Gynecologist Dr. Detlef Gerlach: A "Pretty Interesting Story"

Detlef Gerlach, M.D.

His first clear memory is of when he was only three years old. The young boy from Berlin was in Russia. He was sitting in a small chair in a nearly-bare and freshly-painted kitchen. It looked wet. A flickering candle was set on the small table. He could remember nothing before this, nothing of Germany during the last two years of the war.

Dr. Detlef Gerlach, retired OB/GYN physician, shared what he modestly called his “pretty interesting” story with me several months into the Covid-19 pandemic.

He was born in June of 1943, five months before the British, and then the Americans began a series of hundreds of bombing raids. At least 20,000 people were killed and much of the city was turned to rubble.

In February 1945, Detlef was with his brother and his mother visiting his mother’s sisters in the outskirts of Dresden during the ruinous and still controversial firebombing of that city.  The two boys sought protection under a “huge table” in their aunt’s basement. More than 25,000 people lost their lives, including his father’s sister and grandmother.

Devastated Dresden after the Allied firebombing

Three months later, during the Battle of Berlin, the vengeful Soviets laid waste to what remained of the city and terrorized its people, bringing an end to the war in Europe.

But Dr. Gerlach was too young to retain explicit memories of these terribly traumatic events. 

His brother Ulrich, a bit older, was born in 1941; their sister Ursula had been born two years before that, but died at six months of age, likely due to pyloric stenosis. When his mother became pregnant a third time, hoping for a girl, she reluctantly settled for another boy.

Dr. Gerlach’s parents gave their children unusual but obviously-German names. You see, he noted, his maternal great-grandmother was Jewish and this, according to Jewish law, made the children “technically Jewish.” His parents feared that someone from the National Socialist Workers’ Party, the Nazis, would discover this if their children’s names suggested that despised ancestry. 

But how was a toddler from Berlin in Russia after Germany’s defeat in the war they started?   

This is how: On October 22, 1946, while Detlef’s mother was visiting her sisters, and sometime between midnight and three in the morning, Russian soldiers “armed with machine guns” knocked on the door of their apartment and announced: “You’re going to Russia!”  

A young Horst Gerlach

You see, his father, Horst Gerlach (1912-2006), was an electrical engineer with Telefunken. He specialized in radar and missile guidance and he was one of the many scientists whose technical knowledge was sought by the Allies as they tried to “catch up” to the advanced Germans.  So the Russian military conceived “Operation Osoaviakhim.” They planned to simultaneously whisk nearly 2,200 unsuspecting subjects and their families from the post-war Soviet-controlled Eastern zone of Germany to Russian soil. (They dismantled the labs and carted them away as well.)

So a truck was loaded with all of their things and young Detlef, his brother, and his father were off to the rail station. They had no idea where they were going, or why. The trip on the unheated train to their mysterious and chilly destination took a week, a week that must have seemed forever to the two bewildered boys. 

When Detlef’s mother returned home after calling on her sisters, the comfortable apartment was empty. Her neighbors, wary at first, eventually told her that Russian soldiers came by and left with her family and everything they owned. Dr. Gerlach said that his “always pretty feisty” mother headed straight to the Russian consulate. She demanded to know what happened; she insisted to be taken to her family, wherever they were.  

So they put her on a plane to Moscow and then a train for 25 kilometers to the “scientific town” of Fryazino, a hub of electronics research. The communist Soviets hoped they could use his father’s expertise in their quest for world domination (after Adolf Hitler lost his monstrous fascist bid for the same).

When the train carrying Detlef, his brother, and his father pulled into the station, Detlef’s mother was already there, waiting to greet her anxious family. The two boys first looked at her, and then toward the locomotive that had dragged them away from their home. They were excited and quickly ran along the platform to get closer to (you may have guessed) the massive belching steam engine.

The destination for his father was the Fryazino Institute 160, a Soviet research facility where they manufactured specialized vacuum tubes. There were about 200 Germans working at the institute. By 1947 the CIA was already aware of the facility, including the exact layout and even the names of those who worked there.

Secret 1953 CIA document detailing a floor
in Fryazino 160

The Gerlach family was housed in a cramped second-floor apartment with three other unwilling German scientists. There was the small kitchen noted above, a single bath, and three bedrooms. So the four Gerlachs were essentially confined to living in one room. 

As Dr. Gerlach sat in our family room and flipped through the several pages of notes he had with him and thought carefully about telling me his story, I wondered if he could recall how he felt during this trying time in his life. 

“Let me tell you about my parents,” he said. They were “absolutely fabulous” and “loving.”  He said that they tried to protect him and his brother from anything that might alarm them. Yes, his parents were worried about the Nazis “getting them” in Germany, and the six years in Russia were difficult emotionally. But the boys only remember “being really happy kids.” Kids who enjoyed playing with discarded vacuum tubes. 

Ulrich, always the scientist, learned to identify the specific makers of these critical electronic devices. Younger Detlef “had more fun throwing them at the wall and hearing them pop.”  

