Louie B. Nunn Center for Oral History

Interview with Jacqueline Noonan, February 12, 1986

Louie B. Nunn Center for Oral History, University of Kentucky Libraries
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SMOOT: Dr. Noonan, to begin this morning would you tell me a little bit about yourself, your, your background, your--

NOONAN: --oh, all right--

SMOOT: --family, education--

NOONAN: --okay--

SMOOT: --et cetera--

NOONAN: --well, I guess you'd have to call me sort of a Yankee. I was born in Burlington, Vermont, but moved to Hartford, Connecticut when I was still an infant, about nine months of age, and grew up in Hartford, Connecticut. Went to grammar school and high school there and went to college in New Haven, Connecticut, uh, Albertus Magnus College, and then went back to my home state, uh, Vermont, and went to medical school at the University of Vermont. Uh, I graduated from the University of Vermont in 1954. Um, I was the first person in my particular family to have gone on to college, and, or certainly on to medical school. Uh, the oldest of, um-- I have two sisters--I had another sister that died and a very supportive family that supported me in my career and all that. Um, when I finished medical school, my 00:01:00internship was in Chapel Hill, North Carolina. That was sort of the first time I'd ever been south of the Mason-Dixon Line. That was an interesting, it was a good intel-, educational experience, and it was, uh, interesting. Um, I then went to Cincinnati Children's Hospital for my pediatric residency, and that's the first time I'd ever, uh, been to Kentucky. It was interesting that some of our most fascinating, interesting patients when I was a st-, a resident at Cincinnati were patients from, um, Appalachia. Uh, at that time, the children from Hyden--the Frontier Nursing Service--uh, referred their patients to the Children's Hospital in Cincinnati. This was in the days when hospitals were willing to give free care and, of course, there wasn't any Medicaid and many of these patients had no funds. And, uh, so that the, uh, uh, they were sent to, uh, Children's Hospital for, uh, some 00:02:00really, uh, pretty complex, serious kinds of problems. Um, and it was interesting that almost--some of the most fascinating patients had come from Kentucky. I also, um, one of our, um, future faculty members, Dr. Nancy Holland, who was then Dr. Nancy Hinkle, was a resident with me at Cincinnati, and she's from Paris, Kentucky. And we had been to Paris, uh, as residents; she had taken us to her home--we'd been to Keeneland. (Smoot laughs) And so I had some, uh, understanding of, uh, Kentucky. I did not really have any idea that I would be back in Kentucky when I left Cincinnati. I went then to Boston Children's Hospital where I did my, uh, training in pediatric cardiology. Um, I finished there in 1959, and at that time pediatric cardiologists were in demand. Uh, every medical school wanted one; there weren't many around. So just as I finished my training, uh, there were job 00:03:00opportunities. And I ended up going to, uh, the University of Iowa in Iowa City, Iowa to be their first pediatric cardiologist. And, uh, I was there for two and a half years, and that was a very interesting experience, and I think, uh, a big job for somebody just finishing their, uh, training. Um, and while I was there doing that, uh, I received a letter from Dr. John Githens, who was the first chairman of pediatrics at the University of Kentucky. Dr. Githens had come here from Colorado and he was looking for a pediatric cardiologist, because every school wanted one and there weren't, uh, an over abundance of them at that time as there are now. And so he wrote and, uh, invited me to come for an interview; that I had been recommended by somebody as a potential candidate for pediatric cardiology. Um, I was happy 00:04:00in Iowa City; I wasn't anxious to leave. But it turned out that the chairman of pediatrics in Iowa was also leaving to take the job as chief of, uh, pediatrics at Cornell. That was Dr. Wallace McQuarry, so he was leaving. That made it a little bit easier for me to consider leaving, but nonetheless, I did not accept his invitation to come for an interview right away. I said, "Well, why don't we meet and talk about it at the spring meeting?" There is a--used to be in Atlantic City every year--the Society for Pediatric Research met every year in Atlantic City. I was going to that meeting and so I thought, well, I'll see what this Dr. Githens is like. I'll hear a little bit more about it before I, you know, go to look at a job. So we sat at the-- in, uh, Atlantic City, and, uh, Dr. Githens is a very fine person. Was enthusiastic about the, uh, new school, and, uh, although I had just started a pediatric cardiology program where there had been none, there 00:05:00had been adult people. And there were children with heart disease and there was already some pattern developed about expectations and all of that, which was a little different than starting from real scratch, because these children had been seen by the adult people first. I thought, well, you know maybe it'd be fun to start really right from scratch where everything is, is brand new and you do things the way you'd like to see them done. And so, um, after I talked to him I did decide to come for an interview. It was interesting, when you came for an interview for a new faculty position back in 1961 here at the University of Kentucky, uh, there were very few people in any one department. And, uh, they were very--it was very important to, to Dean Willard and to the chairman who were here that they have a very--sort of a compatible group, people that would have the same philosophy. And, uh, so that instead of being interviewed just by people in your, uh, department and maybe a few others, I think I saw about every 00:06:00chairman that, at the time I saw, uh, George Schwert and Bob Straus and Ben Eiseman and, you know, Harold Rosenbaum. I think about everybody- -Ed Pellegrino. These were all people that I saw coming as an assistant professor in the Department of Pediatrics. And, uh, they had looked at a couple of other candidates, so I was, oh, one of several they were looking at. I stayed with Jack Githens at his home over on Parker's Mill Road. There weren't all the hotels we have now. And it was a very, uh, uh, it was a very warm place with, uh, a vision. Uh, the hospital at that time was still being built. It wasn't completed. You could see where pediatrics was going to be. Um, and I thought, gee, this, this sounds like fun. I, I, it was close to Cincinnati and I had, uh, good memories from Cincinnati. Uh, the faculty they were attracting were certainly very outstanding. Uh, and so, uh, they, 00:07:00uh, offered me the position really very soon after I came and, and I accepted, and actually came in, um, in December of 1961, uh, to, uh, Ken-, to