J. Willis Hurst, MD, Master Teacher, Olympian Human Being

To quote Captain Willard (played by Martin Sheen) in the movie Apocalypse Now , “There is no way to tell you his story without telling you my own.” Of course, I could tell you about J. Willis Hurst, MD, without discussing myself, but I think it will be more interesting if I tell you about both of us.

I did my internal medicine internship and residency at The Ohio State University Hospital, where, as an intern, one of my residents was Mark Silverman, who next went to train with Willis at Emory University from 1966 to 1968. At Jim Warren’s (scion of Emory’s and Duke’s Gene Stead) Ohio State, Willis came and put on a clinical show. Everyone in the audience was amazed by his inferences, deductions, diagnostic acumen, voice, speaking skills, and presence: Willis was a tall and handsome man with an interesting natural wave at the front of his hair that is seen in all of his pictures. He had a pleasant upper baritone musical voice. I believe he was at his long-lasting clinical peak then: he had not become so involved with Larry Weed’s “problem oriented” SOAP system (a later pitfall for Willis) and had just finished writing the first edition of his cardiology text, The Heart , to deserved and wonderful acclaim. I was sold, and Mark said that I should apply to see if I could get a cardiology fellowship with Willis. I applied to what I, and most others, believed to be the 2 top clinical cardiology programs: Emory and Georgetown. I was accepted at Emory and deferred 1 year for acceptance at Georgetown (W. Proctor Harvey, Joe Perloff, Tony DeLeon). I took the Emory acceptance.

In my cardiology fellowship at Emory from 1968 to 1970, I found that the theory behind cardiac catheterization and myocardial mechanics (the work of Braunwald, Sonnenblick, Sarnoff, Roberts, Epstein, and other National Institutes of Health giants) were my interests rather than the practice of that catheterization skill. However, I did learn the Judkins and transseptal techniques, did coronary angiograms, His bundle electrophysiology, valve and shunt calculations, and so on. From 1966 to 1968, it was said that Mark Silverman was Willis’s confidant, if not therapist, which I felt I became for Willis’s second in command, Bob Schlant, from 1968 to 1970.

Willis was a master at reading electrocardiograms by vector analysis. At one Saturday morning cardiology conference in front of Willis, Bob Schlant, Nannette Wenger, Don Nutter, and possibly the beloved Bruce Logue (who once used my Harvey stethoscope on a clinical case!), it was my “turn in the barrel.” It was not a shining moment for me; I did terribly, was flushed, sweating, and embarrassed. Not because of that but as another part of my fellowship, I was farmed out for a standard 1-month research project in the “dog lab,” to the very bright N. Sheldon Skinner, MD, a nonpracticing full-time researcher. He and I did not get along very well! Working on the dog isolated hind limb studying reflex responses to various infusions was certainly neither my interest nor my ability. However, I am eternally indebted to Sheldon, who taught me one of the most important phrases that I frequently use to this very day: in fact, it is the very first slide of my PowerPoint grand rounds presentation “The Simultaneous Prevention of Multiple Diseases.” His phrase is “An invitation to consider,” not as a demand or command, but to fairly think about the idea that is under discussion.

Willis held physical diagnosis sessions to teach the fellows: he would inspect, palpate, percuss, and auscultate to arrive at the diagnosis on a patient unknown to him. He would sequentially describe the neck veins, then the carotid arteries, then the apical impulse and right ventricle, and finally the heart sounds to arrive at the spot-on correct diagnosis. I prepared the case 1 week. The patient was completely covered except for the eyes. I gave Willis an ophthalmoscope, he looked in the eyes, saw huge cyanotic vessels and correctly diagnosed tetralogy (really tetrad, as it is not “the study of” but is “the presence of”) of Fallot in an adult! I don’t know if every fellow had to give grand rounds at Emory, but I did give grand rounds, “On the Origins of the Heart Sounds.” At the end of that presentation, Willis literally leaped out of his chair and extolled my very well delivered insights, completeness, concision, and clarity. My speaking career began.