Detlef peering down
 through a Rollieflex

Dr. Gerlach noted that food was “not plentiful” in Russia and that his mother deprived herself so that he and his brother were not hungry. Sometimes the three took the train to Moscow to buy what they couldn't find in Fryazino, and they brought the treasures home in carefully-guarded leather suitcases. New clothing was also scarce, and after desperate Russians lifted theirs from their balcony one day his mother “knitted everything” for them including shirts, pants, and mittens. 

The boys went to a school with about 50 other German kids
and Detlef became fluent in Russian.  His father worked on the fourth floor of the Institute in the Klystron vacuum tube lab making high power beam amplifiers used in radar systems and missile guidance.  The director was fellow-German, Dr. Karl Steimel. 

According to CIA documents, the Russians tried in vain to indoctrinate the Germans in Marxism and dialectical materialism. At one point they enlisted “a (charming) Mrs. Pipko” to “raise the morale” of the group and to get “Drs Steimel, Schaaff, and Gerlach to take over management” of a “cultural committee”  to “ensure its success.”  

The Russian Secret Service (SS) tried to pit his father against Dr. Steimel to create mistrust between them, to see, perhaps, if they were plotting something. But his father was wary and cautious and did not fall for this well-known geopolitical tactic.

But one morning before his father left for the lab there was an ominous pounding at their door. The SS simply informed his father that he was “going to Moscow.”  The family was shaken. And when he was dropped off back at their apartment three days later Horst was horribly bruised and was missing two teeth. Nothing else happened. I guess his father didn’t “talk.”

Ulrich and Detlef with their mother on Christmas in Fryazino 

Detlef’s family spent six years living with fellow Germans and working side-by-side with the Soviets. Until one day when his father was “no longer needed.”  The Russians were apparently able to get what they wanted from him and his fellow scientists, and he and they were now expendable. 

While some of his father’s colleagues were “sent to Siberia” and were never heard from again, Horst was allowed to return to one of the Soviet-controlled areas outside of Russia. He could go to Eastern Germany, Poland, or Hungary. He chose Germany.

Allied zones in Germany after the war

So in 1952, the family took another tiring rail journey. They could return to Berlin, but only to newly-formed East Berlin (without the dividing wall yet).  His father was able to work in electronics in his home country again. But before long he sensed that things were “unsafe.”  He wanted to come to the U.S. 

This is where things get even trickier.

You see, while the Russians had Operation Osoaviakhim to exploit German war-making know-how we, the Americans, had our own version of such a program. It was initially termed Operation Overcast. But there were thorny immigration issues for those with a Nazi past. So selected sensitive files were simply noted with a paperclip and set aside. The name of the plan was changed to Operation Paperclip. 

Dr. Gerlach told me that this was a secret and very controversial program to bring thousands of German scientists and technicians, including hundreds of “ardent Nazi supporters,” actual Party members, or even Nuremberg-convicted-and-sentenced war criminals to the States. We wanted their expertise in instruments of war, including rocketry and the use of (banned) chemical and biological agents. 

The most well-known scientist who was quietly ushered here from the Third Reich was Dr. Wernher von Braun (1912-1977) who developed the feared V-2 rocket for Nazi Germany and the massive Saturn V launch vehicle for the U.S. manned missions to the moon, but there were many others who ended up in prominent positions within NASA and other governmental agencies.  

Wernher Von Braun (wearing Nazi badge) with Fritz Todt, who utilized
slave labor for major works across occupied Europe

According to author Annie Jacobsen, after the start of the Korean war in June 1950, there was more urgency to be certain that the German scientists didn’t wind up in enemy hands. This led to the so-called Accelerated Paperclip program, with headquarters in Frankfurt and an office in New York City at the Alamac Hotel, where scientists could live while they were waiting for assignments.

So, in 1952 Detlef’s father started working for an electronics company in East Berlin. But he wanted to leave Germany behind for good and come to the West. He was in touch with the CIA and British Intelligence and they agreed to help. The plan was to sneak him into West Berlin. 

So one quiet Sunday afternoon, Detlef, his brother, and his mother took an innocent-seeming train trip to visit his aunts in Allied-controlled West Berlin. The brief journey was okay with the Soviet authorities--so long as his father stayed put.

Horst was being watched, so he needed to evade detection as he hoped to join the family. With detailed instructions from the CIA, he took one train, and then another, before slipping onto a bus to lose his tail. The plan worked (just like in the movies) and he was then able to get on yet another train to his destination.

After being reunited in West Berlin the family was shuffled onto a plane to Frankfurt, where his father was extensively debriefed. After a few months, they were off to the ancient city of Ulm on the Danube in Bavaria for his father’s job with Telefunken. After three years there Horst was finally given the word that he would get to the U.S.

Are you ready for more?

