M.D.s and D.O.s Today


Photo: Alan Menkes

Dr. Alan Menkes interviewed by Dr. Michael Seffinger, DO

at the Doral Resort in Palm Springs, CA during the Osteopathic Physicians and Surgeons of California Annual Convention
February 25, 2007

  • Dr. Seffinger:  Please introduce yourself and tell me how you became involved with the osteopathic profession.
  • Dr. Menkes:  I am Alan Menkes. I was born January 30th, 1943. I lived and was raised in Brooklyn. I got involved with the osteopathic profession as a result of my introduction to our family physician (we did not know he was a D.O.) in Brooklyn, New York. While I was attending the City University of New York at Brooklyn College, I met the Chairman of the Department of Anatomy, Dr. Benjamin Coonfield, who had been instrumental in sheparding pre-med students to the Kansas City College and he became my mentor. He watched and observed how I was dissecting the dogfish shark and said I had quite a talent with manual dexterity. He invited me to join his bridge games. Unfortunately for him, I had brought my 4 month old child whom he insisted on holding on his lap. Poor Dr. Coonfield, it had been a long time since he had held a baby and he was bouncing little Dan on his lap. Dan promptly shared his breakfast with Professor Coonfield who didn’t hold it against me. He went on to suggest that I learn more about Osteopathic Medicine, which I did. Ultimately, he encouraged me to apply to the Philadelphia College, which I did. I’ll never forget my interview. Besides the Dean and the Registrar, the Chief of Psychiatry was present. The Dean had a little facial tic. Where I thought he was winking he actually was grimacing slightly. I reciprocated with a wink of my own, thinking that was polite. The psychiatrist asked me a question “Do I date women?” I said no. Then the Dean winked at me again. Still I had not realized the Dean had a medical condition. The psychiatrist asked, “Is there a problem, Alan?” I replied matter-of-factly, “Well, yes.” The psychiatrist asked, “Do you care to elaborate?” I said “Not a problem. My wife would be jealous.” They really hadn’t read the application. Even though I was twenty years old, I was already married and had a child. I guess that lightened the interview a little bit. I could be enrolled in the class entering in ’63, based on the grades that I received my freshman year at the Philadelphia College of Osteopathic Medicine (PCOM), which was “PCO” at that time until I graduated. That was the first year they added the M (for Medicine) in ‘67. The City University gave me credit for my biochemistry and anatomy courses. It was enough to complete my undergraduate degree. I earned both the Bachelor of Arts and the Doctor of Osteopathic Medicine degrees. Interestingly, I had applied to enter into the freshman class of ’64, but they said if I could get all my paperwork in by June 1st of ‘63, and it was acceptable, I could be enrolled in the ‘63 matriculated class. I needed a letter of recommendation from 2 DOs. I didn’t even realize that our family doctor was a DO. I found a Dr. Stanley (Or Sidney) Kanan in the phone book that interviewed me and wrote a kind letter of recommendation. He then referred me to Dr. Packer. I contacted him and even though it was Memorial Day weekend, on the Saturday he met me at his office. He wrote the letter of recommendation, typed it himself (with many re-dos), which I made sure I hand-carried to my interview. All the paperwork was in by the 1st of June and I became a member of the class that would graduate in ‘67.
  • Dr. Seffinger:  And what was his name?
  • Dr. Menkes:  Arnold S. Packer, D.O. Another interesting thing that happened during the Comparative Anatomy lab, dissecting the dogfish shark. Its middle ear was embedded in cartilage including the semi circular canals. I dissected them out so they were free standing on one side of the fish. My wife was going to be in active labor around that time so I went to the pay phone to call to check on her progress. When I came back, my dogfish was completely smashed and vandalized. When Professor Coonfield was going around the room grading the work, looked at mine, went, “tsk, tsk, tsk”, shook his head and said “that’s worth an F.” I just sat there dumbfounded. I realized this was the pre-med class; I was not a pre-med student at the time. This was my first introduction to Dr. Coonfield. And when everyone had left I was still sitting at my desk in shock. I couldn’t believe that someone would actually destroy the lab specimen. He took me into his office. He said he had been watching the work the entire time so there was no way he was going to give me an “F” but in case the perpetrator was present, he wanted to play along with it and just let them think that their work was successful and that’s when he told me that the students that were applying for allopathic schools were very cutthroat. That’s when he began his mentoring process for me into the DO profession. It made a big impression on me.
  • Dr. Seffinger:  What was his relationship with the D.O. profession if any at all?
  • Dr. Menkes:  He had polio as a child. Walked with a cane and had been treated all his life when he was in Kansas City until he came to New York to teach so he was intimately familiar with the DO profession.
  • Dr. Seffinger:  Do you think he was treated by DOs?
  • Dr. Menkes:  He was.
  • Dr. Seffinger:  He saw you had promise in anatomy, biomechanics and...
  • Dr. Menkes:  Manual dexterity.
  • Dr. Seffinger:  Do you think it was more than that? Manual dexterity? Do you think it was like he saw an interest in anatomical structure function relations, things like that?
  • Dr. Menkes:  Oh there’s no question about that. I had also been working as a lab tech after college to support the family. So I was familiar with hospital work but I was not pre-med at the time.
  • Dr. Seffinger:  So you had to take pre-med courses then to apply to PCO?
  • Dr. Menkes:  Ultimately, yes. This was my second year. I was biology major so there was not a problem.
  • Dr. Seffinger:  So this was in 1960 that you met Dr. Coonfield.
  • Dr. Menkes:  1960. Correct.
  • Dr. Seffinger:  What was your impression of the osteopathic profession at that time?
  • Dr. Menkes:  I had no familiarity with osteopathic medicine inasmuch as our family doctor never differentiated himself nor identified himself as distinctly a D.O. The most emotional impact I remember ever made upon me as far as a healing profession occurred when I was working after class during high school across the street from my apartment at The Haym Solomon Home for the Aged. I was assigned to the laboratory. I had received honors in Chemistry, yet I was only allowed to wash out test tubes, bottles, and other equipment. The chief lab tech who was there ultimately allowed me to do urinalysis and stool test analysis but he never let me handle machines or other technical equipment. He seemed to reverse the Caste System from his native Jamaica. He was always highly critical of me, despite never showing me any methods or techniques. I observed a great deal, and kept a notebook. The flame photometer was used for chemistries present, or blood sugar analyses. He just limited me to the lower end of the scale of bodily by-products. My sense was he enjoyed the power differential. He had not yet earned his associate degree and knew I planned to enter college to be a chemical engineer. He was also quite a playboy and took long lunch hours. One day, Dr. David Nathan, the Medical Director, came in to the lab and asked, “Where’s Mr. Simmonds?” I said, being the loyal subordinate, “Oh, he just left for lunch. You just missed him.” He said, “Well, knowing his habits, I’ll wait right here for him.” After nearly an hour, Mr. Simmonds hadn’t returned. Dr. Nathan was concerned since he needed electrolytes done STAT on a patient at the Home. He looked at me and said, “Do you know how to do them?” referring to the electrolyte studies. I said, “Well sir, as a matter of fact, yes” because I had been taking notes and I’d done a few tests with known controls to make sure I had the accuracy nailed down. “I’d be happy to do them for you.” I did the studies as Dr. Nathan watched. Mr. Simmonds still hadn’t returned. The doctor was able to treat the patient for hypokalemia based on what I did. When he came back and Simmonds finally showed up, Dr. Nathan said “This boy is not going to scrub bottles for you any more. You’re going to hire an assistant for him and you’re going to train him to be your co-tech.” So, with that skill I was able, when I graduated high school, to take on a job as a laboratory technician while I went to college. I became certified in blood bank technology as well. All this was a necessary prelude to describe what touched me the most about medicine. I was allowed to draw blood from patients, after being trained by Dr. Nathan himself. I went down to one of the floors to draw a blood sugar from an elderly blind lady for the second time in a month. As soon as I took her hand and went to put the tourniquet on, she touched me and said, “You must be Dr. Kindele” (which is Yiddish for “child”). She knew from the touch of my hand who I was and that made such an everlasting impact on me. I never forgot it. I think that was probably engraved at the base of my subconscious. It was responsible for my transition from wanting to become a professor and having a nice easy life teaching biology or chemistry, why medicine was probably in the background. The healing touch. I never forgot that.
  • Dr. Seffinger:  So you went on to become a DO and you trained in Philadelphia in your third and fourth year, rotations, internships...?