Having gone to Emory and having Willis’s recommendation, referring to me as “brilliant” (I think he grade-inflated everyone with such an accolade), got me my job offer here in Hartford, Connecticut. Since leaving Emory, I have saved every article I’ve come across that was written by or about Willis: I have them at my elbow as I write this (I have also saved other important American Journal of Cardiology interviews of Eugene Braunwald, William C. Roberts, W. Proctor Harvey, and the “in memoriam” for Ohio State’s Charley Wooley). In 2000, I wrote Willis a letter about how much I appreciated his choosing me to be a fellow at Emory. His response of August 17 was “I really appreciate your letter and know you are doing well. I surmise you are extremely active and trying to tell your fellow doctors that they can do more to prevent CHD than we could do a decade ago. I enjoyed reading your communications, thanks again for your kindness.” The “communications” he refers to in that letter are my patient (and physician) education, mostly 1-page essays, of which about 10 sheets are given to each new patient and which are available at my Web site, www.thepmc.org .

I do not have a copy of the letter I wrote to him in 2003, but he wrote me back on May 5 in response to my 2003 letter to the editor published in The American Journal of Cardiology titled “The Abolition of Symptomatic Coronary Artery Disease.” In that letter, I related that I had 20 consecutive patients who all underwent open-heart surgery 20 years earlier, and not 1 had needed any further angioplasty or repeat coronary artery bypass grafting thereafter, because of their maintaining total cholesterol levels <150 mg/dl (more recently, I say it as non–high-density lipoprotein cholesterol of 90 mg/dl) and similar as best possible control of the remainder of their coronary risk factors. This clinical success was based on the dietary and percentage body fat, exercising, and nonsmoking model of pretechnological societies, in which coronary artery disease (and diabetes, high blood pressure and high cholesterol, and many common cancers) do not occur regardless of age. Willis wrote, “Your letter to the editor speaks well for your work. I’m sure it will influence others. I still teach 8 sessions each week and write the remainder of the time. Stay in touch. Sincerely, Willis Hurst (MD, MACP, Active Consultant to the Division of Cardiology, Chandler Professor and Chairman Department of Medicine Emeritus, Emory University School of Medicine).”

In 2011, I made a donation to Emory University in Willis’s name. He was notified and wrote me back on April 26: “I am 90.5 years old now but teach the interns and residents once a month. They come to my retirement facility for dinner and a teaching session. I wrote a novel as a hobby, see Amazon. Medicine is a mess—no one seems to know what doctors do. Every effort is made to make good medicine a business which it is not. National newspapers tell us about the unprofessional acts of doctors. In each of my novels I address these issues but, of course, no one listens. Hope you are well and happy—your patients need you. Sincerely, JWH.” On May 20, I received a personal letter from R. Wayne Alexander, MD, chairman of the Department of Medicine at Emory, thanking me for that donation.

After that letter, on May 9, I wrote Willis back, saying, “I am so flattered that you wrote me. I have had the greatest respect for you and am so pleased you remember me. You have made such a difference in my life: you are (at) the top of a very select group of teachers.” In that letter, I sent him some of my newer patient education handouts, as well as my book Maximum Healing . He wrote me back on May 24: “Thank you for the book there is a lot of information in it. I retired from Emory 1.5 years ago. … I am deaf and can’t walk because of skeletal myopathy … my advice is keep on keeping on. You have much to give. Stay in touch. JWH.”

I respect and miss him so, as I know so many others do.

The writing of this piece was (finally) motivated by my reading in the Texas Heart Institute Journal (2011;38:613−614) “In Memoriam: J Willis Hurst (1920−2011)” by Herbert L. Fred, MD, Denton A. Cooley, MD, and James D. Willerson, MD, and other pieces I have read since Willis’s passing.

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Dec 15, 2016 | Posted by in CARDIOLOGY | Comments Off on J. Willis Hurst, MD, Master Teacher, Olympian Human Being

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