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Joseph E. Murray, M.D., Nobelist: Some Personal Thoughts

Goldwyn, Robert M. M.D.

Plastic and Reconstructive Surgery: October 2004 - Volume 114 - Issue - p 53-55

Originally published in Plastic and Reconstructive Surgery in June 1991 (Plast. Reconstr. Surg. 87: 1110, 1991).

This editorial is one that I was particularly happy to write because it is about an unusual person, who has been for many, many years my mentor, colleague, and friend. It was, indeed, Dr. Murray, then Chief of Plastic Surgery at the Peter Bent Brigham Hospital (Brigham and Women’s Hospital now) when I was a surgical resident, who inspired me to enter this specialty.

Because of the long lead time in publishing this journal, this editorial is obviously appearing many months after the world learned that Dr. Murray had received the 1990 Nobel Prize in Physiology or Medicine along with Dr. E. Donnall Thomas (for bone marrow transplantation); both, incidentally, were residents together at the Brigham. Dr. Murray was cited for having performed the first successful kidney transplant from one identical twin to another and later for having pursued research enabling renal transplantation between noncompatible persons through the use of irradiation and drug therapy.

I was in my second year at Harvard Medical School when on December 23, 1954, Dr. Murray, along with Dr. Hartwell J. Harrison, urologist, and Dr. John P. Merrill, renologist, accomplished this feat. The operation took 5½ hours and was the first time a human had successfully given an organ to another. It was a magnificent event from the point of view of science and medicine. It also had a magical quality—fulfilling ancient and modern myths and fantasies. The vibrations of the excitement I can sense even now. So newsworthy was the achievement (and, as we know, many, if not most, medical-surgical happenings that are covered by the media are really inflated) that one of the local newspapers planted a “spy” in the hospital chemical laboratory in order to get the results that would indicate either failure or success.

Later, when I was doing my surgical residency at the Brigham from 1956 to 1961, kidney transplantation was a major focus of activity, bringing together at the bedside experts from all over the world and from a multiplicity of disciplines. Those were heady days and nights, filled with work, but also with invigorating expectation. I wish to make clear that I was not a key member or investigator of the transplant team. Nevertheless, despite my lowly position in the hierarchy, I also felt part of a new era in medicine and human thought. The ethical considerations even then were enormous, not to mention what they would soon become.

I also recall several years later, as an attending surgeon in the dressing room one medical student say to the other: “Another of these dull kidney transplants I have to scrub on.” It was obviously a tribute to Dr. Murray and all who worked with him to have transformed a spectacular, unique event into the commonplace.

That the Nobel Assembly chose Dr. Murray for the prize did not surprise me, since I, along with many others, thought that it was long overdue—by about 30 years. But I was thankful that Dr. Murray and his family, all vigorous, could enjoy the momentous, tangible expression of appreciation for his work. The readers of this Journal need not be reminded of Dr. Murray’s other numerous and major achievements in many areas: head and neck cancer surgery, trauma, and cranial/facial surgery, to mention just a few. His excellent publications document with clarity and honesty the breadth and quality of his accomplishments.

Dr. Murray, though respectful of the details, is not a trivialist. He has always lived and worked on the major side of the decimal point. His ability to see what is important and his tenacity in pursuing it and succeeding are his trademark.

In his office, on the wall, was a small placard with the words, “Difficulties are Opportunities.” Someone whose name I cannot recall once remarked that “Success is the inverted form of failure.” If anybody’s philosophy fulfilled this message, it is Dr. Murray’s. His indestructible optimism in the face of what most of us would consider an insurmountable obstacle is legendary. When we were residents, that attitude would both amuse us and, on many occasions, encourage us. Characteristically, Dr. Murray would walk into the operating room when things were going not poorly but not splendidly and would remark with conviction, “It just couldn’t be better.” He would then scrub in, and not unexpectedly, everything would soon be better. As a resident and later as an attending surgeon who learned much from him, I was always reassured by his presence.

