Lloyd W. Kitchens, Jr., MD

loyd Kitchens was born in Jackson, Mississippi, on October 19, 1946. He grew up in Crystal Springs, Mississippi, attending public schools. He graduated from the University of Mississippi, or Ole Miss, in 1967 and from the University of Mississippi School of Medicine in 1971. His internship and residency in internal medicine were at Baylor University Medical Center (BUMC), as was his fellowship in medical oncology and hematology. He entered the private practice of oncology/hematology in 1976 and has been teaching at BUMC and The University of Texas Southwestern Medical Center at Dallas ever since. His life with Crohn's disease has not made it easy for him. Severe flare-ups recently have necessitated his retirement from practice. He remains active in the American College of Physicians and with his many nonmedical interests. He is a well-loved physician at BUMC and has a great capacity for friendship.

William Clifford Roberts, MD (hereafter, WCR): I am speaking with Dr. Lloyd Wade Kitchens, Jr., in the study of his home on September 11, 1998. Lloyd, I appreciate your willingness to talk to me and, therefore, to the readers of the Baylor University Medical Center Proceedings. Could you talk a bit about your parents and growing up in Mississippi?

Lloyd Wade Kitchens, Jr., MD (hereafter, LWK): I grew up in Crystal Springs, Mississippi, a little town 25 miles from Jackson. At that time, it was an active area in truck farming, particularly tomatoes. The people there used to refer to the area as the “Tomatopolis” of the world, and a big tomato festival was held every year. Now Crystal Springs is basically a bedroom community for Jackson. Its population then was 5000, and it still is.

My father was from a large family. My grandfather had lost two wives. My father is the only child of my grandfather and his third wife. My father had numerous half-brothers and half-sisters, many of whom were old enough to be his parents. He was the first member of his family to finish college, which he financed by working 2 or 3 part-time jobs. He initially went to Copiah-Lincoln Junior College, but received his degree at Mississippi State University.

My mother is a native of Vaiden, Mississippi, which is about 100 miles north of Crystal Springs. Its population was about 500 when the train used to stop there. When the train ceased stopping in Vaiden, it lost most of its population. It also was hit by a bad tornado about 10 years ago, and there is not much left of what was a very genteel community. My mother and all her siblings studied piano. Mother studied with a lady I later took lessons from when I would visit my grandmother in the summers. By that time Miss Lena Armstrong was nearly 100 years old and still a very good teacher.

When my mother was a senior in high school, she taught some first and second graders. There were 3 or 4 classes in the same room and they didn't have enough teachers. My mother's youngest sibling was one of her students. Mother went to a little college located in the northeastern extremes of the state called Blue Mountain, which at that time was an all-girls Baptist school. Mother also did some summer work at Ole Miss and Mississippi State, meeting my father at State. They got married in the late 1930s. Daddy went to World War II. By that time, he was a college graduate. During the war, he taught illiterate troops how to read at Camp Shelby in Hattiesburg, Mississippi, and in several other places. He also began having some intestinal problems. They were diagnosed as peptic ulcer disease.

I was born in 1946. I have a brother who is 6 years younger than me. He is in business in northeast Alabama near Huntsville. I also have a brother, an attorney, who is 3 years older than me. He was a district attorney for about 3 terms, but he resigned because he has 5 children and was strapped financially trying to send them to college on a district attorney's salary. He survived an assassination attempt as a young prosecutor in 1973. One night in Crystal Springs, he developed a headache and walked home from the evening Baptist service, leaving his family at church. Shortly after arriving home, he got a phone call. The caller said he had a tip on a drug deal that was going to happen: “I'll be there in just a few minutes. I wanted you to know what it was so you would come to the door.” My brother restrained his dogs. As he walked back into the house, a person stepped out from behind a bush with a gun and said, “You are never going to send anybody else to Parchman [the prison farm in Mississippi].” My brother grabbed the gun and hit the guy. They fought, and my brother was shot through his upper left leg and left hand. Fortunately, the bullet didn't hit any bones or major vessels and he did okay. He had FBI protection for a long time after that. He has had some pretty grizzly cases through the years.

Our father was elected mayor when I was in the fifth grade. He had been a city alderman for years before that. Being mayor was a quarter- or half-time job. The mayor was the municipal judge as well and dealt with misdemeanor crimes. Many times we would be awakened at home by police bringing in an inebriated man who had beaten his wife; my father had to declare that this person should be admitted to the jail. He also frequently had to settle disputes that did not put people in jail. It was exciting and somewhat frightening as a child.

The civil rights movement also was really gearing up. I finished high school in 1964, and there was a lot of activity that year, a lot of cross burnings. My father, in addition to being mayor, had a large wholesale grocery operation and some cattle. The wholesale grocery business was demanding. He worked very hard at it. My older brother and I also worked at the warehouse a lot. We worked with adult black men, doing the same work they did. I never had any difficulty with other races, but there was much vigilante and Klu Klux Klan activity at the time. During my high school years, I was student body president, student council president, and editor of the annual. I played football (guard on offense and inside linebacker on defense), although not very well. In rural Mississippi, one pretty much had to play football to be accepted.

WCR: Did you go to public high school in Crystal Springs?

LWK: Yes.

WCR: How many students were in your high school?

LWK: About 300. My graduating class had 82.

WCR: That was 82 whites?

LWK: Yes.

WCR: About the same number of blacks?

