Is There a Doctor in the House?
Date: February 1, 2013
When David Guyton started his ophthalmology residency at the Wilmer Eye Institute in 1973, his youngest brother Gregory was just five years old. Like David, Gregory would grow up to be a doctor—not all that unusual, except that Greg happened to be the tenth of 10 Guyton siblings to earn a medical degree.
As children, the Guyton offspring didn’t realize that their noisy and industrious Mississippi family stood out in any way, much less that they would become the next generation of an extraordinary medical dynasty. “We didn’t know any differently,” says David Guyton, Zanvyl Krieger Professor of Pediatric Ophthalmology in the Division of Pediatric Ophthalmology and Adult Strabismus. “In retrospect, it was quite a remarkable experience.”
Today, the Guyton “kids”—eight brothers and two sisters—work across the country in an array of academic and community settings. Besides David Guyton, the brood’s only ophthalmologist, there are two orthopedic surgeons, two cardiothoracic surgeons, two anesthesiologists, one rheumatologist, one retired internist and one professor of medicine (see “Where Are They Now?” p. 35). Gregory, an orthopedic surgeon at Union Memorial Hospital, and David are the only two Guyton's who settled in Baltimore.
As youngsters, David and his siblings were not actively encouraged to follow in their father’s footsteps. Dinner table topics tended more toward go-kart pulley systems, sailboat keel designs, and how to weld tractor parts rather than the principles of clinical medicine, David says. Seated in his East Baltimore campus office chockablock with thousands of neatly stacked papers and curious gadgets, he chuckles while recounting the constant commotion of a childhood spent building things under the guidance of a man who believed devoutly in self-reliance. “We had so much respect for my father, who was so successful in the face of adversity; we literally wanted to be like him.”
When David was 2, his father contracted polio early in his surgical residency following graduation from Harvard Medical School. Partial paralysis quashed Arthur Guyton’s plans to become a surgeon. His family in tow, Guyton returned to his hometown, Oxford, MS, to teach at the University of Mississippi’s School of Medicine, where his father, ophthalmologist/otolaryngologist Billy Guyton, had recently stepped down as dean. In Oxford, Arthur Guyton began his landmark work, the Textbook of Medical Physiology, still widely used around the world, taking occasional breaks to play chess with neighbor William Faulkner.
Guyton encouraged his children to learn by doing, be it carpentry, electronics, auto mechanics, welding, masonry, plumbing, or even knitting and sewing. In that sense, his disability was “a blessing in disguise for my siblings and me,” David says. “We became his legs and his hands, and were guided by his mind.”
When the family moved in 1955 to Jackson, where the Ole Miss medical school had relocated, the Guyton offspring helped to construct a house made of poured concrete and reinforced steel—likened by the children to a “fall-out bunker”—and a swimming pool where his father swam after work.
As the youngest Guyton by six years, Greg felt removed from his siblings, yet reveled in the opportunity to “kick around this big empty house, with all these things to do.” In a family-built house that frequently needed repairs, he also served as Arthur’s first mate, a role that enabled him to see his father in unguarded moments and know him more deeply. “I had a very intense exposure to Daddy. It was very special.”
Her father handed down “the whole idea of trying to figure things out, not learning things by memorization,” says Jean Gispen, the sixth child born to Arthur and Ruth Guyton. “It’s about when you have a problem and you can’t quite see what’s wrong and you break it down and you figure it out.”
A rheumatologist in Oxford, where locals still call her the “Guyton girl,” Jean absorbed an equally important lesson from her parents, she says. “I learned from my father and my mother that you can learn something from everyone, no matter what station they hold in life.”
Ruth Guyton, the daughter of a Yale Divinity School dean, shared her husband’s teetotaler culture, if not his stern nature. Arthur doled out praise sparingly, but his wife championed her children’s accomplishments and, when necessary, soothed their wounded pride, David says. Her locally published essays chronicled family exploits and offered lessons learned in childrearing, including such pearls as: “We were not strict. We had guidelines and limits, but with that many, you can’t have too many rules or you drive yourself crazy.”