Lexington. And, uh, I've been here ever since, uh, and it, it was, it was an exciting time, and it's, it's fun to look back at, uh, things now. I came from Iowa where I was very busy doing cardiac catheterizations, having a big clinic, working hard and all of this. Came to the University of Kentucky Medical Center where the hospital wasn't opened yet, where there weren't any patients, where there was nothing. Uh, we did have a lot of meetings, um--(Smoot laughs)--but within a very short, and I, of course, I'm really basically a clinician and, uh, that was not, uh, very interesting to not have anything to do, so, uh, I don't think I'd been here but a few, uh, weeks when, uh, I 00:08:00went on one of our first regional heart clinics, which I've been going on ever since. Dr. Githens and myself and Dr. Jack Reeves, who was here in medicine and cardiology, we went all over Eastern Kentucky as we still do, and went on, I came at the end of December, almost the first of January and by the end of January we were going on our first regional heart clinic. In addition, Cardinal Hill Hospital, we had, uh, an affiliation with them at that time. One of the pediatricians, Dr. Kenneth Dumars, that had come from Colorado with Dr. Githens, uh, was, uh, the--in charge of the medical program over there. And, uh, there were some children with cystic fibrosis who were over there. There were some children with other kinds of problems. And, uh, I admitted a patient with rheumatic fever, so that I did have a patient in the hospital over at Cardinal Hill. Um, some of the pediatricians in town here, who knew I was coming, uh, sent few patients and I saw 00:09:00a few patients in my office in the hospital before the hospital really opened. The hospital did not open until April of 1962, so I was here several months before the hospital opened. Uh, and once the hospital opened, uh, by that time we'd been to several clinics, and, uh, the very first patient admitted to the University of Kentucky Medical Center or A. B. Chandler Medical Center, uh, was, uh, Margaret Schoolcraft, a child with a patent ductus arteriosus that we had seen in one of our regional clinics and had all lined up to come to the hospital when it opened. Uh, so that was sort of exciting that the very first patient was a patient with congenital heart disease admitted to, uh, to UK. And, uh, uh, she was not the first operation, however. Uh, they did a mastectomy for their first operation, because for some unknown 00:10:00reason, uh, the nurses thought that would be, uh, uh, less complicated post-op care than a patent ductus because that's--they thought that was heart surgery. Of course, patent ductus arteriosus post-operative care is really probably much simpler than a radical mastectomy, but nonetheless--(Smoot laughs)--uh, uh, uh, she was the second case. Um, looking back at the patients that we saw in the hospital, uh, when it first opened, we, we opened on the fifth floor, I think five west was where the hospital opened, and, uh, everybody was on the fifth floor. Uh, and, uh, there was a premature baby and a patent ductus and a boy with a hernia and, uh, uh, and then adults. It was a, it was a fun time. And, uh, I think at the beginning many of our patients were from Eastern Kentucky. These were patients who probably had--didn't have money, had never had any care. And so at the very beginning we saw children with just very serious, long-term chronic illness. Children 00:11:00just very infested with parasites--worms--that came with bloated abdomens, uh, malnourished, and our hospital would have these children sometime there for weeks or months getting them back into some kind of reasonable nutrition. Uh, to look at our hospital today and what it was like, uh, uh, twenty-four years ago, uh, is, uh, very different. Uh, you know, they're in and out of the hospital quickly. They are in with very serious illnesses, they're, uh, where previously they were, many of these were, uh, children with diseases that, uh, were not common in the rest of, of, uh, Lexington at that time. Children with tuberculosis might be in the hospital for many weeks or months. Um, bad cases of osteomyelitis--bone infections--that had gone, that had been neglected. And we had interesting patients, of course, at that time it was before television had reached Eastern Kentucky, and 00:12:00coming to Lexington to this big hospital was a real experience. Many of the patients had never seen an elevator. I think some of them had never seen flush toilets and the like. And so it was a big adventure and very scary for them. Uh, I, I fell in love with the people from Appalachia actually when I was a resident in, uh, Cincinnati. And, uh, so this was a--they're such a very warm, uh, people, and we, uh, certainly had some wonderful stories to tell through the years as, uh, we took care of patients from, uh, Appalachia. They've become much more sophisticated now, television has come, nothing, they sort of are, know everything that's going on now. But in, in those days it really was a real adventure coming on the elevator. And, uh, I don't know if they still do, but children start smoking fairly early in Eastern Kentucky, and I can remember we had--(laughs)--you know, when I think now we're trying to stop smoking throughout the hospital, and where on the pediatric floor our pediatric patients were going in the elevator 00:13:00to have their cigarettes because the nurses wouldn't let them smoke in their rooms, uh. (Smoot laughs) But, uh, we did have a number of children who, uh, were still on pediatrics, but, uh, were smoking. Uh, that has, I think at least they're not smoking as--on the pediatric floor right now, uh, at least not that we know about. (Smoot laughs) Um, but it, it was an, an interesting time and, uh, very interesting patients. Uh, I--the, uh, the pathology, the sort of neglected disease, disease that had gone on for a long time was present. Uh, different people responded in a different way to this. Dr. Jack Githens--John Githens--our first chairman, wonderful person, uh, did not stay here long in Kentucky--went back to Colorado. And part of the reason, uh, that he went back I believe was that he was so moved by the, the disease, the poverty, the everything in Appalachia. This, uh- 00:14:00-he really, it was difficult for him to deal with this. He, he could deal with it, he was wonderful administrator, but once the patients started coming and he had to see this, I think it was difficult for him. Um, I saw the same patients and my response was very different. My response was, gee, isn't it wonderful we're here. They've got someplace to go now. And so I looked at it as we were doing something, uh, good for those people and we were learning a lot from them. And so my, uh, uh, response was very different and has I guess continued to be that way. And what is really, uh, remarkable is with the roads that