LWK: There were about 30% more blacks.

WCR: The classes were totally separate?

LWK: Yes. Black and white students never saw each other. They were schooled 2 or 3 miles apart. The black school was in the black area of town, called “Freetown.” In 1962, when I was in high school, James Meredith was the first black admitted to the University of Mississippi. That was a terrible time. There were talks of insurrection among the whites: “They'll put him in Ole Miss over my dead body” and that kind of thing. The disc jockeys on the radio would say, “They're going to try to put him in there this Thursday. Come on up to Oxford and bring your guns.” I heard that on the radio! Under duress, Governor Ross Barnett was convinced by John and Robert Kennedy to mobilize the Mississippi National Guard. They became federal troops at that point. Meredith would not have gotten in there if Governor Barnett and the Kennedy brothers hadn't made a deal. Despite the presence of these heavily armed guards, there was a riot. Two people were killed and many were injured. When I went to Ole Miss in 1964, the troops had left the campus a week earlier after staying 2 years.

I was a page in the legislature in Jackson several times during high school. One task we did, in addition to the usual step-and-fetch kind of things for the legislators, was to stuff envelopes with letters opposing the Civil Rights Act of 1964. We sent letters to people all over Mississippi and other parts of the country saying, “If this act is passed, America will be communist within 6 months.” That was sent on state stationery through the auspices of the State Sovereignty Commission. It was really the State Segregation Commission. The boss of the pages told us: “Boys, you just got to oppose integration; you can't ever give up. You can't ever give in to the blacks at all or this country will be communist.”

WCR: In high school you were president of the student body, president of the student council, played football, played the piano. Were there other major activities as well?

LWK: I played the piano quite a lot. The other large activity was church work. I was very involved in the Baptist Church. I began accompanying choirs on the piano at a young age. I would accompany the adult choirs when the regular pianists were not there. We were “4⁺ Baptist”! There was a huge Baptist culture, and we were 4-feet deep in the middle of it. In the summers, I used to go to small towns to attend youth revivals. There were several young guys in the seminary at Mississippi College who would go around and do youth revivals in the summers. They would have an evangelist and a music director. Often, more times than I could do it, I was asked to play the piano for these things. I would go for a week to some little town and maybe get paid $50. I did probably 8 of these when I was in high school. Church work was very important to me.

My interest in music rapidly increased. I discovered musical theater and got very excited about it. We had a new stereo record player. I would do my homework, which didn't take very long, and then read Newsweek cover to cover or the encyclopedia while listening to My Fair Lady or South Pacific on the record player. I also dated a good bit. I enjoyed that. There were some pretty nice girls in Mississippi!

WCR: What was home life like? There were 3 brothers and you were the middle one. When you would sit around the table at night, did you have intellectual discussions? Was your family an intellectual one? How would you characterize it?

LWK: I would say it was pretty intellectual. It was absolutely dominated by my father. He, during most of the time that I remember, was mayor. My older brother got into trouble a lot from childhood pranks. Frequently, the dinner table was where he was disciplined.

About the time I was in the eighth or ninth grade, my father's illness became a real issue in our family. Although for a long time he had been thought to have peptic ulcer disease, Crohn's disease was the problem. This disease had only recently been described by Dr. Burrill Crohn. Periodically, my father would have gastrointestinal bleeding, which occasionally was life threatening. I remember going on an emergency basis to the hospital in Jackson with him about to exsanguinate from gastrointestinal bleeding. When I was a junior in high school, he started going to the Oschner Clinic in New Orleans. He might be gone 1 to 2 months, during which time my brothers and I would be cared for by my grandmother or Daddy's half-brother and his wife who lived within a half mile of our house. We spent a lot of time there. If school was not in session, I would go to New Orleans and try to help Mother. Much of our family life came to be dominated by his illness. He eventually died from complications of Crohn's disease. He had cirrhosis, although he never had a drink in his life. Retrospectively, I am sure he had hepatitis C from the many blood transfusions he received over the years. He developed severe portal hypertension from which he died despite a portacaval shunt.

WCR: He was born in what year?

LWK: 1916.

WCR: He died in what year?

LWK: The year I started practice, 1976.

WCR: Your mother was born in what year?

LWK: 1914.

WCR: Was there enough money for the family not to have to worry about that when growing up?

LWK: When I was growing up, we were considered very well off. My father made good money in the wholesale grocery business. I was in medical school when his health really began to wane. He sold his wholesale grocery business to take a job as the manager of a huge vegetable packing plant in Crystal Springs. Sadly, after my father had already sold his business, the manager decided he was too sick to take the job. He was left essentially without employment when he was very sick from Crohn's disease. He started selling insurance. He was still mayor and had that small salary. He did okay, but incurred a lot of debt, partly from my brother being in law school the same time I was in medical school. It didn't cost that much to go to medical school at the time, but to provide for our living expenses, he borrowed more money than he probably should have. Looking back, I think he was encephalopathic. He just wasn't as sharp as he had been. He was taking tricyclic antidepressants, and they probably were not taken correctly.

WCR: How old was he when the manifestations of Crohn's disease began?

LWK: He was probably in his 20s. Burrill Crohn didn't describe the disease until the 1950s. Eisenhower had it also; his case was called regional ileitis.

WCR: What impact on your growing up came from your mother?

