Dr. Ralph Feigin

Duration: 52mins:36secs
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Uncorrected Transcript

Interview with: Dr. Ralph Feigin
Interviewed by: David Goldstein
Date: September 17, 2007

 


DG: Today is September 17 and we are here today with Dr. Ralph Feigin filming for the Houston Oral History Project. My name is David Goldstein. Dr. Feigin, how are you today?

RF: I am doing very well. How are you?

DG: I am doing fine, thank you. Doctor, tell me your earliest life history and then how you came to be in Houston.

RF: I was born in New York City on April 3, 1938. I grew up in the middle of the city and went to school there. I enjoyed myself, played some basketball both in high school and college. I stayed in New York City during my college years. I went to Columbia. I graduated from Columbia and then went to medical school. I subsequently graduated from Boston University School of Medicine and decided I wanted to be a pediatrician. So, I went for pediatric training which I did at the Massachusetts General Hospital and Harvard Medical School and at the conclusion of my three years of pediatric training, the Vietnam War broke out in 1965. I was one of the first 500 physicians actually called to active duty during the Vietnam War and was assigned because of the work that I had done both in infectious diseases and in some aspects of understanding how you make early diagnoses of infection. I was assigned to a unit called the United States Army Research Institute of Infectious Diseases at Fort Dietrich, Maryland. This was a unit that was conducting research on both offensive and defensive aspects of biological warfare. So, I spent 2 years working, in fact, on the defensive aspects of biological warfare and during that period of time, made a number of interesting observations, many of which were published in the medical literature and journals like Science and Nature and New England Journal of Medicine. So, by the time I completed my two years in the military, I was being asked to join the faculties of many different medical schools in the country. I chose to go back to Harvard and Mass. General, which I did. I was there for another year, at which time, I was asked to go to Washington University School of Medicine and St. Louis Children's Hospital to direct the Division of Pediatric Infectious Diseases at Washington University, and to also become the director of the Serology, Microbiology and Virology Laboratories of the St. Louis Children's Hospital. During the 9 years that I spent there, I developed a pretty good pediatric infectious disease program. In fact, many of the people I trained are today international leaders in the field and it has been a great privilege for me to see that happen.

I was there about 8 years when I started to be invited to work at a variety of different pediatric department chairmanships around the United States and I had pretty much resolved that I was not going to take any. I was very happy with what I was doing. I enjoyed infectious diseases a great deal. But when I was invited to come down to Houston to look at the joint position of chairman of the Pediatric Department at Baylor College of Medicine and Physician in Chief at the Texas Children's Hospital, I thought it might be an intriguing opportunity. I came down to, candidly, just look at the position and I thought it had a lot of potential. The hospital was, at that time, not nearly as well-known or developed as some of the hospitals in which I trained or the ones in which I was actually working. Places like Boston Children's, Mass General, St. Louis Children's had histories that go back almost 200 years.

I was invited back for a second interview a few weeks later and I was asked if I wished to bring my wife, which I did. And, at that time, I was asked if I wanted to accept the position. I thought about it a little bit after I returned to St. Louis and decided it would be an interesting opportunity to help build and mold what I thought could become, with a little work and effort, one of the most outstanding children's hospitals and pediatric departments in the world. And so, I came here in July of 1977 and that is the beginning of really my career in Houston. I must tell you that the people I had met during the interview process that were on the board of trustees of the Texas Children's Hospital and the Baylor College of Medicine who were outstanding citizens of this community were quite instrumental in my making the decision to come here because they immediately embraced my own vision that this should be, and we ought to strive to be absolutely preeminent in patient care and education and research and community service and that it was going to take a great deal of work to make the institutions what I thought they could become.

DG: Why this when you were young and you had an aptitude for academics, what was the attraction of medicine to you?
RF: Truthfully, I never thought about being anything other than a physician my entire life. My earliest recollections back to the age of 3 or 4 years of age, I never thought of doing anything other than being a physician. And it is not because there is anyone in my family who are physicians. No one in my family was a physician.

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DG: Interesting. Why pediatrics?

