Dr. Rich Murray: Pulmonary and Critical Care Intensivist

 

Dr.  Rich Murray

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

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

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

Asbestos (Credit: healthgrades.com)

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

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

Geneology

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

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

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

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

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

Manville movie theater circa 1954 (Credit: Neal Ranauro)

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

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

Middle School and High School

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

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

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

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

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

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

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

Yale

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

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

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

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

Medical School and Residency

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

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

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

Dr. Castle

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

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

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

HIV  

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

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

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

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

Fellowship

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

University of Maryland Medical Center (Credit: UMMC) 

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

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

Dr. Criner 

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

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

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

The Move to York

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

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

Police helicopter searchlight (Credit: Getty images)

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

Accidental Needle Stick

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

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

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

Critical Care Team

Lew Williams

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

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

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

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

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

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

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

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

Post-ICU Syndrome

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

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

His "Side" Interest

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

EEG stages of sleep (Credit: Britannica)

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

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

"Too Old" for Demanding Inpatient Work 

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

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

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

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

References and Suggested Readings:

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

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

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

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

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

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

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

By Anita Cherry 7/27/25

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

"Untitled" by Anita