Dr. James Srour: Gastroenterologist with a Mission and an Irish Drum

James Srour, M.D.

When he was five, his father gave him a small black doctor’s bag. So, when anybody kindly asked him what he wanted to be when he grew up he had an easy answer: he would just say, without thinking, “I’m going to be a doctor!” And he kept saying that, giving that automatic and expected response, until he was about twenty-five. Dr. James Srour, a gastroenterologist, said that he is still trying to figure that one out. 

He took his first two years of medical school at the University of the Philippines in Manila in 1972 and 1973. And as he carried his travel bags off the plane his eyes were opened; he saw a different world.  He saw people standing behind and pressed against the fence surrounding the aging airport; he didn’t know why they were there. He saw uniformed guards with submachine guns slung across their shoulders; he guessed why they were there. 

And what he eventually saw in this typical third-world country was “chaos wherever you go.” Particularly after the brutal, corrupt, and extravagant kleptocrat Ferdinand Marcos declared martial law on September 22, 1972. (This lasted until the People Power Revolution in February 1986 that rose up against regime violence and electoral fraud).

Despite this, Jim told me that his close experience with a different culture was “a great thing” and that he “loved it.” So it was here, in The Republic of the Philippines in Southeast Asia, that Dr. Srour felt the stirrings of his interest in medical missions for the poor.

A wide view of Manila (from Pavel Sinitcyn)

He did not plan to journey thousands of miles from home for medical school. Nor was it planned that he would witness the burden of ill health and extreme poverty on people and that this would affect him so deeply. But we are jumping ahead in our story and will return to that part later.

Jim’s father, Farid (1918-2018), was born in Syria, in Tartus, a large city on the Meditteranean coast, a vacation spot, and a still-valued Russian naval base. He came to the U.S. at 26. After he arrived in New York he did odd jobs for a while. He moved to D.C. and went to Washington Missionary College, where he met and married his English language and literature professor, a London-trained Brit with roots in Northern Ireland. He wanted to be a doctor but biology got in the way as Jim was conceived and born.  And since Jim’s father now had to support a family (with three more children to come) and could not go to medical school that meant that Jim would be next to be given that task. Hence, the small black bag. 

Tartus, Syria (a postcard from ProZ.com)

Dr. Srour said that he started his college career at George Washington University, but after a few years he “needed to get away from home.”  He moved down to the University of Alabama to finish up. He eventually realized that he would not be able to “make a living” as a marine biologist, as he had naively hoped. Since his fate was predetermined he took a few additional required courses and applied to medical school, “a bit late.” 

After the two basic science years in Manila, he came home and went to the University of Maryland for the two clinical years. He did ER and Internal Medicine rotations at the York Hospital and was impressed. He decided to do his internal medicine residency there, against the unyielding advice of his best friend who thought community hospitals were not rigorous enough (he was wrong). As a resident at York from 1976 to 1979, Jim enjoyed working with GI specialists Drs. Iain MacKenzie and Bill Thorsen and decided to go into that specialty.

But he had two months between finishing the residency and starting his two-year fellowship at Johns Hopkins. What would he do?  Simple, he would go to New Zealand! 

Why New Zealand, you ask? An island country nine thousand miles away from home? This is a bit complicated.   

His future wife, Cushla, a native New Zealander, had befriended one of Jim’s cousins (his maternal uncle’s son) when she was in college. There is a tradition among Kiwis called the Overseas Experience (OE): when you are in your 20s you pack a small bag with the essentials, leave home, and go somewhere else in the world to work and to expand your view of life. You usually stay abroad for a year or more. Since Jim’s cousin had come here for his OE he thought that Cushla would also have a good experience in the U.S. So she came to the States and she stayed with Dr. Srour’s parents for a while. Are you with me?  

Sheep grazing on South Island (from crbette-Getty images)

Jim met Cushla briefly while she was here, and when he had his two months to explore he chose remarkably beautiful and isolated New Zealand as the destination. He casually wrote to her for advice about where to go, what to see. He said that she sent back a “12-page compendium.” So he went to the other side of the world. The unhurried people in the “quiet and peaceful” former British colony took good care of him. The rest (with Cushla, that is) is history. 