Dr. Murray was a magnificent teacher not only for his technique, but also for his philosophy of personal accountability. Nothing would perturb him more than seeing a patient pass from specialist to specialist without anybody stepping in to take charge, to be that person’s physician, to do what doctors traditionally have done: provide help, lessen pain, offer hope, and never abandon the patient, especially one who might be dying. Many hundreds of patients are alive today because of his refusal to relinquish them—and I am referring here not to renal transplantation patients, but to those with advanced malignancy whom others considered hopeless. On many occasions he was the only one to make the hard stand, to assume the risk by undertaking what others considered impossible. The survival of many of those patients justified his wisdom.

Dr. Murray’s fixed commitment to what is important made him a physician, then a surgeon, then a laboratory investigator, and then a clinical surgeon and a plastic surgeon. Many plastic surgeons could never understand why he did transplantations when, they thought, he should have been doing more classical (and routine) plastic surgery. Although he did those procedures also, his greatness has been his unwillingness to be constricted by artificial boundaries. The human being, including Dr. Murray and each of our patients, is greater than the sum of its parts. In Dr. Murray’s religious view of life, the individual person is a totality, but not an isolated one, and he or she should be viewed in relation to all of medicine and science and the rest of nature.

As someone who worked for years with Dr. Murray as the only other plastic surgeon at the Brigham, I can vouch for the fact that he always kept his eye on the main event; he was never distracted by sideshows. He always stretched himself to do what was new. This meant that he had to leave the comfort of the routine that traps so many of us. He realized early and never forgot that there is more to medicine than monetary gain, which, if pursued for its own sake, will ultimately mislead and corrupt the pursuer.

Nobody who knows Dr. Murray would deny that he can be a fierce competitor in fighting for what he considers important. He speaks his mind even if it discomforts. Truth, as he sees it, is more important than polite, cowardly acquiescence.

“The style is the man,” Buffon, the eighteenth-century naturalist, enunciated upon his admission to the French Academy. Ultimately, what we are and what we do depend on who we are. Dr. Murray has an obvious joy in doing things that help and serve others.

As surgeons and, of course, as plastic surgeons, we are proud that Dr. Murray has become one of the very few surgeons and the only plastic surgeon to have won a Nobel Prize. At a reception honoring Dr. Murray, Dr. Francis D. Moore, who was Chief of Surgery at the Brigham during the early days of transplantation, reminded those present that if Dr. Murray had not executed the first human kidney transplantation with such skill and such perfection, the course of medical history would certainly have been different, at least for a while. Manual dexterity and surgical know-how, however, important as they are, fail to give the proper measure of Dr. Murray as a person and as a physician.

In a recent note to me, in response to my letter of congratulations, Dr. Murray penned at the bottom of the page, “Haven’t we had fun in our lives?” This feeling is one of the most singular and remarkable aspects about him—the unquenchable exuberance he has for whatever he does—from tennis to transplantation.

Somewhere, perhaps it was in a talk or in an article or maybe even in a conversation, Dr. Murray remarked that, “We as plastic surgeons are here to right the balance.” Would that we all could share Dr. Murray’s special vision and mission in this world to aid those whom circumstances or chance has rendered less fortunate.

As wonderful as the Nobel Prize is, it is the person to whom it goes that is more important. After all, Dr. Murray did what he has done and is who he is before he received that happy news from Stockholm. Long before it came, the survival and well-being of thousands and thousands of patients had already validated his accomplishments and his life.

What follows this editorial are Dr. Murray’s remarks made at the presidential dinner honoring Dr. Maurice (“Josh”) J. Jurkiewicz at the American College of Surgeons in San Francisco, October 10, 1990, the day after it had been announced that Dr. Murray had won the Nobel Prize. That Dr. Jurkiewicz, one of our specialty’s true leaders, had become President of the American College of Surgeons was also a unique event, since he was the first plastic surgeon to have achieved this position. And that he had asked Dr. Murray months before to be the speaker at his presidential dinner, without knowing, of course, that Dr. Murray would receive the Nobel Prize, was a most happy coincidence. It will be many, many years, if ever, before surgery, and particularly plastic surgery, can enjoy a similar occasion.



©2004American Society of Plastic Surgeons