LWK: A tremendous impact. We remain quite close. I talk to her on the phone 5 or 6 times a week. Despite being 84, she still has 45 piano students a week. She is very active. She paid all the debts Daddy incurred by teaching piano lessons.

She was a tremendous influence on me musically. When my wife, Connie, and I met 15 years ago, we were astonished to find that we both knew all the Victor Herbert, Cole Porter, Jerome Kern, and George Gershwin tunes. Not many people our age like that kind of music. We both learned these tunes from our mothers.

My mother has enormous energy and talent. She is considered a virtual saint in Crystal Springs since she taught piano to so many people and was so visible playing the organ every Sunday at the Baptist church. She was, and is, a very strong and deeply religious person. She always encouraged my brothers and me to do whatever we felt we could do in our careers.

One thing I resent just a bit was my parents' not letting me attend the college I wished. As a National Merit Scholar in high school, I was recruited by Stanford, Harvard, and Yale. I even had an appointment to West Point that I turned down. If left to my own devices, I would have gone to Harvard or Yale. They could have afforded it, but my parents, especially my mother, were afraid that I would get contaminated by the Yankees or that I would not like it and would leave college early to come back home.

I wanted to get into medical school as soon as I could. I took freshman English and inorganic chemistry at Mississippi College my first summer. English was fine, but chemistry was terrible because the laboratories were poor.

My brother had just graduated from the University of Southern Mississippi in Hattiesburg. I told him how miserable I was at Mississippi College, but that I didn't think our parents would let me go anywhere else since it was only about 30 miles from home. My brother had a degree in social studies but didn't know what he wanted to do. He said he had been thinking about going to law school at Ole Miss. At that time, if you were a graduate of a state university in Mississippi, you were assured admission to Ole Miss Law School. He said, “Let's go up to Oxford next weekend, and we'll tell them we are going up there so I can look at the law school.” We went and he liked the law school. The first guy we met there was Trent Lott, currently the US Senate Republican Majority Leader, who was the liaison to new students. My brother thought if he were there on campus, our parents would let me transfer to Ole Miss. They did. I got through college in 2 years by taking huge loads. During my first year of medical school, I had to take correspondence courses from Ole Miss to get my last few hours of college courses. I was determined to get a bachelor's degree!

WCR: When you graduated from high school, you were how old?

LWK: Seventeen.

WCR: You started medical school at age 19?

LWK: Yes.

WCR: How was college for you? Did you have any mentors, or did you meet people who had a considerable impact on you?

LWK: I did. My interest in German started there. I was admitted to an advanced class taught by Professor and German Department Chairman Dr. Wilhelm Eickhorst, who was an influential mentor.

I also had a small grant to work in a biochemistry research laboratory with Paul Russell, PhD. He was doing postdoctorate work under a renowned biochemist, W. R. Nes, PhD. They worked on steroids, mostly those derived from plants. I was very happy to get the opportunity because I got experience with a lot of radioactive material. We ground up green peas and used rodents a good bit. I learned a great deal.

The first full summer I spent at Ole Miss, Russell was to present a paper at Harvard. He was 6'7" and had played basketball with Lou Alcinder, later named Kareem Abjul-Jabar, at the University of California Los Angeles until he broke his leg. He needed to get from Oxford to Boston. My brother and I shared a Volkswagen bug at the time. This 6'7" man and I drove from Oxford to Boston. Of course, he couldn't drive at all because he was just too big. I drove the whole way. We talked about science, and I got increasingly excited about science. The summer before I started medical school, I went to Ohio State and worked there with Russell in the obstetrics and gynecology department doing some steroid research, such as the effects of too much estrogen on labor.

WCR: University of Mississippi for medical school? Did you apply to any place other than the University of Mississippi for medical school?

LWK: No.

WCR: Were there any mentors in high school that had an impact on you?

LWK: Yes, a lady named Dorothy Alford. She was often my English teacher. She is a very articulate, refined lady who filled a similar role for my older brother. He likes words, writing, and reading like I do. My brother is a wonderful author and speaker now. He captures a jury very quickly. I wish I could speak as well as he does. He got that from Dorothy Alford, and whatever I eventually got came from her as well. My mother also has beautiful grammar. Both of my brothers and I, through the influence of my mother and Ms. Alford, strive not to make grammatical errors. I think for the most part we succeed.

There was another man, T. E. Carney, who considered himself to be a teacher on the side. He had a huge farm south of town and raised cabbage. He had a lot of money but enjoyed teaching biology, chemistry, and physics. Although his fund of knowledge was less impressive than his enthusiasm for teaching, he was the first to get me excited about science.

WCR: Talk a bit about your noncurricular activities in college. I gather music continued to be a very active part.

LWK: I was in a fraternity, Beta Theta Pi, that was quite academically inclined. I was very active and was secretary of the chapter. The biochemistry laboratory took a couple of hours a day. I met my first wife there. We would study together. At that time she was in premed.

WCR: I gather that you became interested in medicine while relatively young. I suspect you learned something about medicine from watching what was happening to your father. Were there physicians in your family?

LWK: No, but there was a rather dramatic event that made me interested in medicine. Most days when I was not in football practice, I would go to my father's warehouse after school and work there until it was time to feed the cattle or go to a piano lesson. The warehouse, where the wholesale grocery operation was located, was across the street from an old 2-story house that had been converted into a doctor's office. Dr. Oscar G. Eubanks was venerated in that town and could do no wrong. Back when the telephone operators talked to you, his phone number was 1. One day, I was working in the warehouse after school and stepped out on the loading dock. Across the street they were taking somebody covered by a sheet out of his office on a stretcher. Dr. Eubanks had had a heart attack in his office and died. This was in the spring of my senior year in high school.

