Methodist Medical Center Foundation: Dr. Charles E. Darling

              
METHODIST MEDICAL CENTER ORAL HISTORY:
CHARLES DARLING, M.D.

Interviewed by Nancy Gray
September 22, 2008
 
MRS. GRAY: Hi, I’m Nancy Gray, it is September 22, 2008, and as part of the Methodist Medical Center Foundation History Project we are interviewing Dr. Chuck Darling.  Dr. Darling, we are anxious to speak to/to hear about his role in the obstetrics and gynecology business here in Oak Ridge, especially the Family Birthing Center, there at Methodist.  So, Dr. Darling if you would state your full name please.
DR. DARLING: Charles Darling.  
MRS. GRAY: Where and when were you born?
DR. DARLING: I was born in Detroit, Michigan on 09/04/1943.    
MRS. GRAY: You just had a big birthday, too.  This was celebrating another end of history.  What brought you here to Oak Ridge?  What were the circumstances for you coming to Oak Ridge?
DR. DARLING: I liked the community.  I was very much interested in the area of Virginia, North Carolina and East Tennessee.  I enjoyed the people I met here, the general center of the research undertaking and I had the opportunity to be part of the medical schools of Memphis and then New Orleans that I wanted to be in private practice. 
MRS. GRAY: Before we precede any further, let me just say too that you have signed the release form and I need to turn this off and make sure we are capturing the sound properly.  Hello, this is Nancy Gray, September 22, 2008.  Do you want me to starting at the very beginning?  Would you repeat when you came to Oak Ridge, you were intrigued by the small town and wanted to go into private practice.  How did you hear about Oak Ridge?
DR. DARLING: We looked at several communities and we knew there was a need through the medical school training program that I had been involved in.  I had been in New Orleans for two years and then in the Navy for two years and then going to Memphis and then coming to East Tennessee.  
MRS. GRAY: Your wife, were you married already when you came to Oak Ridge?
DR. DARLING: We were married and we had one child.  
MRS. GRAY: Your wife’s name is?
DR. DARLING: Marlene.
MRS. GRAY: You ended up with how many children?
DR. DARLING: Three.
MRS. GRAY: The three darling girls, is what we used to call them when they were all in school.  You came to Oak Ridge in what year?
DR. DARLING: 1974.
MRS. GRAY: What was your first job at Methodist Medical Center?
DR. DARLING: I was employed in a private practice and Bob DePersio, Bill Pugh, I and John Schanze practiced together.  The practice of obstetrics had been difficult for a few years for people because everybody had been in private practice alone.  There had been family practitioners.  The number of deliveries was such that they were having trouble covering, so they got a family practitioner to help.  The personalities of the individual physicians were unique and so when I came in under the sponsorship of Bill Pugh, actually Bob DePersio was sponsoring John Schanze then, John and I didn’t know each was coming.  
MRS. GRAY: Surprise!
DR. DARLING: We all met at dinner one night.  
MRS. GRAY: So they basically doubled the staff by DePersio and Pugh hiring you and John.  
DR. DARLING: Right.
MRS. GRAY: So how long did you stay in private practice, alone as a solo or besides you and Dr. Pugh?
DR. DARLING: No, no, we were all four of us in practice together as a group practice.   Tennessee had a malpractice crisis in 1975 and the Lloyds of London was unwilling to insure our group for more than its gross and that was when the State Volunteer Mutual Insurance Company was formed by physicians of the state.   It has become one of the leaders in the nation for clinical insurance, so they are doing very well.  So all of us chipped in money and sponsored the formation of this insurance company, but we were forced to go out individually and so this group of four split.  Bill Pugh retired about six months after I arrived and so that was the situation that I was in for a couple of years until I started to recruit another physician.  
MRS. GRAY: I remember when I was having Michael in 1977, I was in Labor and Delivery two days actually, this little man kept looking through the window, and I kept seeing this shock of white hair.  This little short guy with big head of white hair, I kept thinking “who is that?”  It was Dr. Pugh checking on things.  How has your specialty OB/GYN changed throughout the years that you have been here that you have been in practice?
DR. DARLING: The specialty has changed considerably. One of things that I insisted upon in coming was fetal monitors, those were not being used at that time.  We have become increasingly involved in different technologies and procedures, sometimes at the expense of personalized care I suspect so emphasizing that has been very important.  The original Labor and Delivery unit had labor rooms and you went into the delivery rooms to deliver.   We maintained that for a number of years. There was a nurse by the name of Pat Fisher who was the charge nurse for the department.
