Goodbye to All That

By Anne Bennett Swingle
Photography by David Colwell

His feisty manner, his reverence for William Halsted and his drive for perfection have come to symbolize surgery at Hopkins. Now, after 18 years, John Cameron is stepping down as department head.

By the end of August the word was out: the search committee charged with selecting a new head of surgery for Johns Hopkins Medicine had settled on a candidate, and that candidate was a woman. The news rocked the department and sent shock waves out into the clubby world of American surgery. No large department at Hopkins had ever been headed by a woman, and surgery, that singular redoubt of manliness, was the last place anyone would have predicted it would happen.

Predictable, though, has never been the byword when it comes to leadership transitions in the Department of Surgery. Hopkins' first chief, the famous William Halsted, was the second choice of the search committee. When he died in 1922, his heir apparent, J.M.T. Finney, turned down the full-time appointment. After Dean Lewis, the second chief, suffered a massive stroke in 1938, it took the search committee two years to sift through possibilities before finally settling on Alfred Blalock, their fourth or fifth choice. Twenty-three years later, Blalock very publicly protested the appointment of his successor, George Zuidema. And not even John Cameron, the fifth and outgoing chairman, who has come to personify the very essence of Hopkins surgery, was the selection committee's first choice.

Now after 18 years, Cameron, 66, is stepping down. Julie Freischlag, a 48 year-old vascular surgeon from UCLA, will succeed him. This time, the transition is even more unusual and seems to suggest an elementally different and changing face of surgery.

It's noon on a late-autumn Thursday and a group of third- and fourth-year medical students is gathered around the conference table in the Department of Surgery's Finney Room. At precisely three minutes after the hour, John Cameron takes his place at the head of the table. It's the beginning of what's known as the Professor's Hour, a time in which the lowliest of the low-medical students doing their surgery rotations-encounter, in the person of Cameron, the very pinnacle of American surgical leadership.

The hour always begins with a historical vignette. On this day, a student profiles E. Theodore Kocher, a Swiss surgeon and early Nobel laureate. Another student presents a case:

"J. S. is a 39-year-old woman with nausea and vomiting, pain in the right upper quadrant and a low-grade fever. She's recently eaten fried chicken." Instantly, everyone seems to know the answer: acute cholecystitis, or inflammation of the gallbladder.

"What's the treatment?" Cameron asks tersely.

"You take the patient upstairs..." the student begins.

"What course are you in? You take it out!" Cameron exclaims impatiently. "Who took the first gallbladder out?"

"Kocher?" the student guesses, seizing on the name that still hangs in the air.

"That's a good answer, but it's wrong."

"Halsted?"

"That's even better. I love that answer. I'd give you full credit for that. But that's wrong, too." The mere mention, though, of Hopkins' first surgeon-in-chief seems to warm the atmosphere, eclipsing the right answer (Bernard Von Langenberg) and producing a kinder, gentler Cameron. He now tells the students how Halsted, in 1882, performed a cholecystostomy on his own mother on her kitchen table, removing seven gallstones from her pus-filled gallbladder, possibly the first such operation in this country.

Cameron has a deep and genuine love for the heritage and history of Hopkins, and he takes advantage of opportunities like the Professor's Hour to bring it alive for students. This passion is, in fact, one of the hallmarks of Cameron's term as chairman. He has modeled himself on Halsted, and his legacy, like Halsted's, will be first of all as an innovative surgeon. World-famous for his mastery of the Whipple procedure-to stave off pancreatic cancer-Cameron has molded a portion of the Department of Surgery very much in his image as a gastrointestinal center. More pancreatic surgeries were done here during his reign than anywhere else in history.

Cameron also will be remembered as a relentless teacher who, like Halsted, turned out dozens of impeccably trained surgeons. Many of his trainees now hold top positions at American medical schools, where they are creating the next generation of Cameron-like surgeons.

Surgical residencies, notorious for their grueling hours, have declined in popularity as young doctors struggle to find a balance between work and family life. From 1978 to 1989, 10 percent of medical school seniors listed general surgery as their first specialty choice; by 2002 that figure had shrunk to about 6 percent. But at Hopkins, the number of applications for the surgical internship remains steady. Each year, six of the applicants are selected for the general surgery residency, considered one of the top in the country. "We are seeing the best students from med schools all over America," says R. Robinson "Bricks" Baker, an early mentor and longtime friend of Cameron. "They still want to come to Hopkins, and it's because of John Cameron."