Dr. Marvin Schuster

Dr. Srour did his GI fellowship with, as he told me, the “phenomenal” Dr. Marvin Schuster (1929-2017) at Baltimore City Hospital (now Bayview). Dr. Schuster was “really sharp” and an “uncanny diagnostician” who recognized the importance of appreciating the psychological aspects of gastrointestinal disease and incorporating them in the treatment. He was a world-renowned pioneer in the field of GI motility, of seeing how things move (or don’t move) through the gut. 

(The long tube of the digestive tract, you see, has an extensive nervous system, the so-called enteric nervous system, to coordinate its muscular activity as nutrients are absorbed and waste is discarded. It has, one might truly say, a mind or intelligence of its own.)

After Baltimore, Jim returned to York. He worked with Dr. Thorsen for a while and then started his own practice. He was very happy when Dr. Duane Ahlbrandt joined him. The respected practice grew as other physicians came on board. The field of gastroenterology, like all of medicine, has changed dramatically since Jim’s training years. 

One of the most striking, he noted, was a better understanding of peptic ulcer disease. Stomach and duodenal ulcers, long thought to be triggered by stress and diet, are, in the end, caused by the damaging effect of acid. Until 1976 yucky-tasting liquid antacids were given around the clock to neutralize this. They were partially effective, and many patients needed major surgery to treat the complications of ulcer disease, especially life-threatening bleeding.  

When cimetidine, the first so-called H(istamine)-2 blocker, was released in 1977 acid production could be suppressed and surgery could usually be avoided. The more potent acid preventers, the proton pump inhibitors (PPIs), became available in 1988. These cut the acid by 99%, and general surgeons had to find other things to take care of. (Dr. Srour was careful to say that prolonged use of PPIs may have negative consequences for health, even though they are sold over the counter now.)

But after the bacterium Helicobacter pylori was identified In 1982 ideas about ulcers changed as it was found to be associated with nearly all ulcers. The twisty bug burrows into the lining of the stomach to hide from the immune system, and it stays there unless treated. It can cause local inflammation, gastritis. This allows the acid to injure the thin protective stomach lining, leading to an ulcer. So...ulcers are caused by infection!

H. pylori is found worldwide and is especially prevalent in poorer populations. Most carriers have no symptoms but have a 10%-20% lifetime risk of developing an ulcer. Getting rid of the infection usually gets rid of the ulcer.  H. pylori is also associated with stomach cancers. 

This specific bug is only a very small part of our gut microbiome, the enormous collection of microorganisms (trillions of them!) making themselves at home in our GI tracts. They play critical roles in digestion and directly influence the immune and endocrine systems. And they produce neurotransmitters we usually associate with the brain including (our good friends) serotonin and dopamine. 

The vagus nerve (in yellow) sends signals
from the gut to the brainstem (from Nicole Miller)

(Messages from the GI tract are relayed to the brain through the vagus nerve to affect emotions and behavior. We are beginning to understand this important two-way brain-gut interaction. The bacteria, viruses, and other microorganisms that are adapted to our GI tracts are partly responsible for that communication. And gut bacteria may influence the development and course of brain disorders such as Parkinson's by way of the immune system and inflammation. But I digress. Back to ulcers... )   

Aspirin and other nonsteroidal drugs like ibuprofen or naproxen cause most of the approximately 10% of ulcers that occur without the presence of H. pylori. Additional factors in ulcer disease include alcohol, smoking, high physical stress, a sedentary lifestyle, and lower socioeconomic status. Diet, said Dr. Srour, contrary to medical folklore, does not play a role.         

Dr. Srour told me that the identification of the hepatitis C virus in 1989 was also important in his practice. Chronic Hep-C infection, a worldwide problem, may result in cirrhosis or liver cancer. Before 2014 this was treated with injections of interferon for 6-12 months. But the cure rate was less than 50% and there were severe side effects of the treatment. Direct-acting antiviral drugs, introduced in 2014, result in a cure in more than 90% and are well tolerated (but are very costly). Anyone between 18 and 79 should be screened for the virus since asymptomatic infections are common. 