  • Dr. Menkes:  Actually, we had no rotations in those days. The third year was all didactic. We had to wear a suit or jacket all three first years. Our hair length was measured if it appeared too long and we were ordered to get it cut. Unfortunately for me, being a certified blood bank technician and lab tech. trained, the Pathologist asked me during my freshman year to fill in some shifts in her lab. I said, “I can’t do that. I don’t want to do anything but concentrate on the courses during my first year. I don’t want to take any time away from my studying or family.” Just prior to starting the second year, they almost gave me an ultimatum. I had to do work in the hospital lab run by the school. I still remember the maximum pay for student was a dollar five an hour and my trainees started at four fifty with no background. It was difficult to accept this abuse, but I did what I could but it also got me on the clinical side too, a lot early. In fact, if we have anecdote time, I remember once, it was on a Friday evening about 6 o’clock. We, student doctors and interns, had just finished dinner down in the hospital cafeteria. The meals were inversely related to their cost in taste. They were free. All the seniors said “Well there’s nothing going on, everything’s quiet. We’re going. Why don’t you just hang around?” I said, “Are you talking to ME”? They replied in unison, “We’re gone”! I shrugged, “I’m going to be here until 11 anyway so I guess I don’t mind. What am I supposed to do?” “Just sit here in your white jacket and read a journal. You can go at 7 when the night crew reports here.” Well about 6:45 one of the surgeons comes in, looks around, I’m the only one in a white jacket. He says, “You! Come with me to the OR. We have an appendectomy.” “Okay,” I said enthusiastically. I followed him upstairs. Mind you, I had never been in an OR, never knew what to do because I hadn’t had a surgery class yet. This is early summer, just prior to the start of my second year. So whatever he’s doing, I’m mimicking. He put the cap and mask on, I put the cap and mask on; he’s scrubbing, I’m scrubbing. Because he had scrubbed earlier, he didn’t have to do the full ten minutes. He’s gone into the OR where the doors were open. Now, I’m all finished scrubbing, and I turn off the water with my hand. A Kelly clamp comes flying past my head and crashes into the wall just above the scrub sink. “What the hell are you doing?” I said, “What do you mean?” “You turned off the water.” “Well, yes sir. I didn’t want to waste it.” “Well now you’re contaminated” and I had no idea what that meant. “You’re supposed to turn it off with your knee.” I had to rescrub with him glaring at me. I entered the operating room and the scrub nurse gowned me. I instinctively did not tie the ribbons until my hands were gloved. I took several attempts, having stuffed two fingers into one opening. Dr. Henry D’Alonzo began asking me to identify different anatomical parts which I had no problem with. I had just studied Anatomy for an entire year. At the end of the procedure he said “what are you interested in doing when you graduate?” I said “That’s too far off. I’m just a freshman.” He said “What! What the hell is a freshman doing here in the operating room?” I said “You asked me to come up.” He said “I thought you were a senior student.” I said, “Oh no. They all left.” He screamed, “I am going to report you to the Dean.” He never did. That was my initial introduction to surgery.
  • Dr. Seffinger:  He let you continue, scrubbed in?
  • Dr. Menkes:  Oh yes. He had no alternative at this point. All I did was hold the retractor. I didn’t get to do anything, other than answer a myriad of rapid-fire questions. My senior year, in surgery, the chief of surgery was scrubbing on a case of a rather obese woman. I was the senior student assigned to scrub in. Instead of cauterizing all the little bleeders, he was tying them all off. At the end of the procedure, which took over three hours instead of 30 minutes, he looked at me and asks “Well, Doctor, do you have any questions?” I said, “Well just one sir.” He said, “What’s that?” “Why is there a clock in the operating room?” He said, “That’s a very good question. No one’s ever asked that before. We time the procedure for billing purposes from the time the anesthesiologist begins his induction until the patient is aroused.” I retorted, “Oh. In this case wouldn’t a calendar have been more appropriate?” Well, he didn’t share my sense of humor. I figured, well, I could always become a stand up comic. So I got sent down to central supply on the weekend to scrub utensils and instruments, the whole weekend. The next time I was in the operating room, he saw me at another surgeon’s case and he shouted, “I want him with me.” I thought maybe he’s about to forgive me. So we’re at the table again, and now he’s still tying off the bleeders again, not cauterizing. He looks at me and says, “Doctor, step up closer to the table and cut the knot. I braced myself with one hand atop the other with the scissors, just like I saw on TV, and I give it a snip. “That’s too long!” He then ties the next suture. “Doctor, cut the knot!” And I do so, very carefully. “That’s too short!” He ties the third one. I pre-empted him, asking, “Sir, should I make this one too long or too short?” I was sent back to central supply for another weekend. Oh well. I decided probably that stand up comic would be a better profession than surgery. But interestingly, he requested me on a lot of his cases after that and of course the residents were cringing not knowing what would come out of my mouth. On a later case in the year, another obese woman was undergoing a cholecystectomy. We went through the operation in silence. The Chief Resident was there as well. When the gall bladder was finally freed from its fossa, the Chief of Surgery, Dr. Kohn, handed it to the scrub nurse and barked, “Count the stones”! She meekly informed him, “But Sir, it is all gravel.” He got louder and said “I said count the stones”! Approximately 20 minutes of total silence except for the clicking of locking instruments crept by when the silence was broken by the diminutive scrub nurse. “Sir, there are 357 stones.” Some time later, the peritoneum was about to be closed. The mandatory second sponge count was completed. All were accounted for. Just prior to the closing of the last outer skin sutures, I asked: “Are we ready for a second STONE COUNT?” The Chief Resident’s eyes were glaring a hateful look at me that seemed to say, “Kid, your are Dead”! There was total silence. I could see the creases of a smile extend above Dr. Kohn’s mask; he guffawed with a stentorian laugh that shook the Amphitheater. Soon even the Chief Resident, Dr. Padano, was laughing (probably because his boss was.) I never kept quiet from that time on. Just prior to Labor Day weekend, I asked Dr. Kohn if I could be excused from duty the following Friday and Monday. He asked was it a family emergency. I said, truthfully, I was going for a gastroenterological consultation. He had me elaborate. I explained that my cousin David, a senior at University of Pennsylvania Dental School and I were going to the Massachusetts/Maine coastal border to dive for lobster. He was thrilled and told me to call him at any time upon my return and he would meet me to pick up his 4 lobsters. At 0335 on the Tuesday following, I had the ER nurse call Dr K at home. He was very gruff. “Who the hell is calling me and not the resident at home at this ungodly hour?” I identified myself by name. That was not enlightening. I said I was the Senior Comic for the OR, skilled Central Supply fill-in on weekends and a successful lobster diver. He was at the ER with a container of ice in less than 20 minutes. Some months later Dr. Kohn’s wife was admitted to the surgical floor for a GYN procedure. I called him and said, “I’m sure that you want your chief resident to do the history and physical, not a senior student.” He said “Absolutely not. You’re to do the H and P. That’s your assignment. Forget that I’m the Chief of Surgery.” Well, I did a complete physical and I found a breast lump that no one, including him, had seen. I notified him. He was actually appreciative; he wasn’t upset that I had done a breast exam on his wife. He was thankful that I had found the mass so they could postpone the GYN surgery until they worked up the breast mass. I stayed in touch with him until he retired but I did not become a surgeon.
  • Dr. Seffinger:  This surgeon that was training you, was a DO and this was a DO....
  • Dr. Menkes:  College.
  • Dr. Seffinger:  College. You call it a hospital.
  • Dr. Menkes:  Yes
  • Dr. Seffinger:  It was an osteopathic hospital. Was it mixed staff?
  • Dr. Menkes:  No.
  • Dr. Seffinger:  All Osteopathic.
  • Dr. Menkes:  Correct.
  • Dr. Seffinger:  Was that typical of the day?
  • Dr. Menkes:  Yes, there were DO hospitals around the city too. Metropolitan, I remember. And suburban hospitals, too. In Lancaster, Allentown, Philadelphia. Pennsylvania and Michigan were the two big strongholds for the profession then. Following were Kansas City, Chicago, Des Moines and Kirksville. There were only five schools when I applied.
  • Dr. Seffinger:  You had lost the Los Angeles school by ’62.
  • Dr. Menkes:  I didn’t even know about it.
  • Dr. Seffinger:  When you graduated, you were looking at where to do an internship.
  • Dr. Menkes:  Correct.
  • Dr. Seffinger:  Do you remember that time period?
  • Dr. Menkes:  Absolutely. In our junior year, we had to go around the country looking at different internship slots. I had heard that Botsford Hospital in Michigan was the top of the academic line for the profession so I was very interested in that. Three other students in my class, part of my study group, and I were all interested in going there. They all wanted to fly and not drive. I had a morbid fear of flying. I had a research project I was doing on hereditary enzyme deficiencies that a drug company sponsored...Norwich-Eaton. Because one of their medicines was an antibiotic for bacterial infections, urinary tract infections, but it could cause a hemolytic anemia in people with an enzyme deficiency. I developed and perfected a test that I had read about that if the blood turned dark, under oxidization, they were missing the enzyme. Otherwise, the oxidized blood would turn bright red. A very easy visual test. And as naïve as I was, I asked for a six hundred dollar grant because the time was my own, and I parlayed that into flying lessons. I got over my fear of flying by becoming a licensed pilot in 60 days. My clinic partner, David Phillips, was an avid golfer. I would see his patients two days a week in addition to my load. He would play golf. When he reciprocated, I drove to Millville NJ for my flying lessons.
  • Dr. Seffinger:  The name of that medicine Norwich-Eaton, or was that the name of the company?
  • Dr. Menkes:  Norwich-Eaton was the company. The drug was furadantin. My work was published twice in the AOA journal, 1968.
  • Dr. Seffinger:  That medicine was used specifically for this?
  • Dr. Menkes:  For bladder infections.
  • Dr. Seffinger:  At that time that was the first one. Later it became macrodantin in the eighties or so.
