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JOHN ROSE, M.D.
Past Chief of Staff
Pitt County Memorial Hospital

June 7, 2000

Interviewer: Marion Blackburn

Marion Blackburn: Dr. Rose, to tell me when you arrived in Greenville and began practicing and how you arrived in Greenville.

John Rose: I came in 1977 and at that time I had just completed a Cardiology Fellowship at the University of North Carolina at Chapel Hill. We had decided that we would like to stay in North Carolina and a friend of mine whose father was a surgeon here told me about a hospital practice opportunity with Dr. Fearrington and Dr. Rand. I called Dr. Fearrington one day and he told me to come on down and take a look. So, I did that in the fall of 1976 and I met him in the old hospital actually. He showed me around and we talked. I do remember though we met in the Emergency Department down there where he was taking care of somebody and I remember how cramped and crowded it was. People were talking then about the new hospital which was taking shape a few blocks away and they would be moving into that. That is what I remember of the old hospital. Dr. Fearrington was one of the first internists in town and he is still practicing. Actually, he is probably the first trained cardiologist in Greenville and he came to town, I guess, probably in the early sixties.

Marion Blackburn: He was in private practice but also worked at the hospital? He is definitely on the list to be interviewed and I need to get him for another project. Coming from Chapel Hill, did you feel any of the bitter battles that were going on at that point, did you ever feel any of this?

John Rose: You're quite right. Chapel Hill was bitterly opposed to this whole enterprise here, feeling that it would draw away from their resources and that it really wasn't needed. In fact, that in part turned out to be true because when I was a Fellow most of my patients who we treated in Chapel Hill were from eastern North Carolina. I think that over the long term that really has hurt them. In fact, we are much busier than they are now.

Marion Blackburn: I would venture to say, and I am not supposed to have an opinion, that it was something at the time that was desperately needed just from what I have seen and what I have heard.

John Rose: Absolutely, this has been an incredible success story here. It was bitterly opposed by many in Chapel Hill and from their standpoint I think it probably has hurt them some but it has been an incredible success. No one at all would have envisioned, I think, twenty-five years ago what we would have now.

Marion Blackburn: From that time in the fall of 1976 what was it like to join a private practice?

John Rose: When I finished in the mid-summer of 1977 was when I came. It was to join a private practice with doctors Fearrington and Rand and the three of us practiced together for thirteen years before we joined the medical school in 1990. You mentioned the old hospital, and the only other direct memory I have is I do remember looking at charts after I came and many of the patients were not admitted to a room, they were admitted to the hall, some hall, and they stayed there for five days and they just threw screens around them for their whole hospital stay. So, I guess as cramped as we think they are in the new hospital, it was even worse in the old one.

Marion Blackburn: That's probably the thing I hear more than anything else is how cramped it was, like you described. I don't think it has been described quite so clearly as you have by saying people were not actually in a room that they were in a hall. When our hospital was taking shape, you never really had the chance to practice in the old hospital at all.

John Rose: That's right. They moved to the new hospital in April and I came in July.

Marion Blackburn: That was a great viewpoint.

John Rose: It was very interesting because at that time it was strictly a community hospital still. We had referrals from the region but basically it was mostly from Pitt County. You didn't have any house staff. The medical school presence was amenable so it was like practicing in a community hospital, particularly the first year. All the coverage was done by the attending physicians. In fact they had just gotten emergency physicians. Prior to that had been divided up so that was new. I think the nurses took a lot of initiative then that they probably wouldn't take now because they didn't necessarily want to wake you up in the middle of the night about every little thing. It is really interesting to watch the transition which took place over the next few years from basically a community hospital to a more typical academic setting where we had house officers who did a lot of work.

Marion Blackburn: Of course now it has gone from a community hospital to an academic setting to a regional hospital. That is a lot of change.

John Rose: It is. As I said when I first came we did accept patients from the region but most of our patients came from Pitt County and now it is, of course, the reverse. There has been a tremendous increase in the services we have available and we can offer this to them. We had a fairly complete medical staff even then. We didn't have certain things like cardiac surgery but most other things we were able to take care of here. It was relatively uncommon to send folks up the road to Duke or Chapel Hill or Raleigh except for cardiac surgery in the early years.

Marion Blackburn: Was there a Cardiology Department at the School of Medicine before you came?

