Ann Thorac Surg 2007;83:1916-1917
© 2007 The Society of Thoracic Surgeons
Our Surgical Heritage
Richard M. Peters, MD (1922–2006)
Hermes C. Grillo, MDa,1,
John R. Benfield, MDb,*
a Department of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
b Department of Thoracic Surgery, UCLA Center for Health Sciences, and David Geffen School of Medicine at UCLA, Los Angeles, California
* Address correspondence to Dr Benfield, David Geffen School of Medicine at UCLA, 11611 Terryhill Place, Los Angeles, CA 90049 (Email: j.benfield{at}verizon.net).
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Introduction
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With the death of Richard Morse Peters (Fig 1) on September 1, 2006, thoracic surgery marks the loss of an incomparable colleague. He was a distinguished surgical scholar who displayed scrupulous exactitude as a scientist, rigorous precision as a surgeon, and directed devotion as a teacher. In addition, he had a principled social conscience as a citizen, and admirable integrity in all that he did.
Peters was born in New Haven on February 21, 1922, son of a distinguished Professor of Medicine at Yale. He was a varsity swimmer at Yale when that champion team was foremost among colleges. Peters received his doctor of medicine degree cum laude from Yale in 1945. He trained in general and thoracic surgery at Washington University, St. Louis, under the tutelage of the much admired Evarts Graham. In St. Louis he married Ann Wilson DeHuff, a medical student who became a pediatrician and a valued editor of Peters’ publications. Peters completed his residency in 1952 with a two-year hiatus for service in the United States Army at Fort Myers, Washington, D.C. from 1946–1948.
He became the assistant professor of surgery and head of the division of cardiothoracic surgery at the University of North Carolina in Chapel Hill. Peters and his wife became active in the community. Peters’ profound civic conscience led him to long service on the school board at Chapel Hill, where he and other board members labored successfully for 6 years to desegregate the public schools. It was the first system in the south to be desegregated.
At the University of North Carolina he began studies of the effects of pulmonary mechanics and inspired gas concentration on airway resistance and the distribution of blood flow to the lungs. He pioneered the first intensive care unit for postoperative surgical patients in the United States. This unit became the first desegregated ward of the North Carolina Memorial Hospital. In addition, Peters, with Ralph Stacey, PhD, initiated a unique postgraduate curriculum in bioengineering. Peers throughout the world and the university recognized Peters’ original contributions, and he was promoted to professor in 1959.
In 1969 he became the professor of surgery and bioengineering at the new University of California San Diego School of Medicine and the founding chief of the division of cardiothoracic surgery. Peters achieved wide recognition there for leadership in applying automated techniques to monitoring respiratory and cardiac function of patients in the intensive care unit. The National Institutes of Health supported this work for more than 30 years.
Richard Peters was an outstanding educator. He cared intensely about medical students, and especially about the quality of education offered to our residents in cardiothoracic surgery. In 1980, deeply concerned by the withering of general thoracic surgery, and the shortage of faculty experts in the field, he stimulated the formation of an informal small group of general thoracic surgeons who met twice a year to try to remedy this worsening deficit. When Donald Paulson became the president of the American Association for Thoracic Surgery (AATS), he created the AATS Liaison Committee, which included thoughtful representatives who primarily practiced cardiac surgery. This committee, which was the extension of the informal group that Peters had stimulated, made recommendations about the organization of faculty, facilities, curriculum, and resident case load; it offered specific recommendations for action by the American Board of Thoracic Surgery (ABTS), the Thoracic Surgery Residency Review Committee, and the Thoracic Surgery Directors Association. These recommendations were supported by President Donald Paulson of the AATS in 1981 [1], and they were formalized in the AATS Liaison Committee’s report in 1984 [2]. Peters correctly characterized the work of the Liaison Committee as "vigorous prodding of [this] vocal group of general thoracic surgeons" that did eventually initiate changes that provided a basis for renaissance in the subspecialty.