  • Dr. Menkes:  I guess. I don’t remember that. But the paper I wrote on it was published in the AOA journal in I think it was July ’68. Then I expanded the study with a pathologist at Zeiger Hospital, Dr. Allan Fox, and I think it was published in an AOA journal in 1969.
  • Dr. Seffinger:  This was as an intern?
  • Dr. Menkes:  Yes.
  • Dr. Seffinger:  Were there other interns doing that kind of work at that time?
  • Dr. Menkes:  No.
  • Dr. Seffinger:  So you were familiar with laboratory tests, you were familiar with research a little bit?
  • Dr. Menkes:  Yes.
  • Dr. Seffinger:  And so you felt comfortable doing this kind of work?
  • Dr. Menkes:  Absolutely.
  • Dr. Seffinger:  Then what happened? At internship, did anything happen at that time, did you have a perception of the profession that you can share with us? What did you see when you got out of school? How did you notice the profession was nationwide at the time? You said there were five schools but what about training sites, you mentioned there were a couple of main sites, Michigan had some, Philadelphia, Kansas City. Did you feel that you could go anywhere or that you were stuck with just a few choices because you were a DO? And did you know that going into Osteopathic medical school or was it a surprise when you got out that you had a limited option for training?
  • Dr. Menkes:  It was a surprise. I was naïve. Remember, I was a twenty year old freshman so I hadn’t done much research but I was kind of enthralled that I was going to be a medical student at the age of twenty. I graduated at twenty four. I didn’t have the sophistication to think ahead, plan ahead, so it wasn’t really a concern for me. It was never a worry. I figured once I’m a doctor and I graduate, my training will automatically take place.
  • Dr. Seffinger:  So what happened when you got out and started looking? When was that first time when you realized that you were in a minority profession that had limited training opportunities?
  • Dr. Menkes:  It never occurred to me. Botsford and Zeiger were I think combined with several hundred beds. Zeiger hospital was named after Allen Zeiger who built it in downtown Detroit. It was kind of a center city location. So it would be the equivalent of a poverty area. We had all kinds of clinic patients, OB was very busy.
  • Dr. Seffinger:  So you felt that the DOs had their own hospitals that were good enough for your training?
  • Dr. Menkes:  Yes. As a senior medical student, I attended grand rounds at University of Pennsylvania. I would attend cardiology lectures by Dr, Leonard Dreifus at Hahnemann Medical School. I would participate in discussions and EKG diagnoses. I became known to Dr. Dreifus. We used his text in school. He would invite me to go on rounds with him at Lankenau Hospital. I never felt discriminated against or a second class citizen.
  • Dr. Seffinger:  Felt like you could go anywhere.
  • Dr. Menkes:  Right. And a side note. Are you familiar with Dr. Ketchum?
  • Dr. Seffinger:  Lionel Ketchum?
  • Dr. Menkes:  Yes.
  • Dr. Seffinger:  Yes.
  • Dr. Menkes:  While I was an intern at Zeiger, somehow I got a reputation for being exceptionally good at medicine, which is kind of undeserved. I just happened to have a photographic memory. So lab results were in my head when doctors made rounds, I didn’t have to look up on the chart, I could just spit things out and Dr. Ketchum was a junior partner in the family practice group. He said something to his boss, Dr. Levin, who kept on eying me at the hospital. They asked me to come to their family practice during the day, when I was on night duty at Zeiger, to earn extra money. Technically, you could have called it a rotation, but I wasn’t licensed to practice in Michigan, but I had a New York license. I took the New York board in June of ’67. They didn’t require an internship. It’s an MD board. The few DOs in the state were either required to have reciprocity or sit and take the exam and it was a five day exam, eight hours a day in the New York Coliseum. I think 15% passed the first time and I was fortunate enough to be in that small group. I would fly back to New York from Michigan for $66 round-trip on weekends and cover MDs in pediatric practice on my weekends off, making house calls.
  • Dr. Seffinger:  Amazing. So at that time, the DOs started to, in some states require internship before licensure but not all states.
  • Dr. Menkes:  Ohio and New York were exceptions.
  • Dr. Seffinger:  Oh, just those two states?
  • Dr. Menkes:  That I knew of. So I took the Ohio board too and it was the same exam I took in New York. It was the same booklets, the same pictures of coccidiodomycosis. It was like taking the same exam twice. I figured Toledo is just right down I-75, which would be North-South; it was an hour from where I was living. I could always moonlight there as well.
  • Dr. Seffinger:  You finished the internship in ’68?
  • Dr. Menkes:  Correct.
  • Dr. Seffinger:  And at that time did you apply for licensure in Michigan?
  • Dr. Menkes:  I’m sure I did.
  • Dr. Seffinger:  Did you feel like you had to go to a residency or were you happy with what you learned so far?
  • Dr. Menkes:  Oh no. I was encouraged to go into a residency at Botsford.
  • Dr. Seffinger:  Okay. And you had mentors there?
  • Dr. Menkes:  I remember my first house call in Brooklyn and it was interesting that all the referring doctors who let me cover them were all MDs. And I was never exposed to an anti-DO bias at this point. it never occurred to me that there was any friction. Everything seemed to be cooperative. My first house call was in Bay Ridge. The answering service had called me about a teenager having seizures. There was no 911 in those days; they called an answering service for the doctor. I came to the house and I looked at him and I said that’s not a seizure, it’s what we call dystonic movement or extrapyramidal movement. I asked the parents “Are there any medicines in the house?” and they said, “In the medicine chest” and I found some stelazine, which is a mild anti-psychotic. I asked the mother, whose medicine was it, and she said it was hers and I said “well, how many pills are supposed to be in there?” She says, “There should have been a lot more.” So that was my hint. I knew the antidote was intravenous Benadryl, which I happened to have in my bag and I gave it to him and the dystonic movement stopped immediately. They were very, very thankful and they asked me what they owed me for the house call. This was my very first house call so I didn’t know what pricing was. I said five dollars for the visit and four dollars for the medicine. That was “big money” for an intern in 1967. Gas was 24 cents for Sunoco Premium 240. My first house call made nine dollars. Then, when I gave my report, (I kept a log), I gave a report to the doctor at the end of the weekend, what I had done, and he told me I was vastly undercharging. He said he was impressed and amazed at my acumen and resolution of the problem. He told many of his colleagues who also signed out to me on weekends when I would notify them I was coming into town. In a short while, with the numbers of house calls I was making, I was able to clear about a thousand dollars over a weekend which was significant because my intern pay was only a hundred fifty a month. It made a big difference and exposed me to patient care. I bought my first car in cash, a Triumph Spitfire Mark III and drove it back to Michigan.
  • Dr. Seffinger:  Was house call a common practice then?
  • Dr. Menkes:  Yes.
  • Dr. Seffinger:  So then you decided to go to residency at...
  • Dr. Menkes:  I was torn between going on to residency or doing family practice because it didn’t require three years. I wasn’t sure if I wanted to make the commitment and I had three boys at the time.
  • Dr. Seffinger:  You mean internal medicine would have taken three years...
  • Dr. Menkes:  Three more.
  • Dr. Seffinger:  Three more years.
  • Dr. Menkes:  Right.
  • Dr. Seffinger:  Family practice...
  • Dr. Menkes:  Immediate.
  • Dr. Seffinger:  Oh, you just go out right there.
  • Dr. Menkes:  Right.
  • Dr. Seffinger:  General practice they called it back then.
