The memorials and formal tributes have occurred, but as the legacy of Norman E. Shumway becomes etched in memories, Robert “Bobby” Robbins must look ahead to run the department founded by his legendary mentor.
Today’s chair, Robbins said, requires a bit more fiscal and financial stewardship than the days when Shumway performed the first heart transplant in 1968. That was a time recalled by senior physicians as a golden era when bills were submitted by physicians and paid seemingly magically by the government and insurers. (Although Shumway’s long-time departmental administrator, Lois Takaoka, may have had a more sober view of what it took to get reimbursed).
Patient care and research has also changed radically, Robbins said. “CV surgery and cardiology have come closer together as we find increasingly less invasive ways of treating patients. We are reaping the benefits from the fields of immunology and stem cell treatments” — both special interests of Robbins. Open heart surgeries are declining as, for example, valve replacements give way to less invasive stent grafts.
Ironically, “more adults than children are now requiring treatment for congenital heart disease, because adults come from a generation that couldn’t benefit from today’s early interventions,” Robbins said.
“But despite or maybe because of the changes in CV surgery there’s still a lot of Norm in this department,” Robbins recalled in an interview several weeks after the Feb. 8 death of Shumway at age 83. “And to tell you the truth, a lot of what remains beyond the personal stories we all have is the sense of how much of the culture of the operating room and really the entire Medical Center was influenced or in some cases established by Norman Shumway.
“Norm showed us that we could do a really demanding, stressful job and still go home at the end of the day telling ourselves, ‘Isn’t this fun, what could be better?’ People were relaxed around him despite 20-hour or more work days, and the pressures of life-and-death decisions.
“If we lost a patient, we would be upset and Shumway would tell us, ’Get back in there. Other patients need your help right now’.
“He was a Pied Piper who could convince people what needed to be done,” including making the tough choice to improve the procedure and the immunology by moving ahead despite discouraging patient longevity in the early years.
“Shumway had a vision, and he also understood the reality that the days, weeks or months lived by those early patients were a gift to them of time, and while he wouldn’t talk about it, he understood and subtly acknowledged that he was giving patients an opportunity to contribute to medical progress and history.
“Shumway was forward looking in some rather untraditional ways,” Robbins said. For example just after he stepped aside as chair [in 1993] he was skeptical of a short-lived minimally invasive open heart procedure that his younger Stanford colleagues were helping to develop.
“He said, ‘If this procedure had been developed before traditional open heart surgery, and then someone else came along and invented the sternotomy, that second person would look like a genius’. Norm believed and supported progress, but he had a keen sense to know the difference between flashy but unproductive technology and real progress. A motto of his was, ‘keep it simple’.”
Shumway was not an outspoken advocate of health and fitness. He would say with tongue at least partially in cheek, “Your heart only has a certain number of beats and it seems a shame to waste them doing exercise.” However, up until late 2004 he would play 18 holes of golf, walking, carrying his own clubs, in the rain if necessary, Robbins recalled. “He was a tough guy.”
Shumway had a widespread reputation for terse, often unprintable one-liners, “but significantly the remarks weren’t malicious or disrespectful of individuals,” Robbins said. “Looking back, I can’t remember him ever screaming at anyone. What we remember is that he made all members at all levels of the health care team feel as if they really wanted to be here.
“That was refreshing for me as a young surgeon. I came from a mentality, an expectation, that the chief rules by intimidation, but Shumway showed us an alternative,” said Robbins, who in addition to his role as chair serves as director of the Stanford Institute for Cardiovascular Medicine and as co-director of the hospital’s Cardiac Clinical Center.
Robbins came from a southern tradition, beginning with an AA degree from Jones Junior College in Ellisville, Miss. He graduated from the University of Mississippi medical school in 1983 and began looking for a CV surgery residency while completing his general surgery residency at his medical school alma mater.
“It was natural for me to want to train in Houston, just down the road from Jackson and the University of Mississippi, but my mentor at U Miss, James D. Hardy (who performed the first simian heart transplant in 1964), told me, “You’ve got to go train with Shumway — with him it’s all about the trainee and the team, not the star.”
Robbins wrote to Shumway, met him briefly at a national meeting, and then went on to postdoctoral work at Columbia Presbyterian and the NIH. But he heard back from Shumway who Robbins said had relied on both rigorous background checks — and an intuitive sense of chemistry — to pick new trainees. Robbins became a CV resident in 1989, and then chief resident under Shumway in 1991.
After pediatric cardiovascular fellowships at Emory and Melbourne, Australia, Robbins joined the Stanford faculty in 1995. He was named to head the heart and heart/lung transplant programs in 1998.
Even after becoming chair in 2005, Robbins said his mentor was a regular presence and source of support. Shumway kept a departmental office which he regularly visited up until about a month before his death, Robbins said.
“It’s hard to believe that I won’t be running in to Norm on the stairs, in the office. I’ll miss him,” Robbins said. “We’ll all miss him.”