came to Eastern Kentucky--television, Medicaid, Appalachian Hospitals, and all of those things. The, the health care and all of that is just, you know, you could just see it change before your very eyes. I mean, we don't get children in terribly infested with worms anymore. We don't see those kinds of patients anymore. Um, not that 00:15:00there are not still problems and that there are not poor people, but the health care is available and I think we, the University of Kentucky Medical Center, had a very big role to play in improving the health of people of Eastern Kentucky. Uh, we've been going out there for many years. Pediatrics has gone to regional heart clinics; we've got pediatric clinics. Dr. Vandivier goes all over the state looking at, uh, lung disease and tuberculosis. So that our first community medicine people are out in Inez and Martin, Kentucky doing their thing with TB. So we really did go where the p-, pat-, patients were, where the problems were, and I think developed a referral system for patients to come here and what's more we, we trained a lot of doctors. And people forget that the doctors that are out in Eastern Kentucky now, the younger ones, majority of them have come from this medical school. And so we have provided, uh, physicians for all of Eastern Kentucky that were not available. There may not be as many as they want, but 00:16:00there are more than there were. And, um, I think we have, uh, we've also, I think, helped to, uh, perhaps improve the image of medicine to people in Eastern Kentucky. When I first came here, many of the people were really afraid of hospitals. They look-, looked at hospitals as a place where you came to die. People went to the hospital and died, they didn't get well. And this was a self-fulfilling prophesy. They didn't really have any money; they certainly wouldn't go to the doctor until they were really sick. And then you went when you were very sick and you didn't get better. So it was--and as they began to use the hospital and got well, it was sort of very exciting. And as a cardiologist, you know, to go down to, um, Eastern Kentucky, a little town where they might not have any electricity, but you got patients with heart valves and pacemakers and have had open heart surgery--the most sophisticated medical care. And they go back to, uh, uh, you know, uh, they'll say, well, I had, you know, I had trouble getting 00:17:00across the, the, uh, uh, you know, when they lived in the hollers, that the river would come up in the spring. They might not be able to meet their appointment because the river had risen. But there they were with the latest of, uh, of, uh, care, and, uh, uh, that, I think this was to me, uh, a very, uh very heartwarming that the, uh, Medical Center here could, could provide tertiary, uh, state of the art, uh, medicine to the poorest people in, in Appalachia. And, uh, I think, you know, we're, uh, I don't--I hope that we'll st- --going to be able to continue to do that. I certainly hope we will, uh, but we certainly did that, uh, for many years, and at a time when there was really no Medicaid to even help reimburse, uh, what we are getting, uh, now. Although it doesn't reimburse very well, it--(laughs)--it's better than nothing, which is what we got then. I can remember a number of, uh, patients, uh, I can remember one lady very well. Uh, her son 00:18:00had, um, severe mitral stenosis. This is a rheumatic heart disease condition that generally in the United States, even at that time, was something you saw in peoples in their thirties and forties, fifties. In India you saw it in children. In Kentucky we saw some in children, and this was a, a young man, uh, child with, uh, mitral stenosis. And we brought him in for surgery and, uh, everything went well. And, uh, when I went out to the, uh, recovery--to, uh, the waiting room after surgery to tell his family everything had gone well, then, um, the grandmother said, "Miss Noonan," and, you know, in Eastern Kentucky, um, when they like their doctor they call them, they might call them by their first name. So they called me either Jacqueline or Miss Noonan. And I--(Smoot laughs)--did not--I took that as a compliment because I think that's way, the way they meant it. And, uh, this, uh, lady 00:19:00said, uh, "Miss Noonan, well, I believe you all done such a good job with, uh, Raleigh, I believe I'm going to let you take care of me now." And--(Smoot laughs)--it was really, it was, uh, it was really, uh, it's a very--the people in Appalachia, by and large, have a very personal relationship with their physicians. So that, uh, our house staff used to get upset because a patient would come in and they'd start doing their things and they'd say, "Dr. Noonan's my doctor," you know, and--(both laugh)--they, they would put up with these other doctors, and, uh, uh, you, you become their doctor. And you become their doctor for the whole family, even though you might be able to sort of say, "Well, this doctor will help you with this." It's a very personal kind of a relationship, and, uh, one that I, I, I did enjoy, and do still enjoy. And, uh, it's hard to imagine, but, uh, I go to regional heart clinics all over Eastern Kentucky, and we go to most of them like once a year. But I would, uh, say that probably for many of those patients 00:20:00they have seen me more frequently on a recurring basis than they have any other doctor in Eastern Kentucky, because they see me every year. We go back and they see the same doctor. And, uh, if you go out to Eastern Kentucky, although there are more doctors there, these are, by and large, doctors that don't stay very long. They come and do their National Health or they do their missionary work or whatever. And so the, the, uh, there's a pretty rapid turnover of physicians. And, uh, uh, it's hard for these people then to get a real personal relationship because they don't have that doctor that's there day and night all the time. And, uh, they have the phone and they call down here, but that's, that's something that, uh, that I, uh, uh, have, uh, felt. Uh, it does, I think for a physician it, it's one of the sort of things that makes being a doctor worthwhile, is this sort of personal relationship you get. And, um, uh, it's sort of nice because most of 00:21:00them are a hundred or two hundred miles away rather than right next door here, so--(laughs)--but, uh, but it's a, it's a--I've enjoyed that. Um, I've enjoyed being at UK, uh, for many, many reasons, but the patient population has certainly been a big part of it. To be here in Lexington seeing very sophisticated university people, uh, rich horse people, the poorest people from Appalachia, and, uh, the ability to be able to see all of these patients in the same clinic by the same doctor; all receiving the same kind of care, is something that I have, uh, have enjoyed and hope we will continue to be able to do.