  • Dr. Menkes:  General practice. Right. There was no residency in family practice. So I had to weigh economics versus education. The chief of medicine, who had been following me as an intern, was really impressed that my skills lay in diagnosis because early in my internship, the chief resident had a bad case of asthma called status asthmaticus. He was on the ventilator and things did not look good for him. I called his mother in New Jersey and told her to come on out to Michigan with chicken soup. And the chief of medicine looked at me and said “Why did you do that? What is the correlation?” I said, “I read somewhere where Freud said asthma is the cry for mother. And, Dr. Rabinowitz, his mom and chicken soup might be enough psychologically to make a difference.” Whether or not it was cause and effect or not, we’ll never know, but he was off the ventilator after his mother came. So that worked out successfully. As a resident, income was limited. I couldn’t fly back to New York. I got a job with the city of Detroit called the City Physician service where I would make house calls at night in the ghetto. And that was just incredibly dangerous. I was accosted a few times and talked my way out of it. And I decided no job is worth dying for, so I hired two off duty policemen and we dressed in jackets and ties and we had a map of the city where all my calls came from. I was assigned through central Detroit’s Receiving Hospital. The sergeants did the driving, they filled out the paperwork. I did the treating. After a while, the policemen wanted to give the injections. I trained them, observed them, had no problem with that, and every now and then, they’d see a wanted felon on one of the house calls. But they never ever mixed their job with mine and their police job. They would wait until the next day and phone in the local precinct to let them know that the felon was at a certain residence so there would be no connection to us, so we wouldn’t be set up to get hurt. And there were a few calls that were of dubious origin where someone was lurking around the stoop or something like that and the police noticed it and I didn’t. They said “skip it. It’s not worth going to.” So I owed my safety to them. And I paid them cash. Seven dollars an hour in those days. They were happy to do it. It was lucrative. I remember one particular instance where a woman was raped. She had a gun under her pillow and shot the intruder who died on top of her. I came because she was so agitated the police called and I gave her an injection of Vistaril to calm her before they took her away. I submitted the bill to Blue Shield of Michigan and they rejected it. They said, “We don’t pay for psychiatric diagnosis.” I put down acute anxiety reaction. Well, that was not acceptable. So I took a little adhesive tape sticker, put it over my diagnosis, and I wrote supra ventricular tachycardia which means fast heart rate. This was the truth. That bill they honored. Just for a personal visit she would call me every few weeks just to keep in touch. We shared the same birth date. The job was dangerous. I had to debate, do I want to do this or should I go into family practice. The family practitioner, whom I had covered for, during the summer, made me an offer to join him. That leads to another anecdote. Early in my residency, one of the attendings came by while I was at breakfast with a whole bunch of other interns and residents and he threw an EKG at me. He said, “Okay doctor. You’re the hotshot. You’re the big smart cardiologist from Philadelphia. What’s your diagnosis on this EKG?” And I looked at it, and said instantly, “This is a classic case of Down syndrome.” He goes, “What! How can you tell that’s Down syndrome from the EKG?” I said “It’s classic.” And when he left, my fellow interns and residents went, “How can you tell from an EKG?” I said, “You can’t.” I said, “But I know the patients name, and the doctor whose practice it came from, I covered. I know the girl.” So rather than tell him, I figured, this will shut him up. And he won’t pick on any of us anymore. Unfortunately, that wasn’t the case because he would ask these ridiculously trivial questions. I remember another one which I got to use again. He came in and wanted to know what the blood loss was from hookworm infestation. Without looking up from my meal, I asked, matter-of-factly, “Old World or New World?” He says, “How do you know there’s a difference?” I said, “Well, it’s in Harrison’s.” He says, “It can’t be.” I said, “Yes. I even told him the pages. The Old world is .03cc’s per worm per day and the new world is 0.5cc’s per worm per day, Sir.” He said, “No way!” I baited him into making a bet. If I were wrong I would buy him dinner. If I was correct, he had to buy a complete bagel and lox breakfast for the entire house staff the following Sunday. We marched en masse to the library and looked it up. The breakfast was memorable. The only reason I knew the answer was because he was also the attending at Martin Place Hospital where a classmate of mine was interning. He would call me and tell me what the question of the day was. We were prepared. Dr. Albert Kalman thought we were just the smartest guys in the world. He never put two and two together about the possible relationship between the interns at two different hospitals. I have never, ever asked an intern, resident or student an arcane or trivial question just to prove my knowledge superior to theirs. I remember how it felt to be put on the spot, and be put down and I always treated my trainees with respect and dignity. I tried to teach them that if you don’t know the answer, just say so, followed with, “but I will find out as best as I can.” You can’t be a medical encyclopedia.
  • Dr. Seffinger:  So, what decision did you ultimately make? Internal medicine or family medicine?
  • Dr. Menkes:  Well, I went for the family medicine for its economic impact. And, to take the pressure off from having to make the house calls in the ghetto. My wife and I took a vacation in February of 1969. We got someone to stay with the kids. We went down to Nassau, stopped at Miami, and we were on the beach, I remember it was February 22nd, Washington’s birthday, and when we left the airport, there was two feet of snow on the ground. I had never been to Florida. I was raised in New York, went to school in Philly. And I just knew about bad winters and hot summers. Here it was February, in the low to mid 70’s and we’re in the ocean. So I looked at her and said, “You know what? This is the place to raise kids.” I said, “let me see if there is a DO hospital anywhere in the area.” And that night, I looked in the Yellow Pages, found some DOs in the phonebook and Osteopathic General Hospital and made an appointment. I spoke with Dr. Mort Terry. He interviewed me and said, “Well, they’ll have an opening in July.” I said, “Well, I want to give enough notice. How about I start in August.” And he said, “No problem.” And I stayed there. I remember my first grand rounds assignment during my first week as a resident there. I had credit for the three months of residency I began in Michigan. My patient was an elderly woman from Armenia. She had a fever, cough with purulent sputum of unknown origin and an abnormal chest x-ray with a cavitated lesion. Everyone thought it was TB. The senior partner of Dr Terry, Ronald B. Kaufman, DO, FACOI, assigned the case to me. I had to do the work-up and present the case the following Friday. Nuclear scans were just beginning to develop then and I had learned how to interpret them. My patient had lesions in the liver, the spleen, and she had this foul sputum, so when I presented the case, I said Mrs. so and so has Echinococcosis, which is a sheep tapeworm. Drs Terry, Kaufman and everybody was amazed that I proved the obscure diagnosis. The reality was when I walked into her room the first time, I said, “do you speak English” The first and only word she ever said to me was “Echinococcus.” To this day, I can only repeat my aphorism to a student, “ The best thing to make a diagnosis is to take a history. Let the patient talk.” I wasn’t a genius or anything like that, she blurted it out, I read up on it and knew what studies to order and everything followed the pattern. I got an undeserved reputation of being a diagnostician, to where Mort Terry told me that he’d guaranteed me a position with his internal medicine group once I finished my residency, which was just one week old at that point. I took his offer when I finished.
  • Dr. Seffinger:  And how long were you with him?
  • Dr. Menkes:  Three years.
  • Dr. Seffinger:  And then how did that lead to your move to California?
  • Dr. Menkes:  Well, I became the most junior man on the totem pole, and made the rounds, and then I heard about a DO nine miles up north, a young fellow in his early forties who had bypass surgery. He had no disability insurance; he was new to practice down there in Hallandale in internal medicine. Since I was the most junior man of the group, I told Dr. Terry that when I finished my morning rounds, I’d take my beeper and I’d go see Dr. Herb Pardell’s patients and that his office could do the billing and split the revenue with Dr. Terry. I would do it for free on my own time because I was under contract for Dr. Terry. He said he couldn’t spare me. I said, “Wait a minute, I’d be doing it on my own time” I told him it would be feasible and the right thing to do. He said, “No, tell him you can’t do it.” I really wrestled with that. I couldn’t let a fellow DO go down economically just because he was incapacitated. I called Herb back, and I said “Well, good news and bad news,” and he said, “What’s the bad news?” I said “Well, they won’t let me out of my contract to make the rounds for you to keep you economically viable.” He said, “My god, what can the good news be?” I said, “I resigned, I’m your new partner.” So he made me an equal partner from day one, and I got him through this trying period. I just saw him a few years ago, he looks wonderful, he’s still alive. During the time we were partners, I was appointed director of the intensive care unit. And we had a successful practice. We brought on a pulmonologist.
  • Dr. Seffinger:  And you worked in DO only hospitals?
  • Dr. Menkes:  No, this is a mixed staff hospital. Osteopathic General had a few MDs on staff, ninety percent were DO.
  • Dr. Seffinger:  Now this hospital that you went to in Florida, you say is a mixed staff hospital. Was that recently a mixed staff, or always a mixed staff? Do you know?
  • Dr. Menkes:  I can’t say always, I’d say it was about sixty-forty= DO:MD.
  • Dr. Seffinger:  Do you think it was a recent event in the late sixties that it became mixed staff?
  • Dr. Menkes:  I think it became that because more DOs were coming into Florida, and Hollywood General Hospital wouldn’t allow DOs on staff. So this Hallandale Community opened up, which was an AMI hospital, and they were interested in revenue. They were happy to have DOs referring to them. This recalls an interesting story concerning the Administrator, Michael Baxt.
  • Dr. Seffinger:  And that was what year?
  • Dr. Menkes:  It was ’72, no ‘74.
  • Dr. Seffinger:  So ‘74, that was already after the AMA lifted its ban on DOs and the AMA began accepting DOs as members in 1969, and that helped open up a lot of possibilities after that. So this was after that event. Okay, so did you at that time train other DOs, and did you train MDs at that time as well in residencies?
  • Dr. Menkes:  No, no MDs, but DOs from other schools like Des Moines would come out for rotations.
  • Dr. Seffinger:  Alright and how did you decide to move to California?
  • Dr. Menkes:  I was in charge of the intensive care unit there, and that was my subspecialty, my area of love and interest. The chief of surgery, a urologist named Bob Repel, told me about the DO school they’re starting in a couple of years, and wanted to know if I was interested in teaching medicine, and I told him “Absolutely, I’m definitely open for it.” So March of ’76, I came to California to take the board exam, and I was examined by Viola Frymann, Ethan Allen, and I think Dr. Dilworth. And apparently I did well enough that they encouraged me to definitely come out. I struck up a great rapport with Dr. Eby, when I met him, and his hospital agreed to pay my moving expenses to come out, and I decided that I wanted to have a specific niche to differentiate myself from the MDs rather than just being a general internist. And I had been attending the critical care conferences held by Dr. Max Harry Weil for several years, and I called him and asked him if he had an opening in a fellowship, and he knew who I was because the group was fairly small and I had been a consistent attendee, he said there was a five-year waiting list. And I said Hal, that was his nickname, Max Harry Weil, he went by Hal to people who knew him, and I said, “You wouldn’t have to pay me.” He said “When can you start?” I said, “August first”. So August, September and October, I was a critical care fellow at USC Hollywood Presbyterian Hospital in California. I learned all the invasive procedures, and it was interesting on grand rounds, when Dr. Weil would say, “Does anybody know what Osler’s disease is?” and none of the other fellows would speak up, and I said, “It’s really Osler-Vaquez.” He said “Okay, go ahead.” I said “It’s polycythemia vera.” So I knew a lot of trivia, and Hal was very gracious to me. I was one of two DOs in the program. There was one who was already in it, but he hadn’t passed his license exam, and because I was an examiner for the board, Dr. Weil asked me if I could do anything to help him along. And I said I really can’t, in fact if he came up and I was examining him, I’d have to recluse myself. And the reason he had failed the exam, I had asked him, for the osteopathic treatment of the ventricular arrhythmia, and he said “There is none.” And there’s no way to salvage someone with that attitude. I couldn’t intercede for him. I could only talk to him one on one and say that’s not the attitude that you need to go with. So he humbled himself, and finally passed the license exam.