So, in November 1955, when Detlef was 12, the family boarded an Army transport ship, the "General Harry Taylor,” in the northern port city of Bremerhaven. They were lucky and were given one of the three or four private cabins on the ship. The long passage across the Atlantic was rough as they sailed “on the tail end of a hurricane.” Everybody got seasick except for his father, who was on the deck a good bit of the time.  

Postcard of USS General Harry Taylor military transport ship 

On arrival in New York, it was a bright clear day, storms had passed. Dr. Gerlach found the sight of the city “overwhelming” and he was “blown away.”

And where did the family live for their first six months in America while Detlef’s father looked for work? Where? At 71st and Broadway, at the Alamac Hotel. On the 18th floor. The same floor, though on the other side of the U-shaped building, as the headquarters of Operation Paperclip. 

His father was offered the freedom to work anywhere. After trips to facilities in California and Upstate New York, he settled on going with the Harry Diamond Army Ordnance Lab in D.C. near the National Bureau of Standards. He worked on high-power microwave technology, having to do with communications and radar.

So in 1956 the family moved to Washington D.C. for a few months, and then to Bethesda. Detlef attended Bethesda-Chevy Chase High School (Time magazine’s “Best School in America” in 1960). From there he went to the University of Maryland at College Park. It was only 15-20 miles from home, so he commuted. Tuition (get this) was $165 dollars a semester.

Dr. Gerlach said his brother Ulrich majored in physics and got his Ph.D. in theoretical physics at Princeton under John Wheeler of black hole fame.

John Wheeler (on the right) laughing with Albert Einstein and Hideki Yukawa

But what would Detlef do with his life? He knew he did not want to be an engineer--his father was an engineer. He didn't want to be a physicist--his brother took that. And he didn’t want to go into medicine--his mother wanted him to do that. So, somehow, he decided to major in chemistry in college and, upon his parents’ urging, went on to do graduate work. And in 1965, after Maryland, he went to the University of Wisconsin.

It was here that he encountered, and was instantly smitten by, his wife Joanne, a graduate student in chemistry and computer science. They got engaged two months after their eyes met in 1966, and they were married the following year. When Detlef’s advisor left Madison for MIT Detlef followed him to Cambridge to finish his Ph.D. in (wait for this mouthful…) “the kinetics of stereochemically active transition-metal complexes.” 

Transition metals are in lavender (from Encyclopedia Brittanica)

So, with a doctorate in physical and inorganic chemistry, Detlef would be a chemist. He accepted a post-doctoral fellowship at the DuPont Central Research Department in Wilmington. He was told that he could do anything he wanted. 

But after a year being tucked away in the lab, away from people, he thought to himself, ”Maybe my mother was right. Maybe I should go into medicine.” (You see, it’s not just Jewish mothers who want their sons to be doctors...)

So he took two semesters of required Biology, and thinking he was “pretty hot stuff” he applied to Harvard medical school. Their response? They said they have never accepted anyone with a Ph.D. from MIT! Crestfallen, Detlef had to look elsewhere. 

After an awkward interview at Duke, where he confidently got up to leave the room and almost walked into a closet, he decided to go to Emory. The first year, 1971, was “tough” but he adjusted, and by his third year, the first full clinical year, Detlef found that he “liked it all.” And he saw that with OB/GYN he could do surgery, medicine, and endocrinology.

So he stayed in the South and did a four-year OB residency in Atlanta. They covered three hospitals; the Emory Clinic, Grady (the downtown hospital serving the poor), and Crawford Long Hospital. At Grady, he said, the women were often “pretty sick” and “you saw everything.” There were 10,000, yes 10,000, deliveries a year. 

John Thompson, M.D.

The “very skillful teacher” and “tough taskmaster” Dr. John D. Thompson ran the residency program. You had to know “everything” about your patient before presenting her to him. And there was an unusually strict dress and grooming code for the times: Everyone would wear a necktie and there would be no long hair or unruly beards (as was the “Hippie” fashion then).

A “just great” nurse-midwife taught Dr. Gerlach how to deliver babies, and how to treat the indigent patients who, she said, had no choice in who would take care of them. They needed to be treated with respect and compassion. Those two words, Detlef said, summarized the philosophy of the entire department; this was the principal message. 

Anyway, Joanne became pregnant during Detlef’s residency and delivered their first son, a preemie, at 34 weeks in 1975; he did well. Their second son was born in 1978, a year before they left Atlanta.

Next? Where to go into practice. Detlef’s parents were still in Bethesda and his wife’s lived in Allentown and they wanted to share their boys with the families equally. York, it turns out, is exactly 90 miles from both cities. Detlef looked at the York Hospital and saw that they had a strong residency program and since he enjoyed teaching the decision was easy. 

Dr. Gerlach first joined up with Drs. Bob Farkas (1918-2003) and Mort Kousen (1938-2015).  This wasn’t a good fit and he left and then teamed up with Drs. James Smith and Jay Jackson. This worked out well and the group added other physicians including Drs. Martha Thomas, Leslie Robinson, Mary Keperling, and Carlos Roberts. 

