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Interview with R. Bertram Williams Jr., May 10, 2004 | UNCW Archives and Special Collections Online Database

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Interview with R. Bertram Williams Jr., May 10, 2004
Date:
May 10, 20
Phys. Desc:

Interviewee: Williams, R. Bertram Jr. Interviewer: Mims, Luann Date of Interview: 6/9/2004 Series: SENC Health Services Length 100 minutes

Mims: Today is May 10, 2004. I am LuAnn Mims for the Randall Library Special Collections Health Services series. Today we're talking with Dr. Bertram Williams. Good morning.

Mims: Well, we'd like to start off by finding out a little more about your personal background. Can you give us an idea of where your family was from and what they were doing?

Williams: Yes, I'm a native Wilmingtonian. I was born here in Wilmington on July of 1920 and stayed here all of my life except during my education period and during the Second World War. My home was on Third Street. The building is now gone but it was next to the corner of Third and Grace where the Wachovia Bank Building is at the present time. My mother was a homemaker. She was a Sutton and was raised in the Suttontown, which is in Sampson County. The name of the area is named after their family.

My father was born and raised in Duplin County on a road now, which is named after his grandfather in Duplin County a few miles from Kenansville. My father was a wholesale merchant and sold what they called at that time dry goods and notions. As I said a while ago, my mother was a homemaker. My family was living between Second and Third Street on Red Cross at the time I was born, but they were in the process shortly after that of building the home that I was raised in and lived most of my life here as a child at Third and Grace.

I attended Hemenway School for my grammar school and one of the principals at that time was Mr. Bryce. Mr. Bryce was principal of both Tileston School and Hemenway School and I remember he would go to Tileston School and tell them how good the Hemenway students were doing and he'd come to Hemenway and tell us the same thing. I went through grammar school and then went directly into New Hanover High School, which was the only high school in the area at that time and finished high school in 1936.

I went one year to the Citadel in Charleston, South Carolina and by that time I had decided I wanted to go into medicine and I thought I should go to a university that had a medical school so I transferred to the University of North Carolina in Chapel Hill and stayed there then for my sophomore, junior and senior year. I went to medical school there in Chapel Hill for two years and then transferred to Vanderbilt University Medical School.

I finished college in 1940 and during my first part of my medical education, World War II started and I was in part in the naval program they called V-12, which deferred you while you were in medical school and made you eligible to go into the service as soon as you completed your studies for a nine-month internship. I finished medical school at Vanderbilt in December of 1943 and I had a nine months internship and then went into the US Navy.

I was immediately transferred in to the Marine Corps and sent to Camp Pendleton where I had a few weeks of training there regarding medicine that would have been done in the Pacific and were shipped out of Camp Pendleton to Saipan during the Mariana Campaign. Saipan is just a little bit north of Tinian and Tinian is where the big airplanes flew up to Japan and that's where the atomic bomb originated from Tinian.

We stayed on Saipan Island. The Iwo Jima Battle started. We were reserves for the Iwo Jima battle but I did not go ashore. We then were involved in the Okinawa battle. Our division was doing a faint off the end of the island and the APA on which I was located was hit by a kamikaze plane and we had to abandon it. Had a number of casualties because the plane went into the engine room and exploded in that area.

After the war, as did the Marines, all my time during World War II was with the 2nd Marine Division, 2nd Regiment. We went into the Kiuchi Island of Japan, which is the southernmost island and occupied that until I was discharged for the purpose of us finding all the armaments that could be used in battle and we put them on a barge and took them out in the Pacific Ocean and dumped them in the ocean.

When I was ready for discharge, I was sent back to the States and went to Camp Lejeune and eventually transferred up to Norfolk and was discharged from the Navy. I went back to Nashville, Tennessee where Vanderbilt Hospital is and started my residency again there. I'd already done the one term of internship and I stayed there for four years until I was senior resident at the Vanderbilt Hospital in Surgery. By that time the Korean War was going on and I was called back into the service. This time, however, I was stationed at US Naval Hospital in Memphis, Tennessee and was in the surgical department there and had a very active surgical period during that time.

Mims: Well let me ask you, what was your capacity while you were serving in World War II? You were doing medicine at that time?

Williams: In World War II, I was a battalion surgeon, yes. I had my degree so I was called a battalion surgeon assigned to a regiment in the 2nd Marines regiment and stayed with them the whole time I was out of the states.

Mims: So you moved with the troops?

Williams: Yes.

Mims: So it was like a field hospital setting?

Williams: Well, at the time there was a little field hospital. During the interim between that period, I was stationed right with our battalion of which I was the battalion surgeon.

Mims: So incredible situations as far as how do you get your men taken care of.

Williams: Well, you got to know those people pretty well cause you live with them all the time and it was a lot of nice people. Once of the interesting officers was a Marine officer assigned to our group. He was a junior officer who was brother of Charlie Justice who was a big star up at Carolina so I enjoyed having some time with him. We were about the same age. I often wondered what happened to him. I hadn't heard from him. I had heard Charlie Justice died not too long ago.

Mims: Yeah, didn't they call him Choo-choo?

Williams: When I was discharged from the Navy this time, the naval hospital during the Korean affair, that's when I decided to come back to Wilmington and that was in 1951 and I've been here ever since. I practiced general surgery as well as thoracic and vascular surgery until I retired in 1991. Since then I've been quite active. I have a little piece of land that I work on and I enjoy that and that's essentially what I've been doing.

Mims: What do you think led you into medicine? You said that after the Citadel you said that you wanted to pursue medicine.

Williams: Well, I got interested in medicine back before that time during high school. I've always liked to see things grow and take care of animals and that sort of thing. I've always had an interest in both plants and animals. I just made up my mind for sure during that first year. I was very happy because I liked it very much. You're private the first year so the highest office you have in your second year is a corporal. You can be a sergeant the third year and can be a student officer the fourth year.

But I was appointed as a corporal the second year, but of course I did not go back to take advantage of that. So my record down there wasn't too bad. I really enjoyed the military part of it, but figured I'd better transfer, which I did. Well, it might have worked out if I had completed at the Citadel, but I thought my chances were a little bit better getting into medical school.

Mims: Well, this was a time of iffy economy that you're talking about. We're still just trying to come out of it - the Depression. Economics was not a question for you?

Williams: Well, I lived through the Depression. That's one of the things that my generation was affected by. We never quite forgot what happened during the Depression and we always kind of had that in our background and were programmed through that sort of thing. My father was a very good provider and we always had everything that we needed. We weren't wealthy by any means, but we certainly were not paupers. We had a very nice home. As I said he was a very good financial provider and a good family man so we didn't have a major problem. However, I did go with him a lot during his travels in the summertime.

He would always say that he could take me with him and he knew I wouldn't be in trouble some other place. So it turned out to me to be very well because he knew everybody in southeastern North Carolina who were in the mercantile business. So I got to travel with him and visit all these men that owned stores in these areas and didn't realize how important that was in that time. But looking back on it after I got through, I knew all the areas around southeastern North Carolina, knew who the merchants were and a lot of them I knew very well, I knew the details about them. So it turned out to be a very pleasing thing and I think of that quite often.

Mims: Well, it may have influenced too with outreach to people. You can do it with medicine with people in that way too.

Williams: But no one in my family had been involved in medicine before. I was the first one that did that. And it's rather odd. I did show some interest along that line and my father who was a very good businessman. At that time, of course people had not had that much formal education, but they had a lot of good common sense and they took advantage of that. When he found out I was interested in that, he encouraged me a lot. But you have to do that yourself too. You've got to get into school, then you've got to do all the work yourself too, but you always know that you've got support at home and financial support if necessary and need it.

Going through college at that time at Chapel Hill was entirely different than it is now. You could go there for a while year for about $500. Of course that was a lot of money back then, but not nearly as much money as the big numbers they mention now. And going through the residency program at a teaching institution like Vanderbilt Hospital, you did not receive any money because it was part of your education. So for my internship and my first year assistant residency and second and third year residency, that was all without compensation. Now all those people are compensated really with a living wage.