  • Dr. Seffinger:  When you took that California license exam, was it different than other licensing exams you had to take, for instance in Florida, or Michigan?
  • Dr. Menkes:  Yes, we had to show hands on, they asked to show manipulation, they wanted to see what you did with your hands. And when I became an examiner for several years, I mean for twenty-something years, I was one of the commissioned examiners, and we finally got students for them to demonstrate on. And we said, don’t do an active correction, but get them to the point where if you were going to do an active correction, stop at that point without making the high-velocity move. And one gentleman that I asked what percent of your practice is manipulation, and he said 95%. “Okay, show me how you correct the C5 lesion.” So he walked up to the student, and his bracelet hit the student in the face. Well, someone who’s doing manipulation often would know to take off a bracelet. You wouldn’t wear any jewelry that would hit the patient in the head. So it was obvious he was exaggerating his OMT experience. I asked him a general medical question, “How would you treat a hypertensive crisis?” and his response was, “I would pound the dorsals.” I said, “I’m missing something. When I’m saying hypertensive crisis, he’s lost his vision, his blood pressure is 260 over patent-pending, he’s confused. What medication would you use?” because he’s an internist from New York. He said, “Aren’t you a ten-figured man?” I said, “Doctor, do you see the table here?” “Yes.” Then I said “Everyone on your side gets asked questions, everyone on my side does the asking. So name the medication and the dose, you’re an internist. What you would do to help this guy through an emergency?” He said, “Well I’d give reserpine.” I said “how about nitroprusside, 50 micrograms per minute?” He goes, “Well, I’ve never used that.” He didn’t pass. But he sued me, on the basis that I was trying to keep internists out of the state. How did he expect me to cover the entire State of California by myself? The suit never went farther, because Dr. Billy Jo Stramillo was my co-examiner at the time. I gave him a 50 overall; she gave him a zero. So even if I gave him 100, he wouldn’t have passed the exam, so obviously there was no bias. But, it discouraged me from being a commissioner for a couple of years. I finally went back to doing exams after the Board called me. Then my youngest son wound up being one of the “mannequins” while we were doing them at COMP.
  • Dr. Seffinger:  So he went to school, or he just helped?
  • Dr. Menkes:  He did it just to help out. He drove up from UC San Diego. He’s not a pre-med student.
  • Dr. Seffinger:  So do you think it’s important to have a manipulative portion of that licensing exam?
  • Dr. Menkes:  I think it’s essential. Otherwise, how do you differentiate yourself as a DO?
  • Dr. Seffinger:  That’s a good question, because a lot of people believe that, and a lot of people don’t do manipulation in practice yet they still feel they’re very osteopathic. Do you find that there are other aspects of osteopathic training and medicine, beside manipulation, that you can distinguish a DO from and MD, for instance?
  • Dr. Menkes:  Well I think the philosophy’s very important, treating a whole patient. But I don’t know that allopathic physicians don’t do that. It depends on personality. I’m sure there are some DOs that don’t apply the philosophy.
  • Dr. Seffinger:  So in a licensing exam situation, what were you trying to really evaluate in a person trying to get a license? What were the key things that you were looking for?
  • Dr. Menkes:  That they understand structure and function relationships, and that there is a role for manipulation and doing family practice. We had to assume that everybody was a family practitioner. We were not allowed to ask in the later years what your specialty was, which was kind of unfortunate. I happen to agree that radiologists shouldn’t have to know high-velocity techniques; it’s okay if they learn muscle energy, but at the time they train, I just don’t see that it was essential.
  • Dr. Seffinger:  Was there ever a concern that some manipulation was not appropriate or not warranted, and therefore you would ask questions that people would let you know that it had limitations? Like for instance, in the hypertensive crisis, was that what you were looking for, basically you didn’t want the person to say, “well, we’re going to manipulate” you want them to say that a medication is better and more appropriate. You want them to be able to differentiate when you should use it and when not.
  • Dr. Menkes:  Certainly, if someone had Ankylosing Spondylitis, you wouldn’t want to use a cervical correction. And unfortunately, a DO did, and he became a victim of a malpractice suit. But it was the wrong thing to do, inasmuch as the x-rays showed the AS, it was just tragic that the young patient became a quad(raplegic).
  • Dr. Seffinger:  Was that in California?
  • Dr. Menkes:  Yes.
  • Dr. Seffinger:  What year was that?
  • Dr. Menkes:  Mid-90’s.
  • Dr. Seffinger:  Were there many cases like that in your career in the last forty years, you’ve seen people have problems misusing manipulation or OMT you can recall? Not that you know all the cases, but in your experience, have you seen or heard of?
  • Dr. Menkes:  There was one in the prison system, but it wasn’t done by a DO. It was the manipulations done by an MD that caused some damage. What compounded it was he went up to the patient’s bedside and tried to tell him not to sue and it just hurt the case but he was not a DO. I was asked to be an expert witness against him but cited a conflict of interest since we were both employees of CDC at the time.
  • Dr. Seffinger:  Well in general, are the osteopathic techniques, do you think they’ve been used safely over the years that you have seen?
  • Dr. Menkes:  Safely and selectively, that’s been my impression. In my practice, when my patients had a musculoskeletal component, I had no problem with using OMT, and my students got to see that. It wasn’t a show for them, and it was part of the medical record.
  • Dr. Seffinger:  Okay, so let’s go back to when you were asked to come when the school began, Dr. Repel was the first Dean of the College of Osteopathic Medicine of the Pacific. And that must’ve been, what, 1977?
  • Dr. Menkes:  Yes.
  • Dr. Seffinger:  You got their charter to have the school.
  • Dr. Menkes:  Yeah, we came out together in ’76.
  • Dr. Seffinger:  Okay, to look at the prospects and to start developing the school?
  • Dr. Menkes:  Well he was more intimately involved with that, as the dean, and he had a small practice at the same building I did at Park Avenue. But I wasn’t intimately involved in the planning stages with the politics and stuff like that. I was just trying to get the practice established and get going.
  • Dr. Seffinger:  You were going to be the main person teaching medicine.
  • Dr. Menkes:  Correct.
  • Dr. Seffinger:  So you were the first medicine faculty.
  • Dr. Menkes:  Professor and chairman
  • Dr. Seffinger:  Professor and chairman of medicine at COMP?
  • Dr. Menkes:  Right.
  • Dr. Seffinger:  And you worked with Dr. Eby as well?
  • Dr. Menkes:  Yes.
  • Dr. Seffinger:  Could you describe a little bit of what you knew of Dr. Eby at the time?
  • Dr. Menkes:  He was a visionary, he was compassionate, he was a blue-blood DO, through and through, he was a very, very ethical, and religious man, and somewhat naïve. He saw the good in everybody, and people would take advantage of him. It wouldn’t affect him, wouldn’t faze him. Park Avenue was a small, well-maintained and well-kept hospital where everybody knew everybody else. All the employees had been there a while. It was almost like a home away from home.
  • Dr. Seffinger:  Wasn’t there something about the Park Avenue hospital, Dr. Eby wanted it to be used for a teaching training site, or be given to the school or something like that?
  • Dr. Menkes:  Yes.
  • Dr. Seffinger:  And apparently someone else took it over? Was that Dr. Lee?
  • Dr. Menkes:  I believe that’s his name. I’m not sure what the mechanics were.
  • Dr. Seffinger:  Were you part of that at all?
  • Dr. Menkes:  No. Even though my office was physically on those grounds, from ’76-’77, I moved to Claremont.
  • Dr. Seffinger:  So you moved to your own office?
  • Dr. Menkes:  Yes.
  • Dr. Seffinger:  Okay, and could you tell us what was that like? Now you came to the state at a time when the licensing board was just given its power back to license DOs. You were part of the first group of DOs to come in the first couple years, and you were at the beginning of the start of the school, and your job was to educate the new DOs and help them find their way into a job, basically afterwards, and open up some doors in hospitals I would think, for them to train and to practice when they got out. So you were in essence being asked to pioneer for the profession to open doors that were closed previously by the merger agreement and various things that happened in the sixties, and prior to your arrival in the seventies. Could you give us your impression of what you saw when you got to California, which I think was very different than what you saw in Philadelphia, in Detroit, and in Miami. Could you contrast the impression of what you saw in terms of the osteopathic profession, the DOs, and the impressions you had of the people you were meeting compared to where you had just been in other parts of the country.
