In memoriam: Frank C. Spencer, MD, FACS, pioneering cardiothoracic surgeon

Cardiothoracic surgeon Frank Cole Spencer, MD, FACS, Past-President of the American College of Surgeons (ACS), died July 23 at the age of 92. Dr. Spencer was a distinguished surgeon, patient care advocate, and leader in the surgical community. During his 60 years as an ACS Fellow, Dr. Spencer served the organization and the surgical profession in a variety of leadership capacities.

Great talent and seminal contributions often spring from motivated individuals whose humble beginnings, extraordinary drive, and exemplary commitment to the pursuit of excellence lead to a career of the highest achievement. Dr. Spencer’s life and successful career clearly illustrate these principles.¹

Early life and education

Dr. Spencer has been quoted as saying, “I thank the good Lord for giving me a good brain, access to good education, and teachers who truly wanted me to succeed.” He was born on a farm in rural Haskell County, West Texas. His role model was his paternal grandfather, a physician. The odds were against this boy, educated by dedicated parents and schooled in a two-room schoolhouse, even going to college. The determination of his parents to provide him with an education and opportunity, coupled with a high school science teacher who fueled his curiosity, helped make his dreams a reality.

Dr. Spencer entered North Texas State College, Denton, at 15 years old. A great teacher and mentor, James L. Carrico, PhD, chair of the department of chemistry, recognized potential in “Frank” and chose him as laboratory assistant. Dr. Spencer recalled that Dr. Carrico instilled the students “with the excitement of learning and a warm paternalism, virtually adopting them as foster children.” Dr. Carrico’s mentorship, combined with an innate desire for excellence and a farming background, made Dr. Spencer “an incurable workaholic.”

Dr. Spencer entered Vanderbilt School of Medicine, Nashville, TN, at the age of 17. Surgery beckoned him. He was a member of the Alpha Omega Alpha Honor Medical Society and graduated at the top of his class. The element of luck, a common component in many great careers, put him in the right place at the right time. He went on to complete an internship under Alfred Blalock, MD, FACS, at Johns Hopkins Hospital, Baltimore, MD, which exposed Dr. Spencer to the pioneering work being performed in the new field of cardiac surgery. At Hopkins, he was surrounded by an incredible collection of talented residents and faculty who were working with Dr. Blalock at this pivotal time.

Revolutionizing repair of combat-wounded arteries

After his internship year, Dr. Spencer accompanied William P. Longmire, MD, FACS, to the University of California, Los Angeles (UCLA), to work in the newly developed department of surgery. He worked clinically and in the laboratory with William Muller, MD, FACS, and James Maloney, MD, FACS. However, he left UCLA to serve in the U.S. Navy Medical Corp (1951–1953) during the Korean War.

Dr. Spencer’s interest, curiosity, and dedication to his patients were a constant theme throughout his career. As a young surgeon at Hopkins and UCLA, he learned how to repair arteries. Dr. Spencer was disappointed to see the typical clinical course of injury to the leg leading to gangrene and amputation, in part because of the standard practice of arterial ligation of the injured vessel. Ligation was the treatment of choice after World War II because of the often long delay from injury to surgical treatment. In Korea, the Mobile Army Surgical Hospital unit allowed early evacuation by helicopter, leading to the opportunity for a change in practice and performance of early arterial repair.

Seeking permission from the authorities to attempt the repair of injured vessels on a trial basis was a seminal event in Dr. Spencer’s career. After failing to receive clearance for several weeks, he decided to proceed with performing the repair of arterial injuries, even at the risk of court martial. During the next nine months, more than 150 repairs were performed, with an 80 to 90 percent success rate. The results were published in the Annals of Surgery and changed military surgical policy.²

Dr. Spencer remarked, “I could not live with myself if I was forced to take someone’s leg off when it was not necessary.” Instead of being court martialled, Dr. Spencer received the Legion of Merit Award, which led him to national recognition. “I became a boy hero, much to my embarrassment…but arterial repair in Korea benefited more people than anything I’ve ever done,” he said. It is not surprising that his ACS Presidential address in 1990 was titled The Vital Role in Medicine of Commitment to the Patient.³

Post-service leadership

After discharge, he returned to Johns Hopkins to complete his surgical residency under Dr. Blalock. The Hopkins years included six years on the faculty, where he matured into an innovative surgeon, a gifted teacher, and a mentor to students and residents. These years were among the most innovative and exciting in the development of the field of cardiac surgery.