Dr. Gerlach admitted that he was “pretty tough” on the residents and that he expected them to be knowledgeable. He loved the operating room, especially when there was a “tough challenging case.”  And he was particularly fascinated by what has come to be known as “minimally invasive surgery” (MIS) using a laparoscope. 

A brief history of MIS thanks to Dr. Don Nakayama in an American College of Surgeons poster exhibit in 2017: 

Phillip Bozzini of Frankfurt invented the original endoscope in 1806, a leather-lined box that held a candle between the examiner’s eye and a speculum in the vagina to look for signs of venereal disease. German surgeon Georg Kelling was the first to examine the abdomen with an endoscope; he died at 79 in the Dresden bombing inferno of 1945. 

Gynecologists were the first to seize on the potential of laparoscopy. Dr. Raoul Palmer (1904-1985), a gynecologist at the Hôpital Broca in Paris, and his wife Elizabeth performed the procedure in German-occupied Paris in 1943. 

Dr. Kurt Semm, a German gynecologist, did the first laparoscopic operations beyond lysis of lung adhesions and biopsies. He was a member of Nazi youth groups and of the Nazi army, and he was in Russian hands for a while at the end of the war.

Dr. Semm left Europe, and at a conference in Washington, DC he met Dr. Melvin Cohen, a Chicago obstetrician interested in laparoscopy. Dr. Cohen directed Semm to his technician, a German Jew who had escaped to the U.S. during the war. The former Nazi soldier and the Jewish refugee “overcame their anathema to each other and agreed to work together.”  It wasn’t long before hundreds of laparoscopes were being used here, noted Dr. Nakayama.

Dr. Kurt Semm demonstrating his 
laparoscopic pelvic trainer

In the 1970s, Semm refined his techniques and the tools and he did the first laparoscopic appendectomy in 1980. The first removal of a diseased gallbladder with this technique was performed in 1985, in the small German town of Boblingen, again by a German physician.

And by the late 1980s, two surgeons near Cologne started to do laparoscopy for all of their cases of appendicitis; only 2% eventually needed an open procedure.

And as the use of laparoscopy spread, “the benefits were undeniable, with smaller, less painful incisions and faster recovery. (And) by the 1990s nearly all operations in every major surgical specialty could be done using laparoscopy and minimally invasive techniques.”

So Dr. Gerlach mastered the technique and he joined with Dr. Thompson for three fulfilling weeks in China giving lectures on and doing MIS procedures. They enjoyed sharing their expertise with the eager Chinese surgeons. 

But, according to  Weinberg, Rao, and Escobar (2011), “there are several limitations to traditional laparoscopy. The learning curve is very long, the hand movements are counterintuitive, and the long instruments working through a fixed entry point cause small movements and even tremors to be accentuated. These factors make fine motor control more difficult.”

So when robot-assisted procedures were introduced (the da Vinci device was FDA-approved in 2000) Detlef thought that this was “pretty neat.” With magnification, you could see the tissues in more detail, and in 3D. This allowed one to do complex dissections more safely and with less blood loss. There is less postoperative pain and a faster recovery. But the technique (though easier than laparoscopic surgery for the neophyte) required a new skill, and the loss of touch feedback was troublesome.  

A typical robot-assisted surgery setup (from Tech.co)

Dr. Gerlach “obsessed” about his first case for months as he practiced using the device and studied tapes. He said that “if you don’t know what you are doing (with robotics) you can really damage people.” By “people” he means women, and he told me, by the way, that “women are wonderful.”

Dr. Detlef Gerlach retired from practice in 2013.

(His brother, now retired as well, from Ohio State University, studied the advanced mathematics of general relativity and "quantum theory in curved spacetime." Detlef had studied women. I wonder whose job was harder.)

Dr. Gerlach and his wife

Dr. Gerlach has more time to spend with his wife and he said that he “reads a heck of a lot” now. He enjoys biographies, and he’s been studying philosophy and economics. He recommended John Barry’s timely book on the 1918 flu pandemic, The Last Man Who Knew Everything about the nuclear physicist Enrico Fermi, and a book on the child prodigy and genius mathematician John von Neumann (I didn’t catch the title). 

Von Neumann, in 1957, in his last published work, concluded then that computers and brains work by completely different models. The brain, he said, lacks the mathematical precision and predictability of the computer; it deals, instead, in statistical probabilities, whose outcome is unforeseeable, unknowable. And, you see, the brain is always changing, always adapting. 

For his economic reading, he is partial to the so-called “Austrian School” of libertarian carefully-reasoned free-market thought. In social philosophy, he prefers the scientific,  middle-way, and virtue politics of Aristotle to the idealistic and anticapitalist Plato. 

And Dr. Gerlach appreciates the views of philosopher and (non-practicing) physician John Locke (1632-1704). Locke's “concept that all men are by nature free and equal, and have the same rights to life, liberty and property provided the framework for our Declaration of Independence and Constitution,” he noted.  

