by Syed Tasnim Raza
It was late October 1971. My brother-in-law, Dr. Tariq Khan and I were interviewing together for residency training positions in Surgery. We finished our interview at the Downstate Medical Center in Brooklyn at 7:30 PM one night and then drove to Syracuse in heavy rain. We arrived at a friend's house at 2 AM and after sleeping a couple of hours we drove to our next interview at the Buffalo General Hospital in Buffalo, New York. There was heavy fog with very poor visibility, but we had to be at the Buffalo General before 9, so we sped west in the fog and made it there just in time.
The person to interview us first that morning was the acting director of the residency program in Buffalo, Dr. Richard H. Adler, a general Thoracic Surgeon. He had an angelic face and a lovely soft smile, and his presence immediately made us comfortable. The first question he asked us was why our eyes were bloodshot. We explained the all-night driving session after our interview finished later than expected in Brooklyn. He seemed impressed. After reviewing our application and reference letters he sent us to meet two other young faculty members, Dr. Jack Cudmore and Dr. Roger Dayer. And then we were given a tour of the hospital by Dr. Robert Milch, then the senior resident in surgery. After lunch, we met Dr. Adler again, for the closing interview, where he offered both of us the first-year residency position in surgery. This was a pyramidal program, so that there would be 15 first year residents, but these would be reduced to only six in the second year. Both Tariq and I were so excited we accepted the offer on the spot. We would join the program in July 1972. Thus, began my relationship with Dr. Adler, who would become my teacher, mentor and friend for the next 45 years.
Even though there were many Thoracic surgeons in Buffalo during the years Dr. Adler was active, he was the thoracic surgeon and did over 80% of all thoracic surgery at the Buffalo General Hospital. He was Professor of Surgery and eventually Director of the Thoracic Surgery Residency program until his retirement in 1990. He was one of the best thoracic surgeons both in the operating room, and also in his fund of knowledge about thoracic disease, which he always kept updated and current. Dr. Adler was trained at the University of Michigan in Ann Arbor under Dr. Herbert Sloan, one of the eminent thoracic surgeons of his time, who also was the Editor of the Annals of Thoracic Surgery. After his training, Dr. Adler came home to Buffalo and joined the Surgical faculty at the Buffalo General Hospital under Dr. John Payne, the Chairman of Surgery. During the next decade, Dr. Adler spent a year of further training in England in one of the foremost thoracic surgery clinics. While in London, Dr. Adler was exposed to Norman Barrett, one of the premier thoracic surgeons, who described the mucosal changes in the lower esophagus due to chronic reflux of acid from the stomach, now commonly known as Barrett's esophagus. On his return to Buffalo, Dr. Adler started methodically collecting patients with hiatal hernia and acid reflux and did mucosal biopsies of the lower esophagus. When Dr. Adler presented the results of his studies at a Thoracic Surgical meeting, Norman Barrett was in the audience. He discussed the paper and congratulated Dr. Adler for presenting the largest series of well documented cases of Barrett's esophagitis reported until then. Dr. Adler had similarly large series of case-studies, where he performed talc pleurodesis for malignant pleural effusion or patients with post-pneumonectomy space and others.
His attention to detail and very methodical follow-up of any given thoracic disease was remarkable. I always enjoyed assisting him at the smallest procedure, because he made it into an art form.
Simply, draining pleural effusion, or inserting a chest tube at the bedside was so well done, that one almost never saw a complication after these procedures. He wrote meticulous notes in patient's charts, documenting the diagnosis, findings, procedure he performed and frequently illustrated his notes with a drawing. I learnt how to write good notes from him. Dr. Adler taught me how to do safe surgery on lungs, esophagus and the chest wall.
We used to have a weekly thoracic surgery conference, which Dr. Adler moderated. It was the best learning experience for young residents and medical students, because Dr. Adler always explained things to make them easy to understand and remember. On days when the weather in Buffalo was not good, there would be just three or four people in the audience and Dr. Adler would always start the conference on time, saying "the dedicated folks are here, so let's start."
