“Never turn down the opportunity to keep your mouth shut.” - Dr. William “Bill” Hamilton
Bill Hamilton and Ted Eger both passed away in 2017. I had great stories about these historical figures—my beloved teachers—and I felt a responsibility to share them. As with many good intentions, however, these recollections were stored away for a different time.
My memories of Dr. Hamilton and Dr. Eger came back in January 2020. Like many people, I tuned into TV news reports of the early Democratic presidential primaries, with the first in the nation in Iowa. Much of the coverage of the candidates occurred in common places like small diners or the Iowa Fair. After a few of these interviews, during which Iowans were asked about candidate preferences, a specific pattern emerged.
Iowans never seemed to say anything bad about any of the candidates. They seemed thoughtful, resolute, and firm, but never mean or snarky. Iowa Nice. There always seemed to be an underlying invitation: “Would you like to sit down and have breakfast with me?” As I watched this coverage, I was reminded of Ted Eger and Bill Hamilton, who had both made their way to frenetic San Francisco from the University of Iowa. To me, they were both “Iowa nice”.
The UCSF Department of Anesthesia and Perioperative Care has strong Midwestern roots. Stuart Cullen, John Severinghaus, Ted Eger, and Bill Hamilton all grew up in the Midwest and completed anesthesia residency at the University of Iowa. They, along with Ronald Miller from neighboring Indiana, arrived in San Francisco in the 1950s and 60s.
Perhaps it was a strange time for our Midwesterners, for the 1960s was the era of the Summer of Love and peace protests in the neighboring Haight-Ashbury district. These anesthesiologists mostly settled in rural Marin County, which was more affordable at the time. They would often commute together across the Golden Gate Bridge.
In spite of a possible cultural adjustment, they led the way in the newly re-energized UCSF Department of Anesthesiology. Stuart Cullen gained fame for developing the first paralytic, d-tubocurarine or curare, from the Amazonian vine Chondrodendron tomentosum—work he had performed in Iowa. John Severinghaus developed a physiological fingerprint for the OR and ICU—the arterial blood gas panel. Ted Eger developed all of the modern volatile anesthetic gases—non-flammable, of course. Bill Hamilton expanded the department into one of the best in the world. And a young Ronald Miller of Miller’s Anesthesia fame—the baby among them—devised the massive blood transfusion protocols we still use today while he was serving in the Vietnam War.
I only worked with Dr. Eger, Dr. Hamilton, and Dr. Miller in 1995—a time when the field of anesthesia was in trouble, with falling reimbursements, a lack of jobs, and unfilled residency positions. CRNAs were openly talking about taking over the profession. It was a very sad time for the field, for those who can remember. At the start of my training at the esteemed UCSF program, several residents had already quit, and others, including myself, were considering other career options.
In that time of need, there was Eger, Hamilton, and Miller—anesthesiology demigods—still working with first-year residents. They must have felt a compelling need to support a profession under attack, I’m sure, but by all accounts, they also liked working with young people. They were unwaveringly nice. Iowa nice.
I would work several times again with Dr. Hamilton, the Mask King, after my first encounter. Dr. Hamilton always remembered me, and would even notice my clinical progress in the O.R. He always offered professional tips: “Stand up straight,” or “Keep your scrubs clean.” He once relieved me from the O.R. so that I could change out of scrubs that were soiled with blood at the pants cuff. He insisted that I do so. “Unacceptable,” he intoned.
Eventually, we would also intubate patients together, and he would teach me about PEEP, CPAP, and the finer points of the anesthesia machine.
One day in the O.R., the surgical team was complaining about another surgeon. Such idle talk I had learned to filter out over time, but this sort of “back-stabbing” seemed to disgust Dr. Hamilton.
He shook his head as he witnessed the unprofessional conduct and whispered to me: “Never turn down the opportunity to keep your mouth shut.” He made eye contact and continued stiffly, “Let your thinking and character speak for you—not tearing down a colleague.”
I stared back at him, dumbstruck. Even then I knew that I was hearing something profound, not about the science of anesthesia, but about how to behave as an anesthesiologist. 25 years later, these words carry even more weight because they have become a part of my professional core.
During all of my higher education, but at UCSF in particular, I mingled with people of many different institutional cultures from around the country: West Coasters, East Coasters, New Yorkers, and Southerners. And then there were the Midwesterners. “Stand up straight. Wear clean scrubs. Be polite, quiet, and intellectually resolute.” Sound familiar? To me, these statements represent the modern anesthesia culture.
I see the anesthesia legacy of Iowa Nice in the O.R. and hospital every day. Can you imagine our specialty without volatile agents, paralytics, ABGs, Miller’s textbook, or transfusion protocols? The scientific leadership of these Midwesterners has stood the test of time.
But it is not only the science, but also the personality of these giants that has created their footprint.
“Let your thinking and character speak for you,” said Dr. Hamilton that day in the UCSF Moffitt O.R.
Anesthesiology—for me, it is a quiet, thinking, and resolute specialty. “Iowa Nice” is not just a political news report but also a legacy of professional behavior left to me by several Midwestern greats. “Iowa Nice” is me, it is you—it what our specialty has become.
More information about the CSA Committee on the History of Anesthesia can be found here: http://csahq.org/about-us/history-of-anesthesia
Harrison Chow, M.D., M.S., is a frequent contributor to CSAOF and was a resident anesthesiologist at the University of California-San Francisco from 1995-1998. He is an Associate Professor of Clinical Anesthesia at Stanford Medical School, and was a former Department of Anesthesia Chair at Good Samaritan Hospital. He is a Delegate for CSA District 3 and for the Hospital-Based Practice Forum of the California Medical Association.