RF: I did not decide to be a pediatrician until I was in my third year of medical school. In fact, when I went to medical school, I thought I was going to go into internal medicine or possibly surgery. But as soon as I went through my core rotations in pediatrics, I knew that you could do the most that could possibly be done in any branch of medicine in pediatrics. Just think of trying to help children and the large number of years of subsequent life expectancy if you can change the course of the disease that they have.

DG: Interesting. This project that we are engaged in today is about recognizing outstanding Houstonians and you mentioned people that were on that initial welcoming committee. Do you remember the people who particularly influenced you? Can you name names?

RF: Yes, I do. People like George Peterkin who was the CEO at the time of Kirby Industries; George Bellows, who is well known in the construction industry; Gibson Gale, who was the managing partner of Fulbright & Jaworski; Herman Pressler who, for a period of his life, was the general counsel and vice-president of the Humble Oil and then Exxon Corporation, and was chairman of the board at the time of Texas Children's Hospital; Leopold Meyer, who is well known to be one of the two founding members of Texas Children's. These were all people who were very instrumental in my thought process.

DG: What was your wife's impression of the city when she came down?

RF: My wife was pleasantly surprised. She is also from New York City, and I think her concept of Texas generically from just long, long years of not having revisited Texas was that it had wide open spaces and she could not quite conceive that there were really large cities here and it was quite cosmopolitan.

DG: You were at a position where you really could have selected from a variety of positions around the country. Can you speak in a little more detail about what it was about Houston and this opportunity specifically that attracted you, that convinced you?

RF: Yes. Many of the other opportunities that I was asked to look at, both before I came and, I might tell you, during the subsequent years, I had great fortune in my life and I had been asked to look at the chief positions at Harvard Medical School and Boston Children's and Children's Hospital of Philadelphia and all kinds of other positions like that. But I do not think any of them have the quality of potential for growth and development and the kind of community support that you have here in Houston.
DG: What does that community support look like for somebody in your position?

RF: That community support is in the time and effort that citizens who have nothing to do with medicine are willing to contribute to recruit people to the city, to make them feel comfortable, to help guide and direct major institutions like Baylor College of Medicine and Texas Children's Hospital, and actually to give of their own resources in order to make the opportunities come to fruition - whether it is building buildings or recruiting people - all of that takes money.

DG: What was the Medical Center like when you first came here would you say in 1977?

RF: When I came in July of 1977, Texas Children's Hospital had a single building, a sliver of a building that was called the Abercrombie Building. It was 7 stories in height. We had about 210 beds in the building. To give you a little feel for the nature of the hospital, it was run jointly at that time with the St. Luke's Episcopal Hospital in terms of having a common administrator and common billing and collecting functions. The Texas Children's Hospital had its own units where you could house patients. We did not have our own emergency center. We did not have our own operating rooms. We did not have our own radiology area. All of this was comingled with adults at the St. Luke's Episcopal Hospital. We did not have our own pharmacy or central supply or occupational therapy or physical therapy or social service or a variety of other essential features that you would find in a hospital. It did have a pretty good initial faculty but they were small in number. There were 38 full-time faculty at Baylor who were physically and geographically housed at Texas Children's when I arrived and they spanned most of the medical and some of the pediatric surgical disciplines but not all of them. For example, there was no full-time pediatric surgeon here. There was no pediatric immunologist here when I came. And there were a number of other critical areas where there literally was no one in place - not a person. And so, there was a lot of building to do. The rest of the Medical Center -- Smith Tower, Scurlock Tower, they did not exist. The Dunn Tower of The Methodist Hospital, it did not exist. Most of the current buildings that you see at M.D. Anderson were not present. The Taub Building, the Smith Building at Baylor College of Medicine were not there. The Alkek Building was not there. The DeBakey Building was not there. The Ben Taub Hospital which was in the Medical Center was a completely different facility, a much older facility. So, by and large, many of the facilities that Houstonians today take for granted, they did not exist.

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DG: From what you just described, it sounded pretty bleak and desolate to someone coming from the main medical centers of east, up north. What was here that you think laid the foundation?

RF: Well, the interesting thing is all of the institutions were here, even though they were smaller than they are today. So, M.D. Anderson was here, Baylor College of Medicine was here, University of Texas Health Science Center in Houston was here, Methodist Hospital was here, St. Luke's was here, Texas Institute of Rehabilitation and Research was here, Texas Children's was here but they were much smaller in scope, and certainly they did not have the breadth and depth of faculty that you see today.