MRS. GRAY: I remember Patty.
DR. DARLING: She did a group of studies called “Architect Tonics”  which were projecting where we might go in the late 70’s and early 80’s and projected what has become a modern Birthing Center at that time.  The question was, should we convert to that or put that on hold and we had gone from about 580 deliveries in 1974 to 1320 deliveries in 1976.
MRS. GRAY: Holy smokes!  
DR. DARLING: The big draw had been the introduction of epidural anesthesia, which I brought to the area.  It did not take long for physicians in Knoxville to realize the patients were driving through Knoxville to get to Oak Ridge to get their epidurals and so they began to do epidural anesthesia in Knoxville.  
MRS. GRAY: So we really pioneered it here?  At Methodist?
DR. DARLING: Yes.
MRS. GRAY: I remember hearing that was the Cadillac of anesthesia, the epidural.
DR. DARLING: At that time we were just obstetricians doing our own epidurals.  Sometime in the 1980’s the anesthesia group were, I guess, coerced into doing that.  That was unfortunate because they didn’t advertise it as well as they might have.  
MRS. GRAY: Explain to me, as a layperson what is the difference between a traditional labor and delivery department and a birthing center?  What were the elements that characterize a birthing center?
DR. DARLING: Transparency.  The model that the hospital had when I arrived was in terms of the schematic.  There was a woman in a wheelchair pregnant coming into this black box labeled “hospital” and coming out on the other side with a baby in her arms in a wheelchair and what happened in the hospital was not really very well known.  Families were not allowed to be with laboring mothers. Scopolamine was used which was part of twilight sleep at the time.   There were a number of things that were being done that were reactive too by the people out in the community.  They banned together as the Childbirth Education Association.
MRS. GRAY: I remember that.
DR. DARLING: They had a newsletter which ultimately became an essay and once the delivery experience was tried to out do anyone else’s essay……
MRS. GRAY: Fish stories!
DR. DARLING: But these were blow by blow accounts of what people experienced.  There was a movement among women to become recognized as a force in the culture and be recognized individually as people; in the areas where they could really have an impact on childbirth which was theirs and so there was a huge focus on hospitals, physician’s practices and other things during that time and Oak Ridge was one of  the first hospitals to really liberalize pregnancy care.  One fellow who wanted to be present for the labor and delivery for his child was explained they required all these courses at the hospitals in Knoxville and he really did not have the time or money to do that but he pulled a lot of cows.  He thought that maybe he could probably withstand whatever happened in there with the birth of the baby.  There was a tremendous release and the staff meetings were mixed when we discussed the husband being present for cesarean sections for example. That was a whole new concept for the hospital and so I had to line up my ducks and I spaced these physicians around the room in the staff meetings, so they could stand up and have their say for the various parts.  It really looked like the whole staff was involved in supporting this which really wasn’t the case at all.  So we were able to pass that through the staff.
MRS. GRAY: What year was that?
DR. DARLING: Probably 1975.  The epidurals were initiated in 1974 and we really had a liberal program by 1975. It was selling well by 1976.  We proceeded to expand the numbers of obstetricians and gynecologists with the notions of what we were doing.  
MRS. GRAY: What about the nurse practicers?  Since I have been in Oak Ridge having members of the OB/GYN staff be the (I don’t know if nurse practicer is the word I’m looking for but).
DR. DARLING: Nurse practicers became a very important part of care in the state and in conjunction with the liberalizing policies in the hospital, I became involved with Planned Parenthood of East Tennessee.   At the time I became involved, they were covering nine counties of East Tennessee in place of the Health Department which was confused as to which Family Planning Services we needed to provide.  The use of physician’s extenders had not been explored in the state and so we sent a lady by the name of Mona Roberts to University of South Carolina to train as a Family Planning Nurse Practicer.  She was an RN, the wife of a physician who had been the Safety Coil.  We were fortunate she was able to come and join us for a couple of years and write our protocols and be our first draw for other people who were interested in getting nurse practicers.  The state remained confused.  We had a physician’s assistant by the name of Rivka Gordon who joined us and the state said we could not employ any more because physicians assistants were not properly trained and would not be certified with the state.  The Appalachian Regional Commission had begun to establish primary care clinics in various parts of the state.  Vanderbilt had sent out buses to screen people in the hollows, they were called, so we were getting and reaching out to the populations that hadn’t really had their blood pressure checked.  That group began to meet with Planned Parenthood to actually get some cross training from obstetrics and gynecology and as a result of those meetings we began to meet in Nashville and The Tennessee Association of Primary Care Centers was actually born in Oak Ridge, Planned Parenthood and with the Mountain People’s Health Clinics in Huntsville.   