Prevalence of Hepatitis C 2015 (from CDC Yellowbook)

Another area that changed dramatically, as in most of the field of medicine since the 1970s, is that of imaging. For gastroenterology that mostly meant endoscopy.  The flexible fiberoptic scope, invented by South African Dr. Basil Hirschowitz in 1957, replaced the rigid (ouch!) scopes by the 1960s. It was said by Wilcox that this was "the singular transformative event of the last century for gastroenterology." Dr. Srour would, I think, agree.

The diagnostic capabilities were soon complemented by therapeutic applications, including removal of colon polyps with a wire loop snare. The CCD (or TV) camera endoscope was developed in 1983, and you could see and record the goings-on along the lining of the GI tract in living technicolor.  

And, Dr. Srour said, the routine search for and removal of colon polyps by colonoscopy prevents their transformation into colon cancer. Since almost all cancers arise from polyps this is the only clinical situation, he noted, where cancer is actually prevented, not simply picked up at an earlier stage. Countless lives have been saved.

Slow progression of colon cancer (from Biovendor)

There have also been tremendous advancements in treating inflammatory bowel disease, where worrying about patients sometimes kept Dr. Srour up at night. And we know more about the common problems of irritable bowel syndrome and heartburn.

The day-to-day practice itself changed, too (as we have seen in previous stories in this series). 

One notable change, he said, was the nature of communication between doctors. Early on, after Dr. Srour saw a patient he often made a phone call to the referring physician to discuss his findings. He then sent a letter. Over time, the style of communicating changed. It became cooly digitized, without the warm nuance of the human voice. Without a carefully-crafted narrative.

Dr. Srour told me that, years ago, the referring doctors, usually primary care family physicians, were “quarterbacks.” They knew their patients extremely well, he said, and “took great care of them.” And they were often able to tell him precisely why they needed his expertise. The “relationship was really powerful.”  

And the general internists in the hospital such as Dr. Leo Samuelson, Dr. Jack Kline, Dr. Ronald Reinhard, and Dr. Ben Hoover “did first-class medicine” and “didn’t miss anything. They were genuinely great doctors," said Dr. Srour. They shared information with him and with each other smoothly.  He noted, wistfully, that the hospitalists don't seem to be as tightly-knit. 

The electronic health record (EHR) was supposed to (among other things) allow the medical team to coordinate care. Jim feels that it hasn’t accomplished that fully yet. He said that it may even perpetuate errors. Mistakes for example, in a patient’s list of medicines or their diagnoses.

Communicating is even more treacherous when there is a language barrier, and this brings us back to Dr. Srour’s wide travels for medical mission work.  

When he’s in a non-English-speaking country he talks with patients through an interpreter. But the helpful amateur usually has no medical training and doesn’t fully comprehend what he’s saying. The two sides struggle to understand each other. And yet, he found that the people always appreciate receiving care, however minimal. After waiting in line for hours or even all day, they were happy, he said, “just to be seen.” 

Reflecting, Dr. Srour believes that every college student should spend a month in a developing country. It would change their lives, he said; they would not be the same when they returned home.

I asked him what kinds of things he saw on his mission trips, often arranged, he told me, through the Living Word Community Church in Red Lion.

In Mumbai, for example, he came across so-called “pavement dwellers.” These souls are the poorest of the poor. He said that “when you walk down the street you find yourself literally walking on their homes. Homes marked out by the expansion joints in the sidewalk.” He thought to himself, “I can’t do this; these are human beings.” But after a while, you do it “because everyone else does.” Yes, you do it because everyone else does.

Indian pavement dwellers (from Vishesh Gupta) 

In a Romanian Gypsy camp, he said, “the best you could do was to give them Tylenol and vitamins. You could do something for pain relief, and for that they were extremely grateful. It was very humbling.”

He was struck by the remarkable “sameness “ he experienced in each of the third-world countries he visited.  He saw utter mayhem. There were, he said, no written rules of the road. The winner was the one with the loudest horn or the heaviest foot. You had to be very aggressive just to survive.

He said that we don’t understand how fortunate we are to be born here unless you have been to an area where millions of the poor lack nourishing food, clean drinking water, safe reliable shelter, and affordable health care. But where the super-rich and the desperate-poor often live side-by-side.