SMOOT: You obviously love your work.

NOONAN: Yes, um-hm.

SMOOT: What motivated you to go into pediatrics in the first place?

NOONAN: Well, when I was a--I wanted to be a doctor since I was five, so I decided on that fairly, fairly early. By the time I was seven, I wanted to be a pediatrician. I, I don't know how much I knew about pediatrics, but I liked working with children. And so when I went to medical school I, I knew I wanted to be a pediatrician, and the, um, 00:22:00but I didn't know what I wanted to do in pediatrics. I hadn't really looked beyond, you know, what I would do after I was in pediatrics. Uh, I remember in medical school, however, Dr., uh, Jim McKay was the chairman of pediatrics at Vermont. And I remember thinking, gee, he has a fun job because he was there teaching medical students, he saw all the interesting patients that came in the hospital. And the other doctors were out giving baby shots and seeing these--I sort of liked being where the action was and I really--that, I, I'm sure in my wildest dreams I never dreamed I would be chairman of a Department of Pediatrics some years later. (Smoot laughs) But way back then I can remember thinking, gee, that looks like a fun job. So I went then to do pediatrics and, um, in the s- --as I finished, was finishing my pediatric training, um, I said, gee, you know, I'm going to have to, I've, finishing my training, I'm going to have to do something. And, uh, I liked everything. I mean, I liked endocrinology, I liked 00:23:00newborns, I liked cardiology; I liked everything. But I thought I really wanted to learn more about something, and cardiology had sort of fascinated me. I took three months of pathology as an elective during my, and, uh, and, uh, looked, looked at the anatomy of the congenital hearts; I was fascinated by that. And, uh, so I ended up, uh, going into pediatric cardiology and was fortunate enough to go to Boston Children's where they had--Dr. Alexander Nadus was my mentor. And, uh, uh, you know, probably--I'm sure he's the best clinical teacher there ever was. So that was a wonderful experience at Boston. And, um, so I, I did my pediatric cardiology at that time, and, uh, I've always thought of myself as a pediatrician first and a pediatric cardiologist, uh, second, uh, because when you do take care of children of heart disease, you sort of have to take care of the whole child. You can't just limit yourself to their heart. And, uh, I was very happy being a pediatric cardiologist here at Kentucky. And, uh, uh, I 00:24:00guess probably I had more fun when I wasn't chairman than I do when I'm chairman. That's, this is not, you know, being chairman is not quite so much fun as being a pediatric cardiologist. But because I knew I needed to, uh, continue to be active clinically, uh, I've--I'm, I'm afraid I've never given up one of my jobs when I've taken on another one. So, uh, when I did become, uh, chairman of pediatrics in 1974, I continued to be, uh, chief of the pediatric cardiology division and an active pediatric cardiologist. I still do cardiac catheterizations. I still take call every third weekend. I still take a month of pediatric cardiology every third month. Um, and that becomes frustrating in that I, I sort of have the feeling I don't do any one job as well as I could if I had more time to do them. Um, but I, I sort of, uh, also feel 00:25:00that a chairman of a clinical department needs to be a doctor. I mean, I don't see how you can be a good role model for house staff -- how you can understand your faculty if you spend all your time in your office. And fortunately, pediatrics is a relatively small department--not very small--(laughs)--but a small department. So you can do both. It just happens that pediatric cardiology is a--it's a busy service so it's a little harder to do all of that plus do your, your other things as well. Um, I'm not married--I've never married, so that, uh, uh, my, uh, my job is my, uh, my total commitment. And I think that's why I am able to do both things. But it's frustrating because, uh, it's, it's hard to always do as, uh, all the things that's expected of you on all areas and, uh, you know, to have to go to meetings. I, I have to really pretty much live a fairly scheduled life and, um, I have to 00:26:00set priorities. Uh, my administrative job as a department chairman obviously has to assume very high priority. Uh, if I am involved as a, uh, clinician and have patient care responsibilities, uh, if there is, uh, a problem there I have to then rely on one of my other two cardiologists to, to do something for patients if my chairman job is essential. Uh, uh, by and large, patient care comes first, but there are times when I might have to delegate patient care to do my other job. Um, so those are the kind of decisions you have to make and it's, you know, just a little bit--sometimes frustrating. Uh, being chairman is not anywhere near as much fun as being a pediatric cardiologist. Uh, part of the thing is that when you become chairman, you lose, um, some of the wonderful peer relationship you have with your faculty. You become them, you know--(laughs)--and I, I really didn't think I 00:27:00changed. I thought I was the same person, but to everybody else you now become part of they, that they that does all these things. And, uh, uh, that's sort of difficult because, uh, you know, people treat you differently. They, uh, they, they talk nice to you on one hand and talk behind your back on the other hand. And, uh, uh, you also learn that, uh, by and large, uh, most faculty are most interested in themselves, and that people as a group are relatively selfish. And, uh, as a department chairman, you have really to be responsible for a, a whole department. Uh, I don't think you can be a good, uh, department chairman if you are not unselfish. And I think that you, uh, if you're going to be a good department chairman you have to really have very much in mind the, the, the Medical Center itself--the university. And, um, and there are conflicts because what's good for one thing may not be good for the other. And so you, you sort of are, 00:28:00uh, you have to do what you think is right, but I think if you are a department chairman, you have, and are going to stay a chairman you have to be part of the, uh, the establishment, because that's--you are an administrator and that's--your loyalty is to the administration. The challenge is, can you affect administration by, you know, your role in things? And, and I, I, I feel that's, that's to me is the challenge. Uh, uh, the thing that makes it worthwhile is that you, uh, that I do feel I do play a role in this. I do, uh, play an active role, in, um, in things that do happen at the Medical Center. They certainly don't always do the things the way I'd like them to do it-- (both laugh)--but I do have, I do have a role in it. And, uh, I think that, uh, that, that is a, um, that's a challenge that makes the job of chairman, uh, worthwhile, uh, because, you know, if you're in your own little thing you can, the rest of the world can be going wherever 00:29:00it wants and all you're worried about is did your grant get funded? Did this happen or how are your patients doing? But when you're a chairman, that's--you got to worry about all of that plus you got to worry about how the state's doing, how the country's doing, and all of these-- so it's, it's, it's a big job. It's a challenge, but I enjoy it.

SMOOT: Let me step back and ask you about your impressions of the original team of administrators and academicians here at the Medical Center. When you came in you met everybody--

NOONAN: --yes, um-hm--

SMOOT: --what were your impressions of these people?