MRS. GRAY: Harvey’s cousin was a PA out of Vanderbilt and worked right outside of Huntsville.
DR. DARLING: Yeah, so that is still a feather in the cap of the Roberts Woods Johnson Foundation that sponsored these meetings and they put together this group that has now been going for over twenty five years.  The hospital was part of this movement to establish a better care pattern for woman and others. 
MRS. GRAY: Now, we talked about some of the technology.  What about patients?  Any changes in patients?
DR. DARLING: The practice had been schizoid in the sense there was a time that really left an impression with me. When I walked into one room and this lady had scattered on the floor the number of articles that she had apparently obviously laid out. She had time to get them out and look at one or two of them and when I asked what she was reading about, she said cadmium metabolism.  I did not have too much more to say about that.  In the next room was a lady from the state line that had come out of the country and really had a completely different set of circumstances and educational background, so they were all there at the same office, at the same practice, obtaining care for one reason or another…  But what we did, I think Victor McLaughlin was involved as well from the standpoint of cardiology, was to extend the horizon of the hospital.  The hospital was the old government hospital that Howard Baker, Jr.’s father had tacked on to the appropriations bill for the defense budget.  The hospital was then built very slowly but the foundation settled for a year or so and looks like a fortress.   The result was then a city/county hospital, the title of the hospital was Oak Ridge Hospital of the Methodist Church and then they did a survey in the late 1970’s deciding what direction to take.  They compared themselves with Harriman City Hospital and with Rockwood and LaFollette Hospitals, Scott County Hospital and all these other county hospitals because that was the perception that they had.  Marshall Whisnant had joined the staff as CEO in the late 1960’s.  The hospital was in the red at the time and he managed to get the hospital out of the red by controlling variable expenses.  Variable expenses, pertaining mostly to the nurses’ salaries, and as a result there was some antagonism developing between the people who were employed at the hospital and the management of the hospital and we ended up with the hospital union.
MRS. GRAY: When was that?
DR. DARLING: That was sometime in the 1970’s.  
MRS. GRAY: I remember reading in the Ralph Lillard interview about a strike in the late 1960’s, some labor issue in the late 1960’s so it is like every decade, you can expect it or at that point in time.  So they had the vision then to take this hospital to the next level…..
DR. DARLING: No, we developed that vision for them.  I think they were very content to be a city/county hospital until they realized that they had become actually a regional hospital with this outreach that we have had through the Primary Care Centers and through the extended cardiology interest that the cardiologists were providing.   They were willing to provide that that way and when they did their next survey in the early 1980’s they compared themselves to St. Mary’s, Ft. Sanders Regional, and Baptist and they saw themselves as a larger regional hospital.  
MRS. GRAY: I guess some of the questions I had thought of asking you too…what was your first impression of Oak Ridge when you came here from Memphis?  You grew up in Detroit, schooled in New Orleans, you were sorta a big city guy and you came to Oak Ridge, what was your first impression of it?
DR. DARLING: I found the community fascinating.  I think that Bill Pugh attended a cocktail party sometime in the late 1950’s where there were five Nobel laureates who were there that night.  Oak Ridge had collected a fascinating group of people through the years.  The community has not necessarily been the only focus of living for people coming in from outside in the last decade or so.  For a number of years, people intended to come to Oak Ridge to promote the school system.
MRS. GRAY: What do you think, did you ever serve as Chief of Staff of the hospital?
DR. DARLING: No.
MRS. GRAY: Ever on the board at all?
DR. DARLING: I have been on the Medical Board.
MRS. GRAY: Any particular birth, other than of course Michael Gray, any particular births that stand out in your mind, something that was just one of those memorable moments in your career that you could anonymously discuss.