I asked Dr. Gerlach if he thinks that the German people were aware of what was happening as hundreds of thousands, and then millions of Europe’s Jews and other “undesirables” were taken away on trains and murdered or worked to death in the name of the Third Reich. And that absolute genocide became Hitler’s single-minded obsession. Detlef said he thought they knew, but that they were fearful for their own lives, and were silent.

He referred me to a book of interviews of ten German men, all Nazis, written after the war, They Thought They Were Free, by Milton Mayer. In an afterword to the 2017 edition historian Richard Evans stated that though “we live in an age of fervid politics and hyperbolic rhetoric (the book) cuts through that, revealing instead the slow, quiet accretions of change, complicity, and abdication of moral authority that quietly mark the rise of evil.”

But Detlef was too young during the frightful war. He doesn’t remember living amongst evil or living in fear. He remembers the candle. He remembers the light.

The beautiful rebuilt and reborn city of Dresden, Germany

References and Reading:

1.  Hazlitt, Henry. Economics in One Lesson: The Shortest and Surest Way to Understand Basic Economics. New York: Currency/Penguin Press. New York, 1979 

2.  Jacobsen, Annie. Operation Paperclip: The Secret Intelligence Program that Brought Nazi Scientists to America. New York: Back Bay Books, 201

3.  Mayer, Milton. They Thought They Were Free: The Germans 1933-1945. Chicago: University of Chicago Press, 2017

4.   Nakayama, Don K."The minimally invasive surgeries that transformed surgery." American College of Surgeons Bulletin of the Surgical History Group, 2017. 

5.  Weinberg, L., Rao, S., and Escobar, P. F. "Robotic surgery in gynecology: An updated systematic review." Obstetrics and Gynecology International, 2011  (Article ID 852061)


Anita Cherry 6/26/20

Dr. Jay Nicholson: The Way to a Man's Heart is Through the Groin

Walter J. Nicholson, M.D.

The year? 1961. The place? An intimate high school math class. The instructions? “I don’t care if you ever get the answer [to a problem] right in this course, but I do care if you set it up right. If you set it up right, you are going to get an A. Because when you grow up there is going to be somebody with a computer in their hand that can put the numbers in and get the right answers,” said Mr. Modess. 

The teacher was preparing his six eager pupils in the “extremely advanced” science and math sessions at Georgetown Prep “to think,” said interventional cardiologist Dr. Walter Joseph Nicholson, one of those lucky students.

Jay, as he is known in the York community, made the decision to go into medicine when he was attending that rigorous all-male Jesuit Catholic school. He told me that he wanted to help people. No, that he had to help people. And that he didn’t want to get bored. And that he wanted to be (and that he is) a diagnostician.

The family left Jersey City for Middletown, Pennsylvania when he was in grade school and they later moved to Pittsburgh, and then Dover, Delaware. After high school, Jay went to Georgetown University for a year and then transferred to (then all-male) Franklin and Marshall College in Lancaster for tough pre-med studies. He met his wife Carol (a native of York) while at F&M. She was studying at nearby Millersville, long recognized as a fine training ground for teachers. 

Georgetown Prep in Bethesda, Maryland
(from Archdiocsis of Washington)

Jay then attended the University of Pittsburgh School of Medicine. While there, he encountered the legendary “Black Jack” Myers (1914-1998), the “pretty rough” (Dr. House-like?) chief of the department of medicine. Jay planned on being an ophthalmologist and he did an internship at George Washington in D.C. under the tutelage of prominent hematologist Dr. Wally Jensen (1921-2003) with that specific intent. 

When Jay went to Dr. Jensen one day and informed him that he had changed his mind, that he wanted to switch to cardiology and to go to Emory, the insightful Dr. Jensen “was not surprised.” The professor had good contacts, and he graciously facilitated the future cardiologist’s transition to Dr. J. Willis Hurst’s program. 

But before he went to Atlanta Jay served two years (1969-1971) in the United States Public Health Service in Tampa where he practiced general medicine as he took care of those in the Coast Guard and Merchant Marines as well as retired military. He left the Service with the rank (his wife, who was listening quietly as she was sitting across the room during our late February afternoon interview, had to remind him) of Lieutenant Commander. He and Carol still enjoy visiting the Tampa-Clearwater Beach area for a few days when it’s frigid up north.

J. Willis Hurst, M.D.

The eminent Dr. Hurst (1920-2011) had trained under “the father of American cardiology," Dr. Paul Dudley White (1886-1973). Dr. Hurst, according to his Emory obituary, "believed deeply in the power of good teaching." And he became Dr. Nicholson’s “biggest mentor.” He was “never snobby” and “always a gentleman,” and Dr. Nicholson said that he holds Dr. Hurst “in high esteem.” 

Jay did a formative year-long fellowship with master diagnostician Dr. R. Bruce Logue (1911-2007). Jay found him to be “the most intense man on the planet” and “a terror.” He was “totally intolerant of indecision.” (Those who work with our protagonist in the cath lab may, perhaps, spot faint glimmers of those endearing traits during an especially busy day, or when there is a tricky case.) 