NOONAN: Well, I was impressed with the quality of the people and of their dedication. Uh, they, uh, I wouldn't want to say--(laughs)--the term brainwashed, but they had really been, uh, brainwashed about what this place was all about. You got, uh, a lecture; you know, pictures -- the cornfield dean. It was a, this was a, uh, uh, there was a real commitment to a, uh, a school that was going to be very much communicating one department with another. Uh, where we were 00:30:00going to give total patient care. Where there would be collaboration between surgeons, psychiatrists, pediatricians, blah, blah, all this and that philos-, philosophically wonderful utopia. Uh, and it was fine because the hospital wasn't open. There weren't any patients. We got everybody that said all the right things. We all were great and, uh, we were going to have a, we were going to have adult wards and children wards, and they would all be mixed together. And the surgeon and the psychiatrist and the medicine people would all make rounds, and obviously the medicine person will probably be in charge because that would be--(both laugh)--reasonable. Uh, but it was sort of interesting. Uh, once, uh, we got beyond, uh, five west with all of us in one little, uh, wing, it became, it became apparent very soon that this utopia was not part of the real world. And although they were able to be very selective, and as you, uh, got their key sort 00:31:00of in early faculty, as the faculty began to grow, you got a lot of sort of people who really came after the hospital was built, after the place was going, they didn't, it was just another medical school and they were going to do their thing. And it wasn't very long beca-, before, uh, we had a surgical wing--(laughs)--and a medical wing and a psychiatry wing, and people pretty much did things. But I think there has always been, um, uh, we've been a different school. You know, we, we came with a Department of Behavioral Science. Not many medical schools had a Department of Behavioral Science. Um, that meant that from very early on our students were very aware of the effect of medici-, of, uh, illness on people, the economics of illness and all of that. And so many of the things that people keep complaining about, that nobody knows anything about, really has been part of our existence since we started here. I think our, our, our students know how difficult it is, they, it's not as hard as it used to be, but to 00:32:00get from Prestonsburg to Lexington before the Mountain Parkway went in, that was a long ride. Uh, our students knew more about those things. Uh, when you, uh, talk about getting medicine, and you've got to be sure, do they have that in that particular town? Is there a drug store in that town? These kinds of things. So I think we, we did have that kind of a, uh, of a, uh, philosophy that we were interested in, in the whole patient and, and, uh, the effect of, uh, social economic situation on, on medical care. And although that's become more popular now and we're int-, it, it has always been part of our, uh, of, of the philosophy of the school. Now, uh, how well, uh, this came across to all the students, I don't know. But I've been impressed that, by and large, both our students and our house staff that train here are quite aware of that. They're, they're, they're, they understand a little 00:33:00bit more about the real world and, of course, many of our students came from Appalachia. They know what it's like to be out there, so there's, there, there is this kind of a relationship. And I sort of laugh when people talk about us being in the ivory tower, because I don't think, by and large, we were ever an ivory tower type school. Uh, now, there may be, there may be some people in an ivory tower here and there may be some basic scientists who are in their laboratories and all that, and that's fine, but I think the majority of people taking care of patients are pretty much aware of what life is like on the outside. And so it's, um, I always sort of laugh when they accuse us of not understanding about what's going on, when most of us have really been around and have been out there and know a little bit about what it's like on the outside. And a number of the faculty have actually trained on the outside. Dr. Doane Fischer, for example, in our department, was for many years in Hyden, Kentuc- -- Harlan, Kentucky. So, you know, we have had people that have been out there that have, have come 00:34:00in. Uh, so it, I think that was, uh, the, uh, this behavioral science part was one thing. Um, it was interesting when we first came, you know, there--since we didn't have a medical school here, there really weren't very man Kentuckians sort of in the early medical school days. The exception was Dr. Harold Rosenbaum, who was chairman of radiology and a, a Kentuckian. And, uh, the other person that came as a Kentuckian was Dr. John Reeves, who is from Hazard, Kentucky. He came as the, as a cardiologist, and Jack and I worked very closely together. We went on regional clinics together. He did cardiac caths on adults and I did them on children. We were very, very close, uh, very supportive of one another. Uh, uh, as new procedures came about in the cardiac cath lab, uh, I'd go down there and hold his hand while he did a, a, uh, transceptal puncture on an adult and he'd come down and hold my hand when I was doing something likewise in pediatrics. 00:35:00Uh, uh, I really missed him when he went to Colorado after he'd been here for some years. Dr. Boro Sawarwitz (??) was the first chief of cardiology. He had come from Vermont, uh, not, by way of several other places--(both laugh)--but had been a, uh, fellow up in Vermont sometime during my training up there, so I had heard his, uh, his name, uh, and then we were, you know, as a pediatric cardiologist, I have just been blessed with outstanding surgeons. Uh, the very first heart surgeon we had was Frank Spencer. Dr. Spencer came here, uh, having come back from the Korean War as a hero; having really been one of the many young surgeons in the Korean War that was doing surgery on the heart and blood vessels and all of this that, uh, had never been done in, uh, any other previous war. He had, of course, trained at Johns Hopkins under Dr. Blaylock and was a, uh, surgeon that--very skilled in doing congenital heart disease--and he was our first, uh, sur-, heart 00:36:00surgeon that, particularly for children and, and adults as well. Dr. Ben Eiseman was chairman, but Frank was the, the, uh, cardiothorastic surgeon primarily, and we just had a wonderful relationship. Uh, he was a wonderful man--a very good surgeon. Uh, you know, it was just fun to work with him. Much mutual respect between the two of us. I really had a wonderful, uh, professional relationship with him, and then he went to become chairman at, uh, New York University, one of the largest surgical programs in the country, and has, is still there doing a very fine job. Uh, uh, when he left, uh, we, uh, were very fortunate to get Dr. Gordon Danielson. Dr. Gordon Danielson came here from Philadelphia--very talented, bright man--wonderful surgeon, uh, uh, particularly, uh, skillful, uh, technical surgeon--was, uh, recruited away by the Mayo Clinic. Uh, is, speaks at every conference 00:37:00there is now, pretty much, on, uh, congenital heart disease. Has certainly continued to be, uh, an outstanding, uh, nationally, internationally known person, and that was my second, uh, cardiac surgeon. Uh, we had Dr. Ken Trinkle, who was here for awhile and is chief of cardiothorastic surgery in, uh, in, uh Texas--San Antonio. We had Lester Bryant, who was, uh, cardiac surgeon and, um, is now head of surgery--well, now, I think he's now a, I believe he's now dean at one of the medical schools in the, uh, I'm not sure just which one he is right now. He was at Johnson City in, at, head of surgery, but I believe he's moved to be, uh, an administrator someplace.

SMOOT: I believe he's at Marshall University.

NOONAN: Yeah, that's right. I think, yeah, he's become ch-, uh, dean I think at, at Marshall University in West Virginia.

SMOOT: That's right.

NOONAN: And then, uh, and then we got Dr. Joseph Utley, who, uh, again, 00:38:00a very skillful surgeon, and, uh, uh fun to work with, uh, wonderful sense of humor, a very good surgeon and he recruited Dr. Ed Todd, so that when Joe left to go out to San Diego to do heart surgery, we were left with, uh, Dr. Edward Todd, who again, uh, is very gifted in being able to put back together the most complex of, uh, congenital heart defects and, uh, uh, has been able to operate on tiny babies with all kinds of complex, uh, lesions, and, um, so I've been very fortunate that I've had really outstanding heart surgeons to work with throughout the, uh, the time I've been here. Um, and if you're doing pediatric cardiology and want to have your children's hearts fixed, that's very essential, that you have somebody that you can trust that will do their best and that their best is very good, and we've been very fortunate 00:39:00here to, uh, to have that kind of, uh, a surgical back-up. And, uh, so that's been, uh, that's been why I've certainly continued to like to do pediatric cardiology here. Uh, I think that, you know, we had Ed Pellegrino as the first chairman of medicine, uh, you know, you just had to meet Ed to know he was a very outstanding person. Uh, uh, Kurt Deuschle was our first chairman of community medicine. Again, uh, somebody who's gone on to make a name for himself, as Ed has. Uh, Bob Straus is still here, but in behavioral science, you know, again a nationally, internationally known figure, so that I think, you'd have to say that, uh, Dr. Willard did an outstanding job in recruiting really a, uh, a very top-notch faculty, a young faculty at that time. But he picked them very wisely because they've done very well through the years and, uh, I guess probably I, I don-, it'd be interesting 00:40:00to look at other new schools and see if any new school ever started out with quite such a, um, talented, uh, group of, uh, department chairmen. Uh, it's not always easy to get, uh, great people to come to an unknown place and all of this and that, but I think, uh, you know, we've really been, we've been very fortunate in the, in the faculty that we have been able, uh, to attract. Uh, in pediatrics, I think we've always had a strong pediatrics department. Dr. Nancy Holland came to do the renal disease in, uh, in pediatrics and, uh, I think we were one of the, uh, earliest people to do renal transplants in children. We actually did renal transplants in children here before they did them at Cincinnati Children's. In fact, they sent one of their patients down to us for a, for a kidney transplant many years ago. Uh, of course, there, everybody's doing them now, but in those days they, we, we were doing, we were one of the pioneers in doing 00:41:00kidney transplants and certainly one of the earliest ones to do them in children and, uh, that's continued.