I was very frugal though and I hear now that so many students get through medical school and through college and they owe a lot of money, but I didn't owe anything. Because I lived very frugally and I worked out well and of course my parents supported me as far as tuition, even in medical school and that sort of thing. My senior year in medical school I lived at the St. Thomas Hospital in Nashville and I did physical examinations for new patients. For that they gave me room and board so there was very little expense except for tuition in my fourth year of medical school.

When we were in Japan in occupation after the war was over, we had a lot of time on our hands at night. As a junior officer there were a number of others in similar situations. They were not doctors, but there were intelligent, pleasant, nice, young men and we would get together in a Quonset hut every night, I oughtn't to put this on tape but I will, we'd play poker. I turned out to be pretty good at that and I was always able to send money home and my father would put it in Carolina Savings and Loan at that time at the corner of Second and Princess. So when I came home and as soon as I changed my yen into greenbacks, there was no gambling, I've done no gambling since that time.

But that was money that we had and when I got married in 1946 and was in the residency program, that's the money that we used to live on for most of those four years. My first child, a boy, was born a year, year and a half after we were married in 1947 and my wife who was a surgical nurse and who was working for the first the year and who helped support me along with my gambling savings was retired then and she was a full time homemaker from then on and eventually gave me a nice son born in about 1950 and she's done a very good job of raising those two.

Did it all herself because most of the time they were young I was working and they'd be asleep when I left and when I got home they'd be asleep too so I give all the credit to her.

Mims: How did you meet your wife? Was it overseas or what?

Williams: Well, she was a surgical nurse out at St. Thomas Hospital. I was living in some quarters at St. Thomas Hospital doing the physicals at that time and I met her. We had to walk through the surgical department going to the quarters and I saw this very good-looking young lady working there and that was our contact. I eventually brought her home with me and we've been married since 1946, which is a good number of years.

Mims: Congratulations too. That's a long time. You hear a lot of talk now about the long hours that residents need to put in, a controversy about whether that's really good for a patient/doctor situation. What were your residency hours like?

Williams: It's difficult for lay people to understand that young physicians take this for granted. It doesn't disturb them as much as it disturbs some of the others. When we were taken on as a member of the surgical department during our residency training at Vanderbilt Hospital, we were taken on for a while year. There was no time there for a vacation. And it was a 24-hour day and a 7-day week. If I wanted to leave the hospital to go to a movie or something, I had to get one of my colleagues to cover for me while I was away.

So my job was for a year and every minute of that year when I did get out and of course at that time you did want to get out a little, but I had to get someone to cover me. Unless I was able to get someone to cover me, I couldn't do it. The rest of the time I was available and working, we didn't have the hours. That's not what we were there for. I was there to learn and the more I could be there, the more I would be associated with and the better the learning would be.

Our Chief of Surgery would not hire a married house officer. Everybody had to be single. He said your full time interest should be medicine and if you were married you had to divide that and that's not what he wanted and he wouldn't hire you if you were married. Now after the war that changed a little bit because so many of the men were coming back looking to complete their residency. They'd been interrupted by the war and of course they were a lot older then and a lot of them had been married so he mellowed a little bit about that at the very end, but that wasn't very long because he retired just a few years after that.

Mims: And this is at a time when there were no cell phones, no pagers either, which has been a device that physicians used to be able to move out of the hospital setting. Was it word of mouth contact or did you just have to stay there by the phone. How would they alert you that you were needed?

Williams: Well, in the hospital we had a paging system. Of course I lived in the hospital, had a room in the hospital, all my meals were in the hospital. I had a telephone in my room so they could reach me at any time during the night and of course we were associated with medical students too so we were responsible for them and part of our job was teaching of the students. When you left the institution, you had to have someone to cover for you in the hospital. They couldn't be at home. They had to be in the hospital, otherwise I couldn't leave.

Mims: So you were in the hospital.

Williams: There was always somebody covering for me when I wasn't there and I covered for other people because we reciprocated to get that done. But at the most during the week I might leave for a couple of hours, the rest of the time I was there. And no pay associated with that because it was an educational process. You consider now if you go to college, you don't pay the university for teaching you, I mean they don't pay you for teaching you, you have to pay them for learning. At that time they looked upon the medical program and the residency program the same way. But that's changed now. They have a very good living wage.

I got through without owing any money and what was a big help. I understand that's not true now. People owe a lot of money when they get out of school. I've always thought part of that was not living as frugally as they could live. They wanted to live at a normal good level like they would at home and you can't do that.

Mims: Well it seems like maybe the discipline has changed a little bit. What led you into surgery specifically?

Williams: Well, if you look in the medical profession there is something in it for everybody cause you've got so many different specialties like dermatology, ophthalmology and ENT and general surgery and then you have all kinds of subspecialties. If you look at doctors pretty closely, you find out that they're doing well and enjoying and have been attracted to things that fit into their personality. If you look at a dermatologist for example, they're very good, they're very knowledgeable in their field, but they're not people that want to stay up all night and they don't want to be under a lot of stress and a lot of them would just not be interested in all of that. The same thing is true about other kinds of physicians.

I've always generally had an aggressive type personality. I've always liked to do things and I liked to get immediate rewards from it. I think that's probably one thing that attracted me into something where you could get some individual that was extremely ill and involved in a very serious illness and you needed to take care of him in a proper way and you'd get him well and that was what I liked to do and I enjoyed it. It was a pleasure for me to do that. I was always complimented when a person came to me for attention because they had a wide choice out there and I thought it was a compliment for a patient to come to me and want me to give them the care.

After so many years in practice here I had become part of a family of so many different families in the area, they depended on me to give them my services and I felt responsibility for taking care of them and it was a fine mutual arrangement. I always looked at my work not as a money job, but as a job of service and if you performed good service and good quality of care and the best you could do and honest care and tell them all the truth, it was very gratifying and people generally appreciate that kind of relationship.

People would ask me real often - do I miss doing surgery - and I'd say well I did a lot of emergency work, I rarely ever slept through a night without a telephone call and more than half the nights, had to get up during the night and had to go in and do something and frequently when you're involved with a surgical problem in the middle of the night or an auto accident or someone has a major catastrophic event that occurred and it takes the rest of your night to work on them so you start your next case, so you started at 7:30 and I usually got home oh at 9:00 at night.

A lot of that kind of thing, that middle of the night thing and the calls in the middle of the night. But I do miss my close relationship with so many nice people that I dealt with over the years and worked out such a good relationship with. I like people and I do miss seeing those people regularly.

Mims: When you started your practice in Wilmington, about how many other surgeons were there, can you recall?

Williams: It was an entirely different situation from now than it was at that time. The heavy training of physicians was getting started at the time I was in my program of training after getting an M.D. degree. What we call now the Boards, the Boards were started and they set a certain minimum amount of training that a person could have to go into training.

For example in my area, you would finish medical school and to get your boards, which is the recognition of the training that you've had, it required five additional years after medical school. Your fifth year you had to be the senior resident in a hospital, all of which I did. Then you had to take an oral and written exam to have what you call or be a member of the American Board of Surgery. Of course I wanted to get that and did work on that and did get that.

I came back to Wilmington and there were two other people who had their surgical boards here. One was Dr. Koonce who had lived for a good while and he was a very excellent surgeon and the other one was Dr. Watts Farthing who got his training at the Mayo Clinic. I was the third once. Since then we've gotten numerous ones, extremely world trained, people well fixed here in Wilmington with qualified physicians and surgeons.

But when I came here the Medical Society in this area was Pender County, New Hanover County and Brunswick County were in the same group. As I recall there were probably 35 or 40 doctors here out of those three counties. When we would meeting at the medical society meetings once a month at the Cape Fear Club, we could all get around a big table, which was present in the Lord's Room up on the second floor and I often thought if somebody put a bomb under that table and let it go off, it would wipe off the medical profession in southeastern North Carolina.