At that time, my parents would have allowed me to go to West Point. I had an appointment there from my congressman, and that is what I planned to do because I knew they would not let me go to a civilian school that far away. I started thinking a great deal about the world and decided that if I wanted to help people and do good, which was a goal of mine, I was more likely to be able to do that as a physician than as a soldier. After a couple of days of intense thought, I wrote to my congressman and thanked him, but told him I was not going to accept the appointment. That is when I really became interested in medicine. I had always been interested in science but didn't think about doing it myself until Dr. Eubanks suddenly died.

WCR: You mentioned that your father had cattle. Did you actually live in town?

LWK: Yes. We lived on the outskirts of town. The farm was 5 miles out of town. Our house, where my mother still lives, is on 9 acres and has lots of pecan trees. We didn't keep livestock there, but we did keep horses occasionally.

WCR: How many cows did you have?

LWK: When I was growing up we had about 80. During my senior year in high school, my father bought 40 hogs and put them in a pen on the farm so he didn't have to discard spoiled food from his warehouse. All through the winter, my job was to feed them the stuff that humans couldn't eat. I would mix this horrible stuff and pour it out for the hogs. It used to get very cold and the roads were slick. I would frequently get in a ditch and have to hitchhike home, hoping to make it back in time for my piano lesson.

WCR: You were always busy in high school and college. Did you need much sleep to be effective?

LWK: At that time I didn't sleep much. I would read late into the night and get up early in the morning. I require very little sleep now. That was reinforced in medical school, housestaff training, and my practice. I was one of those guys who could get a call and be perfectly lucid at 2:30 am to deal with a problem properly and then turn over and go back to sleep within a minute or two. I'm able to go to sleep quickly for brief periods. Since my forced retirement from active practice, I'm compelled by my physicians to rest a couple of hours during the day. That's been hard for me to adjust to, but I do fatigue easily from hepatitis C and Crohn's disease. I'm chronically moderately anemic and do better when I rest during the day. It's still psychologically hard to do that, never having done it before.

WCR: Did your family have lots of books and did they read a lot?

LWK: My father read very little. My mother read a lot. She read periodicals like music magazines more than books. The books in our home were primarily those purchased by my brother and me. Neither of our parents read many books. My older brother and I read voraciously.

WCR: What does your younger brother do?

LWK: That's been difficult. When my brother was in junior high and high school, my father was ill. My younger brother didn't have the benefit of Daddy's strong guidance. My father used to tell us that we would know how to work even if we didn't learn anything else from him. My older brother and I have that skill due to our parents' training. We both work a lot. My father was ill and frightened that my little brother was going to get drafted, sent to Vietnam, and killed. They were very lenient with him. He has knocked around in a number of different low-level business jobs. Right now he probably has the best job he has had, as an assistant manager for a pest control company in Huntsville, Alabama.

WCR: What were those 4 years in medical school like?

LWK: Do you remember Richard Joseph, an obstetrician/gynecologist who was the youngest president of the Dallas County Medical Society? He and I were fraternity brothers at Ole Miss and roomed together our first year in medical school. When he was inaugurated as president of the Dallas County Medical Society, they did a big feature on him in the society's journal. He was asked to prepare some remarks. He talked about what the early days of medical school had been like. The first day, students, especially freshmen, had to park far away from the school and walk up a long hill. Walking uphill, I said, “Joseph, what kind of doctor do you want to be?” He said that his goal was to take care of healthy people and keep them healthy; he is an obstetrician/gynecologist and that is what he does. He takes care of people in a normal physiologic situation and tries to maintain their good health. He said, “Kitchens, what do you want to do?” I said, “Joseph, I want to take care of the sickest people around and try to do the best I can for them,” so I do oncology. It worked out as we said.

WCR: Who influenced you in medical school?

LWK: My first year I loved medical school. I liked the anatomy lab the first day, being in charge of the remains of a human being. I didn't have any major medical problems that year except for some abdominal cramping. That summer I went to Ohio State and didn't think any more about it. When I came back, I went to the first day's orientation, saw all my friends I had gotten to know the year before, went home, and had a massive lower gastrointestinal bleed. My hemoglobin when I got to the hospital was 7 g/dL.

WCR: This was when you were 19?

LWK: Yes. I had just started my second year of medical school. Things kind of cascaded, and I started having in rapid succession just about everything you can have from Crohn's disease: erythema nodosum; 9 or 10 recurrent, very painful perirectal abscesses; and several heavy gastrointestinal bleeds. Finally I had to drop out of school because they thought I was probably going to die.

I eventually had surgery which, in retrospect, was probably not the right thing to do. The terminal ileum was extensively involved in Crohn's. The more proximal ileum was anastomosed to the transverse colon, but the diseased bowel was left in. Over the next few months, I continued to have abdominal cramping. The perirectal abscesses continued, and eventually a diverting colostomy to the left lower quadrant was performed so that the rectum was “rested.”