In 1987, Peters presciently alerted the profession to problems that subsequently burst into cardiothoracic surgery [3]. He predicted that a crisis in recruitment to the specialty’s training programs would (in just a few years) also profoundly constrict access to cardiothoracic surgery. Peters noted that the "fundamental changes [that] have occurred in general and cardiothoracic surgery ... a combination of ... new technology, disease incidence and those consequent on decisions by the Boards and Residency Review Committees" demand attention and change. He favored complete high-quality education before starting thoracic surgery residency, and he deplored the American Board of Surgery’s decision that largely left intensive care to anesthesia and internal medicine. He advised that "criterion reference [defined experience, number of procedures, types of experience] for each year of training [be] an essential goal" and that there be accountability. He foresaw the need to consider decreasing training years in general surgery and in cardiothoracic surgery. He recognized that "alternative paths" in cardiac and general thoracic surgery were needed, with enrichment of each of the two subdivisions. He warned of the additional influence of medical student debt, and noted this among factors that were driving more top quality students away from thoracic surgery. Prolonged apprenticeship might also result, he warned, in "the stifling of new ideas," echoing Edward D. Churchill’s earlier concerns.
In a provocative editorial in 1991, Peters [4] perceived that increasing total length for cardiothoracic education was increasing "servitude" without compensatory increase in "quality." He pleaded for us to care about such matters as deterioration of general surgical training before thoracic surgery residencies, and about dogged resistance to constructive change in cardiothoracic training programs. He said that change should only be for educational reasons and not to enhance the service functions of residents. He also made specific recommendations for improvement, stating that "the future of cardiothoracic surgery depends on a constant infusion of new capable individuals into the specialty," and he said that all cardiothoracic surgeons should be "guardians of this future." Peters’ concluding sentence in that editorial was a warning: "If we wait until the quality of trainees has deteriorated, radical surgery will only be palliative at best." We now know that his warning might equally well have been a prediction.
When Peters retired from the UCSD School of Medicine in 1989 he had published more than 250 articles and a truly classic book on respiratory mechanics. He had served as senior editor of 5 textbooks including one published in China, and had contributed numerous chapters to many books. His editorial and committee duties were important and multiple. He was widely invited to lecture nationally and internationally, especially on respiratory mechanics, cardiac function, intensive care unit computer monitoring, electronic health records, and appropriate use of intravenous fluids in acute care and trauma management.
Peters was a model of a socially responsible citizen. Despite the demands of his intense involvement in surgery, research, writing, and teaching, he actively promoted racial desegregation, civil liberties, and social justice. He advocated universal health insurance for Americans. In his last years he became interested in researching his family’s history, with a special focus on his distinguished father’s courageous battle to maintain dignity and reputation in the black years of the McCarthy inquisition. Perhaps this experience sensitized the young Peters for life against threats of the erosion of civil liberties. He was deeply disappointed by many directions that he observed in public life.
Peters was a well-rounded man who loved his family and was loyal and supportive to his friends. He enjoyed sailing and skiing. He relaxed especially in his later years by enjoying fly fishing for trout in Montana, Wyoming, and Idaho, and skiing at Mammoth and Deer Valley with close friends. These expeditions were accompanied by long evenings of intense wide ranging conversations without limits, and more often than not they ended without resolution. He was a wonderful friend, a wonderful human being, a wonderful colleague, and he will be remembered with warmth and deep appreciation.
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Addendum
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On October 14, 2006, Hermes C. Grillo died in a traffic accident in Ravenna, Italy. He and Dick Peters shared the strongest possible devotion to excellence in thoracic surgery.
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Footnotes
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1 Dr Grillo died on Oct 14, 2006. 
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References
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- Paulson DL. A time for assessment J Thorac Casdiovasc Surg 1981;82:163-168.
- Grillo HC, Benfield JR, Faber LP, et al. General thoracic surgery in cardiothoracic surgery: the search for balance J Thorac Cardiovasc Surg 1984;88:321-323Ibid. Ann Thorac Surg 1984;38:427–8.[Medline]
- Peters RM. Training of the thoracic surgeon Ann Thorac Surg 1987;44:565.[Medline]
- Peters RM. Should we care? Do we care? What should we do? Ann Thorac Surg 1991;51:807-808.[Medline]
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Introduction
Addendum