But after I came, we started getting very world trained young men coming in. Prior to that time, the requirements were not the same to perform medicine so the specialties were not developed to that extent. The quality of the men that were here at that time were very good for their time, their training was not equal though to the training we have at the present time. But they were all very good doctors. Wilmington has always had a high quality of care compared with other areas of a comparable size.

Of course when James Walker Hospital was completed in about 1901, it was the envy of the whole state. It was the nicest hospital at that time but like everything else, after a period of years where things had improved in other places, this hospital was active and gave most of the medical care for southeastern North Carolina until the new hospital was built and occupied in 1967. So for about 67 years it was the hospital in this area.

It was also one that trained nurses. They provided nurses for southeastern North Carolina too. The nurses at that time lived in the building, which was still present, down at 11th and Red Cross Street and that building is still there. They lived there and it was right behind where James Walker Hospital was. They got their training and were surrounded by hospital activities and they knew everything that was going on and a lot of things rubbed off on them that they weren't taught in class. They got a lot of classroom teaching too.

But these turned out excellent practicing nurses. Some of them are still around and I think you've interviewed some of them already. They were very, very world trained and performed so well at the bedside. Nurses at the present time have a lot more book learning because they have a lot more technical activities to do and technical equipment and a lot more is known now about medicine than was known back in the days of the old James Walker Nursing School.

Mims: Well, I was wondering since they were trained at an institute versus now it's an academic learning environment, I know that the nurses still get clinical, but like you said the James Walker and the community nurses were exposed to the hospital setting at all times and they became part of that environment at a much quicker pace because of that.

Williams: Yes, it gamed an entirely different atmosphere for those girls. They were surrounded by medicine. They lived that for their three years of training. They knew everything going on with the hospital. Their friends were working one shift and they were working another so they all lived together so they all were swapping stories. And they were required before they graduated to be the head nurse in a ward, on a floor and be in charge of that floor.

Of course they had back up RN nurses there, but that was experience for them and when they got out they just kept on doing the work that they had been doing in the senior year as a student. The only difference was they did it as a learning process in their senior year and once they graduated, they got paid for doing the same kind of work. They had time to decide what they were interested in, what kind of nursing they were interested in and they generally would take their special period during their senior year in the things that they liked to do.

Some girls were attracted to the operating rooms and they would go ahead and do that in their operating room and as soon as they graduated, they continued doing the same thing they had been doing, but as I said they got paid for it before. But they were very well trained from a practical standpoint.

Mims: You were talking earlier about the board certification for surgeons. Prior to that, how would one put out their shingle, so to say, as a surgeon, or was it as a general M.D. that also did surgery?

Williams: Yes, well, it was much difficult back before what they call the Fleming [Flexner] report. It was recognized that the best medicine in the world was performed in Europe in that area. The real good training surgical program, the residents were also required to go abroad to either Germany or Austria or France and take a year's training over there because that's where the best quality of medicine was practiced. The physicians and people in charge realized that we were not the best in the world and so they set up a study to find out why we weren't and what we had to do to get our standards as high as it was in other parts of the world. I think that was called the Fleming report. [Flexner]

After the Fleming [Flexner] report came out, all of the medical schools started trying to adjust to that form of training. What they required then was a full time medical school with people who were dedicated to teaching in a certain specialty so the students would be taught by that quality of individual. They were required then to have periods of training to get your M.D. You had to have full time teachers in the medical school. Prior to that time, the teachers were people who were practicing medicine in the area and their prime interest was in their practice and their office and what they did on the side was teach a course at the medical school.

When all the medical schools got that report and they started trying to adjust to that, of course Vanderbilt Hospital and Vanderbilt Medical School in Nashville did the same thing. And that's the way they got full time professors in all the medical schools and the whole quality of training improved and changed for the better and very shortly after that the best quality of medicine in the world was practiced in the United States and that's remained that way since then. You get the best quality of medicine available to you here in the United States.

Mims: That's interesting. I wondered how that evolved because you read about some of these old time physician, I'm talking like Dr. Thomas Fanning Wood, who read with another physician and just learned medicine that way almost like a hobby with no formal training. So I wondered how that evolved into what we have now.

Williams: Yes, at Vanderbilt School of Medicine, the built a whole new medical school at that time. They hired full time professors and the Chief of the Surgical Department when I was there was the one they hired, Dr. Barney Brooks, he was a full time teaching surgeon, an excellent teacher. He came from Washington University in St. Louis. I think that's Barnes Hospital I believe. He came there as their first full time surgical professor.

His first full time senior resident was Alfred Blaylock who left Vanderbilt several years after that and became Chief of Surgery in Baltimore at Johns Hopkins Hospital and the one that developed the Blaylock operation for the heart for children. That's when vascular surgery got started. Then other full time men were hired as assistant professors and associate professors.

Mims: So you're an output of this change?

Williams: Well, that change had already occurred, but it had not been very long. We still had some of the aftermaths of that. It was a big honor for a physician practicing in Nashville, Tennessee to be a teacher at the university in addition to his practice. That was kind of a little star in his crown. Well, when this was all changed, he no longer had that affiliation. He still had his practice, but he was no longer a teacher because all the teachers were then full time men who dedicated their whole profession to teaching.

Some of the people resented that and by the time I got into my surgical training out there, there were a few of those people still around and there were a few of those people still around and they were not very happy. But there were some that understood that and realized it was the right thing to do and were very sympathetic and they were very big friends of Vanderbilt.

That was in the periphery. I could feel that, I knew that was going on. I remember that and it lets me know what must have happened at the immediate time that occurred that created a lot of friction there but somebody must have been strong enough to do what was right to be able to stand against that and stand up for what they thought was right and that led to the quality we've got today.

Mims: I was going to ask when you arrived here as a young physician, did you meet the same kind of situation here with some of the older physicians?

Williams: That big change occurred after I got here. The surgical department was made of the people, a number of people who were very good surgeons. They had a wealth of experience and they were excellent surgeons. Some of them had big enough practices where they did surgery and surgery alone. But a number of the ones that were in the surgical department did other things too such as general practice and just did surgery on certain occasions.

As I said there were only two people who had their boards. Shortly after that, the Board of Trustees of James Walker Hospital realized that they had to reorganize all their medical staff and they got some consultants down here who were very similar to what happened on a national level who advised them how to get it organized and reorganized. Now to get privileges at the medical center and that's a carryover from James Walker, the same thing is true at James Walker, you've got to have either qualified or have your boards in the specialty in which you plan on practicing.

So it really gets down in an area that the quality and the demands on the training of positions are due on the hospital requirement in the local area. The state only requires that you get an M.D. degree and you have one-year internship. Then as far as they're concerned you can do anything you want to do. But the hospitals will combine what you're able to do. Its very much confined here to what you are capable of doing, what you can do well and you have privileges that are specifically set in what you can do here in this institution. It's very high organized at the medical center here.

Since the time that I came back and we had only 35 or 40 positions in the area, I think there were about 600 physicians here at the present time, all the specialties and most of the subspecialties are covered by well trained young men, average age of a physician in Wilmington is very low so we're fixed for a long period of time.

The reason is because our new hospital has abstracted so many people coming in and they're all coming in out of the residency program that they have completed and it makes the average physician age very low which is excellent or our area because that means we're going to have these covered specialties for many years in the future. So we're in very good shape here with a progressive and aggressive hospital as far as getting new things in and we're very fortunate.

Mims: What was the old James Walker facility like? Can you give a description of what the surgical area was like?

Williams: Yes see when I started…well let's get back to the beginning. When James Walker, who was an architect in Wilmington, decided a hospital needed to be built in this area we had a number of smaller hospitals in our area, none of them very well developed and he drew up the plans and got the land and drew the structure of the hospital up and started building the hospital, which I think was 1901, I believe it was completed. And he died before it was opened by the way so he never got to see it at a completed state.

As I said a while ago, it was THE institution in the state. It was the main, the hospital he built was the main central hospital and there are many pictures of that. They've got some in front the medical center at the present time. It was several stories high and the operating room was on the top floor. We had no air conditioning at that time and so the operating rooms were always placed high up on the floors because they had to open the windows to get air circulating through the operating rooms and of course the air brought some bacteria through and you had an open wound so the higher you got the less chance you got of getting an infection.