Dr. Logue, with his steely gaze, could “seize on the one important piece of information” that would instantly clarify a clinical situation and clinch the diagnosis. Jay worked hard, side-by-side, and hour after hour, with him to acquire that valued skill.

R. Bruce Logue, M.D.

(Jay has a signed copy of the edition of the widely-read textbook The Heart, edited by Drs. Hurst and Logue, that was put together when Jay was a fellow. It was purposely left in their car when Jay and his wife came to the house to talk. My husband’s “signed” copy of that same edition, an engagement gift in 1977, was in our stuffed bookshelf to Jay’s right. It was easily spotted. It’s a really fat book, and I know my husband didn’t read the whole thing, but parts were carefully underlined.)  
  
Anyway, Jay’s second fellowship year was spent with innovator Dr. Spencer B. King III in the cardiac catheterization lab. It was there that Jay experienced the beginnings of what would become his passion in medicine. At the time (the early- to mid-1970s), a diagnostic cath was the only “procedure” available to the non-surgical heart specialist. 

Reflecting on these experiences, Jay noted that, as a doctor-in-training, the most important lesson he learned was to make himself available to the mentor. To be there. He said that he cannot stress that enough to young people. He realizes, however, that advanced training in medicine has changed, and that a close and extended mentor-mentee relationship is not common anymore.

After Atlanta, and with a single catheter in hand (“99% use three,” he said), Dr. Nicholson joined the congenial and welcoming York Hospital staff in 1976.  He teamed up with cardiologists Dr. Jack Gracey and Dr. Ed Martin. The “three musketeers” relied on the patient’s history, the physical exam, the EKG,  the chest X-ray, and the simplest of echocardiograms to make a diagnosis; “everything was clinical” then, Jay told me (with obvious nostalgia for those disappearing skills). 

Laennec's Baton ~1816 (he later coined the term "stethoscope")
(1960s poster by Robert Thom)

But things change, (“Thank God,” said Jay), and purely clinical methods gave way to advances in imaging, and precise imaging led to more procedures, the current focus within the field.

Anyway, when starting out in York, Jay’s goals (apart from expert patient care, of course) were to teach and to develop a strong and enduring cardiac program. He felt an “obligation” to share his knowledge. And he wanted to build something. So he went to work. 

At that time, the late 1970s, the cardiologist’s treatment for heart attacks in the coronary care unit (the CCU) was limited to controlling dangerous rhythm disturbances, especially chaotic ventricular fibrillation (that often resulted in sudden death), and alleviating acute congestive heart failure (due to the weakened heart muscle). 

Specific medical therapy to restore blood flow to the area of the heart that was deprived of oxygen and dying was simply not available; the heart surgeon was needed for that. After a heart attack, if you survived, you carefully rested for weeks while waiting for the damaged muscle to slowly heal.          

But the next year, 1977, things changed. 
  
The charismatic and darkly handsome Dr. Andreas Gruentzig, from Dresden through Zurich, had been inspired by the work of radiologist Charles Dotter (1920-1985). Dr. Dotter showed that clogged arteries in the leg could be gradually opened using a series of rigid catheters.

But there were complications of the procedure as the plaque was scraped off of the wall of the artery and plugged up smaller vessels downstream. Andreas had a better idea. He thought he could open an artery, even a narrowed coronary artery, more safely if with a less traumatic technique.

Dashing Andreas Gruentzig, M.D. with his balloon catheter

He toiled at his kitchen table for a year as he tried to fit the tip of a catheter with a strong smooth inflatable balloon. With this, he could carefully squish the fatty inflammatory plaque obstructing blood flow in the coronary up against the wall of the artery. This would let more blood through to nourish the starved heart muscle. 

He came up with a working prototype and then spent the next two years looking for someone to manufacture the unlikely contraption that everyone knew would never work. 

Dr. Gruentzig finally succeeded, and on 9/16/77 he cautiously (with the surgeon standing by, waiting for something to happen) used his device to open up a short segment of Adolph Bachman’s critically narrowed left anterior descending artery. This instantly relieved the awake patient’s chest pain, and the surgeon could quietly put his scalpel away. Cardiology (and medicine) was changed forever.

(As noted in an article on Gruentzig in Wikipedia: “By utilizing the arterial circulation as a 'therapeutic highway' many types of devices and drugs can now be delivered directly to the heart, kidneys, carotid arteries, brain, legs, and aorta without the need for major surgery and general anesthesia.”)

Dr. Andreas Gruentzig was given a standing ovation when he presented his revolutionary data at the big American Heart Association meeting later that year.

Dr. King (against Dr. Hurst’s advice, at first) managed to convince the sought-after Dr. Gruentzig to join his staff in Atlanta in 1980. While there, Andreas enthusiastically shared his knowledge with the world. Dr. Nicholson, ever hungry for learning, “took all of his courses.” 

“These mentors, and a bit of hard work, have made me who I am,” said Jay. (You see, his mentors had something he wanted.)