SMOOT: May I pause a moment?

NOONAN: Sure, um-hm.

[Pause in recording.]

NOONAN: You asked me also about the administrators. Uh, of course Dr. Willard was a, uh, you know, uh, a unique individual with a lot of vision and all that. Um, as a lowly assistant professor of--(Smoot laughs)--pediatrics, I really didn't get to know Dr. Willard all that well. I mean I knew him and all that, but, uh, I was not involved with him in meetings and all that, so I don't have a real personal, uh, view of Dr. Willard like many of the chairmen who were here at that time do. Um, our first, uh, uh, Dick Wittrup, I believe was the first, uh, uh, hospital director and, you know, uh, they've kind 00:42:00of changed what the, uh, uh, goals of this hospital or the--what is their, what is their--mission of this hospital were, but I sat through a lot of that rhetoric when I came, and the mission of this hospital was to provide care for the people of, uh, Kentucky who were referred by a physician, who either--we had illnesses that could be treated here or would be good teaching cases. This was the, sort of the charge to this hospital. It is true that in no time-- but it also was also part of it, which I think that's the part we've kind of left off now--that patients would not be denied admission to this hospital for any, uh, economic, racial, whatever kind of reason and so it was clear from the beginning that patients would not be denied access to the hospital because they did not have money. It was never written down or intended that this would be a hospital for people to come just 00:43:00because they didn't have money, but you could see how it would be very easy to decide this was a very good teaching case who also happened to have no money. Now, the other part was that they all were referred. Patients didn't just walk in and say I'd like to come to UK, they were all referred by a physician. It wasn't until some years later when we sort of got into the competing business, started talking about primary care and all this business that we then began to sort of try to recruit patients directly to us. Um, so those are things that, you know, if I were king I would have, not have changed perhaps, because I think we, we have a unique role, uh, which we, we sort of do not have as much as we did because as all teachers, when we train our students, they then do our thing. So that, uh, in surgery and in medicine particularly, both of those fields, we have trained cardiologists and heart surgeons and neurosurgeons and orthopedists and renal people so that what was 00:44:00unique to this hospital is no longer unique. Now, fortunately in pediatrics we've been a little more-- well, we've--I think just because of the, uh, economics of it. You can't do pediatric renal disease out in private practice unless you've got a very, very large population so that we, we have not trained a lot of, of tertiary care sub-specialists in pediatrics who've gone out in the state. Uh, the ones we've, we've trained, uh, uh, some who've stayed right here on our faculty or have gone elsewhere, but we have not ever developed a large fellowship training program. We've been more, uh, we thought our mission was to train pediatricians to go out. We did not feel our job was to train a lot of sub-specialists who, which we didn't need in Kentucky, we had them here and had them in Louisville. Uh, we are training a number of neonatologists because there is need for, for that throughout the state as well. So I think we, uh, I think probably felt our mission was more 00:45:00for, uh, training, uh, pediatricians, and so we, we've avoided that problem. And so in pediatrics I always, they, I finally have convinced everybody, even here now, that pediatrics is different. They, they, they will agree pediatrics is different so that uh, uh, we, uh, we do feel that since we are the only place that has, uh, tertiary care for children, that we need to continue the same sort of philosophy that we did before. Granted we, we certainly have to, and I'm certainly very supportive of the hospital's need to be, uh, solvent and to be in the black so that we have a place to take care of anybody, but on the other hand I th-, and we, we certainly, uh, are cooperate in every way we can, but on the other hand, it, it's going to be very difficult to set a percentage or a limit on patients that have no other alternative. Children with malignancies, leukemia--that's a disease that's getting 00:46:00close to curable today, but it requires very, very dedicated, precise care. We're part of a national, uh, you know, study section. These children are on protocols. You can't have somebody doing that, uh, one patient a year. You've got to get them all together, so that if you're doing, if you're the, if you're the place that takes care of children with cancer you can't say, "Well, I'm sorry, we've already taken care of our quota of cancer children. You're just too bad, you can't come." We, we can't do that. I don't think we can do that, and so far we haven't had to. Uh, I keep telling them, you know, there's a limit. There's only going to be so many children with cancer. There's only going to be so many neonates born. There's only, you know, maybe more than you'd like, but there's not no matter, there's not going to ever be a hundred babies in the NICU [neonatal intensive care unit], there's only so many babies born, and if we're going to take care of them we have to be able to take care of the number that are needed. Uh, that, as you know, was a, a big story. That was probably one of more, our more exciting aspects was, uh, getting our neonatal intensive care unit 00:47:00built. Uh, in 1974, when I became chairman, one of the things that I did say at that time was that, uh, one of our highest priorities for the Department of Pediatrics was to develop an outstanding neonatal program. We, uh, we had a premature nursery as such, which was outdated, not adequately staffed, not adequately equipped and not staffed with the sort of modern day neonatologists. And actually I was appointed--I think I was appointed chairman, I was--it was decided I was going to be chairman like in January something, but I wasn't going to start till July, but Dr. Wheeler said, "You can start running things, but--(both laugh)--he'd continue to get the money." ( laughs) I think is the way he put it, uh, and, um, uh, we, I, my first, uh, recruitment was Dr. Doug Cunningham, who's--came as our neonatologist, having 00:48:00trained with Lou Gluck out in California, came with modern ideas, high expectations and a commitment to quality care, and we, uh, had a rough four or five years until we finally got the outstanding nursery we have right now. And I think I am very proud of our neonatal intensive care unit, the kind of care the babies get, the kind of dedication that Dr. Cunningham and Dr. Desai and, and Hermansen and now Dr. Pauly give to this unit. We can be very proud of that unit. It's known throughout the state and throughout the nation as an outstanding unit and I am personally very proud that, um, that this was one of the high priorities I had when I came as chairman, when I was appointed chairman, and, uh, um, I'm very proud that we have this kind of a unit. It did not come easy. It came amid, uh, a lot of, uh, shouting, uh, TV ads, uh, uh, legislative, uh, meetings and the like, uh, but it's, 00:49:00it, it's there. It's something that was needed and it was something that, um, I think, I personally did have perhaps some influence in having that come about as opposed to what perhaps was perceived as a high priority for the Medical Center at that time, uh, I think in the long run it has, it has been a good thing for the, the Medical Center. It's one of the things we do that nobody else does and certainly nobody else does it as well and, uh, so that's, that's probably one of my things that would look back on with some, some, uh, pride.