DG: I see. When did you have a sense that we were building not just a series of facilities but a medical center?

RF: I think the Medical Center was well established when I came as a concept. In fact, the people who originally thought of putting a medical center together back in 1949, they were the people that had the vision of what this really could be but I do not think any of them envisioned what it has become. The concept of having multiple institutions working together and sometimes even competing with each other, I think that was something they had dreamed of and had thought of, and maybe by 1977, thought that that had come to some reasonable fruition. The real issue is how do you bring the best of medicine to the citizens of Houston and in my arena, that, of course, has to do with pediatric health care. So, I am going to use some statistics to contrast what it was then with what we have today. So, at Texas Children's Hospital, the first year I was here, we had 4,100 admissions to the hospital. Today, we admit about 25,000 patients a year. In the outpatient area, we had about 9,200 outpatient visits the first year I was here. That was visits to subspecialty physicians for subspecialty pediatric care, care for pediatric cardiology or endocrinology or infectious diseases -- subspecialties of that type. A little over 9,000. We ended last year with 496,000 outpatient visits to subspecialty people at Texas Children's. And I will talk about what we have done also in the primary care space in a few minutes. Emergency room the first year I was here had 6,250 visits. We ended this last year with 88,000 visits to the emergency center at Texas Children's. So, what really ensued in the intervening years? My plan was a very simple one -- it wasn't to build buildings, even though that is what ultimately happened. I do not believe that buildings of any kind are the heart and soul of what makes good medicine. Good medicine is produced by good people who have spectacular training and who really want to advance the field and not just practice what they learned 5 or 10 years ago.

So, you have to have a constellation of outstanding patient care, outstanding educational programs and research to move the field forward. Sometimes when I am asked to articulate the vision of Texas Children's Hospital, I say, well, we want to be preeminent in patient care, education and research and that is translated by many people into this tripartite mission of an academic medical center and I frequently like to remind them that to me, it is not a three-part mission - it is a singular mission. You cannot have outstanding patient care if you are not bringing outstanding research to the table and literally trying to move the field forward, and providing innovative care for the children who are under your care all the time. You have to be training people for the future in order to replace the people who are here today. So, what did we basically focus on? I focused on recruiting from outside of Houston the absolutely top pediatric medical and surgical talent, and I focused on training the top pediatric talent by developing the training programs that could, in fact, do that. So, I mentioned we had 36 to 38 faculty when I first came. This year, we have 535 full-time geographically based physicians with tremendous depth and breadth in every subspecialty area. I have 48 people who do nothing but pediatric cancer care here. I have 39 people who do nothing but pediatric cardiac and cardiac surgery here for children. I have 25 people who do nothing but pediatric infectious diseases, 49 people who do nothing but pediatric emergency medicine. And I could go on and on. The point I am making is this tremendous breadth and depth of talent here today which is what has caused us to have to expand the hospital in terms of the number of beds, the number of buildings where we could house outpatient visits, etc.

On the research side, when I came, we had about 490,000 of research funds coming in from peer review grants from outside of Houston. We ended this last year with $102 million a year of extramural research funding, most of that coming from the National Institutes of Health or the United States Department of Agriculture. So, what I could do then is give you a little timeline of how this has actually developed.

By 1983, it became very clear to the board of trustees of Children's Hospital and myself that to become a true outstanding children's hospital, we would have to be freestanding -- we would have to have our own ER, our own operating rooms and basically not be working out of St. Luke's Episcopal Hospital space. So, by 1985, we developed a plan to separate the institutions. Part of that plan included building the building that we are currently in today which was originally designed to be a combination outpatient building and research building because we had grown out of the little small outpatient space we had and we have no research laboratory space. And we also decided we would have to build the first 5 floors of what today is known as the West Tower Building to house all of our intensive care units and neonatal intensive care units and our emergency center and our dialysis unit. And we began that construction in 1989 and we completed those projects in 1991. Now, an additional project that I need to mention is a building here called the Children's Nutrition Research Center. In 1979, the United States Congress circulated a request for a proposal for people who were interested in doing research on normal nutrient requirements for newborn infants, children, adolescents and pregnant women. So, we submitted this RFP. We were asked to submit a full grant, which we did. Forty-four other medical schools and children's hospitals submitted grants. We were one of five selected to be site visited. I was very pleased when our grant was the only one chosen to be funded. It was funded initially at one million dollars a year in 1979 by the United States Department of Agriculture and we began to do the work. By 1985, we had gotten about $5 million a year in funding and I did not have any more laboratory space to put the program in. So, Dr. Buford Nichols and I went to the United States Congress and we asked them for $55 million to build the building that today is called The Children's Nutrition Research Center.