(He felt that Dr. Gruentzig, the most famous cardiologist of our time, would have received the Nobel Prize for his work had he not died in 1985 at 46 when his single-engine Beechcraft Baron crashed in a violent storm as he was piloting it back to Atlanta to take care of scheduled patients.)

It may seem to you that cardiology, the cath lab (that was named after him four years ago, to his slight embarrassment), and commitment to the York Hospital (who last year honored his 50 years of steady dedication and support) might be Jay’s whole life, but there’s much more.

Dr. Nicholson (you can spot him in the white shirt and tie) and his loyal cath lab team

After he and Carol initially got together they stayed together. And he let her know right away what he wanted to do, and that he wanted her with him. “And that’s what we did!” said Jay. So, for a short while, it was just Jay and Carol, and their shared dreams. 

“But then all these kids showed up,” marveled the proud, and (mockingly) surprised father. Tommy, now 50, arrived first; Billy and Cindy soon followed. All three played basketball in school. Jay coached both boys and rearranged his schedule so he could go to “a thousand” of their games. 

Tommy was a talented “sixth man” scorer at F&M while Billy (also a student at his father’s alma mater) settled on the more gentlemanly sport of golf.  Both boys went into medicine (a bit more on this later). Cindy (owner of, get this, eight varsity letters) was terrifyingly intense on the basketball court. She decided to take that energy to the court of law where she defends physicians against claims of malpractice.      

When the kids were involved in their high school sports Carol was the busy “taxicab driver.” A pizza for dinner from Domino's was the routine. And Jay remarked that if they missed ordering a pie two days in a row someone from the shop would call to see if there was anything wrong. (Hey, could it be that they just wanted to try Papa John’s?) 

“I tried to be the best dad in the world, and it was a thrill to have the kids,” said the sometimes-modest Dr. Nicholson. He told me, in fact, that he had the “best time” of his life with them.

Jay’s own father, one of eight children, grew up in Brooklyn during the Great Depression and didn’t finish high school. He worked for the government, and Jay said that he was “the smartest guy” he ever met. He “always wore a white shirt and tie.”  He was a “gentleman and a gentle person.” Jay’s mother graduated from college at 41 or 42. Sadly, she died in her later 40s as a result of trauma.

Men in a bread line in Brooklyn during the Depression
(from Hulton Archive)

 But let’s get back to the remarkable advances in cardiology during Jay’s five decades in medicine, changes for which he’s most grateful.

In 1980 it was definitively shown, contrary to the conventional (and wrong) thinking at the time, that heart attacks occurred as a result of an acute clot, or thrombosis, in a coronary artery, not progressive gradual narrowing to a critical point (with the clot occurring later).  

In 1986 an important study showed that adding a medicine (streptokinase) to break up the fresh thrombus resulted in a slightly lower death rate at three weeks (10.7%) compared to usual treatment alone (13%). But there were bleeding complications, sometimes severe.

Process of acute coronary thrombosis (from bioninja)

Was there something better? While the first balloon angioplasty performed during an acute MI was done in 1979 there was an annoying tendency for the vessels to close off later. So, the idea of stenting. The first metal stent, or scaffold, to hold the artery open after angioplasty was cautiously placed in 1991.  Stents have gone through several improvements since then, including a coating to prevent dangerous clotting later. The newest stent gradually disappears as it is slowly reabsorbed by the body. 

The balloons and stents have relieved countless patients of debilitating anginal chest pain and preserved the heart muscle of millions of individuals who were in the throes of an acute MI. The sooner angioplasty is done during a heart attack, the more vital tissue is preserved, so speed matters (and Jay, as I’ve heard, is fast, really fast). This technology has allowed patients to avoid the physical trauma, the slow post-op recovery, and the inherent risks of general anesthesia and coronary bypass surgery.

Most with an acute MI now have angioplasty within 90 minutes
(from PLOS ONE)

The busy physician must keep current with the advances in his (or her) field, and Dr. Nicholson made certain to do that. Not satisfied by simply passing the Internal Medicine and Cardiology boards, and not one to shy away from a difficult test, he took the eight-hour board exam in Critical Care Medicine in 1987, the first year it was offered. He passed, of course, and he was the only physician so-certified in York for several years. Jay then added certification in Interventional Cardiology in 1999 (again, the initial year it was available).  

Listening to him, I asked Dr. Nicholson (who said he’s done more than 60,000 procedures) if there were any of his former patients that he still thinks about. Yes, he said, as he looked towards his wife. He cleared his throat (he had used a lozenge-what a funny word, “lozenge”) and recalled that there were “about five patients” who stayed with him. 

Were these miraculous and dramatic “saves” in the cath lab, like on TV? Were these people brought back from the brink of death? No. They were not. 

These unforgettable patients were individuals who demonstrated remarkable bravery as, over the years, they underwent repeated major heart surgeries while their complex disease, disease that could not be fixed with a catheter tip or the latest medication, worsened. Jay felt their suffering, and he admired their courage and their faith.     