Down low of course you would have all the vehicles and the dust and all that sort of thing. So there were two operating rooms up on the top floor of James Walker Hospital. They stayed there until the annex was built to the south end of that institution. First the Sprunt annex was built when the Sprunt family realized that we needed something special for women's and children's care and they gave money to start that annex.

Later on during the war we needed more space and they built out of wood an addition to the southern part of the hospital, which was where they put the new operating rooms which was again on the top floor, but by this time, shortly after that at least they got air conditioning, but I think at the time they were built they did not have air conditioning. It was added later.

But still it was on the top floor so you could open the windows. That was what was available here and they were modern for their day. They would be antiques now, but for that day they were real modern and a high quality of care was performed for that time. When the new medical center was built and occupied in 1967, there was a big transition then. The doctors were asked to discharge as many patients as they could to get home to keep it down to just the people that had to be in the hospital.

The whole community got together particularly the funeral homes or their ambulances and that sort of thing and everybody contributed their time and their care and all of the expenses to transfer those patients from James Walker to the new medical center. It was all done in one day and I don't think it took but a few hours to do it. It was a community project. It was done with no mishaps; nobody had any major problems there. We had good people getting them started and good people to receive them when they got there. So that was a very, very good transition.

Mims: Can't even imaging something like that happening today. It seems incredible.

Williams: That hospital was wood and of course if you got down and lifted the floors, it was like a ripple, like looking across the ocean when you had small waves across there. But it worked. People wanted to give the care. You can give good care in an old building as long as you have the right people and the right tools to work with.

Mims: I understand it was a positive thought for most people practicing at James Walker that this new facility was being built. Was that your idea as well, that it was good to have this new building instead of renovating the old to build a new structure?

Williams: The main annex of the James Walker that was built during the war was a temporary structure just like you saw so many barracks all built out of wood and all temporary. It was not built to last and time proved that that was a good decision. Of course the old James Walker was built with wood. It had no steel in it. I understood that it had part pine wood going from the ground up to the top and so it was built very stable. You could build everything around a piling like that and it's there to stay. But I often thought of a match being down at the bottom of that thing and turpentine and it burning.

Now the first addition to James Walker was built between James Walker and Red Cross Street and that was very good construction. That had steel in it and all and that was the best construction of the whole.

Mims: What was that area called?

Williams: Well, I think there were three floors there. Downstairs on the ground level was the x-ray department and the second and third floor they had patient rooms and wards. Back in those days there were a number of wards that had a lot of patients in them, sometimes 25 and 30 patients and the nursing station was in the center of those patients so the nurse could stand in the center of that room and look around and see all of her patients and so she could have good surveillance all the time.

As things got "better" they started dividing the rooms up, so then you eventually got maybe two patients to a room or four patients to a room and then eventually one patient to a room. The nursing station was down the hall so for her to see that patient, she'd have to walk down the hall, open the door and go in. So she had visions of her patients much less than they did in the surgical ward so the patients really got more aggressive nursing observation and care on a ward than they did in a private room, but patients liked private rooms because it was nicer.

But as a result of that so many of them would have private nurses, which would stay, in the room with them if you were affluent enough to be able to afford it. First they had 12-hour shifts and then eventually they had 8-hour shifts.

Now if you look at the sickest patients we have which at that time were around the ward where the nurse could see them, were in now what we call intensive care units and these are structures where the nurses have a nursing desk in the center of the room. The patients were in a circle around her or him and they can look through these open cubicles, open doors and see every patient. So we've gone 360 degrees. We're back essentially to the wards where we were in the beginning to get the highest quality of care.

Mims: That's interesting. I never thought of it like that but that’s right.

Williams: Well, that's the way it is. If you look at all these places, that's the way they are.

Mims: Did you have any input on how the surgical area developed at New Hanover Hospital?

Williams: I had some…but the man to be given the biggest credit for our medical center at the present time is Mr. Seymour Alper who everything got the citizenship award, lifetime citizenship award given by the newspaper and there's nobody more deserving in Wilmington by the field of medicine than Mr. Seymour Alper.

He was a dedicated man who fortunately had a brother who helped run his business, Queensboro Steel and of course he spent most of his time, many, many days, very long, out of town, seeing what other people had, trying to find the right people and that sort of thing and left his business up to his brother who was extremely cooperative. His brother is dead now, but I talked to him many times. I liked him. He was a real nice fellow and asked him how in the world did he do with his brother building that hospital and taking all that time.

He said his brother performed all of his jobs at his business that he needed to. I read between the lines on that. It took him to build that hospital too because he had to run his and his brother's business while his brother was doing the hospital.

Mims: Daunting task.

Williams: The difficult part was getting the bond issue passed. After the war, it was knowledgeable then that we had so many people in the state who were classed as 4F because they had not gotten the medical care in North Carolina that they needed. So the state level people and the Senate and the representatives took that seriously and decided and other places in the United States did the same way, we better upgrade our hospital system in this state.

So then there was Federal money available along with state money then to upgrade hospitals around the state, which meant generally new hospitals being built. So we had hospitals taking advantage of that all over the state. New Hanover County did not do that. So we ended up with our then old building, which was once a state of the art but now was old and well behind the other facilities, not the doctors or quality of care, but the facilities. That was realized here and the idea was born in the medical society locally.

The first person I heard mention talk about it was Dr. Robert Fales. He brought it up one night at the medical society meeting about how all these new hospitals were being built and we didn't have one and we ought to. Well, that planted a seed and then a lot of people realized that was correct and we should take advantage of that money because most of the money was gone then that other people used and it would not be available much longer.

So eventually we got the county commissioners to agree to put a bond issue out for vote. And it was voted and there was a group that was formed by some of the business people here who realized it was going to be more a tax burden to build the hospital and pay for it and that sort of thing and they campaigned against it very strongly. It was defeated by a very heavy margin. So we did not get it.

About five years later, I may be a little off on that number, we realized we had to try again because we were really getting further down the road towards antiquity structurally wide and organized a little better and in the meantime James Walker Hospital started the Ladies Auxiliary. It was all ladies at that time. So we got very interested, concerned homemakers and other females that would come in and form the auxiliary then. They then worked in the hospital as volunteers and they saw the condition of the hospital. This is my personal opinion.

That to me was the thing that made the difference between the first bond issue and the second one because we had these ladies that knew what was going on over there and all of them had friends and so the word got out and that was a big influence. We had one or two that just spent their full time job during the campaign for the bond issue campaigning for it and they would do anything.

They'd be on the radio, they'd be on television, they'd go to clubs. They'd do anything it took. They'd do anything they could to get the word out in the community. So when it came up for a vote, it barely passed. I mean by just a very few votes. But it passed. There were two things on the bond issue. One was the money to provide for brick and mortar to build the institution. A lot of that money was not money that had to be raised locally. I think the bond issue was only about $5 million, something like that, to build the whole medical center. The rest of it would come from other grants.

There was the bond issue for the brick and mortar and then all over the state they had another bond which was put up for vote at the same time which was money they gave them for start up money and money to keep them going until they could have enough cash flow to support themselves. When these bond issues were put up in other areas of the state, they all passed. Everywhere they were put up, they passed.

When they were put up here in New Hanover County, the bond issue for the brick and mortar passed by a very few votes. The maintenance bond issue was voted down. So the people that were to build the hospital had to figure out some way to get money together so that they could pay the nurses and the people who worked there and buy the materials and when this bond issue wasn't there, they had to figure out how to get some money to get that going until they could go to cash flow.

That was very difficult and there again we get back to Mr. Alper. He had all those problems on his hands. Not only did he have to find the right people to build a state of the art structure, he eventually got the Boney Group to do it which did a great job, and Boney got the best consultant they could get, Blumenkranz, was his name out of New York who had a lot of experience there to build to the best of their knowledge a state of the art institution. Mr. Alper and his group had to face all of those things in addition to finding the site for the hospital. He selected the site where there wasn't even a road. You could only get to it by a little path or something. First time I saw it, I took a horse out there so I could ride around and see it real well.