One by one, the Guyton siblings were drawn to medicine. “I do not think it was the expectation initially, but later it became a self-imposed expectation as we grew increasingly proud of our record,” David says. Doug, the seventh Guyton sibling, briefly contemplated a writing career and Greg considered the field of high energy physics before Congress canceled funding in 1993 for construction of the Superconducting Super Collider in Texas. Medicine grew more appealing as well because it would provide “more personal exposure to people” than physics, Greg says.
Royalty income from Arthur Guyton’s textbook funded his children’s college, graduate, and medical educations and now helps to support schooling for his 33 grandchildren, David says. “We were so very lucky and privileged in that regard.”
Like their father, the Guyton crew gravitated to Harvard. All eight sons attended Harvard Medical School, and daughters Catherine and Jean enrolled at Radcliffe College (which later merged with Harvard). Catherine earned a PhD in organic chemistry at Harvard before attending medical school at the University of Miami, and Jean obtained her medical degree at Duke. Although their student years in Boston often overlapped, the Guytons didn’t study or do research together. “We preferred to be family rather than competitors,” David says.
To their surprise, the Guyton offspring found medicine to be a more demanding discipline than anticipated. “My father went to work from 7 to 5, Monday through Friday, and then he would come home and eat dinner, and take a nap and sit in his chair and write and edit his book,” Jean says. “It was an academic, intellectual life. No phone calls in the middle of the night. And so we were sort of tricked. I didn’t have any exposure to what the life of a practicing clinician was.”
None of the Guyton siblings has left the discipline (though Catherine is now retired). “I feel lucky that medicine turned out to suit me very nicely,” Jean says. “It’s an incredible honor to have people let you into their lives and tell you things and trust you not to repeat them.”
Another Guyton figures into the family’s legacy at Hopkins—Jack Guyton, a pioneering opthalmic surgeon and Arthur’s oldest brother. David followed his Uncle Jack’s path from childhood in Oxford to Harvard Medical School, and—at Jack's recommendation—to Wilmer, where both were chief residents. Yet he never had a chance to know his uncle professionally. Jack left Wilmer for the Henry Ford Hospital in Detroit, 18 years before David arrived. After Jack’s wife died in 1952, he had little contact with his brother’s large family. He died at his Florida home in 1987.
From his uncle’s best friend, A. Edward Maumenee Jr., director of the Wilmer Eye Institute from 1955 to 1979, David later learned that he and Jack Guyton shared more than a fascination with ophthalmology. They both relied, for example, on a stash of Coca-Cola to fuel their research. When he gave the Jack S. Guyton Memorial Lecture at the Henry Ford Hospital in 2006, David shared several such tidbits.
In 2003, Arthur and Ruth Guyton, then in their 80s, died after an automobile accident near their Jackson home. Afterward, the Guyton children gathered in their childhood home to divide the family belongings.
“I asked for all the brass and steel stock and Greg got the machinery,” David says. They loaded the stuff on a U-Haul truck and drove nonstop to Baltimore. The brothers, 23 years apart, had never spent so much time together, David says. Up to then, his eldest brother was “a bit of a stranger,” Greg says. “I didn’t know him terribly well. Then on the way home, I found out he is in fact very much like me.”
In retrospect, it became clear to Greg that his connection to David “came through Daddy. And it made me recognize the influence he had had on our lives two decades apart.” The brothers, for example, share an “innate practicality and desire to be independent that comes from my father. And I think the greatest gift he gave us was a lack of fear when trying to understand something. It was not so much his physical but his intellectual approach to life, to attack a subject rather than defer to somebody else, right down to the smallest thing,” says Greg.
So far, only four of the Guyton brethren’s 33 children have chosen medical careers. David’s twin sons both work in the computer field and a third is a business consultant. Still, there are opportunities to mentor the family’s newest generation of physicians. Last year his niece Kristi Guyton, a fourth-year medical student at the University of Chicago, came to Wilmer to do a visiting clinical rotation with her uncle in pediatric ophthalmology and strabismus. Of his brother Steven’s daughter, David says, “It was truly thrilling to teach my own flesh-and-blood in my specialized field and marvel at her skill.”