John Rose: Tom Blair had come, I think, I don't know if he predated me or if he came right around the time I got here. Then I think Lynn Orr came the next year. There was an academic crowd right around the time I came, not at all before. Basically when I arrived here just a few of the Chairs were here, Dr. Pories, Dr. Tingelstad, Dr. Furth, and we kind of filled in from there.

Marion Blackburn: I would like to go back to something that you were talking about which is when you arrived here in July of 1977 you were just out of your Fellowship at Chapel Hill. Are you from North Carolina?

John Rose: No, I grew up in Colorado and had gone to medical school and did my residency in Philadelphia. We liked Chapel Hill and we liked North Carolina so after our two-year stay there we decided we would like to stay.

Marion Blackburn: I was speaking to Mary Raab and I think she did hers there.

John Rose: Yes, she went there and I was at the University of Pennsylvania. I didn't know her then, of course.

Marion Blackburn: You were at Chapel Hill and you liked North Carolina and you came here and looked around and then in July you came into a hospital that has just opened. Can you describe the atmosphere then. Was everybody already organized or was there still a lot looking for pens and pads and other kinds of equipment? How would you describe the atmosphere?

John Rose: Well, it was fairly organized by that time. The medical staff then was quite small about 100 or maybe less and that meant that pretty quickly you would meet and know everyone who was around. Even then the nursing staff was very good and it was easy to work with them and they were very helpful. The Administration at that time even then was very good and forward looking and had been one of the keys that made this place so successful. Jack Richardson was the CEO then and he was superb, as has been all the administration since. It was a very friendly open place and it was a lot of fun to practice over there. You quickly got along well with everyone. It wasn't the sort of place that because you were new that it was difficult for you. That didn't seem to happen at all. Of course, a lot of the new people like me were bringing in new skills and some new things and the people that were here kind of liked that.

Marion Blackburn: I guess you were fortunate in a way that you came from Colorado because, of course you came from Philadelphia, but I am thinking that there could have been some of the prejudices about someone coming in from a big city from the north thinking they were going to teach those folks in the south how to do things. I can imagine that it could have been difficult if you had either had the wrong hometown or the wrong conditions or the wrong attitude. Did you notice any kinds of ideas like that at the time?

John Rose: Not much. I think you are right because I felt when I came east to go to school I felt like an outsider too so in that sense I felt more akin to southerners that came north too. You know, we had a lot of people that came from many parts of the country here and very few of them ever had that sort of attitude. I think if you talk to a lot of people that came here and have been leaders here, a lot of them are from different parts of the country. Of course, the flip side of that was the people here had been very open and welcoming to people from other parts of the country. I think a lot of that is because the university is here and they were just used to different kinds of people. It has always been a very cosmopolitan place for a small city in eastern North Carolina. I think it is a combination of the people that came here didn't have any condescending attitudes and the people who lived here didn't feel that they were being invaded by a bunch of people that they would rather see go back home. I saw very little of either attitude actually, which is very nice. That is one of the reasons that it is so nice to live here.

Marion Blackburn: That's very good to hear I am not surprised because it seems that the people who came, especially early on to participate in the first years of the medical school or in the hospital as it was becoming a teaching hospital, it seems like folks came because they were committed to teaching, they were committed to outreach and they were committed to making a real vibrant medical center here. I have seen a lot of that.

Jack Rose: I think by that time too, you know ten years earlier the south was a different place in many ways from the rest of the country. I think things had changed a lot by then so at that time it made it easier for people from other parts of the country to come here.

Marion Blackburn: What were your major responsibilities in those days? How are they different from what you do now?

John Rose: Well, at that time, of course, I didn't have any official responsibilities in the medical school although from the outset we did a fair amount of teaching and usually had a resident with us, so that role has grown. I think part of my role when I came here was as someone who knew some new and different things like bedside right heart catheterizations (Swan Gantz catheterization) and I kind of introduced that here and echocardiophy. I helped get that started here, I think.

Marion Blackburn: I guess these were things from Philadelphia you had been exposed to?

John Rose: No, from Chapel Hill and not too many people were doing those when I came here. I was probably the first Fellowship trained person to do those. Of course, that was kind of the way things were. You had people come out of Fellowship and then they had new things and they introduced them and then the older folks learned them.

Marion Blackburn: Your Fellowship was specifically in those things?

John Rose: In Cardiology yes, but those were relatively new things I picked up that weren't being done here and I brought with me. Actually, Don Tucker, one of the cardiologists already here, one of the private cardiologists, was already doing a little bit of Echo but he and I got the Echo Lab running. The technician from those early days was Barbara Gilmore who is no longer here. I think the change over the years is that since we joined the medical school, we do a lot more teaching both formal and informal. I have had some administrative roles as I was Chief of Staff in 1986, but I have a lot more now. I am Medical Director of various units. I guess it is formalizing of a more informal role that we always had.