James Walker Hospital Board of Trustees said, “We will give to you all the cash and everything we have that we can give to you to help you get started.” And it turned out I think they had $250,000 that they gave over to the medical center and that is part of what they used.

They also were able to borrow some money. Mike Brown was head of one of the banks here and he was also a member of the Board of Trustees and he knew that the hospital didn't have any money and he went out on a limb and loaned them what money they needed. They didn't know it, but it was against the law because it was a public institution and they could not borrow money on a public institution without approval of everybody else, but they did not know that and Mike Brown didn't know it.

Of course they paid it all back, he knew it was secure and it worked out just fine. It wasn't until 10-15 years later, they realized, they found out state law was against.

Mims: We were continuing to talk about the development of New Hanover Hospital. So getting all this money together was quite an ordeal. The catalyst was like a community involvement. Everybody seemed like they were going to go ahead with this. Did the Hill-Burton Act play any role in this, the appropriation of government funds for building a hospital?

Williams: Who?

Mims: It's called the Hill-Burton Act. It passed in 1946. It was how a lot of rural hospitals developed. It was government funding for hospitals.

Williams: Well, that's what got it all started all over the state and the federal government realized the same thing and they made this money available to the various states. The state had to put up a certain amount and then of course the community had to put up a certain amount. The hospital/bond issues, as I recall was around 5.5 million dollars and that's all they put in the institution.

When they got the Board of Trustees started and they became solvent and they had a cash flow, then all the additions that had been made to the institution were paid for by the hospital out of hospital funds until the big addition, that is the eighth, ninth and tenth floors were built and there they had another bond issue that was raised. It really was more than the first one although it was on the three floors. The first was including the land and seven floors.

A few years ago the County Commissioners asked the hospital to take over the balance of that bond issue which was about 3 million dollars and they took it over. So the county has about 5 million of the initial 5.5 million or the initial investment and maybe a couple of million, 2 or 3 million of the second. So they have less than 10 million dollars in the whole outfit over there and no telling how many, many, many millions it is the best investment that the county could have possibly made.

The hospital has never, never from 1967 received one penny of county taxpayers money. Most people think it's owned by the county so it's supported by the county, but that is not the case. At James Walker we had the Welfare Department they called it then, it's called the Social Service Department now. If we had a patient that qualified for welfare care, the county would pay James Walker Hospital a certain stipend, I've forgotten how they arrange it, but it's per day, but they pay a certain part of the expenses over there.

But James Walker was owned by a self-perpetuating Board of Trustees set up by Mr. James Walker and in that document that set up the hospital it stated if that piece of property ever became such that it was not involved in providing medical care to the community, its ownership would revert back to the county so that's how the county has got it now. As soon as the hospital shut down, it automatically went as part of the county and as you know the county owns it at the present time.

That's why the Board of Trustees could not give that to the new institution. Their qualification was when they were in the hospital medical center was looking for cash flow money the Board of Trustees had to say we'll give you everything that we can give you that we have, but they realized they could not give them the real estate and the county didn't give them the real estate either.

The county has retained the real estate and still has it, the county put nothing in it except initial bondage and the second bond issue which eventually the hospital had taken over and having paid off now which isn't the way to do it, isn't the right way to do it because the only source of income that the hospital has is from grants and gifts, but mostly from patient charges which means that whatever the hospital does is paid for by the sick patients in the hospital.

The hospital has to provide all the care in the area. The taxpayer pays nothing of that as taxes. So the county sick patient has got to be charged enough to cover for all the indigent care, all the bad accounts, all the losses and all that sort of thing. To me that's not right. That responsibility should not be on just the sick patient. That facility is available to all the well people out there and eventually they're going to get sick and they're going to use it. But all during that time, the expenses are having to be paid and it's not shared equally among those of us who are not in the hospital.

So actually those expenses are to a great extent should be shared by all of us. An example that is emergency room has got to be set up over there to take care of an emergency room. It's got to be set up to take care of a large emergency like a bus accident or an airplane accident or a fire or an explosion so it's got to have very high priced, well trained people available 24 hours a day in that emergency room. They're not often used for that purpose. They are used for other purposes, but they are available in a setup so they could handle something of moderate size. Now part of that plan is to call other people in, but they have to have a core, which is there all the time.

That's expensive and the most expensive place for you to get medical care is in the emergency room for that reason. The hospital doesn't make any money out of it. As a matter of fact it doesn't make what is called a profit, what I call a profit. It does have excess income over expenses but all of that is put in reserve. It's used to buy new equipment to modernize itself, to make new capital improvements and to be used as a reserve.

The business people who are involved with the hospital such as ours says that the hospital this size must have enough money to let it run in some catastrophic environment where it has no income, they want you to do it for six months, but they say the minimum is three to four months. The hospital spends to run itself over a million dollars a day so it says, the businessmen say that the hospital should have a reserve of 120 to 130 or more million dollars in reserve to run itself.

Now a lot of people don't understand why the hospital has a struggle to maintain that reserve and when it's done something of a capital improvement, it wants to do it without having to attach that reserve for the reasons that I just gave you. But if you think about it a little bit. Suppose we had an earthquake here and the whole city was wiped out or we had a hurricane, which really did us some damage, or we had a tornado that came through here and we had a large percentage of the people here destroyed and hopefully the hospital wouldn't be destroyed.

That hospital, nobody would have an income, no businesses are open so that hospital would have an enormous number of people who needed medical care from injuries and what not so it would have to pay all of its people and it's personnel and run itself at the regular level with no income at all and how long do you think it would take to build our assets back up from the city. You couldn't do it in 90 days, three months. So three months really is not enough to go under those conditions.

Mims: That's incredible. I never had that depth of knowledge to understand that, but that's really very interesting.

Williams: It's all really very logical if you think about it.

Mims: Well, it's saying it's well thought out and maybe that's why this hospital here is so recognized as good quality. Let's go back for a minute and talk about some of the other hospitals that were available. Did you ever work at the Bullock Hospital or have anything to do with that?

Williams: Yes. Bullock Hospital was started by obviously Dr. Bullock and as you know he was located on Front Street, there's still the sign up there with Bullock Hospital. The ambulance entrance was from the side street there. As I recall that hospital had about 25 beds. Dr. Bullock was a very good entrepreneur and a very good medical man and he did most of the workmen's compensation work in the city at that time. He was good at that. He had his own organization and for a long period of time, he was the only doctor that was practicing there.

He eventually brought in a young fellow named Billy Mebane and a third full time doctor was Dr. Sinclair. They did have other people on their staff and I went down there and operated a time or two and they were very active at that time. Tuberculosis for many, many years was a big problem in the whole United States, but certainly in North Carolina and the county had their own tuberculosis sanitarium because people had to be hospitalized or confined for a long period of time. They had appreciably no income of course being so sick and confined for that length of time.

They needed to be isolated, they needed to be cared for by some people who were interested in that kind of disease so like most counties in the state never had a tuberculosis sanitarium which was somewhere out close to where the jail is out now at the other side of the airport.

That was a wooden structure and it became antiquated and they built a new building on Wrightsville Avenue and that was the County Tuberculosis Sanitarium. That's the way Cape Fear Hospital started. After the war, antibiotics were beginning to be developed and of course sulfonamide drugs were the first, then penicillin and one of the ones that came along later was streptomycin. So sulfonamides, sulfa drugs and penicillin had no effect on the tuberculosis germ, but streptomycin did.

You could then treat TB with an antibiotic for the very first time in the history of the world. Patients then, the whole atmosphere changed for them. The whole kind of treatment changed. If you had someone with a large tuberculosis abscess in the lung that you had to confine them and you tried to collapse the wall of their chest so it would squeeze that terminantile until out of that abscess and close that abscess. You could not directly attack that because when you got in there to remove that abscess portion of the lung, of course pulmonary surgery was at its infancy then and it was very dangerous to do that.

