sent to Vietnam as a foot soldier. However, the Berry Plan allowed physicians to finish their residency before being required to fulfill a military obligation.  But this deferment was awarded by “the luck of the draw.” Vince applied, but wasn’t so lucky. 

Considering his options carefully, he decided to enlist in the Navy before he could be called up. He became a Battalion Surgeon with the 2nd Battalion 6th Marine Regiment at Camp Lejune, North Carolina. He served with the Marines (“true professionals”) in the Mediterranean on the USS Guadalcanal (LPH-7), an amphibious helicopter assault ship, from June to December 1973 (the Paris Peace Accord in January 1973 had ended direct U.S. military involvement in the war).

The USS Guadalcanal (Credit: US Navy)

While Vince’s ship was moving through the Mediterranean and docking at well-known strategic spots, his wife, Kathy, was traveling around Europe with friends. They coordinated their efforts, and Dr. Butera had “a girl in every port–but it was the same girl!’

While Vince was in the Service, he applied for an orthopaedic residency. He wanted to go to Pittsburgh to study with Dr. Albert Ferguson (the internationally recognized founding chairman of the department). Time passed, and he received nothing in the mail. So he decided to call the office directly. Dr. Ferguson (who had served in the Marines in WW II) picked up the phone. They talked, and when “Ferg” asked Vince if he wanted to come to Pittsburgh, he (of course) jumped at the chance.

Dr. Ferguson
(Credit: Pitt)

Dr. Butera (who served as Chief Resident) said the training program under Dr. Ferguson was “great.” It was intense, and there was no vacation time. He viewed orthopaedics as “a delicate specialty on hard tissue.” And during his years in Western Pennsylvania, he developed a keen interest in hand surgery. He told me that he, in fact, had “always been fascinated and intrigued by the intricacies of the hand.”  And hand surgery, he noted, does not rely on the “mallets, chisels, drills, and saws” found in the classic toolkit of the ortho surgeon.    

So when he finished his residency, he did an intensive six-month training program in dedicated hand surgery in Denver. 

By age 32, it was time to go into practice. Seeing that York was a “unique and sophisticated medical community” and a teaching hospital, Vince returned to his hometown. Rather than joining the established group, he chose to open his own practice. So he took a two-day course given by the Pennsylvania Medical Society titled “Establishing Yourself in Medical Practice.”  They let him know how to hire staff, which billing system to use (3x 5 cards might suffice back then), and which typewriter to purchase (probably an iconic non-jamming IBM Selectric). That was it!

He received “manna from heaven” when he hired a former Catholic nun who had worked in an orthopaedic practice in New Jersey for 17 years. He said that she knew more about orthopaedics than he did. He was on-call 24/7, and he initiated regular ortho conferences for the residents (who greatly appreciated his teaching). He was soon busy, and the first six months were rough as he adjusted to the heavy workload. After that initiation, he felt he could take anything: “Hit me again!” The three-person practice of one doctor, one nurse, and one secretary grew.

Dr. Moritz

And in 1982, after four years of being a solo practitioner, Dr. Butera was joined by Dr. Micky Mortitz (who was a medical student at Pitt during Vince’s residency there). Now with an able partner, Vince felt like he was “on vacation every other night and every other weekend.”  Over the next eight years, they added two more excellent surgeons to the group–Dr. Douglas Hofmann and Dr. Nick Pandelidis,

While Vince maintained his special interest in hand surgery, which eventually accounted for about 20% of his work, he performed many hip and knee replacements for people whose joints were injured or simply worn out.  He told me that the modern era of hip replacement began with the British surgeon Dr. John Charnley in the early 1960s. Major advances in joint replacement soon followed. (Dr. Butera has two artificial knees himself, having inherited his father’s crooked legs.)

In the early 2000s, the two York orthopaedic practices decided to join forces, and the Orthopaedic and Spine Specialists (OSS) group was created. Dr. Butera was part of this until he retired in 2008 at 62, as the business of medicine was becoming increasingly complicated.

Looking back, Vince felt that he was part of “the great caring and healing profession” of medicine during “the golden years” of private practice. He especially valued the intimate relationship between the physician and the patient found in the exam room or in the OR. His life’s work, he said, came down to “satisfaction and giving back.”

While he was in practice, Kathy, a talented ceramicist who trained in fashion design at the Moore College of Art & Design, was busy raising their daughter, Emily. Since retirement, Vince abandoned the lofty idea of learning to play the saxophone. And no longer able to play tennis, he took up golf (“a ridiculous thing to do,” he noted). 

He and Kathy have spent many summers at Chautauqua, the well-known forward-thinking adult educational and cultural center in far western New York. And he has taken courses at the local Osher Lifelong Learning Institute at Penn State York and has given several himself on “the intricacies and beauty of the hand.”

Athenaeum Hotel on Lake Chautauqua
(Credit: Chautauqua County Visitors Bureau)

Waxing philosophical, Dr. Butera said that the fully opposable thumb, where the tip of the thumb can touch the tips of the other four fingers, makes us unique in nature. Nine muscles in the hand and forearm are used to produce the thmb's exceedingly complex movements. Aristotle said that “the hand is the tool of tools.” Sir Isaac Newton is quoted as noting that “in the absence of any other proof, the thumb alone would convince me of God’s existence.” And in the words of Scottish anatomist and surgeon Sir Charles Bell: “And we  must confess, it is in the human hand that we have consummation of all perfection as an instrument.”  

Physician and primatologist John Napier traced the evolution of the human hand as it developed the form needed to produce a power grip and a precision grip, allowing us to wield clubs and to throw rocks. But these two advanced mechanical abilities may also be used to mold clay into beautiful pottery, to hold and guide the surgeon’s scalpel and sutures to mend a torn tendon, or to repair the worn-out leather sole of an orthopaedic shoe.

The hands of Liborio Butera (Credit: York Daily Record)

 

Suggested Readings:

1.  Napier, John (revised by Russell H. Tuttle). Hands. Princeton, N.J. Princeton University Press, 1993. (Nearly everything one needs to know--and more--about the anatomy and evolution of the human hand. He states that "the movement of the thumb underlies all the skilled procedures of which the hand is capable." And that finger-thumb opposition "was probably the single most crucial adaptation in our evolutionary history." p.55)

2.  Sobinov, A.R., Bensmaia, S.J. "The neural mechanisms of manual dexterity." Nat Rev Neurosci 22, 741–757, 2021. ( In-depth technical review--for those with the required background-- of the complex sensory and motor activities involved in the remarkable functions of the human hand.  According to the authors, “The hand is the most versatile manipulative organ in the known universe.”)

3.  Wilson, Frank R. The Hand: How its use shapes the brain, language, and human culture. New York: Pantheon Books, 1998. (Extensively referenced and far-ranging text building on Bell's and Napier's work, but from the standpoint of a thoughtful clinical neurologist whose focus is on the remarkable "hand-brain" complex.) 

4.  Young, R. W. "Evolution of the human hand: the role of throwing and clubbing." Journal of Anatomy, 202: 165-174, 2003. (The hypothesis is that the first tools used by our ancient hominid ancestors were hand-held weapons used against adversaries that enhanced the chances for reproductive success.)

By Anita Cherry 5/19/26

Kathy Butera's "Carved Vase,"
using iron oxide pigment reclaimed from an abandoned PA coal mine
(Credit: Evergreen Conservancy)

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