At one point last year, a third family member joined Kristi and David in the OR. Jean Gispen’s daughter Fiona was interviewing at Hopkins; she is now a first-year medical student. Like her mother’s, Fiona’s career path may seem inescapable. As a child, she relied on second-grade phonics lessons to spell out her plans—“I want to be a roommatologist”—on a series of self-portraits that adorned her mother’s office for years.
Deciding upon medicine, though, “was not a linear process,” Fiona says during a break in the Wenz Café on the medical campus. As a Stanford undergraduate, Fiona’s expansive interests led to economics and mathematics as well as pre-med classes. She stayed on at Stanford to earn a master’s degree in management science and engineering.
Ultimately, she circled back to medicine; not because it was her destiny but because in true Guyton fashion it well suited her love of problem solving, serving people, and innovative use of technology to improve health care. Says Fiona Gispen, “It was a destiny I chose.” *
Where Are They Now?
Keeping straight the medical specialties of the Guyton siblings can be tricky—after all, there are 10 of them. Here’s a summary, from oldest to youngest:
1. David L. Guyton, MD
Zanvyl Krieger Professor of Ophthalmology
Pediatric Ophthalmology and Adult Strabismus
The Krieger Children’s Eye Center at The Wilmer Institute
The Johns Hopkins University School of Medicine, Baltimore, MD
2. Robert A. Guyton, MD
Charles R. Hatcher, Jr. Professor of Surgery
Chief, Division of Cardiothoracic Surgery, Department of Surgery
Emory University School of Medicine, Atlanta, GA
3. John R. Guyton, MD
Associate Professor of Medicine
Director of Duke Lipid Clinic
Duke University School of Medicine, Durham, NC
4. Steven W. Guyton, MD, MHA
Division Chief, Cardiothoracic Surgery
Oregon Health and Sciences University, Portland, OR
5. Catherine A. Guyton, MD
Internist - retired
Formerly employed at:
Harvard Community Health Plan, Boston and University of Pittsburgh Medical Center
6. Jean Guyton Gispen, MD
Rheumatologist and Internist
Staff Physician, Employee Health Service
University of Mississippi, University, MS
7. Douglas C. Guyton, MD
Physician’s Anesthesia Group, PA
St Dominic-Jackson Memorial Hospital, Jackson, MS
8. James L. Guyton, MD
Department of Orthopaedics
University of Tennessee/Campbell Clinic, Memphis, TN
9. Tom S. Guyton, MD
Medical Anesthesia Group, PA
Methodist Healthcare of Memphis, Memphis, TN
10. Gregory P. Guyton, MD
Greater Chesapeake Orthopaedic Associates, LLC.
Department of Orthopedic Surgery
MedStar Union Memorial Hospital, Baltimore, MD
Solving Problems, Fixing Sight
In a lab across from his office at the Wilmer Eye Institute, David Guyton displays the latest prototype of a vision-screening instrument for children that he and partners have been developing since 1991. The Pediatric Vision Screener, designed to detect amblyopia (lazy eye) using an infrared-laser-based eye-fixation monitor, is just one product of Guyton’s boundless enthusiasm for novel clinical inquiry and problem solving.
Guyton, the Zanvyl Krieger Professor of Pediatric Ophthalmology, has amassed a vita brimming with more than 280 publications, 11 U.S. patents, and dozens of honors, lectures, and keynote addresses. His research, enhanced by solid mechanical know-how, has yielded groundbreaking methods for measuring strabismus and diagnosing its underlying causes, and a wealth of other findings for which he received the 2007 Mildred Weisenfeld Award for scholarship in ophthalmology.
Guyton has also been lauded for his lucid lessons in ophthalmic optics written for the Lancaster Course, Stanford Course, and other curricula. One of Guyton’s educational videos on clinical refraction earned first place at the John Muir Medical Film Festival. His training materials “have contributed to the optics education of virtually every ophthalmologist trained in the past three decades,” notes Guyton’s frequent collaborator, David G. Hunter, chief ophthalmologist at Boston Children’s Hospital.
An account in a recent Wilmer newsletter of a surgical procedure to correct a young boy’s strabismus captured Guyton’s talents as a teacher and a clinician. When the patient’s father saw that the surgeon was surrounded by medical students, he asked who would perform the surgery. “This procedure takes four hands,” Guyton told him. “My two and two others; but I am responsible for all four of them.” —SS