Or you got those tuberculosis germs all over everything so you ended up in a very much worse situation than you were. When streptomycin came out, you could treat it. It would cut down on the bacteria. You still would end up with that big old cavity, the abscess, but now you could go in and sure that you removed it and you had good healthy lung tissue and you wouldn't get all that tuberculosis germ spread over everything so it changed the whole treatment of tuberculosis.

All the county hospitals then started closing. We had about one or two in the state. One was in the western part of the state. There was one up on the Piedmont section that remained open for the few patients that had to be confined for tuberculosis. But the trouble was aggressive then so they didn't have a long-term confinement. That made the new institution out at Wrightsville Ave unnecessary for the county. They didn't have enough people to make it worthwhile and keep it open because those could send those few people to the state hospital.

That was available and Dr. Sinclair and Dr. Mebane bought that building and that was the beginning of Cape Fear Hospital. All of those structures that have been additional to that have been started since then.

Mims: Kind of an independent entrepreneurship. They did not count on bond issues etc like trying to get New Hanover Hospital. It was set up in a different way.

Williams: Well, that was a privately owned institution. Eventually it was set up to be run by a Board of Trustees and the control was really in the hands of the Board of Trustees, self-perpetuating board, but it served its area and it served its function in the region very good or very well.

In addition to that we had over close to Williston High School, we had Community Hospital, which was used by the African-Americans here. There was segregation at the beginning of the time of James Walker and when I first started practicing over there the segregation lasted only a short time. They had a section of the hospital that was used by African-Americans.

But shortly after that it was all desegregated. You couldn’t tell the difference. The quality of care of the black American there was as good as it was in white America, they were treated by the same doctor, treated by essentially the same nurses and that sort of thing. Community Hospital was a nice structure, but it did not carry a high census for a big part of the time. At the time the medical center was started, it was all consolidated and both James Walker was closed and the Community Hospital building, which was a much better building, James Walker addition was is still available.

Mims: Did you ever do surgery at Community Hospital?

Williams: Yes, I did, not much. The surgery I did for that time was sort of sophisticated for our area. The best-equipped hospital by far at that time was at James Walker Hospital. The best trained people and that sort of thing. The things that I did like lungs and what not, in addition to general surgery and some of the larger surgical procedures, it was better for me to do them there where I could have more than one place or when I made rounds I could not have to travel so much and use my time that way. So I enjoyed working there and the quality of care was good and that sort of thing. And it was headed by a very well oriented aggressive and progressive Board of Trustees as we have at the medical center now.

Mims: And so the integration issue really was supposed to be a catalyst for New Hanover Hospital was going to be totally integrated, but like you said up until the time they had the two separate facilities. As a physician did that interfere with your practice at all?

Williams: It had absolutely no difference. Physicians don't look at that any different. Once you get through that making that incision through the skin, everything is the same. The care given to blacks and whites and yellows and any other color you want to mention, green or pink or what not, physicians look upon them as individuals and always have. It was the same. I understand slaves here got the best care they could get.

The newspaper would like to tell you differently, but that's not the case. Somebody was doing for slavery like you are doing now, it started out at the federal government but they wanted to get recordings and information from the slaves that were still living and it was done here in North Carolina and they interviewed a lot of people who were older at that time, but were slaves and I read all those documents and I recall only about one that was not respectful and complimentary of their masters and mistresses.

One of them talked about things that went on that were probably not very good. But all the rest of them…none of them mentioned being abused and apparently they were treated entirely different than the average impression is at the present time. But a doctor doesn't see any difference that was all the way true. Now maybe society has segregated them, but when they went to James Walker to the operating room, they went to the same operating room that everybody else did. It's just that when they went back to their bed they were in an area that was different.

Mims: I know that Wilmington New Hanover County has a long history of really strong physicians. At one time there was a medical college that appeared. It didn't last for very long. Dr. Fales talks about some of that.

Williams: Down on Third Street, there was a sign about that. That was before the Fleming Report [Flexner], medicine was scattered around and you got training like people did back in the old days, was by somebody that they could stay with the doctor and learned what he learned. As you can imagine the training you get that way is not near as well as the training you get in an organized situation.

And that sort of thing the Fleming Report [Flexner] did away with you know. When the teaching institutions started developing a real teaching institution and full time teaching and that's why we're number one in the world at the present time for quality of care.

Mims: Well, you certainly have seen a lot during your career. What do you think has been the most prolific change in the field of medicine or in surgery?

Williams: The two big changes that we've had in care, one is the oncology treatment. The use of drugs that have been effective against malignant diseases. That's amazing.

So many people were a diagnosis was equal to death eventually, taking a little while, but now 90% are cured and so it's an entirely different ballgame. Ovarian cancer for example, if you can get it within a reasonable time frame, they cure a lot of those people even with advanced disease. The drugs that they have available to them now are very, very effective against that and its very good.

In my particular field, the thing that has been added was vascular surgery. When I started, there was little vascular surgery being done in the world and certainly including the United States. All the vascular field has developed since I started in my medical school training back then. And now vascular surgery of course is very advanced. I guess the acme at the present time is heart replacement and you've got all these people walking around.

We've got a person here in Wilmington that lost both of his kidneys and so he had a kidney transplant and then he had heart failure. His heart got so bad, it's wasn't effective any more and he got on the list and he got a heart so he's walking around in that situation living a normal life. He would have been dead many, many years ago from his kidney disease if that had not been available.

Now of course to do those transfers you've got to know how to put blood vessels back together so that they'll function, the blood will flow, they won't clot off and all that sort of thing. So in surgery I think the vascular field has been such a big advancement.

Going along with that in the medical line and certainly in the cardiac field, the cardiac medical treatment has just tremendously improved and the resuscitation has improved. I think a lot of it is peripheral care. For example, we've had a great history here in this county of the emergency service. The emergency medical service was run by the county and sometime ago they talked the hospital into taking that over.

Dr. Atkinson was head of the hospital. It cost them about 3 million dollars a year. At the same time, they talked the hospital into taking over the remaining bond issue of about 3 million, they got the emergency medical service transferred to the hospital which cost about 3 million dollars to run. That was that much of a county loss. Fortunately we had Dr. Bill Atkinson and his forte was emergency care. That's what his Ph.D. degree was in. He was not an M.D., he was a Ph.D.

He was head of the hospital here, the CEO. He started developing that emergency medical care. Now the emergency medical service is the place where people all over the state come to see where it's done best in the state. They come here to see how it's organized. I heard the other day some of my colleagues say that the recovery of patients who have heart disease and developed an emergency at home and recovered up until this emergency service was revamped and reorganized by the hospital was about 2%. Now they told me it was 30%.

I assume that the information I got is correct, but that is a tremendous improvement. The reason for that is response is quick and the people that are on the response team are well trained. They've gone through all sorts of training and they have resuscitation knowledge with the equipment to resuscitate people. They give IV's. They have immediate contact with the emergency room physician by radio. So the emergency room physician is treating that patient while he's still in the home telling the people what to do and that sort of thing.

So he starts getting qualified help at home and gets that care all the way in the ambulance until he gets to the emergency room and there is has a team waiting at the door for him. Everything is prepared for him. They rush him in, they hook him all up and he gets immediate care and that's the sort of thing that makes resuscitation much more effective. The time element is so important.

Mims: Just over all medical care too with the whole time issue and looking back over the time you spent you know following that battalion around, you know, the difference between the response that you were able to get these guys in versus what could happen now.

Williams: Then we used to put some of them on hospital ships. The hospital ships you know were equipped right up to snuff. They have everything they need there and they really get state of the art care at these hospital ships.

Mims: One other question I'd like to cover is community leadership among the medical personnel here, you said you were an active member of the Rotary Club. Is that true for other physicians you think, that they take an interest in their community?

