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IV. The physician as co-workers see him

Those who worked with Dr. Bob, while he was drinking and while he was recovering, saw different aspects of the man and his problem.

Starting in the late 1920’s, Dr. Bob had been going quite often to St. Thomas Hospital (where he was appointed to the courtesy staff in 1934). It was on one of his first visits, in 1928, that he met Sister Mary Ignatia. She had taught music, but after being ill, was assigned less strenuous duties in the admitting office at St. Thomas, which was run by the Sisters of Charity of Saint Augustine, as it is today.

“Doctor would call and say, ‘Sister, may I have a bed?’ remembered Sister Ignatia. “I would always recognize his voice with its rich New England accent. He rarely came to the hospital without visiting the admitting office.

“He loved to use slang words. If he was at some big dinner, he’d say, ‘Well, we put on the nosebag yesterday.’ Or he would come into the admitting office, where I’d have many other people around, and ask about his patient. I’d say, ‘I put Mrs. Jones in 408, but there’s another patient there.’ ‘Another patient, Sister?’ ‘Yes, Doctor, another patient.’ ‘You mean a frail, Sister.’ So the next time I would say, ‘Doctor, your Mr. Brown is in 241, and there’s a frail in 218.’ He would just enjoy it.”

Dr. Bob was also in the habit of calling almost everyone by a nickname. “He always called me Abercrombie,” said one of the early A.A.’s. Bill Wilson was Willie or, on state occasions presumably, Sir William. Alcoholics in general were U.D.’s, for “unknown drunks.” And according to Smitty, the good sister had her nickname as well—Ig. However, he was doubtful that his father ever had the nerve to use it in her presence.

As Sister Ignatia recalled, their first meeting seemed of no particular consequence. She knew nothing of Dr. Bob’s problem. “He just always seemed different from the rest,” she said. “He brought something with him when he came into a room. I never knew what it was. I just felt it.”

Another who thought Dr. R. H. Smith was different— “wonderfully different”—was Betty B., then a young student nurse at City Hospital. “He was known to us as Dr. R. H. S., because there were two other Smiths at City Hospital,” she said.

In 1934, Betty had no idea that Dr. R. H. S. was an alcoholic, although she was aware that his hands sometimes shook when he did a dressing and that his eyes were bloodshot. Only years later, when she herself came into the A.A. program, did she learn that City Hospital’s Dr. R. H. Smith and A.A.’s Dr. Bob were one and the same.

Yet the problem of alcoholism among staff members was

Some colleagues at City Hospital were unaware of Dr. Bob’s

drinking problem. Slowly, it became obvious.

not unknown even to student nurses. Betty heard that one doctor who had been chief of surgery was dismissed for this reason. She was told they allowed him to operate surreptitiously. And once, when she was on call, he wheeled someone into the operating room in the middle of the night.

Betty saw Dr. R. H. S. as neither pompous nor condescending at a time when student nurses were at the lowest level in a hospital hierarchy where doctors were demigods, at least in their own estimation.

“He didn’t ignore me or any other student,” she recalled. “When we’d step aside, as required, at an elevator or door so a doctor could precede us, we all knew Dr. R. H. S. would push us ahead, just as he’d stare above his glasses and growl, ‘Sit down, woman,’ when we automatically started to rise upon his entrance to the chart room. Most unusual of all, he’d thank us after we’d made rounds with him or helped change a dressing.

“His patients loved him. So did the nurses,” Betty said, remembering a time when, in her huge white apron and bib, she was still in awe of doctors and afraid of most of them. But not Dr. R. H. S. “I learned that beneath his abrupt and sometimes gruff exterior, he was kind and understanding, even a little shy.”

He called all student nurses “woman,” a term that made her feel a little less gauche, a bit more mature. She thinks he knew this and that was why he had chosen this incongruous term for student nurses. A select few, charge nurses he had known and respected a long time, were called “sugar.”

Betty remembered that he wore purple striped socks beneath his always-too-short surgical trousers. And his surgical cap, instead of being snugly fitted, was perched high above his ears like that of a rakish baker.

“He kept it simple before A.A., and the nurses who scrubbed for him loved him for it,” she said. “His surgical skills were admired by nurses and doctors alike, yet he used fewer instruments and other operating paraphernalia than any other surgeon.

“Over the years, I learned to admire and respect some doctors,” Betty said, “but I didn’t like many of them, because of their attitude. It is hard to find a doctor who is good professionally and is also a decent, fine man with humility. This is a very special sort of person, and Dr. Smith was that kind of man.

“When I became a surgical nurse, I learned that most surgeons are prima donnas. They have temper tantrums and they throw instruments. They are arrogant and can make it pretty rough, especially for a student nurse.

“If things started to go bad in an operation, Dr. R. H. S. would remain very calm. He made us all feel comfortable, and there was nothing hurried. His somewhat raspy voice would become soft and low. Orders were given quietly. The rougher the going, the more calm he became. This attitude infected us all.

“There was no screaming, no swearing. He was not snide, and he did not make off-color remarks to embarrass the students. Others would try to belittle us and would sometimes be really cruel. Dr. Smith was not that way, and because of that, we all loved him. I never heard an unkind thing said about Dr. Smith.”