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The first year, we got $5.5 million for architectural and engineering fees. We went back the next year and asked for the remainder of the $55 million which was $49 million. And fortunately, they did give it to us and we built this building which is just adjacent to this structure and that program has now been in continuous operation since 1979, housed in that building since 1989 and it is funded at about $13 million a year that is coming into Houston.

By 2001, actually by 1999, we recognized the need for still additional space. The number of children we were seeing had grown dramatically, the number of people we were recruiting continued to grow and so, the board of trustees of Texas Children's made the decision that we would build the top 15 floors of the West Tower Building and we would build a completely additional building at the corner of Fannin and Holcombe which we would put all of our outpatient activity in, and that is called the Clinical Care Center. Those buildings were completed in 2001 and, of course, you can see them here today.

Unfortunately, we have not stopped. Programs continue to grow. We see children today from all 50 states, from more than 50 foreign countries every year. In a given year today, Texas Children's touches almost 600,000 children from the Houston community and many from beyond. We have about 2 million patient encounters a year. Obviously, we see many children more than once. That is an extraordinary number of childhood patient encounters in any facility. By far, way more than any place else in the world. So, what are the plans for the future? We are building another hospital at I-10 and Barker Cypress Road. That will be initially a 96-bed hospital. There will be an outpatient department and an emergency room there. We will staff it with the same people we have here, same quality people. It will be focused mostly on primary and secondary pediatric care. We are not going to do all of the intensive care we have down here. We will not be doing bone marrow transplants, heart transplants. We are not going to be doing some of the interventional cardiac cath work. But virtually all of the other things that require primary or secondary pediatric care, we will be able to do in that facility just as we can here. We are also building a pediatric neurologic research institute. This is the only one in the United States.

The decision we made to do that was based on the fact that we have an extraordinary group of pediatric neurologists here. I have recruited over 28 full-time pediatric neurologists that are leaders in the field. Now, we have an extraordinary genetics group at Baylor and Texas Children's. Literally, the leaders in the world. We are one of three centers that has been the home of the Human Genome Project. The Genome Sequencing Center is used for many things besides just sequencing the human genome. We have tremendous advances that have been made in molecular biology. We have tremendous advances made in neuroimaging, not just CTs and MRIs that most of the public are familiar with but functional MRI where we can actually see the function of individual brain cells, not just their structure. Those constellation of things coupled with the fact that 45% of all of the known neurologically handicapping conditions that have a genetic basis in children were discovered here by our people, permits us to be at the real leadership position to do this. And I know that Mayor White has been very helpful and instrumental in helping us support that particular project. He thinks it is going to be really something that is extraordinary for Houston and beyond. We have many people from all over the country like the Nobel Laureate, Eric Candell, and Gerald Fishback, the former head of the National Institute of Neurologic Disease, Blindness and Stroke, who have been staunch supporters of this particular project. We hope to have a building to put that kind of activity into completed also by 2010. That would be located immediately adjacent to the Commons Building in the Texas Medical Center directly across from Baylor College of Medicine and adjacent to the M.D. Anderson Hospital. The building we are physically in today is also being expanded. There are 8 floors being added to the top of it. It will end up being a 20 floor building. That construction will be completed and will be ready to occupy the upper 8 floors by August of next year, 2008. And so, we have got a lot of plans to continue to grow and develop the hospital with one goal in mind -- to provide better service and more research advances for the benefit of children. Not just in Houston but all over the world and literally any place they could come.

DG: When you came here in 1977 and you spoke about opportunity and potential, what was your dream? It is easy to look back now and see where you are but what were you hoping for when you came in 1977?