Speaking of faith, as a practicing Catholic, Dr. Nicholson said that he attends church regularly. He gives thanks for what he’s been given, and what he has been able to give to others. 

Let's get back to the heart. Unfortunately, many patients with advanced disease, it turns out, have no (or only vague non-specific) symptoms before they suffer an acute heart attack or sudden death. Stress tests and CT scans looking for calcium build-up in the coronary vessels (a good study, if negative) are useful, but they are imprecise. “If you want the 100%  test you need a heart catheterization,” said Jay emphatically. And he feels that “patients want to know,” that they want the study that will give them a clear answer.

Calcium CT scan showing calcified vessels
(from Radiology Associates of Clearwater)

And we are getting much better at knowing about the heart and treating its ailments. There has been a spectacular drop in the U.S. death rate due to heart disease from 1950 to 2017 (from 588 deaths per 100,000 to only 165). Much of this decrease was due to the understanding and control of the major risk factors such as cigarette smoking, diabetes, hypertension, and, especially, high serum cholesterol.

The effective treatment of elevated cholesterol, or hyperlipidemia, with so-called statins, discovered in 1976 by dogged Japanese chemist Akira Endo, and weakly approved by the FDA in 1987, revolutionized the medical treatment of coronary atherosclerosis. (Statins also stabilize plaques and reduce inflammation of the vessel wall.)

Thus, Jay’s typically no-nonsense straightforward advice to his patients: “Stop smoking and take a statin!”  

And about half of the decline in the death rate over the years has been due to better management in the CCU and efforts in the cath lab. In the 1960s nearly 50% of those admitted to the hospital with heart attacks died in a few days; the fatality rate now is only 4-6%. However, the decline has been leveling off over the past decade, and heart disease is still the leading cause of death in the United States.

So Dr. Nicholson, wearing a crisp white shirt and a tie, and with our dog, Toby, quietly nestled by his side, told me that to accomplish his goal of providing an enduring source for the best cardiac care possible for the people of York he managed to recruit many talented physicians who could have easily chosen to go elsewhere. He feels that the heart program here is strong. He first envisioned a free-standing cardiac center about ten years ago. It took a while, but construction for this began recently.

Artist's rendering of the new WellSpan Heart and Vascular Center
(from Wohlsen Construction)

Over the years, Jay has been given multiple teaching awards as a testament to his need to share his knowledge and experience, and his skill in doing that. He’s quite proud of this recognition.      

And what about his doctor-sons I mentioned before? The elder, Tommy, is a colorectal surgeon in a busy practice across town with two partners. His younger son, Billy, followed his father’s example more closely and went to Atlanta and became an interventional cardiologist himself. 

Father and son team

Jay and Billy have worked together for “15 thrilling years” as the protege grew and eventually handled the more complicated cases. Billy now does a full array of intricate procedures including (this sounds amazing to me) replacing a defective aortic heart valve by use of a catheter alone. 

Dr. Nicholson has often told his wife that if he “dropped dead” today, they could say of him that “that guy found what he wanted to do, and he had the best time in the world doing it.” That “he got everything he anticipated, and a lot more.”  

“It has been perfect.” Jay was pleased to tell me.

But things change. Billy is set to move on. He wanted to be more active in teaching at all levels, and he’s been asked to head up the renowned interventional program at Emory. Jay said he hates to lose him, but he understands why his son needs to take advantage of this wonderful opportunity. 

So, from Dr. Paul Dudley White to Dr. J. Willis Hurst and  Dr. R. Bruce Logue, to Dr. Spencer B. King III, to Dr. Andreas Gruentzig, to Dr. Walter J. Nicholson, to Dr. William (Billy) Nicholson, to...

When a generous teacher meets an engaged student good things happen.

(Note: Despite the fantastic advances in heart care over the past 50 years there is much more to be done. Roughly 640,000 Americans still die of heart disease each year. And heart disease has been the number one cause of death in the U.S. every year since 1910--Except for the years 1918-1920, when the most common cause of death, by far, was influenza and pneumonia during the devastating Spanish flu pandemic.)

Recommended readings:

1.  Forrester, James S., M.D. The Heart Healers: The Misfits, Mavericks, and Rebels Who Created the Greatest Medical Breakthrough of Our Lives. New York: St. Martin's Press; 2015. (Enjoyable, and very well written.)

2.  Jauhar, Sandeep. Heart: A History. New York: Farrar, Straus and Giroux; 2018.

3.  Hurst, J. Willis, Logue, R. Bruce, Schlant, Robert C., and Wenger, Nanette Kass, eds. Third edition. The Heart; Arteries and Veins. New York: McGraw-Hill, 1974. (Later editions are okay, too.)

4.  Warraich, Haider. State of the Heart: Exploring the History, Science, and Future of Cardiac Disease. New York: Martin's Press; 2019.

Orchid opening (photo by SC) 

 Anita Cherry 4/30/20