Betty saw him as innately kind and possessed of an inner strength, and recalled his telling students that pain was the greatest leveler and that suffering patients should be treated with equal solicitude and compassion whether they were in charity wards or private rooms.

Above all, Betty remembers assisting Dr. Bob with a lumbar puncture, then dropping the specimen. Instead of reporting her, he merely said, “Well, we’ll just have to get some more.” And when her supervisor inquired why they were going through the complicated and tedious procedure again, Dr. Bob replied that he had “dropped the damn thing” before Betty could get hold of it, saving her from severe reprimand.

“I don’t know whether the supervisor believed that, but she couldn’t say he was lying,” Betty said. “So I just . . . well, I could have kissed the ground that man walked on.”

Betty also recalled that Dr. Bob could be blunt. “I got a call to the O.R. one Sunday afternoon. There was just Dr. Bob, an intern, the anesthetized patient, and me. Dr. Bob was not garrulous, and none of us were saying anything.

“The patient was turned over on his abdomen. Dr. Bob, who was a rectal surgeon, felt there was no point in prepping them there.

“The intern, who was a rather shy young man with his head in the clouds most of the time, was sort of leaning on the patient, using a hemostat to pull hairs out of the rectal area. It was as though he was plucking petals from a flower—‘She loves me, she loves me not.’

“I’ll always remember Dr. Bob saying, ‘Um, Doctor?’ And the intern said, ‘Yes, Dr. R. H.?’ And Dr. Bob said, ‘Just how the hell would you like someone pulling hairs out of your ass?’

“Yes, he was blunt. But there was nothing cross or phony about that man. I knew that long before I knew anything else about him. He was just a real guy.”

Lily, Dr. Bob’s receptionist-nurse, was equally devoted, according to Sue, who remembered her mother’s comment that Lily “had nothing but praise for him, but said she had a hard time getting him to tell who was indebted to him. He didn’t like to send out bills, and there were many people he didn’t charge at all.”

“That’s true,” agreed Smitty. “He did more charity work than he did for his regular patients. I remember how he’d say, ‘Well, I’ve got three operations this morning—two for the Lord and one for R. H.’ Not only that, but people would come into his office in desperate straits, and he would literally give them his last cent. He might only have 50 cents, but he’d give it to them.”

In 1933-34, of course, there were probably fewer and fewer bills to send out. Dr. Bob’s position at City Hospital became precarious, to say the least. There are some who say he was actually dismissed, but no record of dismissal has been found. It is likely that discussion of the matter was in a preliminary or “informal” stage when Bob stopped drinking— just in time. However, his surgical practice had dwindled, and he was supplementing his income through catch-as-catch-can general practice.

More light was thrown on this crucial period by Dr. Thomas Scuderi, later the medical director of what is now Ignatia Hall, the alcoholic ward at St. Thomas Hospital.

Dr. Scuderi, a young intern in 1934 when he first met Dr. Bob, described him as “a big hulk of a man, well built, with a husky voice. He was very good to the interns and residents. Couldn’t do enough for you. And when he laughed, you couldn’t help but laugh with him.”

Dr. Scuderi was not then aware of Dr. Bob’s drinking problem, “because everything was on the Q.T. in those days.” But he later found out that others knew. He advanced several reasons why Dr. Bob might not have been more severely disciplined than he was.

First, Dr. Scuderi felt Dr. Bob was a better surgeon than most, even though disabled by alcohol. Second, Dr. Bob was extremely well liked by his colleagues, who probably did what they could to cover up for him. Third, there was (and to some extent, still is) a tacit agreement in the medical profession to deny that such problems as alcoholism existed among doctors.

Dr. Scuderi (who in 1977, at the time of these reminiscences, was in his seventies and never did start to drink) said Dr. Bob always gave help and guidance to younger men. Furthermore, he himself became interested in alcoholism through the example of Dr. Bob and Sister Ignatia, when they established the alcoholic ward at St. Thomas.

“I remember he used to tell the young interns, ‘Stay away from alcohol if you’re smart. Look at it but don’t touch it, because it won’t get you anywhere.’ He said, ‘The older you get, the more tempted you are to drink. Stay away from it.’

“Doctors work under a lot of stress,” Dr. Scuderi said. “Alcohol is a temptation. They go to a lot of parties, and they don’t think they’re mixing with the other doctors unless they have a drink in their hand.

“I don’t know anything about him being dismissed from City Hospital. All I know is that he made a terrific comeback in surgery at St. Thomas. And he’d get up at two or three in the morning to help another alcoholic.

“R. H. Smith used to visit the alcoholic ward every day. This was in addition to his regular practice—it was entirely voluntary A.A. work. He couldn’t do enough for them. He talked to them in short sentences, very simply. He was very approachable, and he would talk to everybody the same way, whether they were the highest or lowest level.

“When I went to Italy last year, I looked up A.A. in the telephone directory. I said to my brother, ‘If only Dr. Smith knew how it is—all over the world today.’ ”