That's the way I finished medical school. I went back the next year and joined the class that was coming along, so I finished a year later than I would have. Looking back, I am simply not sure how I finished medical school. At one point I remember having to wear 3 different ostomy bags because I had 2 enterocutaneous fistulas. I was very ill until I came to Baylor as a medical intern. I couldn't believe that Ralph Tompsett and Mike Reese hired me but they did. About 2 years into the residency, Dave Barnett, a wonderful man and surgeon, and Dan Polter, my gastroenterologist, informed me that my rectum was a disaster, that it would never function again and that I needed an abdominoperineal resection with removal of all diseased bowel. That procedure was done. After that operation, I did quite well for 12 years.

Subsequently, I have had several more bowel resections. Several recurrences appeared in the distal-most part of the bowel at the stoma. I had Stevens-Johnson syndrome, and Crohn's arthropathy developed. I had multisystem organ failure from toxic shock syndrome 4 years ago and was in the intensive care unit for about 3 weeks. I had many debridements and skin grafts on a huge necrotic area on my left ankle. My internist, Russell Martin, told me there was just no way I could practice again. I have had manifestations of Crohn's disease now for about 31 years. About 2 or 3 days a week, I cannot do the things I would need to do if I were practicing.

WCR: Did Dr. Arthur Guyton have a major impact on you in medical school?

LWK: Dr. Guyton, of course, is the world's dean of physiology. He wrote the definitive textbook, which is used in medical schools all over the world. While a surgical resident at the Massachusetts General Hospital, right after World War II, he was stricken suddenly by polio. He almost died. He kept meticulous clinical notes on himself as to what was going on. Unable physically to continue surgery, he became a physiologist without formal training. He was entirely self-taught. Dr. Guyton is one of the kindest people I have ever met. He has 10 children, all physicians. I was at Ole Miss with two of them. I got to know their father fairly well. Dr. Arthur Guyton has very little use of his legs; he has pretty good use of one hand. He gave at least 80% of our lectures in physiology, one every day. He devised a system where he could project his writing on a screen. It doesn't sound like much now but in the 1960s it was impressive.

Once I was in the dog lab doing an experiment, trying to cannulate a vein. I was so nervous about doing that first real technical procedure, I could not get it in for love or money. All of a sudden he was behind me. He couldn't see my nametag, but he knew my name. He said, “Lloyd, you can do it.” He said do this, that, slip it in, and you won't have any trouble. I did, and it went right in. I have never been so relieved in my life. The thought that this man, who should be a Nobel Laureate for his work on hypertension, did hands-on teaching with me, knew me, and was interested in my career and my doing well was just fascinating to me. I was not real close to him personally. I was more of a distant admirer of his. We were all in awe of him. I still admire him tremendously.

Another was Dr. Jim Hardy who is still alive though physically beginning to fail. He was a cardiothoracic surgeon. He is the father of Dr. Kaki Little here at Baylor. Dr. Hardy had 4 daughters, all doctors: 2 MDs and 2 PhDs. I went to the church Dr. Hardy attended, and he was really an inspirational guy: enormous energy, very kind, and very religiously devout, but still able to do some high-powered medicine. He did a baboon-to-human heart transplant several years before the first human-to-human heart transplant by Dr. Christian Barnaard in South Africa. I admired that he could work as hard and long as he did and still be extremely active in the church. Those were the two people who were most influential.

Following closely after those two was an old gentleman named Dr. Guy Campbell, a sputum and x-ray pulmonary doctor. If you had a “bronch,” it was done with a rigid scope, usually by a thoracic surgeon. It was not like it is now where the pulmonologist can “crawl out” almost to the chest wall and see with their bronchoscopes. He, like many of those older guys, had had tuberculosis himself. He was just wonderful. I spent a month with him on an elective at the Veteran's Administration Hospital, which was 500 yards from the main university hospital. He was extremely kind to me. I was fairly sick and had another pretty severe bleed one day. My hemoglobin dropped quickly and I collapsed on rounds. I am very active now in the American College of Physicians, and part of that is because Dr. Campbell was an American College of Physicians supporter. He told me it was important. Dr. Ralph Tompsett pushed me to be active in the organization.

The internist who was my primary doctor while I was in medical school tried hard to take proper care of me. I think he thought I was manifesting drug-seeking behavior, which I was not. Perirectal abscesses are among the most painful things a person can have so I would respectfully ask for pain medicine. It was as though if you didn't have cancer, you didn't get anything more than Darvon. Once as a junior in medical school, he said, “We have to talk. You're talking like you are going to get through medical school.” I said, “Yes, sir, of course I'm going to get through medical school.” He said, “Look, it is part of my job to be realistic with you and try to get you thinking straight.” He thought it was extremely unlikely that I would get through medical school and that if I did, I could never take care of patients. His comments made me so furious that I was even more determined to make it through. I hadn't seen him in 30 years until a couple of years ago when I was leaving a large ethics session, one I presided over, at a national meeting of the American College of Physicians. After the session, he said that he knew there had to be some mistake, that it could not possibly be me up there. That was very gratifying. His comments when I was in medical school hurt. It was as if all my efforts were for nothing.

WCR: Did you have difficulty deciding what you wanted to go into in medicine? You mentioned earlier that you wanted to take care of the sickest people you could and certainly that is how you ended up. When you were in medical school, did you know all the way that you wanted to be an internist, or did you strongly consider other specialties as well?