DR. DARLING: In coming to the community I had anticipated having a more staid practice than I encountered and I thought there would be a lot of extra time and I would probably end up with projects of community things to do.  We actually ended screening problems that people don’t see at big university centers. There have been many remarkable people, really very personable to me.
MRS. GRAY: Now we have talked a lot about obstetrics what about changes in gynecology and the practice of gynecology, how would you say that has changed here at Methodist?
DR. DARLING: Well, the laparoscope when it was eventually used here, didn’t have fiber optics lighting. I think it actually had a light bulb in it.  So if you got a wand this could be a very long procedure.  You can always use tools sterilization primarily.  John Schanze waited for me to come so that I could show him how to use a laparoscope and so we started a program and I think now people are doing laparoscopic cholecystectomies, hysterectomies and colectomies, all kinds of things laparoscopic assisted nephrectomies.  
MRS. GRAY: Now are the OB/GYN physician using the De Vinci robot for OB/GYN procedures?
DR. DARLING: There are a few of the physicians who are using this and experimenting with it.  From the stand point of private practice it takes more time to set it up than it does for most of us to do a hysterectomy.  It does seem reasonable from the stand point of doing complex cancer surgery in very large people. Tom McDonald is here using it trying to get certified so we can go over it every once in a while.
MRS. GRAY: So in 1974 we had 580 babies born a year here at Methodist, 1976 with the advent of epidural we jumped to 1324, what would you say approximately is the number of births that we have now?
DR. DARLING: Around a 1000.
MRS. GRAY: About a 1000.  How many beds in the birthing center would you say?
DR. DARLING: There are eight birthing center rooms and then there are a number of post-partum rooms and surgical rooms.
MRS. GRAY: Anything else, any incidents or activities to note during your tenure, that would add to our history at Methodist Medical Center?
DR. DARLING: The people who were here as part of the war effort and stayed were unique and need to be remembered.  I think that Dr. Diddle and Dr. O’Conner practiced together in Knoxville but Dr. Diddle I think was Chief of the Service during the war and he became a rather large figure at the University and Ft. Sanders Regional.  To the point, it was necessary that I meet him in order to be properly introduced to Obstetrics and Gynecology Fellowship in East Tennessee, so I was taken to the Knoxville Academy meeting once where he was and I was introduced.  Bill Pugh had quite a time here. Matter of fact, I think of a story, Pugh was courting his wife at the time he was first assigned to Oak Ridge and he decided to accompany Bill Hardy, the pediatrician, to try and call and propose on the phone…. They may have had a cocktail at that point.  And so they talked for a long time and Bill Pugh came out with a sort of a mean look and Bill said, what happened, what happened?  He said, “The phone went dead. I didn’t have any more change just when she was getting ready to answer.”  
MRS. GRAY: How funny…
DR. DARLING: Bob DePeriso was a scratch golfer. He used to exercise his shoulder.  He was always worrying about a rotator cuff injury, so walked around pressing his arm against the walls where ever he went, sort of propping himself up.  He told us to tell the family of laboring patients “the baby is making head way”!   Julian Regan was a character.  I had just started and he was retiring and I helped him a few times, but I did not know him as well.  
MRS. GRAY: It has been a pleasure talking to you.  We thank you so much for your contribution to this institution and look forward to celebrating the 65th anniversary with some of your historical notes and anecdotes included in our volume. 
DR. DARLING: The Birthing Center is here because the administration was not willing to do that and we had to nudge them a little bit.  I was doing about sixty percent or more of the deliveries at that time solo.  That is when I moved some of my practice to Park West.  They thought I would take at least sixty percent of the patients which would close their unit.  So part of our team to set up a program and set up a facility and everybody agreed to that but in reality what we got was a facility and now some fifteen years later we are still trying to implement the program.  We can do that and I don’t think anybody else in the area has done the full program yet.  I think it would be very worthwhile to see how that would market but there really has been a misunderstanding about what that program truly comprises.  Celeste Phillips, a consultant, who was a nurse, used Methodist Medical Center as an example of what not to do if one wanted to follow her consulting services.  There was a fairly large misunderstanding.  
MRS. GRAY: Again, thank you very much.   
DR. DARLING: You are welcome again.
MRS. GRAY: Well, if you have other thoughts or ideas, please let me know and we will add them to the tape as well.  Thank you very much.
[End of Interview]