SMOOT: Um-hm. Are there any other things that you would like to point to that you look back with, uh, pride upon?

NOONAN: Well, I, I'm proud of our, our, our department as a, as a group and about the, the, uh, residents we've trained that are out 00:50:00there doing a very, uh, good job in pediatrics, both here and, uh, in other parts of the country. Uh, I just got back from a meeting at New Orleans, the Southern Society for Pediatric Research, ran into one of our ex-residents who runs the, uh, intensive care nursery in Arkansas, uh, heard about our neonatologist that's now at the Ochsner Clinic doing a fine job down there. Those are very rewarding things, people that you've trained that go away and, and do a good job. Uh, seeing our house staff--our ex-house staff--sending patients back to this hospital having just done a superb job in taking care of them. Um, I think, I've, very proud of the fact that, uh, Dr. Bryan Hall came back to Kentucky from California to do our genetics program. He's a class person, uh, and is doing a fine job in that area, an area that's high, highly important to, uh, Kentucky. This is a, uh, 00:51:00uh, genetics' dream. (laughs) Uh, uh, Bryan has, has come here with an outstanding reputation, international and national reputation, and has, uh, come back home. His family is from Paintsville, Kentucky. So he's a Kentucky boy returned and we're very, uh, pleased at the fine job he's doing. The other thing that I'm proud of is that one of the other things that I thought was important is that if we're going to train people to be, uh, pediatricians we need to train them well in general pediatrics, and, uh, there wasn't--you know, most pediatric departments in medical schools didn't have very much in the way of general pediatrics. They had somebody they called an outpatient doctor and we had, and our general pediatrician pretty much were the clinic doctors, and then the specialists were the inpatient doctors, and I thought, you know, you're not going to attract any bright, uh, young, 00:52:00uh, pediatrician that's just finished their residency who's used to taking care of real sick kids, they're not going to be very happy to spend the rest of their life just sitting in the clinic, and that's not a good role model because the people you're training are going to go out and they're going to have to take care of sick children as well. And so, uh, Dr. Fischer at that time was, uh, the, uh, person in general pediatrics and had a couple of people in his division. Um, Jackie Campbell was the first general pediatrician I recruited when I came. She was one of our residents, very bright gal, trained. And we then decided we would dis-, we would have a division of general pediatrics which would be involved with the inpatient as well as the outpatient. So our general pediatricians have since that time taken their turn on the inpatient service. They generally take care of the inpatients on the ward as well as the outpatient. And that division has grown, uh, to, uh, well, it's, uh--Dr. Fischer kind of argues 00:53:00about how many people they have, but there are five or six of them over there and a few other people that help out, uh, and, uh, uh, this is I think, uh, another area that, which I am proud, that these now, where I think we're giving a good role model to our house staff that you can take care of patients in the hospital, you can take care of them in the, as an outpatient, um, you can stabilize a newborn baby, you, this is, this is what the kind of pediatrician we need out in Eastern Kentucky should be able to do. So I'm, I'm pleased with that. Uh, I, and there's one other area I was going to sor-, oh, I know. The other area that, when we took a sort of a poll of what do our house staff, what, what are we not teaching them they should know when they go out into practice. We did that some years ago, and at time they said, "You know, we, we know how to do a lot of the acute care stuff and all that, but we're not very comfortable in dealing with the sort of emotional problems that people have, bed-wetting and school phobias and all this kind of business," and there's a lot of that out in the world. 00:54:00That's what people are worried about, that's what mothers talk to you about. So Dr. Abe Fosson, who had been in practice at, uh, Lexington Clinic and then was over at Saint Joe's with us, then came pretty much full-time over here, decided he would take his sabbatical doing some child psychiatry in England with the understanding that when he came back he would be our psychosocial pediatrician and so, uh, that was in my, in my term as chairman. Uh, Abe came back from, uh, uh, England and we developed the division of psychosocial pediatrics. So that this has been very much integrating into our pediatric program. Our house staff are aware of how illness affects families and what kind of things and how--not only, we, we try to do it that we teach the house staff how to manage it rather than sending them to another clinic. Psychosocial isn't a clinic you send them to, you get a consult and you work together with them to learn how to manage these things, and, 00:55:00uh, so I, I think we've tried to, uh, keep, um, uh, up to date about what the changing needs for pediatricians are and what the expectation of the public is and perhaps mostly what we think, uh, a child really needs from a pediatrician, and all of these things are important. You need somebody that will, uh, understand their growth and development, see that they develop not only well physically, but mentally and emotionally and yet you want this fellow to be smart enough that if they really get sick they're going to recognize it and either take care of it or know where to send it. And so we try to do all of these things and it's a, it's a, it's a big job and it's hard to do it in three years, but, uh, I think we do it and we do it all right.

SMOOT: I think I can anticipate your answer to this question, but what has been you impression of the quality of the students that you have been, uh, training at the university?

NOONAN: Well, I think that, you know, I think we're like most places. 00:56:00Our good students are, our very good students, are as good as students any place in the world. And, by and large, we have good medical students. I think there may be a few in each class that you sort of wonder how they got there. There're a few, and I think we're very concerned that there shouldn't be any. But, by and large, we have good medical students. I just was on service last month--on general, uh, pediatric service. I took the month of, uh, January and, uh, I had three students, all fine people, good students, uh, mature, dedicated, they're all going to be fine physicians. I don't know what grade they got in biochemistry, and all those things. All I know is, as seeing them as clerks in their junior year, we're going to be proud of all three of those. Uh, Dr. Johnson, who was on the month before, had four students and I know he was happy with all four of his. Uh, I go 00:57:00to all our grading sessions and, you know, throughout the course of a year there may be two or three students in the whole year that we sort of really are concerned about. Uh, I think there will be less of those. We're, we're trying very hard to, uh, to weed out students that we're concerned may not be the kind of physicians we want them to be later on by having more of an ongoing review. Uh, Dr. Fosson, in our department, is involved in that, one of those committees looking at that. But I think we have good students. Well, look at our first class. You've got Bill Markesbery in our first class, uh, who's certainly an outstanding person. I can remember almost everybody in the first, uh, class of medical school--the first couple of years. I can't rem-, I don't know a half of the people in the, a third of the people in the present class. Once they got that large it's hard to remember them all. Uh, but we've had good medical students.