In 1961, Benjamin Eiseman, MD, FACS, recruited Dr. Spencer to become professor of surgery at the University of Kentucky, Lexington. Five years later, Dr. Spencer accepted the position of the George David Stewart Professor and Chairman, department of surgery, New York University (NYU) School of Medicine, New York. He served in that capacity for 32 years, establishing one of the great surgical departments in terms of clinical volume, innovative research, and superb residency training. From 2002 until shortly before his death, he remained active at his beloved NYU as chairman of clinical facilities and development, as well as director of patient safety.

Dr. Spencer’s wise counsel and leadership resulted in his election to high office in several professional organizations in American surgery. Prior to serving as ACS President (1990–1991), Dr. Spencer was an ACS Regent, serving as Chair (1987−1989) and as a member, Board of Regents (1980−1989). Other ACS leadership positions in which he served are as follows: Chair, Ad Hoc Committee on Professional Liability (1982−1986); Chair, Scholarships Committee (1984−1987); Chair, Central Judiciary Committee (1985−1987); and Chair and Consultant, Committee on Patient Safety and Quality Improvement (1986−1996 and 1998−2012, respectively). In 1979, he delivered the John H. Gibbon, Jr., Lecture at the ACS Clinical Congress—Competence and Compassion: Two Qualities of Surgical Excellence.⁴

Outside of the ACS, he was president of the Society of Clinical Surgery (1974–1975), New York Surgical Society (1976), Johns Hopkins Medical and Surgical Association (1994–1995), New York Center for Liver Transplantation (1994), American Association for Thoracic Surgery (1982–1983), and the American Surgical Association (1997–1998).

A consummate surgeon and teacher

Dr. Spencer never forgot his Texas roots and dedication to each patient. He never delegated postoperative care to others. His clinical rounds were legendary for their attention to detail and logical scientific problem-solving. His morbidity and mortality conferences were unparalleled. Faculty and former residents have vivid memories of feeling respect and occasional fear when attending this time-honored surgical conference. We were taught to understand outcomes, medical and technical errors of omission or commission, and knowledge gaps long before these concepts became formalized in “practice-based learning.” Residents and faculty always were professional and prepared in his presence. His clinical judgment, experience, and knowledge of the medical literature were always current and innovative.

In the operating room, Dr. Spencer was a master surgeon. His dedication to detail and compulsive recording of observations, which he later reviewed, allowed him to discover patterns that remained obscure to others. He always pushed the envelope to advance the safety and range of surgical treatments. He pursued perfection, teamwork, and communication. He demanded focused decorum during operations.

The advances in the field of surgery for coronary artery disease, valvular heart disease, myocardial preservation, mitral valve repair, and safe cardiopulmonary bypass are, in part, because of his direct efforts or the efforts of those whom he inspired. For example, he sent George E. Green, MD, FACS, to the laboratory to investigate the use of the internal thoracic artery as a bypass conduit, an idea that Dr. Spencer investigated during his years at the University of Kentucky. He sent O. Wayne Isom, MD, FACS, to work with Sir Brian Barratt Boyes in New Zealand to bring his innovative surgical experience in congenital cardiac surgery to NYU. He was an early supporter of Gerald Buckberg, MD, FACS, and an early adopter of the clinical use of blood cardioplegia for myocardial protection. He sent Stephen Colvin, MD, FACS, to Paris, France, to learn new approaches to mitral valve repair from Prof. Alain Carpentier, MD, PhD, FACS(Hon). He encouraged Joseph Cunningham, MD, FACS, to investigate spinal cord protection during descending thoracic aortic surgery.