LWK: During the academic year that I had to take off due to illness, I got a job in the blood bank at the university. I was cross-matching blood like I knew what I was doing. The criteria for doing that job back then were not very strict. The cross-match lab was next door to the cancer ward. There was not a lot you could do for those patients other than try to make them comfortable. I would hang out a lot in my white coat on that ward. The guys treating those patients were people who could not do much of anything else. They were not cardiologists, gastroenterologists, neurologists, or surgeons. They were guys who by default wound up taking care of a lot of patients with hematologic malignancies. Since most of the drugs would make white counts go down, they became experienced with patients with low counts. The hematologists became the oncologists. Even today there are not many physicians making a good living in practice doing “pure” hematology, such as anemias, leukemias, and coagulation disorders. You have to do some oncology. Many of the people who were seeing those desperately ill patients were the dredges of medicine of that time, with some notable exceptions. Oncology has really taken off since then as the fastest growing subspecialty in internal medicine. It is very respected now. You do some neat scientific stuff these days in oncology practice, but in the mid-1960s it was pretty crude. I decided that I wanted to take care of cancer patients and to try to bring state-of-the-art treatment linked with compassion to these patients and their families. Once I made that decision, I never wavered. I knew I wanted to do internal medicine as a stepping-stone into hematology/oncology.

WCR: Did you keep up your music in medical school?

LWK: Yes. I played at home. My mother always saw that I had a reasonable piano at home. I still do. I would play it almost every day, not because I was working toward a performance, but to relax and keep up my skills.

WCR: Did your two brothers also play?

LWK: Yes.

WCR: Did you sing?

LWK: I did more than they did. I have always sung in church. Each Wednesday night I went to choir practice. I rarely soloed. Although my mother was the main piano teacher in town, she didn't teach her children, which was wise. She felt we would do better being taught by someone else. My older brother plays by ear quite well. He can also read music easily. My younger brother plays pretty well. He didn't get into it quite as much as I did. I went after it pretty hard and still do. I enjoy it tremendously.

WCR: In high school you practiced how much each day?

LWK: About 45 to 60 minutes. It was customary for a serious high school piano student to give a solo recital as a senior. I told my mother I would be too busy when I was a senior so I did mine as a junior.

WCR: I gather Dallas had not played a part in your life until your internship. What were the factors that led you to Baylor in Dallas in 1971?

LWK: Richard Joseph! Because I had to drop out of medical school for a year, he finished ahead of me. He had interned at Baylor. I was planning to stay at the University Medical Center in Jackson, where I had gone to medical school, for my internship and residency, but Joseph said to spend the weekend with him in Dallas and interview at Baylor. It was a much sought-after internship, even back then, and it has gotten much more sought after.

Dr. Mike Reese was the director of the internship program, and Dr. Ralph Tompsett was the overall director of Medical Education. Reese was intimately involved with the interns and residents, and he was a hematologist/oncologist. I liked Reese and I liked Baylor, and I was absolutely taken with Dr. Tompsett. I was in the upper third of my class in medical school despite being out a good bit. I was surprised when Reese took me aside from the rest of the group and asked when I was going back. He asked if I wanted to make rounds with him the next day, which was Saturday. I said, “Yes, sir, absolutely, I would love to.” I borrowed Joseph's stethoscope and made rounds with Reese, which was an all-day affair. I kept up with him. I think he wanted to see what my physical capabilities were because he knew about my physical condition related to Crohn's disease. He also wanted to see if I knew anything. Worried to death, I didn't sleep that night. We made rounds and I was pleasantly surprised and grateful when I matched here because this is the only place I put down. I was planning to do the internship at Baylor and the residency in Mississippi, but Reese convinced me to stay for the residency and a fellowship in oncology and hematology.

In 1976, I had a faculty job offer at Mississippi after my fellowship, but the Medical Oncology Group was just beginning to form. We later changed the name to Texas Oncology, PA (TOPA). Reese was the only guy for a long time, and then Dick Williams joined him. John Bagwell joined them on paper, although he continued to work out of his father's office. I finished my fellowship on June 30, 1976, and went into practice with them, as did Lewis “Skip” Duncan, who did his fellowship at Southwestern Medical School. The 5 of us started the Medical Oncology Group that summer. It has grown enormously since then.

WCR: What was internship and medical residency like for you at Baylor? How many interns were in medicine then?

LWK: About 11, some of whom are still around Baylor and are quite prominent. The internship was very difficult for me physically. I was determined that I was going to do everything anybody else did and not ask for any dispensations. It was hard because I was beginning to get Crohn's arthropathy in my large joints. At that time, I had a colostomy with a mucocutaneous fistula, and I was always worried about getting another enterocutaneous fistula. Just the logistics of having a colostomy complicates one's life tremendously. I was on call every third night and had to run to codes. It was hard but I was determined to do it. The call rooms were old hospital rooms that didn't have baths in them. When I had the abdominoperineal resection, the colostomy was converted to an ileostomy, which is much worse because the output is so much higher and the frequency of leaks is increased. It was challenging, but I enjoyed the housestaff training. The medical attendings at Baylor were excellent. The ones I respected seemed to respect me. I got to know Jabez Galt very well. Jabez befriended me, along with a number of other people, and he was very supportive. Billy Oliver, George Carman, and John Binion were role models. Just the normal duties of being an intern and a resident, complicated by not feeling well and worsened by having to deal with the ileostomy, were challenging. I am proud to say most people didn't know I had any physical problems.

WCR: When did you get married the first time?