RF: You know, I dreamed of trying to create something that I hoped would be viewed some day as the finest pediatric program and children's hospital anywhere. But you never chart a course that would say, well, I want to have so many buildings, etc. That is not my goal. My goal is to build great programs and when you do that and people come because of those programs, you are forced to build the structures. So, my goal is always to incrementally every day move the field forward. If you do that, good things generally happen.

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DG: What is your dream now? What is your dream today? When you are done and you retire and you sit back and allow yourself a moment of reflection, what do you want to have done before you reach that point?

RF: I want unequivocally for this institution, Texas Children's and the pediatric department at Baylor to absolutely be recognized as the preeminent programs of their kind, not just in the United States but in the world. Most importantly, I would like to have continued to help thousands and thousands of children. And the most important thing to me is to see that that tradition and that kind of quality is continued into the future. It has to survive the current generation and subsequent generations if anything I have done is to be meaningful into the future. So, when I look at it, the heart and soul of what I try and do is I try and create and train wonderful people to be able to carry this out into the future. And that is why our training programs here are fundamental to everything we do. We talk about that a lot. I put an enormous amount of time and effort into the training programs because that is the only way you can have quality that is sustained into the future.

DG: What are you most proud of, of what you have accomplished so far?

RF: I would have to say that I am most proud of the people that we have trained that have gone on to do wonderful things in their own right. Almost 50% of the people currently here on our full-time faculty came through our training programs including many of our leaders. The people who went out into private practice in the community have had an enormous impact on pediatric health care at the community level. In fact, today, 65% of all the pediatricians in Houston were trained in our institution. Forty-five percent of all the pediatricians in the state of Texas were trained here. So, the impact that we have had on pediatric health care, even in children that we cannot touch physically here, is enormous. It is hard for me to even think about it but 5% of all the pediatricians in the United States I have had the great privilege of training, including 10 current pediatric department chairs and hundreds of section heads and other programs. People who give care all around the world in our pediatric AIDS program, that are all over Africa and Romania and elsewhere, we have trained all those people. And so, we touch many, many children that cannot physically come to the Texas Medical Center and I think that is a tremendous source of pride to me.

DG: When you become the leader of an institution like this, you reach a point where your time is not really your own. You sort of get captured by the momentum of what you started. Today, given the choice to spend your time caring for patients, teaching and training or doing research, in a perfect world, how would you spend your day?

RF: Well, you know, I try and do a little bit of all of those things, candidly, as well as a whole lot of administration, but I enjoy teaching enormously, particularly teaching residents at the same time that we are providing patient care, so I cannot pull those two apart. I love to see very complex patients with very complex infectious disease problems and other complex pediatric problems and I do see those because they are presented to me all the time and they are referred to me from patients all over the country and all over the world. So, I enjoy doing that a lot and I enjoy teaching while I do that. I also enjoyed designing research projects based on that and based on some of the insights that we get out of patient care. So, a lot of the research I do is patient care driven. And I enjoy that enormously. And some day, if I were to be able to give up my administrative responsibilities, I would unequivocally spend most of my time seeing complex patients, teaching and doing research.
I do a lot of writing, which I would also continue to do. I write textbooks and a lot of web-based programs and clearly, I will continue to do those things if God gives me the grace to keep my mind active and physically, I am able to do it.

DG: You give a lot of credit to the people that have made the Medical Center what it is. Do any particular hires stand out in your mind? Remember, this is a database of outstanding individuals. Were there any that you felt really put a certain department of a subspecialty on the map with a particular hire that you could mention? I do not want to slight anybody that you do not mention but do any stick out in your mind?

RF: There are so many people like that. I do not want to slight anybody either, but I will just name a few because they were, I will say, the people that really helped me put a complete program together here. So, Milton Feingold really developed pediatric pathology to its full extent at Texas Children's, and he has done a wonderful job. And I know people do not realize but pathology is very important, clinical pathology. Those tests are what help you make diagnoses in any institution. Marvin Fishman, basically developed one of the finest pediatric neurology programs in the country. I brought him here in 1979, he retired just this year, and that program which has, in turn, trained leaders all over the country has been instrumental in that particular field.