Cameron also has managed to instill a few of his own traditions into the residency. On Sunday mornings, he meets with house staff to talk over tough cases and chat a little about history. On intern interview days, he meets with every general-surgery applicant-about 75 each year. Just before the year officially begins, he brings together all the surgical interns-the six he's briefly met who've made the cut in general surgery, and the 24 others in surgical subspecialties-cardiac, pediatric, orthopedic and plastic surgery, otolaryngolgy and urology-he's never seen before. He's carefully scrutinized head shots and bios, and without looking at a list, greets each by name, school and specialty. He then presents every resident with the Halsted tie.

Hardworking and highly disciplined, Cameron is a perfectionist who expects perfection in others. In those who study with him, he inspires awe, respect and not a little fear. "He was an absolutely relentless teacher in the operating room," recalls Jeff Drebin, one of Cameron's former chief residents, now a pancreatic and biliary surgeon at Washington University in St. Louis. "Even today, eight years out, when I do a Whipple operation, and I've done nearly 180 of them since coming here, the residents joke that within the first hour, I've already told a story about Dr. Cameron. I'm still doing that operation with him looking over my shoulder."

Drebin will never forget the first operation he did as chief resident on Cameron's service, a gastrectomy, excision of part of the stomach. He pretty much knew by then just what Cameron expected, so "I was making a real effort to hold the needle driver and place the needle through the tissue just the way he likes it. After three sutures, Dr. Cameron said, 'Jeff, you're squeezing that needle holder too tightly. You should be more relaxed in your motion.' I couldn't believe it. To have picked that out required incredible focus on his part, and it really gave me a message that no matter what I did, he was going to find a way I could improve. But he was 100 percent right. When I do that procedure now, I do it the way I learned to do it in that final year."

Supremely self-assured, always witty, by turns quick-tempered and exceedingly well-mannered, Cameron describes his style in the OR as obsessive/compulsive. "It's a very good trait for a surgeon," he insists. "You've got to be obsessive/compulsive so that things you sew together don't fall apart, so things you stop from bleeding don't start bleeding. You don't want someone operating on you that isn't going to be compulsive and obsessive about doing things just right."

Cameron is the first to admit he can get mad in a second. When he says "Look it!" trainees pay attention. He's mellowed of late, says Joanne Coleman, his nurse of 18 years, but there was a time when nurses would duck into a room when Cameron came walking down the hall. "He can be madder than a hornet," she says, "but when it's over, it's over."

"Look it," Cameron declares, "I yell at everybody, and everybody knows my bark is much worse than my bite. Because at the end of a case, if there's been a lot of yelling and screaming, I always apologize to people. I tell them, you did a good job, this was a very tough case, we had some trouble. I was yelling at myself because we were in that trouble." The experience, for residents who scrub with him, can be excruciating. "But after they're out of here," says Coleman, "they all call home to Daddy."

The Hospital is the place where Cameron loves to be. He's there every day, including Saturday and Sunday mornings. On weekend afternoons, he's out on the golf course, the only place anyone's likely to see him not wearing a tie. (A fastidious dresser, Cameron may not send his shirts to Paris to have them laundered as Halsted did, but he does have them made in Hong Kong.) Four mornings a week for four or five hours, he's in the OR. "That's where I'm most comfortable, where I think I'm best. But I never operate by myself. It's always with residents. I'm operating and teaching together. The two go hand in hand."

Cameron is very much a creature of habit, so punctual that you can set your watch by his comings and goings. He arrives at the Hospital at precisely 6 a.m. He always parks his Subaru Outback, or occasionally his 18-year-old black Porsche Targa, in the same space (near the guard door). After early morning rounds, he repairs to the main cafeteria for his coffee and doughnut-always chocolate glazed. If occasionally he finds no chocolate glazed available, he makes perfectly clear to the cafeteria help that his needs that morning have not been met. He always pays at the same cashier (far left upon exiting).