  • Dr. Menkes:  Sure. First, there were no young DOs. The ones that I met were very congenial, collegiate, caring, understanding, and helpful. The ex-DOs were very hostile, very aggressive, negative attitude, obstructive. I remember one would actually take my parking spot even though my name was on it behind my office. He felt entitled to park there if he got there first. If I said something, he became confrontational. And I was not about to back down, and he actually backed his car into mine, which is kind of sad. Then the MDs were kind of aloof. I didn’t encounter hostility until I actually interacted with them, and I remember I asked for an application for one of the local hospitals that had no DOs on staff, and never received an application. So I called the medical staff secretary, and she told me if I was not a graduate of an approved medical school, and she couldn’t do it. I said, “Can you send that to me in writing, because there’s a senate bill that says you can’t discriminate since 1974, and I’m looking at my calendar, and this is ’76. Instead of getting a letter turning me down, they sent me an application. I filled it out and I got called in for the credentials committee meeting. And the committee, I believe there were eight or nine doctors, some were ex-DOs; the rest were “congenital” MDs, ranging from general practice to medicine. I forget the gentleman’s name; he was the chairman of the committee, reviewing my application. He said, “By the way, doctor, when’s the last time you manipulated a Swan-Ganz catheter?” And he and all of his colleagues started laughing, having a joke at my expense. I waited for the laughter to die down, and I said, “1956.” He said, “Doctor, you’re a liar, in a hostile and confrontational tone. The catheter wasn’t invented until 1972.” I said, “Nope, 19:56 is military time. And if you read my application, you’d see I’m currently a Critical Care Fellow at USC. And four minutes to eight o’clock last night, while I was on duty, I manipulated a Swan-Ganz catheter into a patient’s right ventricle. I would bet my car that not one of you “gentlemen” at this table has so much as even touched a Swan-Ganz catheter. I know Dr Jeremy Swan and Dr. Ganz personally. So why not just leave all the derogatory, pejorative comments aside, and let’s just focus on my abilities and credentials, and see if I can’t make a positive contribution to the hospital.” I’m still on the honorary staff to this day.
  • Dr. Seffinger:  And you did admit patients there, and took care of patients at the hospital thereafter.
  • Dr. Menkes:  And delivered two of my sons there. With the chief of OB in attendance.
  • Dr. Seffinger:  So when you came in, what were your goals and some of the challenges that you took on?
  • Dr. Menkes:  I wanted to bring out more family practitioner DOs, to help with the teaching at this school, and wanted to show the MD doctors that the DOs are their peers, and in my case because of the extra specialty training that I had, that I could actually help them. Because there were no hospitalists, per se, in those days, and that was basically what I was trained to do. I had to take care of pulmonary, GI, and cardiac. Thanks to my training at USC, I could do all kinds of invasive procedures. I used the first ventilator at Ontario Community Hospital for an overdose in the emergency room. And this is the first one to survive through use of a ventilator because it was changing technology in those days. That got me more and more referrals, including pre-op clearances from the MDs. If there were Codes, I was able to put a pacemaker in through the internal jugular vein in less than a minute and the ER docs would call me, day and night. I was stretched pretty thinly. I had no days off the first eleven months I was there. Finally I said, “I can’t take any new cases. I need to empty out the ICU.” So I went without income, took time off, went scuba diving in Grand Cayman Island.
  • Dr. Seffinger:  So what were some of the failures that you recall those first years?
  • Dr. Menkes:  Well, not getting the application was distressing. When I was on another hospital staff, we had to rotate alphabetically taking emergency room back up call. Unless they were using a Cyrillic alphabet, I wound up on call every holiday, and never got called during the week. It was always on a weekend. A Friday, Saturday, Sunday, or holiday. Mathematically, it’s impossible. But, I would get the overdoses, the uninsured and stuff like that just to be stressed. There was no way that was completely fair. Eventually, I decided not to use that hospital, nor subject myself to harassment. At the next closest hospital, Doctor’s Hospital of Montclair, the all-MD department, chief of medicine, elected me. It wasn’t an appointment, I was elected. The same thing transpired at Ontario Community Hospital. Amongst my peers, there were no other internists for a while, and then a few came. But most of the medical staff were MD and they elected me chief of medicine. This facilitated both institutions to take third and fourth year students and eventually interns.
  • Dr. Seffinger:  That must have been quite an honor.
  • Dr. Menkes:  It was. It was. It was good recognition and enabled us to improve patient care and I introduced a new concept. Instead of being punitive, if a doctor had a bad outcome, in retrospect, he could always find the reason. So I would say, “Did you consider the following?” “Oh no, I wish I had.” “Well, that’s honest. Next time, if you do the following or you need help, give me a call.” No records, no minutes, nothing showed up on his medical record. Certainly no report to the licensing board about privileges and stuff like that. The one thing I did was in-service the RNs in the ICU. That’s when they went to twelve-hour shifts. So at 7pm I’d bring in the pizza and drinks and if there’s new equipment, I’d explain the new equipment, why I’m using it, what I expect it to show and how it will impact the patient. There was one particular case where this doctor had called in an order for a vasopressor to raise this elderly woman’s blood pressure because it was at a very low level. The nurse said, “I’m not going to do that.” “What do you mean? I just ordered a vasopressor.” “Well doctor, your patient’s probably dehydrated. She needs a central line for you to measure the central venous pressure. She probably only needs fluid.” “When did you become a doctor?” “I’m not, sir. I’m trying to help you and our chief trained us. This is what we have to look out for in his patients and it always works. In fact, it’s what we came to call “instant lady syndrome”. You just add water, and they wake up.” He said, “Well, I don’t like your attitude. So I’m ordering you, you’ve got to start the vasopressor.” And she would not back down. So he reported her to me and I listened to his story and said “You owe her an apology.” He angrily retorted, “ I’m not going to apologize.” “Well doctor, either you’re going to apologize or you’re going to lose your ICU privileges for thirty days.” “Then I’m going to report YOU to the chief of medicine.” “You just did. ‘Cause I wear two hats.” I said, “Put your ego aside, apologize to the nurse, and thank her for giving you the information that would have made a difference in your patient.” Well, he muttered and mumbled and I said “it’s either that or an 805 report to the board.” There was an insincere apology, but it was better than nothing. There was a similar and parallel situation on the licensing exam. I would ask the applicants, when they came into the osteopathic board, and I was one of the commissioning examiners, “For example, let’s suppose it’s Super Bowl Sunday, you’re on call, and you get a phone call from the CCU nurse: “Your patient in bed 5 doesn’t look good.” “What’s your next step?” “I’ll order enzymes.” I said, “They’re all normal.” “Uh, check the blood pressure.” “Normal. No matter what study they would order, my response was, “It’s normal. What are you going to do?” “Well, I’ll call a consult.” “No doctor. First, you turn off the TV, you go to the bedside. The best euphoric agent for someone having cardiac difficulty is seeing his or her own physician. Number two, the nurse is with him twelve hours. She’s got a lot of experience. If she doesn’t like the way he looks, an arrhythmia is going to happen between the time you are arguing with her and the time you get there. So if you want to stave off the catecholamines and the arrhythmia, and she says, ‘I don’t like the way he looks’, get in there. And that might be enough but, don’t ever start ordering a bunch of tests.” And hopefully it made a mark on these people that to this day, they will still go in and see the patient.
  • Dr. Seffinger:  Now did you continue teaching that to the students that rotated with you?
  • Dr. Menkes:  Oh. They could observe it. And I gave them beepers and I said, “It’s your option, if you want to turn it on.” I said, “There’s no downside except loss of sleep. Your grade will not be measured on what you do after hours. You’re only responsible for daytime hours on this rotation. However, if you took on a night or weekend, I’ll teach you how to put in arterial lines, central venous lines, Swan-Ganz catheters as third year students, fourth year students. Your call.” And 99% of them went for the beeper. On Sunday, I would take them out to breakfast with my family. On Saturday, they came to my house and I fed them breakfast. To show there’s a life outside of medicine, and family time is crucial.
  • Dr. Seffinger:  Did you also participate in the admissions of new students coming into COMP?
  • Dr. Menkes:  Yes. I did serve on the clinical faculty part of the admissions committee. And had some interesting applicants. One, I asked what motivated him to become a DO and he said all his life, he knew he wanted to be an ‘osteometrist’. It was difficult to keep a poker face. I also remember a gentleman who was forty-five years old, who applied. This was in the late seventies, early eighties. And the basic science people felt that he was “too old” and this was before age discrimination was a factor. I said, “Well, considering he made it through his other profession, to retire with honor, as an FBI agent, and academically, he’s sound.” “Yeah, but by the time he finishes his studying and his training, he will be in his fifties. How much time can he give to the profession?” “It’s not relevant. He may last thirty years. Some doctors will have an MI in their forties. Age should not be a factor. He could be a mentor; he could be an example, and a leader. So my recommendation is, we give him a chance.” And he did quite well. He has a cable TV show of his own.
  • Dr. Seffinger:  What were you looking for in a DO student, somebody that wanted to become a DO student? What qualities were you looking for to determine whether or not they would make a good osteopathic physician?