But there are also uninsured individuals here too, and Dr. Srour has volunteered his services at the Katallasso free faith-based healthcare clinic in York City. He told me, with some irony, that they use the same computerized EPIC health record as the hospital, but that the well-known hassles of the cumbersome system are avoided since “they don’t bill anyone and don’t need to worry about diagnostic codes.” He said it was a “joy” working there.  

After a rewarding career, Dr. Srour retired five years ago. He is enjoying himself. For many years he, his wife, and two of their three sons, both accomplished fiddle players, have immersed themselves in traditional Irish music.

The musical Srour family

Over the past 20 years, they have performed together throughout the local area and beyond. Jonathon is a foot-and-ankle surgeon doing a fellowship in San Francisco. Josh is in the Army in El Paso doing hospital administrative work. Jim’s third son, Jeremy, has Down syndrome and is the family’s “super glue." Dr. Srour plays the bodhrán, the hand-held tambourine-like Irish drum, and the wooden flute.

His small black bag, so to speak, has been carefully placed on the shelf, waiting for the next mission.

Reference and Recommended readings:

1. Jacek Budzyński, Maria Kłopocka. "Brain-gut axis in the pathogenesis of Helicobacter pylori infection." World J Gastroenterol 2014 May 14; 20(18). 

2. Marmot, Michael. The Health Gap: The Challenge of an Unequal World. London: Bloomsbury, 2015. 

3. Narayan, Deepa et.al.Voices of the Poor: Crying Out for Change. Oxford: Oxford University Press, 2000.

4. Nhat Hahn, Thich. The Art of Communicating. New York: Harper Collins, 2013. 

5. Perlmutter, David. Brain Maker: The Power of Gut Microbes to Heal and Protect Your Brain-for Life. New York: Little Brown Spark, 2015. (Maybe a bit overstated, but interesting reading.)

6. Wilcox, C. Mel."Fiberoptic Endoscopy: The Singular Transformative Event of Our Time." Digestive Diseases and Sciences, 59, 2619-262.

Mid-October early morning on the York Heritage Rail Trail 
(looking north from the Howard tunnel)

By Anita Cherry 10/23/2020

pages2619–2622(2014)

Dr. David Neuburger: The Turning Point in My Life

David L. Neuburger, M.D.

It is the black-and-white 1950s, and the curious young boy from the Upper West Side is taken by what he sees on the small gently-curved TV screen. He is watching “Lassie.”  Watching with interest. He likes the idea that the orphan Timmy lives on a farm. But he finds himself in a tightly cramped city. He wants a dog. But his mother won’t allow it. He wishes his dad had an old pick-up truck. But it’s New York and there’s no need for one. So as he watches the Sunday evening show he feels that he’s “missing out on that sort of stuff.” He dreams. 

Dr. David L. Neuburger has a few distinct memories of the New York City neighborhood of his early childhood. He remembers the green newspaper stands with stacks of the day’s papers bundled up. He recalls the ubiquitous corner phone booths (where Clark Kent sometimes morphed into Superman). He remembers that after his school was destroyed in a deliberately-set fire he was bussed to Harlem for first grade.  He remembers carrying a dime in his pocket in case he got lost and had to rely on one of these phone booths to call home. He remembers his phone number: “Wadsworth 7, 4437.”          

The interview: It is during the early months of the Covid-19 pandemic and it is a warm June day. We are sitting in the wide backyard of Dave’s log home on ten wooded acres bordering a branch of the meandering Codorus Creek in Southern York County. We are, of course, carefully sitting at least fifteen feet apart. We had talked about doing this by Zoom or such, but Dave thought this setting would be safe enough, and much nicer. The freshly-mowed grass, the tall mature trees, and the lovely songbirds were a welcome delight. 

So a relaxed Dr. Neuburger sat on a bench, stretched his legs out, and told his story. 

He was born in 1953 in Manhattan and spent his early years in the immigrant-rich culturally-diverse but sometimes scary Upper West Side (recall the ground-breaking 1957 show “West Side Story”). His parents were refugees who fled the anti-Semitism and violence of Nazi Germany as children. They didn’t talk about this when Dave was young, and he didn’t experience anti-Semitism himself as a child. Their harrowing stories, including the untimely death of his paternal grandfather, a well-respected member of the small Battenberg community, after he was taken into “protective custody” by the local police would not be allowed to intrude into Dave’s childhood, and he only learned the details much later.