Williams: Yes, most physicians are sensitive to civic activities. When I came to Wilmington, I first joined a club that was made up of just young people and you age out on that. When I aged out on that, I wanted to stay involved with the community and I looked around and I felt that I would fit into the Rotary situation. So I joined the Rotary many years ago and I'm one of the older ones in the Rotary Club at the present time. I'm glad I'm still around, but I'm sorry I've got all that age on me.

I've enjoyed Rotary and enjoyed being in association with business people and people who are not medically oriented. I had a good friend who was practicing in West Palm Beach, Florida and he was Rotary and he was an orthopedist. To be a Rotarian if you miss three meetings in a row, that's your resignation. You've got to attend the meeting. Of course they make it easier for you to attend because you have other Rotary meetings that you can go to, any club, any club you go to counts for your meeting.

But somebody asked him one time, "Why do you want to be a Rotarian where you've got to take time out of every week to attend the Rotary meeting every week, you haven't got that kind of time, why do you want to do that?" My friend listened to him and said, "Listen, they're the only normal people that I'm ever around."

So that's not exactly true because his wife is normal as some of his friends are normal. So when he goes to the office, those people were not what you would consider thinking like the average businessman or the average homemaker. They've got something specific on their mind. So his statement was basically a true statement. It is a pleasure for doctors to be out among other people. It's interesting because most of the time they do well in those city clubs and there are a lot of them that headed up their club for whatever the term would be. And that's good because doctors need to be influential in those communities and those environments because they have a lot of information they can give them along the medical line that would sort of go into the decisions of these people who have big decisions for the whole community and are very good at making those decisions.

Mims: Well, certainly the leadership here that has taken place locally has been instrumental even in the development of the university that we have now so physicians' influx has been very welcomed here. I'm trying to think if there's anything we haven't talked on. Is there anything you can think of that maybe I didn't bring up that you'd like to talk about now?

Williams: I've done a lot of talking here, but one thing I have learned over the years is that the average person walking around in our community doesn't have any basic idea the state of the art medical care he has available to him in a community hospital. That hasn't come by without a lot of effort on a relatively small number of people who realize the importance of that. It's so nice that that quality of care is available here in our area.

The average person doesn't realize it. If you would take anybody that was walking down the street, they'd say, "Well my tax money runs that hospital." Of course, you know that's not true and I know that's not true and a lot of people know it's not true. But not the average person, they think they finance the hospital.

One of things I've seen occur here in the general delivery of medical care is a change in which the care has been given and I'm referring to the relationship and the recipient which is the patient. When I first started practicing here, all my dealings were with the patient and the patient's family and you developed a wonderful relationship between them and I was mentioning that to you when I was talking about what I missed mostly here.

Your relationship with them, I knew what their home situation was and it was a pleasure for me when it came time for them to compensate me for my care, I realized they didn't have anything, I'd say forget it, I'm just glad you're doing well and most doctors at that time looked upon that as a pleasure to do that to a really needy person, but you knew them. You were in the community.

So you had a good relationship. The quality of care we could give them was not near as good then as it is at the present time, but that relationship is not as strong between the physician now as it was then. When I first started practicing here in Wilmington, hospital insurance was just getting started. So it was unusual for a person to have hospital insurance. But those that did went into the hospital. You could get a ward bed then for $5-$6.00 a day and the private rooms were $18/day, but you weren't getting the quality of care that you get now. But you got the best they had to offer at that time.

Since that time insurance companies and what we call third parties, doctors one, patients are another, the third party is a person who is the financial one who the patient has an agreement with or is employed without and has an agreement with and he pays the bill. So he comes in between there so he gets between a lot of times the doctor and the patient. That's what we call third party. I remember when I first got here we had an older man come down to Cape Fear Club at the Medical Society meeting and he was somewhat from the state medical side.

He was a practicing physician, but the state society had asked him to tour around and make speeches of the various counties and his subject was third party involvement. He warned the physicians about the growth of third parties. They would get stronger and stronger and more and more prominent and they would eventually control the delivery of medicine.

Those of us that listened to him, I was a young fellow and I didn't know anything about that. I didn't even know when he said ‘third party’ what he was talking about until he told us about what a third party was. But everything that fellow said, the hazards of it has occurred. Now the financial part of medicine is controlled by these third parties. We've got Medicare, Medicaid, all the private insurance companies, we've got all these other delivery systems and to a certain extent they control us.

So now we don't have just that very pleasant relationship only between the doctor and the patients but we've got these other people coming in which are interfering with that. That has divided that relationship to some extent or completely between those two prime individuals. We still have extremely conscientious doctors, doctors who are very primarily patient oriented and they try to recover as much of that wonderful relationship that we had at the beginning and they had all those years prior to that as they can. But a lot of that is gone because of third party involvement.

So that's had a lot of effect. What I was getting around to tell you is that now at our medical center we have over half the patients now being Medicare and Medicaid so you've got third parties involving them entirely. So the relationship financially is between the hospital and these third parties, not with the patient.

These third parties are beginning to tighten those screws down. They want to give less and less money to the hospital. You're aware of that, you see that every day. I envisioned and still envision that that's going to continue and sooner or later, those screws are going to be tied down so tight that there's a shortage of money to appoint, where we can only have the very basic care.

All the niceties that we have now and the things that make it as pleasant as they can make it will no longer be affordable because that money you get from patient care is not coming in. The Board of Trustees envisioned that all that sort of thing was going to happen. This is years ago. That Board of Trustees is a remarkable thing.

All you read in the newspapers is somebody knocking it, but they're the ones that have held all the responsibility, made all the big decisions, made that huge institution over there what it is at the present time. No taxpayer money in it. They've done all of that for free. It's a contribution to the community. Realize that you had to have, if we could get it, some source of money from some source other than patient receipts. One of the ways that other places do it like universities is they have a Foundation and they raise a lot of money.

For example now at Chapel Hill most of the expenses at Chapel Hill, a lot of it comes from the state, but they get a huge amount of contributions from their alumni. The idea of a foundation was not established in hospitals like it was there. At first I remember when they were trying to get that started everybody said you don't need to give it to Chapel Hill. That's a state supported institution so I pay my taxes, why should I give money to them.

Well, you know people have matured since that thinking now, but that's the sort of thing they had to deal with from a medical standpoint. I was asked to start that Foundation up which I did. Now it's a going outfit, but my reason for getting interested in it, I had retired at that time, not retired, I'm a full time farmer now, but I realized as that money decreased from patient receipts that we had to have some source to supply these niceties and the good things that we needed to make sickness as comfortable and pleasant as it could be made and make the quality of care as good as available anywhere.

So the Foundation was started and it was set up as a separate institution. The hospital doesn't run it. It has its own constitution and it does essentially what it wants to. However, it is made to support the hospital, but the Board of Trustees cannot tell that Board of Directors what to do.

Certain members of them can be a member of the board directly, but the constitution of the board of the Foundation says that only a certain number of people can be members of the Board of Trustees. So there's no way the trustees can directly run that Foundation by its activities on the Board of Directors. It's a separate institution. It's to go out and develop projects and awards from various foundations all around the country like Duke and others that you're aware of to raise money other than patient care. And it's done a great job.

The problem with it at the beginning that we dealt with and there were only two people, one full time person named Hall Pyle and I was the one who was helped get it started. Two of us were faced with the idea that people said, “Oh, we don't need that. Why do we need to give money to that Foundation, it goes to the hospital and I'm supporting that hospital. It's a county hospital, it's owned by the county and my tax money goes to that and they get state money and all this sort of thing so I'm already supporting that thing with taxes.”

Well, that's the same thing that the university faced and maturity helped them realize, “Hey if we want the number one professors, we've got to subsidize our salaries.” But if we want the number one equipment here, we've got to give some money to them so they can get it cause the state can't support all that kind of stuff. Same thing is true of our institution here and that's the job that the Foundation has done. Struggle at the beginning, selling the idea and getting people to accept it and they still have some trouble along that line, but they've come a long way in 10 years.

The things that that Foundation has supported in the hospital is amazing. They've done a lot of it not only through their contributions to the Foundation itself, but started the invitational golf tournament.