  • Dr. Menkes:  That they were honest about their choice. That if they told me that it was a back up and they didn’t make medical school but they would be absolutely above board and really wanted to become more familiar with that technique, I thought it was worth a chance. I’d rather they were sincere. And there were ways of reading people too. Just the demeanor and what they had done, what their prior experience was with DOs, did they just show up for one guy’s letter of recommendation or did they actually go to offices and get to understand what it is. That would make a big difference. Versus a one-time letter of recommendation, someone who spent a whole month to learn, observe, and it was someone I happened to know. Not just a stamp.
  • Dr. Seffinger:  How long were you doing that kind of work on the admissions committee?
  • Dr. Menkes:  Gosh. From the seventies to the early nineties.
  • Dr. Seffinger:  Were you on the actual admissions committee or just an interviewer?
  • Dr. Menkes:  That’s a good question. I think initially the committee and then the interviewer.
  • Dr. Seffinger:  Alright. You mentioned some people who were your mentors. Are there any other people that were your mentors that you want to mention or people that you mentored over the years?
  • Dr. Menkes:  Well, besides the students, it’s great to see them here, at the meetings. Sometimes when we’re out of state, students will come up to me, say “do you remember when I was on rotation, you taught me such and such. And I happened to be in practice and I did what you showed me and it really worked out.” That’s immeasurable. Just a great, great feeling. Initially, in the Pomona area, my biggest supporters were the MDs themselves and a handful of ex-DOs. At the smaller hospital, they would observe what I had done, and I guess vicariously were proud that a DO could stand up, shoulder to shoulder with the MDs. And some of the vascular surgeons, for example, if I called a consultation, I had the patient completely worked up, and had the diagnosis laid out for them, it made a favorable impression, and they had good outcomes. More and more came out to the staff so it was no longer just a little “ex-DO” hospital but it became a mixed staff hospital.
  • Dr. Seffinger:  Do you think that you were successful then, at breaking down some barriers that may have existed prior to your arrival here?
  • Dr. Menkes:  Unquestionably. I was, I believe, the first board certified DO internist, to come to California since ’74. When I came to the board in March of ’76, they told me, I’m the first board certified DO internist trained in the DO profession, to take the exam.
  • Dr. Seffinger:  Now you had some training also with MDs though, too, so you weren’t trained only by DOs, you were trained somewhat by MDs too, right?
  • Dr. Menkes:  Right.
  • Dr. Seffinger:  But you were certified by the osteopathic internal medicine board?
  • Dr. Menkes:  Correct.
  • Dr. Seffinger:  Was there also an MD certifying board that you were involved with or just a DO?
  • Dr. Menkes:  No. I became a fellow of the American College of Osteopathic Internists and am now an emeritus member.
  • Dr. Seffinger:  Did you ever join MD certifying or specialty boards or anything like that?
  • Dr. Menkes:  No.
  • Dr. Seffinger:  You didn’t have to? They didn’t expect you to, in order to get into hospitals, or to get on staff or to take CME courses at that time that you were here?
  • Dr. Menkes:  No.
  • Dr. Seffinger:  So they accepted your DO credentials.
  • Dr. Menkes:  They did. In fact, a year after my fellowship in critical care at USC, Dr. Weil invited me to be a panel moderator for the day at their annual convention that was in Las Vegas and I remember my introductory remark to the audience. I said, “I feel like a New York Yankees bat boy way back when DiMaggio, Babe Ruth, and Lou Gehrig had been on the same team, if that was possible, here I am with Dr. Swan, Dr. Ganz, and Linus Pauling, and Hal Weil.” I said, “So, it’s completely overwhelming and it’s a great honor and I’m just happy to be here.”
  • Dr. Seffinger:  Did you write any chapters in books or journal articles thereafter?
  • Dr. Menkes:  During my student years and then my internship I had two papers published on hereditary enzyme deficiency in the AOA journals. ‘68 and ’69.
  • Dr. Seffinger:  But after that, you didn’t write anymore?
  • Dr. Menkes:  One more. I had a rare case I wrote up with a medical student of a patient with parathyroid carcinoma and calcified mitral valvulopathy in a very elderly woman with sky-high parathyroid hormone levels. So we wrote that up. That was also AOA published.
  • Dr. Seffinger:  What advice do you have for future osteopathic physicians in training?
  • Dr. Menkes:  Decide where you want to live and practice. Take out the Yellow Pages of the town, get a map, and put a pin where all the MDs are located and put yourself right in the center. Because you will be differentiated, they’ll become your biggest referral source.
  • Dr. Seffinger:  Do you think that DOs should still continue practicing manipulation and internal medicine as an adjunct?
  • Dr. Menkes:  They’re inseparable.
  • Dr. Seffinger:  How is that?
  • Dr. Menkes:  There is a musculoskeletal component to most diseases, but you have to look for it and you have to know what you are touching and feeling. That’s how they train you in school and I don’t understand how people can let that go by the wayside. It’s the most intimate part of the physician-patient encounter. You’re actually touching a patient. One of the things I showed my students to observe what happens when a patient is in the office and they come in for their exam. I’m looking in their eye grounds and they say, “no one’s ever done that before.” I then listen to carotid arteries, which some doctors do, some don’t. But then, when I’m listening to their heart, I have my watch situated where they can’t see I’m looking at it, I listen for one full minute. The average doctor spends six seconds listening to the heart and you can’t appreciate anything of significance in six seconds; but, you’re touching the patient. That one minute is a bonding time. Then when you do your musculoskeletal exam, you’re touching the patient, that’s an intimacy that the allopathic physician doesn’t share. And even though I did critical care medicine in California for 27 years, I never had a lawsuit. I contribute that to good luck, and the fact that I was honest with my patients, and we had a bond. It was never in the back of my mind. I never worried about medical-legal ramifications.
  • Dr. Seffinger:  So you felt that, when you say bond, they trusted you, they felt comfortable?
  • Dr. Menkes:  Right. And it was a touching situation and you also develop a sixth sense. I cited this to a couple of students I was talking to this weekend, former students. They are all twenty- year plus doctors. I remember telling the students that the worst problems for malpractice happen on holiday weekends, the long weekends. That that’s when most of the mistakes are made. I was covering for a group of allopathic doctors and some ex-DOs in Montclair. It was the Friday of Memorial Day weekend, back in the late seventies, early eighties. A twenty seven year old contractor and laborer came in. He had been to the emergency room twice in the week with fever, joint pain, aches; typical of flu. I couldn’t find anything wrong. Fever was 100.6. In those days Motrin was an Rx. I wrote a prescription and said, “Here’s my beeper number and my home phone number. If you’re not better over the weekend, give me a call, okay? He was a father of three.” He got up from the exam table and while going for his shirt, he stumbles a little bit. “You okay?” I asked. He said, “I’m fine. Just lost my footing for a sec’. ” I said, “Go back on the table.” “What do you mean?” “Go sit on the table. I want to look at one more thing.” “But I’m okay. I just stumbled. I am not drunk.” “Please. Pull your hands apart.” I tap his patella with the rubber hammer. He had no reflex. “You’re going into the hospital RIGHT NOW. I’m going to have to put you on a ventilator by tonight.” He said, “What are you talking about, I’m not short of breath.” I said, “Yeah, but you have Guillain-Barré syndrome. It’s a rare neurologic disorder that starts in the legs, it’s going to work its way up your spinal cord, from your flu.” I said, “You’re dead if you go home. I can’t let you go.” He was on the ventilator for six weeks; had plasmaphoresis. He made it home. Sixth sense. Sixth sense. Yes, some of it was luck. If I hadn’t noticed it, if I had my back to him while I’m writing the script, and I hadn’t seen that, he’s dead over the weekend; how do I defend myself? There wouldn’t be an anatomic diagnosis of Guillain-Barré, just a dead 27 year old, I must have missed something and there’d be a malpractice settlement. Another case was a patient of mine who called on the Friday of a holiday weekend, three-day weekend. She’d been baton twirling with her daughter who was trying out to be a cheerleader. Mother of four, and she had, she thought, pulled out a rib in the back. She said “It’s just very sore and I must have twisted something. I need you to pop me on Tuesday.” I said “Well, come on in NOW.” “No, no, no. I haven’t showered, I’m a little sweaty and stuff like that. Just phone in something for me, I’ll see you Tuesday.” I said, “Vicky, come in.” She reluctantly comes in, I said, “My god! You look like crap!” She said, “Thanks a lot for the compliment but I told you I didn’t have time for a shower and make-up.” I said, “But you’ve been in the waiting room for fifteen minutes. You shouldn’t be sweating. Come onto the table.” I feel not really much of a rib lesion but I said “Let’s do an EKG.” She said, “No, no, no. I don’t need an EKG. I’m 34.” “Let’s do it.” It’s an acute anterior wall infarct, but atypical. Pain and the twirling was completely a red herring and incidental. No risk factors/ I call Loma Linda University Hospital, and told the cardiac fellow the scenario. He said, “So you must have put the leads on wrong.” “Excuse me? I’m board certified in internal medicine.” Well, 34 year old with an MI, I said, “She’s on her way by ambulance, doctor. So stop patronizing me. Get a bed ready for her.” And he’s still arguing with me, so I put the receiver down, call back my friend who is the chief of cardiology at the time, Dr. Jacobson, told him the story and he said “I’ll have a bed waiting for her.” She had complete occlusion in the left anterior descending artery with a left ventricular clot. They were able to save her. Sixth Sense. Know your patient.