LWK: The lady who is the mother of my older children was at Ole Miss and was in premed. We got married around Christmas the year I had to take off from school. She was a graduate student at Ole Miss. I was down at Jackson and Crystal Springs. Our daughter, Elizabeth, is married to Dr. Steve Landers here at BUMC, and our son, Tr?, is a third-year law student.

WCR: You were only 21 years old?

LWK: Yes. We were married for about 10 years and had 2 children. I was single for a couple of years and then married a girl from Illinois who I had met at church, which does not guarantee the success of a marriage. We were married about 2¹/2 years and divorced. I was single again for about 2 years.

Connie is a Dallas native. Her maiden name, which she uses professionally, is Coit. Her grandfather's family were some of the original settlers in Dallas. She lived in New York for about 8 years before we met, working in “the business,” and was pretty successful. In 1986 a new theater opened here in town, and she was invited to come as a guest artist and do Mabel in Pirates of Penzance. I had supported that theater because I had some friends on its board. On the opening night of Pirates, which was the inaugural evening for that theater, I was there with a date. My best friend's son was Connie's co-star. My best friend's wife had been Connie's voice teacher when she was in high school. They all wanted me to meet Connie, who, I believe, was very skeptical of meeting me because I had had 2 children and 2 divorces and, furthermore, wasn't much to look at. Although she and I are the same age, she looks 20 years younger. We met that July night and got married the next December. She went back to New York after the 6- to 8-week run of the show. I started going to New York as often as I could. We kept her place there, which we have since bought as a co-op apartment. It's nice to have since I'm in Philadelphia a lot, and it's easy for me to catch the train and go up to New York. We got married 14 years ago and very unexpectedly had our little boy, Ben. He will be 12 next month. He's a lot of fun. It's good for his grandparents to have him around and good for us too. I am a better father this time.

WCR: Let me ask you about your hobbies. Your home is just loaded with books. Obviously, music plays a big role in your life. Your wife is an actress, and theater has been important to both of you. Tell about your nonmedical activities.

LWK: I am very interested in politics, which I follow closely. I am a Democrat physician in Dallas, Texas, and that is kind of an endangered species. My church work is important to me. I have always been involved in the music programs of whatever church I was in, and I continue to do that. I am in the adult choir and play the piano occasionally at the Highland Park United Methodist Church. I grew up Baptist, but now I go to a Methodist church. Connie was placed on the cradle roll at Highland Park United Methodist Church when she was born. When we got married, I was actually Presbyterian. Although Connie put no pressure on me, I decided I would offer to go to the Methodist church so we would see her parents more. It has worked out very well, and we have some very good friends there.

I like sports, but I am not rabid about them, which is a good thing because my physical condition would not allow that. I follow football and baseball. I am very interested in history and book collecting. A lot of what I have is nice collectable stuff. I love to read. I try to be very involved with my son's activities. My father was not able to do that much with me and I didn't, for whatever reason, do as much as I would have liked with my older son and daughter because I was establishing a practice. I should have spent more time with them.

I am honored to be a member of the Players Club in New York. In the 1830s and 1840s, John Wilkes Booth and Edwin Booth traveled around the country in stagecoaches doing Shakespearean scenes and things like that for 2 or 3 days in each town. About every 2 years, they would return to New York and do plays there. When John Wilkes Booth shot Lincoln, the rest of the Booth family was devastated. Edwin Booth, the spokesman for the family, withdrew from the stage for about 20 years and wrote an impassioned, heartbreaking letter to the American people apologizing on behalf of the Booth family for what his brother had done. He eventually returned to the stage in about 1892 and formed the Players Club. Other founding members included William Tecumseh Sherman and Mark Twain. They met in Mr. Booth's house, which bordered Gramercy Park, the only remaining private park in New York City. They had keys to get through the gate, and no one else could get in. One reason Booth wanted to form the Players Club was to increase the community's respect for actors by having the actors associate with physicians, lawyers, and clergy, people like that. Actors were looked down on at that time. They were considered “show trash.” The Booths, however, were at a higher level than most actors. This wonderful 5-story brownstone on Gramercy Park was bequeathed to the Players Club. It is a beautiful building, and Edwin Booth's bedroom is preserved just like it had been. James Cagney, Leonard Bernstein, and Helen Hayes have all been members.

One category of membership is called “Men of the Theater.” Because I am a patron of the theater and because of my wife and her friends, I was considered eligible for membership, and I was fortunate to be elected to it. It is a lot of fun. They have the largest, most comprehensive theatrical library in the world in the building. For decades it was a gentleman's club, but it has had women members now for several years. Helen Hayes was the first woman member. They have a wonderful chef. When we are in New York City, we often have lunch and dinner there. They have a marvelous New Year's Eve party every year. There is also a Founder's Day party. Sometimes I end up playing the piano while everyone stands around and sings. For a little boy from Mississippi, that is “high cotton.” Music and theater really consume a lot of our interests.

One member of the Players Club is Sidney Zion, a journalist in New York who has written many editorials in The New York Times over the years and the definitive biography on Roy Cohn. About 10 years ago his daughter, Libby Zion, showed up at the New York Hospital in the middle of the night just crazy out of her head. She died without the attending doctor coming. She had been seen by the intern and, briefly, by the resident. The hospital claimed that she died of a narcotics overdose, and Sidney Zion said there was “no way.” A big lawsuit ensued, and it led to the establishment in New York State, and later in other states, of limitations on how long interns and residents can work each day and week.