David Poplack who I recruited from the National Institutes of Health, he was the deputy director of the National Cancer Institute. We had a quite robust pediatric cancer program here before it came which was directed by Don Frundbach (sp?) but David took it to another level. And today, I would say we have the finest pediatric oncology program in the United States. Malcolm Brenner, who directs my cell therapy, gene therapy and bone marrow transplant program, I recruited him from St. Jude's. He clearly is the international leader in the field. And he, Helen Hessla (sp?), Bob Krantz and others, Peggy Goddell, have really made this place world renowned in that area. Charles Frazier, whom I recruited here in Pediatric Cardiothoracic Surgery has really taken the strong program which we had which was started by Denton Cooley and again, brought it to another level in pediatric cardiothoracic surgery. There are many others that I could single out like that. People we have trained here have become international leaders.

Huda Zogby is an example. Huda came here as a resident. We trained her in pediatrics. We trained her in neurology. We trained her in genetics. At the age of 50 now, she is literally the leading figure in the world in pediatric neurogenetics; member of the National Academy of Sciences, and she will be the director of our pediatric neurologic research institute. Jim Lupsky who I first brought here as a resident, founded the entire field of what today is called genomic medicine. So, there are many, many people, some of whom we have trained and brought along and some of whom we recruited from elsewhere who have been instrumental in making this place what it is today.

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DG: You must be a bit of a pied piper getting all of these people to come to Houston and this facility. What is your secret? How do you convince these people to come here? Do they see what you saw? What do you sell them on?


RF: I try and, one, look for people who are themselves talented that I see really are not satisfied with the way things are today - they want to improve it for the future. I am looking for people who will either have or grasp the vision that we have, that can play into that and clearly will take it to the next level. And then, I try and convince them that I am here to help them make their dreams come true. I want to make their dreams come true. And I have tried to do that over the years. And that is how you end up with all these wonderful people.

DG: Terrific. How has medicine in general -- we talked a lot about this particular facility, we talked about the Medical Center -- how has the practice of medicine changed looking back in the time that you were practicing?

RF: Oh my goodness! When I entered pediatric medicine, there were no pediatric intensive care units, there were no neonatal intensive care units. There were, in fact, no respirators that you could put babies on. If they were born with a respiratory problem, you either hand bagged them or they died. We had 5 antibiotics, not 75 different antibiotics. Patients used to die - they still do today - of infection, but many more used to die of infectious diseases. All the immunizations that were around when I entered medicine were diphtheria, tetanus and polio vaccine, and pertussis (whooping cough) vaccine. The vaccines that many people take for granted today -- measles, mumps, chickenpox vaccine, influenza vaccine, vaccines for Haemophilus influenza type B to prevent meningitis, pneumococcal vaccine, hepatitis vaccine -- none of those things existed. Those were all developed during the intervening years. We had no bone marrow transplant units. We were not doing any transplantation at all when I entered pediatrics. So, there have been marked changes. Technologically, we had no MRIs, we had no CT scanners. CT scanners did not come to the United States until 1974, years after I was practicing. So, there have been enormous changes in the practice of medicine that have permitted us to do things that you could not have dreamed of then.

DG: As a consumer of medical services, of course, everybody is preoccupied with insurance and the level of care, accessibility to care, as an administrator, how much of that do you live with and how has that changed the way you do what you do here?

RF: I live with the issue of the cost of medical care every day, and I find it tragic that today, we have so many uninsured Americans and particularly, so many uninsured children. The goal at Texas Children's was, to the extent of the resources available to provide care for every child, irrespective of their ability to pay and candidly, that remains our mission today. More than 50% of the children at Texas Children's Hospital today are on Medicaid, CHIP or have no resources whatsoever. More than 50%. So, we do everything we can to contain costs so that we can provide them the resources that are required way over and above anything that Medicaid or CHIP or certainly someone with no resources can have. So, we can provide care to all those children. I do not want to see any child in this community or anywhere else go without medical care. I cannot tell you how much free care we give all the time, day after day after day. We have to have a more rational way to do this in the future, candidly. Medical care and the cost of medical care is a national crisis that is going to have to be addressed in the very, very near future. [end of side 1]

DG: We are going to go back and talk about one of the things that you have talked about - just another layer deeper. We talked about the need for buildings, we talked about the need for growth, the need for expansion. At another level, what was the hardest part about it -- selling the vision? Finding the money? Raising the money? Building the buildings? You know, a business man looking at what has been accomplished here would say it is just not that easy.

