one of those fancy places, because they are too staid.
Here, they cut me enough slack and provided enough
helpful criticism, as opposed to obstruction, that we
were actually able to do it. I don’t think there are
many other places in the world where we could have
developed this field.
Looking back, do you think you could have
worked at one of those more established institu-
tions? Did you make a personal choice to take a
chance and go to San Francisco?
No, I actually scouted [them] out before I took the job
here. I thought that this type of research would be
possible here, not necessarily because of surgery, but
because it had lots of resources, the kinds that would be
needed to develop this field. I knew the Harvard system
very well, and some other systems a little bit, enough
to know it would be exceedingly difficult or impossible
to conduct this type of research at those institutions.
How long did it take to prepare for your first clini-
cal patient (a child with a urethral obstruction)?
How did you go about it?
It took about four years. We set some standards for
ourselves. We knew it would be such a fragile enterprise that if we had any bad experiences, we would be
finished. We had to do it in animals first. We had to
do the maneuvers in the most difficult animal model,
non-human primates, to show it would be okay for the
mother, that we could do what we intended to do surgically. So we had fairly high marks before we could
offer it to the first patient.
Then, of course, we faced the huge problem of convincing our obstetric colleagues that it was the right
thing to do. This could have been a real turf battle.
“That’s my patient you are operating on! You don’t get
How were you dividing time between animal ex-
to operate on them, that’s my business!” The pieces we
needed in place were helpful, or at least tolerant, team
members, including obstetricians, pediatricians, and
periments and working on your patients?
Well, I was young enough to do both. I had been pretty busy from the start because I had joined a pediatric
surgeon who previously had a solo practice at UCSF.
It was just the two of us for around 15 years. We had a
busy practice of wonderful, top-flight cases, referrals,
and congenital conditions, as opposed to routine bread-and-butter operations. I was busy all the time. Then you
would get to the questions I asked as a clinical surgeon.
The way we swung this deal was that the obstetricians and the neonatologists had a weekly meeting
to discuss their problems. At the time, not many diseases were recognized in the fetus. So I started going
to those weekly meetings and forming relationships
with the prenatal diagnosis physicians, particularly
those who performed sonograms. Then, we would
say, “My gosh, this fetus looks like it has something
we typically see after birth and that we correct surgically.” Then I would start suggesting that maybe we
should fix it. I just hammered everyone about it for
several years in those meetings until they started saying, “You know what? We are kind of thinking about
fixing that.” That’s how we actually swung it—by
attending those meetings and talking about specific
cases. If you had a child and a family who now had a
diagnosis and you were debating what to do, how to
deliver him and so on, then people could rally around
specific clinical problems.
How were you funding that early research with
animals? Large animal research is very expensive.
It wasn’t at that time, surprisingly. It is incredibly expensive now. I came into a system in which people were
doing large animal physiology all the time, almost