SMOOT: Hmm. What has been the response of the Lexington pediatric 00:58:00community towards this institution?

NOONAN: Uh, well, you know, I think, I guess I'm disappointed that we don't have more of a relationship. I do not think we have a bad relationship. I think on an individual we have a good relationship, but we don't, we do not have as much interaction as I would like to have us have and I think that's because everyone is very busy. This hospital is not used by the pediatricians for their routine hospitalization of children and, um, so we don't see them. It's difficult to run over here to grand rounds when you've got to be somebody else. Parking's difficult, it's--we do have some that come. Uh, I feel bad I've not been as active in going to the Lexington Pediatric Society meetings as I should. I do go occasionally and I certainly am supportive of their meetings. We have, uh, uh, you know, we've trained most of the people in town. Now, they're all friends of ours, they certainly refer 00:59:00their sick patients, their, uh, tertiary, I mean their sub-speciality patients to us. I guess I, I think at this point in time we may need to make it a real effort to become more involved with the local pediatricians. It's my perception and again I'd like to have this really documented, that the pediatricians right now are not happy, in general, with the care of children in the Lexington hospitals. Uh, it is deteriorated from what it was ten years ago. Uh, ten years ago Saint Joe's [telephone ringing] had a, uh, a big, uh--excuse me, let me get that. Uh, we had Saint Joseph Hospital, which had a good pediatric unit. Our residents went over there, we had a, much more of a relationship with the practicing pediatricians because our house staff knew them over there. We would go over there to see patients. When we, uh, no longer had a house staff at Saint Joe's, and as perhaps more 01:00:00need for surgery beds came in and as particularly the surgery center opened and much of the children's surgery was done as an outpatient, um, the economics of a pediatric ward became more unfavorable. When you start taking care of very sick children in the hospital, you end up, unfortunately having a fair number of 'em who don't have very good insurance. Uh, elective surgery, you know you don't do elective surgery unless you've got some kind of insurance. So it's, and when you take all those patients and put them in the surgery center, you end up with a money losing, uh, ward, and hospitals have to stay in the black. So, um, Saint Joseph eventually sort of, uh, decreased the number of pediatric beds; they closed their pediatric intensive care unit. At the same time, uh, Good Samaritan's boasting it has a pediatric unit and Humana comes in and says we're going to have a pediatric unit, so, and Central Baptist has a few pediatric beds. So 01:01:00all of the hospitals now are trying to get the pediatricians to bring their patients there and they're all saying they have a pediatric unit. But it turns out none of them, well, really has the kind of pediatric unit that Saint Joseph used to have and none of them have something that we have here. They do not have, uh, nurses for twenty-four hours a day that are trained and dedicated to taking care of children. They'll have a few nurses that ta-, and I think a lot of our nurses moonlight over there on their off hours at different hospitals, they will go in, but they don't have, uh, pediatric nurses as such that are around the clock and, uh, there, there might be a ten bed pediatric wing, but there will be three pediatric patients and seven orthopedic patients. Well, you know, the children don't really get the same kind of attention. So I have the feeling that our pediatricians are really not very happy with this. One of the things that I, I have proposed to the chancellor and I, I don't know whether it will go forward 01:02:00or not, but I think that things have changed in Lexington, in this Fayette County area, and that because less children are admitted to the hospital, it perhaps makes sense to at least try to congregate all the children with fairly serious illnesses into one facility, and I'd like to propose that instead of decreasing beds in pediatrics, we consider increasing the number, and develop what they've done at Vanderbilt and at, uh, South Carolina, a so-called children's hospital within a university hospital and, which would mean we would need some more beds, which would mean the pediatricians could admit their sick meningitis here or their sick bronchialitis or whatever; take care of them in this hospital, get consultation if they think it's necessary. Our house staff would be available to, uh, it would improve the, uh, the, the patient population for our students and our house staff. I think, I'm quite sure it would improve patient care, which is what I'm really most interested in, and, um, uh, it would certainly give us a chance to have 01:03:00our pediatricians become much more part of our, our whole scene. Uh, I don't know whether that will happen. To me it's something that has to be very strongly supported by the pediatricians and the community. It's not something that we should go out and say, uh, look, we need some more patients, let's everybody bring them here. I don't think that's--I think the times have changed. I think if the pediatricians perceive this as a need, that patient care would be improved if we put them all together, then we as a university hospital ought to be, uh, sensitive to this and look at this as another way of perhaps doing a thing here that they're not doing in every other hospital. Uh, I think it would be good for children; I think it would be good for our teaching program, I think in the long run it would be good economically for this hospital. And they may actually pay attention to it, because 01:04:00I think that is an important thing today for any hospital that we have to be economically, uh, solvent. As I've mentioned on many occasions to them, when we talk about improving our patient mix, all those terms, I said, "I do not see any way that we are going to be able to in any way influence, the number of no-pay children that come here or the medical, medical card patients that come here, um, and that our only chance of improving the mix is by attracting private patients who are currently going to all the hospitals around town," and I think if you opened this hospital up and made it comfortable for the pediatricians to come in and had, uh, rooms where mothers could stay with children and the like, uh, I don't see why they wouldn't come, but I don't know. That's something I think we ought to spend a little money in having some of those people come and do all their little surveys and go around and do it because I, I don't think it's something I should go out and do. I think I should support it, I should maybe be behind the scenes 01:05:00doing things, but I think it needs to come from the community and from the pediatricians, uh, there--that they perceive it as a need, then it will work. It won't work if we--if it's perceived as just the university trying to gobble up something. There's so much paranoia out there that it's very difficult to do anything without, and it's, uh, there's paranoia on all sides. Everybody is so afraid of what the other guy is doing, nobody will, you know, it's, that's, that's kind of sad, that, but that's, you know, that's the way things are today.

SMOOT: Um-hm.

NOONAN: Uh, and I just want to be sure that in the middle of all this that we're not doing things that are bad for children, and I think children very often are the ones that get sort of left out and get hurt when, uh, when the times get tough, it gets tougher for children and, and mothers than it does for the rest of the population.

SMOOT: I understand you have somebody waiting to see you, so--

NOONAN: --yes, um-hm--

SMOOT: --I think we stop here--

NOONAN: --um-hm--

SMOOT: --and let me thank you on behalf of the Medical Center and the university--

NOONAN: --okay, fine, good, okay.

[End of interview.]