RF: No, it is not easy at all. The hardest problem and I think the most important issue is to sell people on a vision and put a business plan behind that vision that makes people think it is accomplishable. And you do that, as I mentioned, incrementally. You do not do that in big jumps. I was asking the board of trustees of Children's to accept the vision of building a facility for outpatient care at a time when outpatient care meant less than 2% of the hospital revenues. And I was trying to get them to buy into a vision that I thought that outpatient care was going to be the future of medicine in terms of particularly the intake for more serious diseases and that at some future point in time, we would have 30% of our revenues derived from outpatient activities. That took a little bit of a leap of faith for a board. So, the most important thing is to get them to buy into a vision, and then put a realistic business plan behind it. How much of that money can you actually get from patient care? How much of that money can you actually get based on your business plan by going to the bond market and floating tax exempt bonds? How much can you reasonably raise by putting that vision out to the community from philanthropy? And candidly, it takes a combination of all of those things to make what you see here happen. We have used all of those sources to make this happen.

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DG: In a sense, there is always a competition for funds for attention for philanthropy. How would you describe the competitive nature of your existence here in the Medical Center with all these other institutions with which you share parking lots?

RF: Well, you know, it is very interesting. I have had perhaps the wonderful perspective of serving here as the Physician in Chief and Chairman of the Pediatric Department for 30 years for several years. During that period of time, I actually served also as the Chief Executive Officer at Texas Children's while we were going through the separation from St. Luke's. For 7 of those years, I also concomitantly served as the president and chief executive officer of Baylor College of Medicine. So, I have worked on behalf of a number of institutions in the Medical Center and I have tried to help lead and raise significant sums of money for several institutions, frequently concomitantly all at the same time.

I do not find that difficult. There are many things here that should intrigue and excite donors in a community about what goes on in Houston, Texas. So, in the pediatric arena, there are so many things that we can do for children tomorrow that we cannot do today if we just have the right resources to make it happen. There are people that I am trying to recruit today that are going to require some funds to bring into the community to get their programs established. I can think of two young people - maybe not so young - middle-aged people I was trying to recruit last week. They have a vision for markedly improving newborn care so that very premature infants can be actually monitored in a way that they cannot be monitored today that will diminish the likelihood that the very premature infant might be disabled when the grow up and they are using techniques that we do not have available today in Houston that I think would be extraordinary to bring into the Houston community. I can bring those people to talk to the appropriate donors which is what I do, and I think if you have donors who have had children or grandchildren with neonatal problems and other things, that is the kind of thing that might be intriguing to them. There are other people who have had terrible problems in life with cancer and heart disease and infectious diseases and all kinds of things I can mention, that if you bring the vision to them of how you can prevent those things or treat them better in the future, are very happy to help you and join in the vision. So, I try and pick the kind of thing that I think the donors are most interested in. Sometimes when I don't know what a donor is interested in, I tell them everything we are doing. Usually something excites them.

DG: Other than the generosity of leading philanthropists, how does Houston support your efforts in the Medical Center? If you took this Medical Center and stuck it in any other city, the interaction of the city would be defined by that particular city's culture, that particular city's spirit. What is the spirit of Houston as it relates to the Medical Center? How do they support you beyond the obvious fundraising efforts?

RF: I think Houston, to begin with, is one of the most philanthropic communities in the United States. There may be more money, candidly, in New York City but in terms of the willingness of people to contribute, I do not believe any place in the United States had a lead on Houston, Texas. I think we lead everybody. Secondly, I think people are very willing to give of their time, not just their money, and time is a very important attribute. There are many, many people who volunteer their time and effort to work at Texas Children's that make medical care easier, that make the childrens' time that they spend here much easier, that contribute a whole lot to the milieu of what you are able to put together for any family. So, the time contribution is extraordinary.

At the board level, I cannot overpraise the board of trustees that we have, both at Texas Children's and Baylor College of Medicine. I have watched leaders of this community with their own businesses sometimes give 20, 30 hours a week to making certain that the vision, the goals and the outcome of what has been achieved here literally come to fruition in a way that benefits everyone in the city of Houston.