WCR: Lloyd, tell me about your activities in the American College of Physicians. How did you get involved so deeply with that organization?

LWK: Dr. Ralph Tompsett was the most important mentor to me in my professional life and, indeed, in my entire life ranks second only to my father in influence. Dr. Tompsett was one of the early workers in penicillin and isoniazid, and he made the Baylor training program in internal medicine what it is. It was rudimentary before he came. He was always very good to me, and I just revered him. I was honored to be one of his 2 physicians toward the end of his life. When I was a resident and would rotate with Dr. Tompsett, he would talk to me about the American College of Physicians. At that time, he was in major national leadership roles. He had been the Texas governor of the College, regent of the College, and its national vice president. He was granted a mastership in the College, which is a rare honor.

The state regional meeting of the College was here in Dallas in 1973 when I was perhaps a first-year resident rotating on his service, and he said: “I'm going to be at the Fairmont Hotel today for this meeting, and you should come and participate in it.” There were probably about 30 doctors there from all over the state. The next time it was in Dallas, about 3 or 4 years later, Dr. Tompsett was chairman of the program. I had just finished my fellowship so I was fairly young to be involved. He told me that the College tried to maintain the highest ideals of medical practice. It was not a trade association, but an organization most interested in what was best for the patient. It was an organization that he felt good about, and he put in a great deal of time in it. He encouraged me to be active in the College. I would do anything the man said, and I became active, going to all the regional meetings which rotated among cities in Texas with medical schools. I think it was Woody Allen who said, “Ninety percent of success in life comes from just showing up.” I was always there, and when I was asked to be on committees, I always did it willingly and tried to do my best. Eventually, I was elected to the board of directors several times in succession and was nominated to be governor for northern Texas. I was defeated, however, the first time I ran. Eventually in 1988, I was elected governor and at that time was the youngest governor they had.

I have been in national leadership positions with the College for 10 years. I served my time as governor and was privileged to have some wonderful patrons among the older men in the College: Clif Cleveland, Ralph Wallerstein, and Willis Maddrey, for example. I got to know all the presidents quite well. Again, it was a question of being there. When I was asked to do things, I did them. I was privileged to serve 2 terms as chairman of the national ethics committee. That is a very prestigious, autonomous committee that churns out an ethics manual every 4 or 5 years. I was chairman of the committee when the last one came out. The College is probably the best organization to try to preserve the interests of patients—high standards and ethical practices. In future years with more managed care, it is going to be a struggle to maintain those interests, but the College has always embodied all that is good in medical care. That is why I have spent a heck of a lot of time with College activities. I am now a regent, having just been elected to a second 3-year term. I have about 2¹/2 more years of eligibility for involvement in the national leadership. I have really enjoyed it. If my health had been better and I could have met the physical demands, I could have aspired to be president of the College.

WCR: Lloyd, could you talk a little about your German interest? You mentioned how in college a German instructor was so influential, and your wife has been involved in theater work in Germany for some time.

LWK: A number of my fraternity brothers at Ole Miss took German. I knew that there had been a lot of scientific work done in Germany and published in German. I had studied Latin in high school, and that experience helped me tremendously. I liked languages already, but this professor at Ole Miss was charismatic and turned me on to German. I did well in it and received a German government prize, which was not a big deal. It was a 2-volume set of Schiller's Works for being an outstanding student in some aspect of German studies. As an outgrowth of that, I was offered a year-long opportunity to study in Germany with most of my expenses being paid by the German government. I decided not to go because I wanted to go to medical school.

Other than visiting Germany, I always kept up with my reading. I have always tried to read a little bit of German every week. I subscribe to a volume called Amerika Woche, which is a German-language newspaper written for Germans living in the USA. It rehashes the latest news in German so it is easier to read because I kind of know what it is going to say; that helps me keep up.

Connie went to Germany right after she got out of SMU 30 years ago and studied opera there for about 3 months. Connie's mentor is a Broadway conductor, Jack Lee. He directed the music for most of Tommy Tune's shows for years, such as My One and Only and Grand Hotel. Our little boy's middle name is after him, Benjamin Lee Kitchens. We are the closest thing he has to blood relatives. He is very protective of Connie. He seemed to approve of me when I came along because I played the piano. I told Jack and Connie that I would never do anything or ask Connie to do anything that would impair any professional opportunity she might want to pursue. She was surprised when she got an offer to do this very lucrative job in Germany. I encouraged her to do it. She didn't do it for the money, but they pay Americans with New York experience who can speak German extremely well. It is hard work. The Actors Equity union does not function over there, and they do not take very good care of the actors. At any rate, her working periodically in Germany for 4 years fit right in with my interest. Every time she went over for 3 or 4 months, I would go over at least twice and try to learn the language better. I can read it fairly well and speak it moderately well. Connie can speak it fluently, although she does not read it that well. She has never studied it. In recent years, one of my historical interests is the Nazi physicians. They went from being the cream of the crop in the world at the turn of the century to apparently espousing what Hitler said and turning their interest to how to kill people. I have been fascinated by that and by German literature. I have taken 3 different courses pertaining to German culture taught by Dr. Peter Mollenhauer at SMU. We have discussed the German perspective, which is quite different from the American.

WCR: Lloyd, thank you for sharing some of your experiences and thoughts with me and the readers of the BUMC Proceedings.

LWK: Thank you, Bill.