Mims: They just had it last week, right?

Williams: They just had it a couple of weeks ago and I don't know whether you know how that's set up or not, but all those people pay a certain amount of money to play and that money goes into the Foundation and out of the expenses for the golf tournament are paid out of that, but they have a substantial amount left over that they do extra things for the hospital.

When the golf tournament was started and of course it rains and they don't play golf, the funds are the same, because all the funds are received before the golf tournament started. But those people don't do it for just their pleasure of playing golf. They do it as a civic project for them. It's a contribution by their companies and by them and they do it because they know the value of a contribution and contributing where it's needed and doing something good for somebody does something for you too. It makes you feel good about it and you're happy with it.

The first commitment that was made by the Board of Directors at the Foundation was to get something very much needed in the area for the hospital was a rehabilitation center. We had the rehabilitation hospital at that time, but if one of the physical therapists over there were wanting to teach somebody how they could go and operate handicapped in the grocery store or a bank or down to the beach, or getting in and out of an automobile.

In order to teach them how to do in the grocery store, they'd have to get them in a vehicle; they'd have to get approval of the grocery store to let them come in. They'd have to go in there with one or two wheelchairs and go around and show them how to reach up on the shelf and take things off, how to take that wheelchair to the exit counter and go out and do that sort of thing.

The physical therapist said the big problem has always been for them to rehabilitate people is that they get them out of their rehabilitation center. They send them home and they stay home. They don't get out. They have no way of going home unless they have a family member that was really dedicated to get those people to feel comfortable about going out into the public and doing public things.

What they needed was someway to train people in their institution without having to get them in a car and take them to the bank and that embarrassed people to do that for the first time and having someone trying to teach you how to do that. You can imagine how that would make you feel. There was available in the United States and there are only two that had been done, something called ‘Easy Street.’

It was started out, I think it was in Arizona when the rehabilitation center realized that they had this problem. They said let's just make a little one here in our hospital that we can take people down and have a little area that has food on the shelves and you have a cash register. You got a bank and a cashier and here you have an automobile or fast food place. Over here you've got the beach and all those sort of things and let's build that sort of thing and see how it works out.

And it worked out wonderful. They called it Easy Street. Then they said why don't we make this available to other places so our people here, mostly Hall at that time was aware of that and we realized and talked to the rehabilitation center and all of the people there were just enthusiastic about it. How much easier it would make it, how much more complete it would make for their rehabilitation, how much better the chances that that disabled patient to get out into the community.

So the Foundation undertook that. It was a huge thing, over 100,000 dollars, I forget the exact figures. Well over a hundred and they with no money at all obligated to do that and they were planning on doing it through the golf tournament. The first golf tournament they had $50,000 over their expenses and the second one, they had a little more than that.

They had gone ahead and had the Easy Street installed here and the people would install anything they wanted. Of course in Arizona you don't need a beach, but we did. So we told them we wanted someplace that the person could go out and have an environment of a beach and we played a lot of golf here so we wanted a place where the person could get down out of a wheelchair and play golf. We needed a bank, a fast food, an automobile, a grocery store, a general store like Belk's.

So then we went out and we saw all these people who were in those businesses to see if they would sponsor that and “Yes,” the fast food people said, “Yes,” Hardee's said, “Yes, we'll give you money to start that.” And First Citizen's Bank said, “Yes, we'll give you money to help that thing,” and we’ll name it for Citizens. Shaffer Buick said, “Yes, we'll give you a brand new car over there all the time.” When the car gets a little age on it, they'd take it out and put another car in there. It's over there today after all these years. No charge at all.

By the way the anatomical structure of the area they were going to build Easy Street and the rehabilitation, did not have a way to get a car in so we had to go in and tear a wall and put double doors so you could drive a car in there so there's a Buick over there now, still being given by Shaffer. Grocery stores the same way and Belk's, they've had a place over there. If you've never been there, you ought to go in there and walk through that thing.

Mims: I had no idea it existed.

Williams: It's a great help because those patients then won't be scared to go to the grocery store. Yeah, I'll know how to take all those things off and I'll know how to put them in my basket here and I'll know how to drive that wheelchair and I can just do all those things. Yeah, I'll go to the grocery store with you so they go to the grocery store and they go around and they go to the bank. They don't hesitate. You don't have to go through the drive through. Let me go in, I want to go in where all those people are and go into McDonald's or Hardee's and sit back with everybody else. A great asset.

Well, the Foundation started with that and fortunately our signatures were not just signatures. They turned into money to pay that bill. But it's in use now and it's amazing how that foresight and that thinking has been the Foundation for all these good things that are happening to all these otherwise disabled people.

The Foundation has done other things. For example, every area had heart rehabilitation, very limited in what they could do because they didn't have all this apparatus. The hospital realized that's what they needed to do and the Foundation realized that so we got the rehabilitation people and said tell us what you need. What do you need to put in a room over there to rehabilitation heart patients.

They told us the latest thing, all the equipment and everything and it added up to a little over $50,000. Okay. A golf tournament was had and it was dedicated to rehabilitation so now all the rehabilitation equipment and the cardiac thing was given to them by the Foundation. The charge did not have to go back to the patients. If you went in there to have a finger operated on or something, part of your charge would have to support that. They didn't have to do that, it was given to them.

Those people then can contribute enough and their carriers can contribute enough to furnish the maintenance of it and the person and that sort of thing. They've done the same thing. You ought to go through the pediatrics department up there and look at the things that have happened there. Go through the cancer center, which were efforts of the Foundation. Have you ever been through there?

Mims: The Zimmer Center?

Williams: Yes.

Mims: I've walked through there, yes.

Williams: Have you seen those three dimensional things on the wall. All that's Foundation stuff and the cancer center is all Foundation. The cancer center started with the whole Foundation.

Mims: That's beautiful over there too.

Williams: The Foundation started the whole cancer center. They've done so many other things like that. Now they have an endowment too. They're trying to build up so they can use the income off of it. Not a big endowment compared to what a school would have, but it's a beginning and it's starting and sooner or later people will swallow the hook on the idea. Hey, that thing is really providing a lot of services that we would not have in this area if it hadn't been for them.

But to get back to the big picture, I saw that sort of thing was needed. First to have those nice things and I think it's going to get worse and I think the importance of the Foundation is going to get more and more and more and until it eventually will be very important as far as giving us supply and the quality of care, not necessarily the specifics of the things that the doctors do, but all the environment and all the niceties and the things that make it as pleasant as possible.

Mims: Thank you so much for sharing all that because I had no idea exactly what the Foundation did. I'd heard about the celebrity golf tournament. I know they were working towards the pediatric intensive care, but I had no idea about the other.

Williams: Well, when they needed a bus to go around and do mammograms, the Foundation did it. When they needed some equipment and children resuscitation equipment and that sort of thing, they go in the ambulance and go into the helicopters, the Foundation did it. Right now when they needed resuscitation equipment in each of our schools, who's giving it? The Foundation's giving it.

Mims: Well see and I thought the county had done that, New Hanover County.

Williams: No, the Foundation has been very important. I don't know the percentage of what one's doing, but I know you can talk to Kevin Lee and that's one of the things he's proud of, is getting these defibrillators and he's head of the Foundation.

Mims: Yes, that's very interesting and of course maybe the push from the Foundation would encourage the county to see that this was fulfilled because it's definitely a need.

Williams: People need to be trained too to use it.

Mims: Thank you so much for talking to me today. I appreciate this and the information you have given and will hopefully give more meaning to our health care in the future as well.

Williams: Well, what we have to realize is that what we have available to us from all the contributions to all the people in the past, a little contribution or a big one, but we're where we are now because those people making their sacrifice and it's our job to continue that progress that has been started so that 20 or 50 or 100 years down the road they can say, “Look at the antique medicine they practiced, but that was the beginning of what we have now.”

Sooner or later they're going to look back at what we have now and say, “Golly, that's old-fashioned and that must have been real crude.”

Mims: That's great, this has just been great. Thank you.

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