He never yelled, screamed or raised his voice. He once taught me a great lesson about such behavior. After I had finished my training and joined the faculty as a cardio-thoracic surgeon I had a small practice and could never get the morning slot in the operating room, which were always booked far in advance by the senior and busy surgeons. Once I did get an 8:00 AM slot for a small procedure, but when I got there the nurses told me that they had put a quick procedure for Dr. Adler in that room starting at 7:30, because he had a long day in the other rooms and I would not be more than 15 minutes late. I lost my cool and yelled loudly enough at the nurses that Dr. Adler could hear me, saying they treated me unfairly because my patient has no insurance and other silly things. Dr. Adler never said a word. The next day I was in my office and he knocked on my door, asking if he could come in. I stood up afraid that he would be upset with me and invited him in. He simply said that "we would be working together for many years to come and it would be better to have a good relationship, without anger or mistrust of each other." He was after all my chief and could have done many a thing to hurt me, but for him to walk in and just politely request that we get along was amazing. Much of my future personality was molded by him with this and other similar lessons.
Besides operative surgery, diagnosis of thoracic and esophageal disease and how to be a better person, Dr. Adler taught me many other things. He got me interested in astronomy by giving me a book on ‘Red Giants and White Dwarfs' by Robert Jastrow. He played tennis regularly and encouraged me to do the same. I still love the game and enjoyed playing tennis with my son and now with my wife. Closer to his retirement, Dr. Adler took up piano and encouraged me to do the same. I did take up piano and used Dr. Adler's former teacher, George Jones, after Dr. Adler had retired and moved to New Jersey. Dr. Adler became an accomplished pianist. One day while he was in Buffalo on my invitation as a Visiting Professor, he spent the afternoon in my apartment. He saw my piano and got excited and suggested we play for each other. He played several Jazz pieces for me, which was such a treat for me. I could not muster the courage to play in front of him. A few years ago, at an Adler family reunion in New Jersey, which my wife and I were honored to be part of, Dr. Adler played piano for the entire group for over half an hour, to a standing ovation at the end.
Dr. Adler was a loner in surgical practice. He never took a partner and generally kept to himself. I had joined the cardiac surgical group and was mostly busy doing heart surgery, although I also did general thoracic surgery, which I loved mostly because I adored Dr. Adler so much. Dr. Adler's best compliment to me was when he said that had he ever taken a partner in his practice it would have been me. We often sat and talked about life and all the issues that we face and sometimes our discussions would last several hours. I loved listening to him.
Another lesson I learnt from Dr. Adler was how he never sought fame or recognition. After he had retired and moved to New Jersey, I invited him back to Buffalo for a "Teaching Day" for the residents and others. We had a full program and everyone loved it. After that the Chairman of Surgery asked me to ask Dr. Adler if we could start an annual lectureship to honor him. I made a trip to New York to meet Dr. Adler and discuss starting such an annual teaching day in his honor, but he refused to be part of it. He said that it would only last as long as I was there and then no one would care and moreover he did not want to commit to traveling to Buffalo every year.
After his retirement in 1994, Dr. Adler and Ree settled in New Jersey for proximity to New York, their beloved city and to Ree's family and two of their children. Because both my children had moved to New York, I had many occasions to visit and I always made an effort to have dinner with Dr. Adler and Ree. I had been divorced since 1993 and at those dinners Dr. Adler would always ask about my social life and after hearing my answer in the negative, he would always hold Ree's hand and say to me: "if you find someone like Ree, grab her immediately.!" When I did finally introduce my then girlfriend and now wife, Nazli, Dr. Adler loved her and approved of her wholeheartedly. Nazli also quickly learned to love both Ree and Dr. Adler, and we have spent some lovely times together, including twice as part of their family reunions in New Jersey.
I was fortunate to have ended up in Buffalo and to have had a chance to learn from one of the finest surgeons and more importantly one of the finest human beings, lessons that shaped much of my life. I have often said that America's true greatness is not that we had leaders like George Washington or Thomas Jefferson or Abraham Lincoln, but in hundreds of thousands of people like Dr. Adler who are America's true heroes, but unknown outside of their immediate circles.
I will miss you my friend and mentor.
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Syed Tasnim Raza, MD, is Associate Professor of Clinical Surgery at Columbia University Medical Center, New York City.