Marion Blackburn: How has the hospital changed? Same building but I'll bet it's not the same place.

John Rose: Well, it really isn't the same building at all. Parts of it you can sort of recognize from the early days but I think the most interesting thing or the most outstanding about the hospital is that construction never ceased. I mean that after the original building was built then additions, renovations had constantly gone on. The physical plant has changed completely, of course, it is much larger. The bed size, I can't tell you but it has at least doubled if not more than that. Then we have added on all kinds of specialized units that we didn't have then. Of course, the size of the staff there has grown tremendously both in terms of nursing and medical staff. Medical staff is now in excess of 500. I think I told you that when I came it was about 100. It has been incredible. But I think the atmosphere is still the same as it's still an open and friendly place, the Administration is very good and very aggressive. Physicians bring new things in we try to be at the cutting edge and still deliver good medical care. I think those sorts of things were already here when I arrived. That has been another good thing about this place and it is really a nice place to live.

Marion Blackburn: Can you think of any specific ways that you might say Cardiology, specifically, has changed in the twenty-three years since you first came here? In other words, the way you practiced cardiology then and the way you practice cardiology now.

John Rose: Yes, I think it has changed in two ways. One is that when I came here there were basically two other cardiologists in town and now we have gosh about thirty, I suppose. Things we had available to us then were very limited and we had just started Echo. We had just started doing right heart catheterizations. We didn't have a Cath Lab. That came a couple or three years later. In terms of the scope of things we offer and the number of cardiologists here, that has changed tremendously. The other that has changed tremendously is not so much specific to our hospital but an international trend in just the way we practice the things that we have available to us now. When I started, when a person with a heart attack came in, basically you watched them and treated the complications. Now we have a lot of things that we can do. We know what causes heart attacks. To get at the basic problem which is usually a blocked off artery-open up the artery one way or another and that sort of thing. I could echo that in many areas of cardiology but that is not specific to here, that is going on across the nation and internationally but in this part of the country we certainly have been at the forefront in initiating those changes and offering them to our patients. I guess in two ways it has changed both in what we had available here and the things we do as cardiologists.

Marion Blackburn: The trend has changed. I barely remember when it was that way. When you had a heart attack the idea first coming out was that after a heart attack was that you should begin to exercise or begin to live more healthy because part of that, I think, it had been you pretty much took to your bed and didn't exert yourself.

John Rose: That's right, when I was a resident it was bed rest and special diet. Of course, back then in those days too, to do a heart catheterization on a patient who was having a heart attack would have been malpractice. Now it is the thing we try to do. It is very interesting to see how medicine changes and of course I am quite sure that twenty years from now a lot of things we are doing will seem to be very antiquated and quaint by folks who look back.

Marion Blackburn: I think probably, and I know terribly little about it, but it seems that in all the areas where surgery is required that the minimally invasive procedures, what began as arthroscopic knee surgery has kind of taken off as nobody could have imagined.

John Rose: You are absolutely right. To think back then that we would be doing porthole surgery for the heart is unimaginable. So the changes have really been breathtaking along both lines. Both in what we are doing and what our hospital has available now.

Marion Blackburn: I would like to go back once again and this is really something that may take you a minute or two or you may need to call me back later with it. Do you have any specific memory, a concrete memory, of a day or an event or something that just kind of sticks in your mind as a way you think of the days in 1977 when the hospital first opened and you were just beginning to practice there? Can you recall any images or events that happened that could never happen now or things would never be like that again or maybe things are still the same way? Any kind of images come to mind?

John Rose: I remember one of the first really sick acute heart attack patients I took care of. A fellow who was a farmer from up near Bethel had had a big heart attack and was in shock. Of course at the time where there is not a whole lot we had available for that I put in one of those right heart catheters and I gave him the medication and I remember coming out to talk to the family and I guess I must have looked pretty young at the time and they asked me if I had talked to the expert about that and I said well I guess I am the expert here. I don't know how confident they were about it but he survived and became a good friend as well as a patient. I kind of look back at him now and think gosh if we had just had available then what we have now that it would have been so much better at that time. It really does look a little primitive now.

Marion Blackburn: What kinds of things did you prescribe for him at that time? Were you prescribing exercise and diet?