  • Dr. Seffinger:  So you knew by negative musculoskeletal findings, in this situation, that it was a visceral problem.
  • Dr. Menkes:  Right.
  • Dr. Seffinger:  Do you have any theories about how manipulation may work to help people get better from illnesses that are not musculoskeletal in origin?
  • Dr. Menkes:  The one thing is the intimate contact. I think that it is a great anti-depressant. The fact that there is eye contact between the physician and patient, and then the touching. What can be more intimate? Well, obviously as long as you don’t cross the line, and I’m sure that happens, but most patients react positively to an interaction with the physician that has actually laid hands on them.
  • Dr. Seffinger:  So it may stimulate some of their own natural processes to help fight the disease process?
  • Dr. Menkes:  Yes.
  • Dr. Seffinger:  Okay. What advice do you have for future allopathic or MD physicians in training?
  • Dr. Menkes:  The only thing I can say is to treat your DO brethren as peers, they’re your brothers, and learn from them. One of my cardiopulmonary fellows in critical care at USC was self -administering Darvon, intravenously, that he got from Spain. He was a hematologist who was in the same Critical Care program. He had incapacitating migraines, and I treated him with OMT the nights he was on call with me, and his headaches diminished, to the point he stopped taking the IV Darvon. He became one of my biggest proponents and supporters and advocates.
  • Dr. Seffinger:  Does that mean that all MDs will learn from all DOs?
  • Dr. Menkes:  Of course not, of course not. Just be open, and pay attention.
  • Dr. Seffinger:  Do you have any documents that you have or know about that we should have or know about that we should look up or reference to corroborate the facts and various instances you mentioned in your replies? Being the first internal medicine person, we may be able to contact the board about that. You were the first department chair at COMP, we could probably find those.
  • Dr. Menkes:  Absolutely, sure.
  • Dr. Seffinger:  Well if you have anything that you think might be historical, as far as a document, and you go back and look at your stuff, and see if there’s something that you might think we may need, could you let us know? Give us a copy of it, send it over, I’ll give you my card, you can fax it in or something. If there’s anything like that that shows something how you were, or an honor that you received along the way, that you want us to include.
  • Dr. Menkes:  No, I don’t want this to be about me as much as just about the profession. You have my permission to contact anyone anywhere about me.
  • Dr. Seffinger:  Okay. Anybody else that you think we should contact that was instrumental to the historical development of osteopathy California?
  • Dr. Menkes:  I’m sure you’ve already spoken to them.
  • Dr. Seffinger:  A lot of people that you mentioned, we have.
  • Dr. Menkes:  Too bad you never got to talk to John Covington.
  • Dr. Seffinger:  Now who’s John Covington?
  • Dr. Menkes:  He was a referring man, he was a director of the family practice clinic at Park Avenue and when he had his heart trouble and had to go back to Pennsylvania, he had no disability insurance or coverage, so I covered his practice for him. He assumed I would require the usual 50-50 split. Knowing he had no insurance, I just let all the revenue accrue to him and his family.
  • Dr. Seffinger:  He has since passed on?
  • Dr. Menkes:  Yes.
  • Dr. Seffinger:  Okay, anything else that you’d like to discuss in relation to osteopathy in California that we have not touched upon yet?
  • Dr. Menkes:  No, I’m just glad to see all the new faces on the kids coming in.
  • Dr. Seffinger:  We’ve seen a big change over the years, 25 years now, you’ve seen OPSC start with a very small amount of people I’m sure, in the beginning, and now we have several hundred coming to these seminars.
  • Dr. Menkes:  And influencing legislation as well, a strong force.
  • Dr. Seffinger:  So you’ve seen a lot of changes in this last quarter of a century. Do you think there are still difficulties for DOs ahead of them, or have those been taken care of in the past?
  • Dr. Menkes:  I can’t comment, I don’t know, I haven’t been involved in practice the last several years.
  • Dr. Seffinger:  Did you retire already?
  • Dr. Menkes:  Yes.
  • Dr. Seffinger:  When did you retire?
  • Dr. Menkes:  From active practice, in ’87 with a spinal injury, I just came to my practice to sign checks and stuff and to supervise the doctors covering for me.
  • Dr. Seffinger:  So what have you been doing these last twenty years then?
  • Dr. Menkes:  Well I did a lot of consulting, medical legal expert testimony, got my Master’s in Business from the Peter Drucker Institute at Claremont University. I even went to law school for a semester on partial scholarship. I also worked for the Department of Corrections from 2000-2003.
  • Dr. Seffinger:  In what capacity?
  • Dr. Menkes:  Chief Medical Officer and Health Care Manager.
  • Dr. Seffinger:  So you became a supervisory and administrative role? Or also taking care of patients?
  • Dr. Menkes:  It was mostly administrative, but I would make rounds, etcetera, and got my oldest son, who was a contributor to the Merck Manual this year, to make grand rounds at the institution, and solve three cases that the UC San Diego doctors missed.
  • Dr. Seffinger:  Great. So you’re enjoying yourself these days?
  • Dr. Menkes:  Oh yes, I’ve got one granddaughter, and another grandchild on the way, and five sons scattered around the country, and one teenage daughter. My mom’s still alive, and I enjoy visiting her and her sense of humor. I am having the best years of my life now.
  • Dr. Seffinger:  Any other DOs in the family?
  • Dr. Menkes:  No. My youngest wants to be an attorney. He’s a Harvard grad student who’s applying to Harvard law School. He scored a 172 (99th percentile) on his practice LSAT exam.
  • Dr. Seffinger:  Okay, great. Well it’s been a pleasure talking with you, and I’m glad that you’re sharing this with us, I’m sure it will help a lot of people.
  • Dr. Menkes:  I hope so, thank you.
  • Dr. Seffinger:  Take care.
  • Dr. Seffinger:  Okay, Dr. Menkes, you wanted to mention about another instance that occurred, I believe while you were still in Florida. Right?
  • Dr. Menkes:  That’s correct. I was in my first year of residency, and the state of Florida had a program called the Visiting Professorship, where medical residents were allowed to apply to do a six week rotation in hematology, and six weeks in cardiology at the University of Florida Medical School in Gainesville. I presented my application and was accepted, and was fortunate enough to be able to share a room with a good friend of mine, Matt Terry, Mort’s son. (Now deceased). My first service was hematology, and I remember going on grand rounds. When the senior attending looked at my name tag, after presenting the patient looks at me and says, “Oh, you’re a D.O.” “Yes, sir.” “Then maybe you have an “osteopathic” diagnosis on this classic case of Polycythemia Vera.” I said, “Well, I don’t know if it’s an ‘osteopathic’ diagnosis, sir, but he doesn’t have Polycythemia Vera.” I said “It’s a secondary polycythemia called ‘Mosse’s syndrome’, associated with cirrhosis.” He says, “Mösse’s syndrome, I’ve never heard of that, it must be an osteopathic diagnosis.” “Well, Doctor, with all due respect, Maxwell Weintraub, MD from University of Utah, Salt Lake, is not a DO, and in his Seventh Edition, Hematology, describes Mösse’s syndrome even with a photograph. Its on page 865, on the right-hand side, second paragraph from the top in italics. And there’s an umlaut I believe, sir.” He said, “That’s a nice bluff”. I said “Well Doctor, I don’t bluff.” And there’s thirty-something interns and residents present for the Grand Rounds, and I know that they were rooting for me, because I was playing poker with them earlier in the week, and in a seven card stud game, by the fifth card, I had four kings, and no pair was showing. I did not want someone to bet into me, so I just upturned my cards, and said, “John, I don’t want to take your money.” They started asking more questions about the DO profession and stuff like that, and we developed a bond. So back to the Attending, he says, “Well, I think you’re bluffing.” I replied, “Well I don’t have your income, but I am so sure, I will bet you a dinner, I will take you to the finest restaurant in town, if I’m wrong. But if I’m right, you’re going to treat the entire house staff here as my witnesses.” He said “You’re on.” We went to the library. He lost. At the end of rotation, as he’s filling out my evaluation, he said would I be interested in the hematology fellowship, I said, “Not really.” He said, “Then I have to ask you a very personal question.” I said, “Go ahead.” “Are you the typical DO?” “No, Sir, I’m not.” He said, “I didn’t think so.” I said, “I’m actually at the bottom of my class, and they sent me here for remedial training.” I got him again.
  • Dr. Seffinger:  Okay, anything else that you’d like to share?
  • Dr. Menkes:  No, I mean there’s so many vignettes and anecdotes but I’m just amazed at how the profession’s evolved, and I just hope it keeps and continues growing, and the students understand there’s a value to hands-on medicine, and it’s all to the patient’s benefit, and to our mutual benefit as well. It’ll maintain their loyalty, and the bonding and the intimacy can’t be equaled.
  • Dr. Seffinger:  Thank you very much.
  • Dr. Menkes:  Thank you.