Dr. Spencer understood the value of both basic and clinical research. He understood the power of large clinical databases and their contribution to outcomes research. He was the champion of the standard use of binocular magnifying loupes to perform coronary artery surgery.

Dr. Spencer wrote more than 350 peer-reviewed articles and 38 book chapters or books. Most notably, he was the co-editor of the annual Yearbook of Surgery from 1971 to 1991, Vascular Trauma (Rich and Spencer, editors), and Surgery of the Chest (fifth and sixth editions, Gibbon, Sabiston, and Spencer, editors), and he was a founding editor of Schwartz’s Principles of Surgery.

Dr. Spencer lectured worldwide as a visiting professor. In 1997, he received the American Heart Association Achievement in Cardiovascular Science and Medicine Award. In 2010, the American Association of Thoracic Surgery bestowed its Lifetime Achievement Award on Dr. Spencer for his “outstanding contributions to cardiothoracic surgery that have left an indelible mark for future generations.”

Among all these achievements, awards, and professional recognition, Dr. Spencer derived his greatest pride from teaching and witnessing the achievements of his medical students, residents, and fellows. The Hopkins traditions of clinical excellence, teaching, research, and leadership were the hallmarks of the NYU surgical experience. Dr. Spencer was legendary for memorizing the face, name, and a brief biography of every intern. He influenced the surgical careers of hundreds of young surgeons, many of whom became department chairs and leaders in surgery in the U.S. and abroad. He received the NYU School of Medicine Distinguished Teacher Award in 1969, 1970, and 1977, and the Torch of Learning Award from the American Friends of the Hebrew University in 1976.

An endless enthusiasm for surgery

Dr. Spencer taught us his concepts of the basic principles of surgery. First and foremost he admonished, “Do what is best for the patient.” His second precept was, “Don’t be smart enough to quit.” He believed that all complex surgical problems have a cause often so difficult to figure out that most would give up. Dr. Spencer taught that persistence and using the scientific method with experimentation will eventually lead to solutions.

His comments are timeless, and included the following:

“Surgery is a joy, and the pleasure of a surgical career stems from several basic instincts. First is the deep instinctive personal pleasure in helping a sick person get better. Second is the excitement of intellectual productivity, the discovery of new knowledge, and the scientific basis of our profession. Third, is the pleasure of teaching, a vital [component] of the medical profession since the time of Hippocrates.”

Finally, “Unique to surgery is the creative use of one’s hands to cure or improve human disease.”

Despite occasional failures, the surgeon’s optimism, excitement, and pragmatic resourcefulness remain our strength throughout our careers as we seek surgical solutions to complex problems.

Dr. Spencer’s career spanned more than four decades. His contributions to general and vascular surgery, cardiac surgery, health policy, and surgical art and science are innumerable. His surgical expertise saved tens of thousands of lives and relieved suffering for many others. His impact on patient care is magnified by the hundreds of practicing surgeons he trained and influenced. Clearly, he stands among the giants of surgery in the 20th century. His influence will be long lived through his students, residents, and colleagues. I am indebted to him as my teacher, mentor, role model, and lifelong advisor.

Dr. Spencer’s attitude about the future of medicine was in strict contrast to the “gloom and doom” of others. “I remain as enthusiastic and excited about the pleasures and opportunities of surgery and medicine as in my early house officer days. My attitude is a blend of confident optimism with pragmatic realism.”

We celebrate Dr. Spencer’s life and career. We mourn his loss. We have lost a giant in surgery, and a friend.

References

1. Shemin RJ. Lifetime Achievement Award: Frank Cole Spencer, MD. J Thorac Cardiovasc Surg. 2010:139(1):1-3.
2. Spencer FC, Grewe RV. The management of arterial injuries in battle casualties. Ann Surg. 1955;141(3):304−313.
3. Spencer F. Presidential Address: The vital role in medicine of commitment to the patient. Bull Am Coll Surg. 1990;75(11):6-19.
4. Spencer FC. The Gibbon Lecture: Competence and compassion: Two qualities of surgical excellence. Bull Am Coll Surg. 1979;64(11):15-22.