John Rose: Well, I think at that time it was not nearly as clear the role of exercise, rehabilitation and lipids like cholesterol and the genesis of coronary heart disease. I think in his case we tried to get him through the acute event and then you know later we gradually increased his activities and he eventually returned to a more normal way of life. We just didn't understand much about the pathophysiology of coronary artery disease. Of course even if we did and could measure cholesterol in those days there wasn't much that we had available then that effectively treated it so I think there was much emphasis on some preventative cardiology. Of course at that time in this part of the state cigarette smoking was much more prevalent than it is now and I remember the volunteer ladies that drove the candy carts around also in those days sold cigarettes from the candy carts and the patients in their rooms would buy cigarettes and light up. I guess that is another cultural change-- don't think many people would have imagined that taking place.

Marion Blackburn: You mentioned a word which sort of makes me think of another question which is "acute". You said you got the patient through the acute phase or it was an acute illness. I look at the hospital as we sort of picture the hospital today, Pitt County Memorial Hospital is more called a tertiary care hospital and in 1977 of course that kind of a concept was unknown. Can you talk briefly about the change in the kind of care and the level of care that is expected? In other words, women don't stay in the hospital for a week when they have a baby, they only stay a night. I remember when my little sister was born we didn't see mom for two or three days. It was almost a convalescence kind of attitude and you talked about the gentleman from Bethel being in the hospital for two weeks, I guess bed rest. Now, if you are at the hospital you are going to be having procedures and going to be having some of them as an outpatient. In other words, the whole setup is different. Could you speak a little bit about that?

John Rose: Yes, I think that is true in several ways. One is that we used to admit people to the hospital for things we treat as an outpatient now. We used to be much more ready to admit patients also and they were much more ready to accept it for simple things like pneumonia. In fact this wasn't done at the time I came here but not too many years before it was not uncommon to admit a patient to the hospital for their annual physical. They would come in and they would stay in the hospital a couple of days and they would get all their blood work and their x-rays and so forth and they would go home. The second thing we alluded to is that we used to keep people a lot longer than we do now. There are some pressures to admit only the sickest and to keep them in the hospital for the minimal amount of time and that in some ways is a good change. I think we probably are able to treat people now as outpatients that should be treated as outpatients. On the other hand, I think sometimes people that really do need to get admitted aren't admitted and maybe they leave the hospital and should not. In general, the people that we treat there are sicker and they are older. We are doing things now to patients in their seventies and eighties that we wouldn't have dreamed of doing in those days. The hospital practice is a little bit more complex now, not just because of the complexity of procedures but because of the nature of the kind of patient that we treat.

Marion Blackburn: I have two more questions I would like to ask you which are definitely related. One is the impact that you feel the hospital has had on Greenville, Pitt County and/or the region and of course what you see as the future impact? That is a wide open question.

John Rose: Well that's fair and I think it is an impact on Greenville and Pitt County. There are several things and one is that we have a world-class medical institution now to take care of the medical needs of the people of the county and the people of the region. This was a good hospital when I came and had a good medical staff but I think it has only improved over time and all of us who live here are very fortunate to have this institution here.

Secondly, it has made Greenville much more of a magnet, I think, for other communities. I think there was and still is to some degree some competition or perhaps jealously among cities that are about the size of Greenville that they think why should they send their people here as opposed to Raleigh or Durham or somewhere else but I think that Greenville now has become a much more of a natural attraction for sick people across eastern North Carolina.

Another impact, that of course, is the number of people who have moved here from both in the state and the region and from far away. I think this has enriched the community in many ways, not just in the talents they bring to medical skills but just the different kinds of interesting and bright people who have come here and brought their families with them. I think Greenville has always been a very interesting place for all the years I have lived here but I think it is even more so now because of the incredible diversity, not just from the hospital of course and the university, but I think the hospital, and the medical school have been a driving force in bringing that sort of person to Greenville.

I think the future is going to be more of the same. I think the hospital will continue to be a major medical center. I think we will be at the cutting edge in many areas like Dr. Chitwood's new procedures but I think we will continue to deliver excellent medical care which basically that is the most important thing we deal with. We will continue to train good physicians and the students we have here just seem to be getting better. I see this as a real treasure for the area and region that is going to continue to grow in value.

Right now we are having a sort of changing of the guard. A lot of people who were here at the beginning are leaving, stepping down, and they all have worthy successors but if you haven't talked to those people I think it would be high on your agenda.