The son of a surgeon, Cameron was born in a small town in southern Michigan and raised in Detroit where he attended public schools. Harvard was the only college he applied to. He got in. Without ever having set foot in Cambridge, he boarded a train with his footlocker when it came time to leave home and headed east. Four years later, in 1958, he enrolled at the Johns Hopkins School of Medicine, then stayed on for his residency. In 1971, he joined the Hopkins faculty.

In the early days, Cameron and Bricks Baker nearly always worked together. They operated on vascular, thoracic, endocrine and general surgery cases, and even took call for each other. Then Baker gradually moved into thoracic and breast surgery, and Cameron branched off into abdominal procedures designed to treat liver disease and particularly cancer of the pancreas.

As late as the 1960s, the enormous operation known as the Whipple-in which part of the pancreas, all of the duodenum, the gallbladder, bile duct and occasionally part of the stomach, are removed-was considered one of the riskiest going. One in four patients who had the surgery known officially as a pancreaticoduodenectomy, didn't survive the hospital stay.

Cameron became an expert on the Whipple. By the early '90s, he'd demonstrated that the procedure could be one of very few effective treatment for patients with cancer in the head of the pancreas, when performed with precision. In a banner study 10 years ago, Cameron and colleagues reported they had performed 145 consecutive Whipples-many on patients in their 70s, four in their 80s-without a death. "It was," Baker says, "a great technical achievement."

It was also a challenge that few other surgeons would have taken on, says Toby Gordon, a former administrator in the Department of Surgery, now vice president for planning and marketing. That need to break new ground characterizes Cameron. "There's a great deal of satisfaction in doing a familiar procedure well," he says. "But I'm interested in training the Halstedian academic surgeon who wants to teach and solve unsolved problems."

As director, Cameron has run a profitable department. "He keeps a very tight hand on the department," says Baker. "He runs it very closely, and he runs it himself." On the national scene, he has achieved every top honor in surgery, including serving as president of the American Surgical Association, the highest tribute paid to an American surgeon.

Twice, Cameron almost left Hopkins. In 1982, before he became chief, he actually accepted the job (in Cameron's lexicon, "the job" means chairman of surgery) at Vanderbilt. He'd moved his lab there and put a down payment on a house, but then, as he tells it, "everybody in the family pretty much didn't want to go." The Friday before he was due to start work, he called to say he wasn't coming.

Less than two years later, Cameron was named acting chief at Hopkins. When he learned he was in the running for "the job," he immediately ordered the Porsche. "I figured if I didn't get the job, I was going to be so depressed that I needed something to cheer me up. And if I did get the job, I needed something to help me celebrate." As it turned out, there was a slight fork in the road. A chairman from the Midwest was the search committee's first choice. He, however, declined the offer, and in 1984 Cameron stepped up to the plate.

Eight years into the job, Cameron was offered the chairmanship of surgery at New York Hospital/Cornell Medical Center. This time, he wanted to go. New York Hospital, the second oldest in the country, has what Cameron likes most: "a great heritage." One of Halsted's residents, in fact, had been an early chairman. "I thought it would be nice to have another Halsted apostle go reinvigorate the place," he says.

Cameron also loves the arts-film, theater, museums-and living on New York City's Upper East Side would have been a dream-come-true. He and his wife, Doris, had already picked out an apartment on Park Avenue, when Doris had a change of heart. His residents may call him "the boss" (though never to his face), but Doris, evidently, rules the roost. One evening, she picked up the phone when the resident on-call dialed Cameron at home. "Is the boss there?" the resident asked. "Speaking," said Doris.

Now Cameron has passed the mythical age of 65, and as is customary at Johns Hopkins Medicine, he is stepping down as department head. "It's time for someone else to have a shot at this," he says stoically, and "I'm happy to give my successor the opportunity of 18 years like I've had." He is, however, by no means retiring. He'll still do what he loves most: teach and operate four mornings a week. Pretty soon, in fact, he'll perform his 1,000th Whipple.

"I used to say this is the best job in surgery, and now I say it's the best job, period. I've loved every second of it," Cameron says. "You have defeats and losses from time to time, but never in any single day have they outweighed the pure delights. Somebody once asked me what I did to celebrate when I became department head, and I said, Nothing. Because every day you have this job is a celebration."

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