West Side Story: The rival Sharks and the Jets from the 1961 movie (IMBD) 

 Dave was born in 1953 and when he was almost seven, with the help of GI benefits from his father’s military service during the war, the family moved out of tightly-packed NYC to the village of Nyack in more-spacious Rockland County, about 20 miles north of the city. Dave and his two close friends in high school would often “go canoeing in the “swamp” (that was later made into a reservoir) near his house, where they “caught snakes and that sort of stuff,” he said. He kept his two younger brothers “in line” as they all followed the “rules and regulations” of their “kind but strict” Germanic parents.

As we talked, I found out that Dr. Neuburger’s path to becoming a physician was not exactly a straight line. 

I will try to trace it. He was a Boy Scout, but dropped out “when that got old.” Well, his two buddies planned to go into medicine and that influenced him. So in his senior year of high school, he joined a medical Explorer Post based at a local hospital. While, yes, medicine might be “a better fit“ as a career he, instead, had envisioned life as a field research biologist, “leaning towards large animal biology.” 

But federal funding for such research was being cut off. So he talked with someone from International Paper about “managing a forest for wildlife.”  They were only interested in “cutting down trees.” 

Anyway, even though field job prospects were slim Dave still wanted to attend Cornell to study forestry.  He applied there, and to MIT, on a whim, as his so-called “reach” school. When the principal called him down to his office one day (“What did I do wrong?” Dave instantly thought) and informed Dave that he was accepted at MIT there was no real question; he would go to Boston, “a cool city.”

The MIT Dome at dusk (from Frontiers)

But this was not such a good choice for a biology major who was interested in large animals and field research; in Cambridge, they were more focused on microbiology and genetics. So he improvised and did an “alternate biology” program where he could study civil engineering and field research and even some literature. Dr. Neuburger said that the intense school by the Charles River “was like drinking out of a fire hydrant.” 

During the summer of his sophomore year, as he thought about what to do, he volunteered at Peter Bent Brigham as a transporter. He then took a gross anatomy course (with cadaver) in conjunction with Harvard. He was “fascinated by the whole thing” and he was “struck by the engineering aspects about how the human body works.” 

So medicine, it turns out, had a certain allure. Dr. Neuburger describes himself as “a people person” and he likes an intellectual challenge. And he had specific ideas about how he wanted to live (“in the country,” he said). A life in medicine could satisfy those needs. And he thought it would be “fun getting to know families.” 

While living in Boston he dated a girl from Harrisburg and she told him about Hershey Medical School. Family Medicine became a boarded specialty in 1969, and in the mid-1970s Hershey was positioning itself as a training center for primary care/family physicians for all of Pennsylvania. Dave was interested.

He worked hard and graduated from MIT a semester early. He had six months before starting the grind of medical school and he wanted to spend it traveling. So he bought an old Dodge van and converted it into a camper, and he and his boyhood buddy Mark (who lived two houses away and who now studies sediment cores from freshwater lakes) decided to explore Central America.

Map of Central America (from Lighthouse Magazine)

The road trip through Mexico, Belize, British Honduras, Guatemala, and El Salvadore was “transformative.”  He saw that “there was a world outside of the U.S.” He saw people “living in very poor conditions” and that they were “happy, kind, and honest.” He saw that “you didn’t need material things to get by in life.” And he saw that “people who have the most don’t tend to be happier.” But he also saw dead bodies cast by the side of the road due to the civil war in Guatemala, and he looked down into the crater of Pacaya, an active steaming volcano. The six-month trip was “eye-opening.” 

Steam billowing from the Pacaya volcano

(The two intrepid travelers sometimes went to a local police station to ask where they might safely camp for the night. The police offered them “protective custody” as they were told it would be best for them to park the van there.)

While he was traveling Dave tried to stay in touch with his girlfriend from Pennsylvania (she wanted to join him on the trip but the timing wasn’t right), but mobile phones were not yet available. And while he was gone (to find himself) “she met someone else.”