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DG: You have been the recipient of a lot of personal honors, a lot of personal recognition. Does anything stand out in your mind as the most meaningful to you?

RF: Well, you know, I have been very fortunate in my life and I have received a lot of honors locally, nationally and internationally, and I guess I would pick three of them: one may surprise some people and that is the honors I received from my own students and residents who have, many years in a row, nominated me as the outstanding teacher. So many years, they took me out of the competition, they put me in the so-called hall of fame, Baylor Hall of Fame for teaching. At a more global national level, I just received award notice of the John Howland Award. The John Howland Award is an award that is given to someone whose lifetime contributions to pediatrics have made an absolute difference, not just in your generation but for generations to come in the lives of children because of the research that you have done in your career, that have had an impact, that have sustained or improved the lives of children all over the world. And, of course, that is a very meaningful award. And a third award I guess I would single out is the John McGovern Complete Physician Award which says that it is given to someone . . . it is a national award that has the attributes of Sir William Osler. Sir William Osler was an internationally renowned physician who was known to be a spectacular clinician and teacher, and that award has a lot of meaning to me.

DG: You have talked a lot about the importance of teaching to you. What is the secret of a good teacher? What is the secret of a good medical teacher, medical instructor?

RF: I think a good teacher has to know their field extraordinarily well, so well that they can take complex material and they are able to relate it in a way that anyone can understand at any level. And I think secondly, they need to couple that in the clinical arena with a really fundamental understanding of clinical disease, which is not often easy to acquire and sometimes more difficult, candidly, to transmit to others. And I think they need to have enthusiasm and turn some people on.

DG: Terrific. That is palpable. What are the most significant changes in the city since you moved here in 1977, that said this is a city of rapid change and growth, looking back on, not the Medical Center but now just looking at the city in general?

RF: Well, the city has obviously grown enormously since I came here. We actually purchased a house when I first arrived out just beyond Gessner off of Memorial Drive and we actually went there because we had, at that time, 3 children, 1 entering high school, 1 junior high and 1 in elementary school. Of course, now they are all grown up. Their ages are 44, 41, and 37. But people said, "You know, there are 3 good schools out here in the Spring Branch District which would be good for your kids," so, that is why we bought the house there. People thought we were crazy. They thought we lived way out in the country or something. The demographic center of Houston today I have been told by the sociologists is I-10 and Gessner. There is an equal number of people living north, south, east and west of that point. So obviously, the center of the city demographically has moved to where we actually functionally lived.

Secondly, I think downtown has been markedly reinvigorated since we have been here. Of course, the Metro line was not here at all. Virtually all of the current stadium in which we have football or baseball or basketball, none of those were here. Of course, the Astrodome was here and the Summit was here but we do not use those anymore for the sports venues. I think we have wonderful leadership in this city and I think that has continued to absolutely be first rate over a number of years. I think Mayor White is probably the best mayor of any city in the U.S., in my opinion.
DG: What we are doing here is capturing stories of prominent Houstonians for future generations. What is the short version? What do you want people to know about you in your time here and what you have been able to accomplish?

RF: I want people to know maybe two things about me: one, is I care a lot about my family and that family has to play a prominent role in your life, no matter how busy you are. I have 3 wonderful children and 6 wonderful grandchildren. Secondly, I want them probably to remember me as someone that had the vision that was trying to help a lot of children, not just in Houston but all over the world, and that virtually everything that I have done, whether it is my own personal research or training people or developing programs or anything else, the goal has been to help children.

DG: I do not want to put the words in your mouth but you suggested throughout this conversation that so much of what you have done might not have happened any place else except Houston over this past 30 years. Again, the same question about the city of Houston. What do you want that the school kids 10, 15, 20 years from now when they just take all this for granted, what do you want them to know about their city that helped make all this possible?

RF: I want them to know that in this city, any dream can come true, that you can make any dream come true. You just have to think about what you want to do. You know, you can find the time and the energy which is absolutely palpable in this city to make whatever you want come true.
DG: Was there anything that you were hoping to talk about that you would like to be included in this, that I was not smart enough to ask you?

RF: I think you did a great job.

DG: Thank you, Dr. Feigin.

RF: Thank you.