Anyway, Dave entered medical school in 1975. He had been promised that he would be assigned to a family and that he would follow it closely for the four years he was at Hershey. But that program was dropped because it “interfered with the academics.” He was disappointed.  He settled into his studies. He was let down again when things changed and he could no longer follow his Family Practice patients after they were admitted to the hospital. 

He met his future wife, Marilyn, in 1976. She was the childhood friend of his roommate from college, Bill. Dave was the Best Man at Bill’s wedding on Long Island. Marilyn was there, and they hit it off. She was a speech therapist and when she took a summer job in the Poconos, Dave valiantly offered to drive her the four hours from Long Island to the camp so she didn’t have to take the bus. They kept in touch as she did her Masters in speech pathology in Illinois. Things worked out and they began living together in 1977. 

After medical school, Dr. Neuburger decided to do his family practice residency in Harrisburg and he and Marilyn lived on one farm, and then another. They decided to marry in 1980. He generally enjoyed his post-graduate training.

During his residency, he did a few rotations at the York Hospital and he liked what he saw. He liked the feeling of the well-trained specialty staff and he liked that as a primary care physician you could admit your own patients, even to the ICU and CCU, and take care of them through their acute illnesses. And he liked that the relationship with the internists and specialists was seen as a partnership, contrary to what he sensed while with Hershey. And he liked the setting; that you could live “in the country.”

Dale Kresge, M.D.

So he joined the practice of Drs. Dale Kresge and Mike Dobish, Dallastown Medical Associates. He enjoyed his practice, and as he saw many of his patients every three months they often became “like extended-family.” The gratification was in getting to know his patients as individuals, “not numbers.” These relationships over the years were very important to him.

 Dr. Neuburger felt that he could handle 95% of the problems that came through the office.  And he became good at “recognizing that something that looked like it was one thing was really something else” so he would not hesitate to refer the patient to a consultant who knew a bit more.  

In the era of specialization, what is the role of the family doctor? According to the AAFP:

“Family physicians are personal care doctors for all people of all ages and health conditions. They are reliable first contact for health concerns and directly address most health care needs. Through enduring partnerships, family physicians help patients prevent, understand, and manage illness, navigate the health system, and set health goals.“ 

The focus in clinical primary care medicine in the 21st century is, we have been repeatedly told, on the patient. It is said to be patient-centered rather than disease-oriented. And the patient is a person, someone with a history. As Dr. Eric Cassell wrote:

“Knowledge of persons is particularly important today because what most clearly distinguishes chronic disease [the bulk of primary practice] from acute disease is that it takes place over a long enough period of time so that the nature of the person has an undeniable influence on the unfolding narrative of the disease, and the disease influences the further development of the person.” 

And Dave is, as he already told me, and as I can clearly see, is definitely “a people person” and someone who tries to see the long view.

Anyway, when my husband and I bumped into Dave and his wife one day while he was hiking with close friends around Lake Williams I asked him if he would let me interview him; he quickly said yes. Marilyn walked behind, with my husband, and she wondered if I had written any stories about the pain of legal actions against doctors. She felt that it was important to talk about such things. So I cautiously asked Dr. Neuburger if he would mind telling me his painful story; he said he didn’t.

Late in his career, he was accused of failing to diagnose a patient’s cancer in a timely manner. The legal suit was brought a year later and went to court two years after that. It was “one of the worst experiences” of Dave’s life. The jury found him “not liable” as he had followed the relevant guidelines and shared his thinking and decision-making with the patient. Relieved, he broke down and "sobbed." 

But the terrible emotional trauma was not over. There were several groundless appeals that dragged on over the next two years. These were denied. And it was over. But the finality was, in a sense, anticlimactic. Dave said that there must be a better way of handling such things. 

I wondered if this experience changed the way he practiced? Did he become more defensive? No. Did he order more diagnostic tests? No.     

But as the practice of medicine itself changed over the decades it became more and more difficult for Dr. Neuburger to find the joy. When he started out, he said, wryly, “You could write for any branded medicine and order any test you wanted! Anything you wanted to do, you could just do it! We were kind of like doctors then.”  But now, we have “other people second-guessing everything,” mostly to save money for the insurer. New bureaucratic changes introduced every few years made doctoring increasingly cumbersome as they pulled him away from what he thought was best for his patient.  

“Why and how did that happen?” I asked.

Big-business saw how much money there was to be made in the world of medicine. The insurance industry, the large pharmaceutical companies, the medical device firms, and the number-crunchers in the big hospital systems saw the piles of money for the taking. Dave told me that the number of bureaucrats went up dramatically as the number of physicians inched up only slightly (as their influence went down).

Striking growth in the number of administrators over 40 years (Bureau of Labor Statistics)

So Dr. Neuburger retired in 2015 after 32 years in practice. Though he was “the tech guy” in the office, and was even asked by his partners to pick out which electronic health record to use, computerized notes were not his thing. He saw that this would change the personality of the intimate medical encounter between patient and physician. He didn’t like what he saw coming, and since he “didn’t want to be a complainer” he left medicine early. 

How does he spend his time now? He has more time for family, he enjoys his lovely backyard, he cuts down trees and clears brush, he fashions beautiful wood furniture, he raises honey bees, he is a bow-hunter, he rides his bike (sometimes “pretty fast”) on the nearby rail-trail and elsewhere, and he loves hiking and backpacking through wilderness areas with his wife and their friends. How serious is the back-packing thing? How about hiking the entire state of Oregon on the Pacific Crest Trail, all 455 miles, for starters? (I’m exhausted and feeling blisters on my feet just listening to that.)

Back-packer Dave posing for a photo on the Pacific Crest Trail 

He is proud of the service he has given to the York County Farm & Natural Lands Trust,  including several years as president. This non-profit organization is, according to their mission, “dedicated to preservation of the finest agricultural and environmental landscapes for future generations to enjoy.”

Did I say that he studied literature at MIT? Dave said that he greatly appreciates Mark Twain and has a few first editions of his works.       

What about Dr. Neuburger’s biological family? 

His son and daughter are married. After fleeing the early phase of the pandemic in New York City, son Mark and his wife Heather, a psychologist, now live in White Plains, New York. Taking after his dad, Mark completed a through-hike of the 2,190-mile (!) Appalachian Trail eight years ago with his buddy, Dane Jensen, and is a self-employed software developer. Daughter Becky and her husband, Darren, an accountant,  live nearby in York Township. Becky is a behavioral specialist consultant. Their eight-month-old son, Jon, is the light of "Grandpa" Dave's life.

Dave's parents are “comfortable” and in their 90s. His father was trained as a mechanical engineer. He worked for Raymond Lester & Associates, the famous model-building firm that created the precise 1:1200 scale model of New York City for the 1964 World’s Fair (Dave said he could even pick out the apartment where they lived when he was a kid). His mother was a teacher. His brother Jon is a film editor for PBS who has done shows for American Experience, Nova, and Frontline. And his brother Dan works for Lockheed-Martin, but he is forbidden to tell Dave what he actually does.

1964 World's Fair New York City Panorama (from the Queens Museum; still on exhibit)

 At the end of the pleasant nearly two-hour interview, Dr. Neuburger guided me and my husband around his property. He pointed out the large wooded area that he had cleared by hand. He showed us his three beehives with buzzing worker bees doing their thing. He pointed to dried dung on the ground that he quickly identified as from a fox. 

And as we walked under the green leafy canopy I was reminded of “forest bathing,” the Japanese practice termed Shinrin-Yoku; the meditative process of “taking in the forest atmosphere through all of our senses.” This simple “exposure to nature and green environments” has been shown to lower heart rate and blood pressure, to reduce stress hormone production, to boost the immune system, and to improve overall feelings of well-being. 

So, as Dr. Neuburger knows, there are recognized benefits of playing in, living in, and simply being in nature, or “in the country.”  

Reference:

Cassell, Eric J. Doctoring: The Nature of Primary Care Medicine. New York: Oxford University Press, 1997.

Reading: 

Twain, Mark, (Samuel L. Clemens) ."The turning point in my life" in What is Man? New York and London: Harper and Brothers, MCMXXIV.  ( https://www.google.com/books/edition/What_is_Man/qv0QAAAAMAAJ?hl=en&gbpv=1)  

Dave's leafy backyard the day of the interview 

by Anita Cherry 8/1/20

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